The Mayday call went out—an urgent response was received. We have at last begun to ask the right questions, say Hannah Wilson and Arabella Simpkin

A year ago we published a BMJ Opinion piece asking why exit interviews are rarely carried out with doctors who have left the NHS to better understand the factors that led to their decision to leave. Never has there been a more urgent need to understand driving forces and motivating factors for the exodus from the UK’s medical training programmes. In 2018, only 37.7% of F2’s continued into run through training programmes. It is perhaps the most critical juncture the NHS has ever faced. These doctors are the backbone of the UK’s healthcare system, representing the future of medicine. 

Drexit (“Doctor-Exit”) is the exponentially growing trend for doctors to walk away from their jobs in the NHS, either to new healthcare systems overseas such as Canada, Australia, New Zealand or perhaps worse, into new professions altogether, leaving behind their well trained medical brains. This exodus has been gaining momentum for several years with the workforce now at breaking point. 

In the past year we have spoken with junior doctors to understand their reasons for leaving the NHS. The call for junior doctors who have left UK training posts to tell their stories was met with eager enthusiasm. This is bittersweet. For, these eager young professionals are no longer serving in the country which formed the basis of their early medical training (all gained their medical degrees from UK institutions). Their stories are not easy reading, nor listening, much like the latest report by the General Medical Council: “The state of medical education and practice in the UK” which found that young doctors are pursuing different career paths from their older colleagues. [3] Be it taking years out of UK practice, reducing hours, or leaving clinical work in the NHS earlier. The evidence is mounting for the deepening crisis that our NHS workforce faces year upon year, which shows no current sign of abating. 

A multitude of themes are beginning to emerge from the stories of junior doctors who have left the NHS. Perhaps unsurprisingly, factors such as loss of respect, lack of value, and fragmented teamwork predominate. These factors are known to be significantly linked to satisfaction in academic medical centres. [4] There is a perception that training opportunities have been completely lost in favour of service provision leading to a demoralised workforce. Pay, recruitment, and chaotic rotation scheduling are frequent reasons doctors cite as catalysing their decisions to step away from UK training into more flexible, better paid, and more personalised approaches to their training overseas. Many doctors speak of their regret that they had felt forced to leave. Many spoke of their distress that no one had ever asked them why they were leaving or attempted to change their minds. They truly began to feel like an anonymous being, simply plugging a gap in a faltering system. 

As we previously argued, information from doctors who have left should be collected and used to help our healthcare system identify interventions and strategies to enhance retention of our doctors. Surprisingly, exit interviews are scarcely held, despite the fact that they may hold the key to turning the tide on the accelerating exodus. If we can begin to understand who leaves the NHS, and why, we can begin to develop targeted interventions to enhance retention. The good news is that there is much that is amenable to change, and large sums of money may not be required to begin the fix. For example, assessing and promoting a sense of value and respect in the work environment would be a good place to start. 

Our junior doctors are the beating heart of our NHS and we can no longer neglect them. We must identify their motivations, driving forces, and perceived gaps in training programmes that are contributing to them leaving.

Hannah C.P. Wilson is an academic junior doctor, currently studying for an MMSc in Medical Education at Harvard Medical School.

Arabella L. Simpkin is an assistant professor in medicine at Harvard Medical School. She is the associate director of the Center for Educational Innovation and Scholarship at Massachusetts General Hospital, and is currently completing a DPhil at the University of Oxford.

Competing interests: None declared

References: 

1. Wilson H.C.P SAL. Why are so many doctors quitting the NHS?—it’s time to ask the right questions. BMJ. 2019. 
2. Rimmer A, 2019. Number of FY2 doctors moving straight into specialty training falls again. BMJ
3. GMC. The state of medical education and practice in the UK. 2018. GMC. 2019. 
4. Simpkin AL, Chang Y, Yu L, Campbell EG, Armstrong K, Walensky RP. Assessment of Job Satisfaction and Feeling Valued in Academic Medicine. JAMA Intern Med. 2019.

Authors’ contributions: HCPW and ALS both contributed significantly to the conception, drafting, and revision of the work for important intellectual content and approved the final version of the manuscript before publication. 

Declaration of Interest: The authors report no declarations of interest. Funding: None.