Medical unhappiness is rife in the UK, writes Sarah Marie Farrell, but it doesn’t have to be this way

Like almost all doctors I know, I am proud to be in a caring profession and to work for the NHS, a healthcare system based on need and free at the point of delivery. But to be a doctor in the UK today is relentless and under-rewarded: it seems to require nothing short of pure altruism. 

I am paid three to five times less than many of my university peers. But I work longer hours and carry a higher emotional toll. I take my breaks in a grotty office, amid strewn blankets, the makeshift beds of colleagues’ night shifts. I eat trying to ignore smells of rancid food and body odour. 

On shift, we do not have the luxury of camaraderie, there isn’t time. We barely know who we are working with. It is frustrating to have lost opportunities for spontaneous teaching moments, on now mythical quiet nights. 

Many questions arise. Why am I still using a fax machine? Why is there never any paper in it? Why is the paper cupboard locked, and who has the keys? 

Doctors are required to hone decision making skills to optimise care and facilitate patient autonomy. The irony is that doctors are required to relinquish decision making capacity in their personal lives. The system decides when my holiday is appropriate, when study is allowed, even where I end up living within the parameters of the entire UK. 

There is a constant delay to “adulting,” such a buying a house, getting married, and having children. I have even heard, “If you are not divorced by the time you take your fellowship exam, you probably didn’t work hard enough.”

Dissatisfaction is rife

It isn’t just me. Dissatisfaction among doctors is generally high. Frighteningly, many doctors are considering leaving the NHS. A national survey found nearly half (47%) of doctors working in English hospitals considering leaving their organisation, and one in five are considering leaving the NHS altogether, with a similar pattern in Wales and Northern Ireland. [2-4]

Primary care is also facing a “workforce crisis,” with 37% of 2248 GPs surveyed in southwest England saying they were highly likely to quit, 36% to take a career break, and 57% to reduce hours within five years. [5] 

Burnout and low morale are common concerns. A quarter of doctors struggle with their workload, a 2018 General Medical Council survey found. [6] The World Health Organization defines burnout as an occupational health problem resulting from chronic poorly managed workplace stress, with three characteristics—”energy depletion”, “feelings of negativism or cynicism related to one’s job,” and “reduced professional efficacy.” [7-8] 

Doctors’ morale is at an all time low. A BMA survey published in October 2019 reported that 41% of 729 respondents described their morale as low or very low, an increase on previous surveys. Nine in 10 doctors feel that the NHS is in year round crisis. [3]

Doctors at every career stage are on average working longer than their contracted hours. The BMA’s survey found that GPs are worst affected, with 79% working overtime often or very often. [3] Discontentment also results from a lack of agency in local planning, with 84% of doctors having no involvement in planning how their local healthcare systems support the government’s long term plan.[9]. 

Some doctors report feeling hampered by government imposed targets—the most obvious being the A&E 4 hour target;  only 1% of doctors think this is “useful,” and 31% believe it has a “negative impact.” [9] GPs particularly say they fear litigation and feel blamed for failings in the system. [10] There are many other reasons that doctors feel devalued, underpaid and overworked.

Data suggest a better work-life balance for doctors who venture abroad. For example, in a survey of 282 UK-trained doctors working in New Zealand, mean job satisfaction stood at 8.1/10 compared with 7.1 in the UK. [11] Doctors in New Zealand scored 7.8/10 for free time for leisure, compared with 5.7 for the NHS doctors. Australian working environments have also been perceived as friendlier, and the lifestyle better there, by doctors wishing to leave the UK. [12]

For doctors who wish to stay in the UK, the promise of autonomy in the private healthcare sector is tantalising. We hear rumours of free breakfasts and respect. And private sector work can be lucrative, with benefits of which NHS workers can only dream. 

Where do we go from here?

There’s a tough road ahead for the NHS, with an ageing population, high public expectations, and rising numbers of tests and treatments available, increasing the burden on already crumbling infrastructure. Unless things change to reverse doctors’ unhappiness, the NHS could see a medical exodus.

To make the NHS more appealing to doctors, conditions must improve. “Resilience” is not a panacea for burnout. More demand from patients can be met only with more doctors and more efficiency. Both require substantial investment.

The GMC recently made hopeful overtures promoting wellbeing for healthcare workers. Its report “Caring for doctors, Caring for patients” discusses doctors’ poor wellbeing. Highlighting the importance of autonomy, belonging, and competence–its authors suggest six urgent steps, including the cultivation of compassionate and inclusive leadership. [13]

Two other changes are urgently needed. Trainees’ time must be ringfenced as required by the national training programme. Currently, many shifts comprise pure service provision without time for operative hours, auditing, and teaching. 

The NHS needs also fully to embrace less than full time working for doctors. Many doctors who might otherwise leave the workforce would be happy to contribute in roles with greater work-life balance.

The feeling that doctors are being forced into an abusive relationship with the NHS seems to be growing. But doctors’ wellbeing is no less important than patients’, and the NHS should reflect compassion for all, including its workers.

 

This is an edited version of an essay that won a competition run by Doctors for the NHS and The BMJ with the title “Where have all the doctors gone and why?”

Sarah Marie Farrell, Core Surgical Trainee, London

Provenance and peer review: Commissioned; not externally peer reviewed.

Competing interests: None declared.

References:

1. The UK Foundation Programme Office. F2 Career Destinations Report 2018. https://www.foundationprogramme.nhs.uk/wp-content/uploads/sites/2/2019/11/F2-Career-Destinations-Report_FINAL-2018.pdf
2. NHS England. National NHS Staff Survey 2018. Data accessed 30 October 2019. 
3. British Medical association. Survey report found at: https://www.bma.org.uk/collective-voice/policy-and-research/education-training-and-workforce/quarterly-survey/quarterly-survey-results/quarterly-survey-q2-2019 British Medical Association Quarterly Survey (October 2019). Last accessed February 2020
4. NHS Wales. NHS Wales Staff Survey 2018: National report [Internet]. 2018. Available from: http://www.wales.nhs.uk/sitesplus/documents/866/4.3b%20 National%20Staff%20Survey%20Report.pdf. Additional analysis conducted on data provided by NHS Wales.
5. Campbell JL, Fletcher E, Abel G, Anderson R, Chilvers R, Dean SG, et al. Policies and strategies to retain and support the return of experiences GPs in direct patient care: the ReGroup mixed-methods study, NIHR Journals Library. 2019.
6. General Medical Council. National Training Surveys 2019. Data accessed 30 October 2019.
7. World Health OrganisationPrimary Prevention of Mental, Neurological and Psychosocial Disorders, 1998 p. 91-110
8. World Health Organisation. International Classification of Diseases (11the Revision). 2018.
9. British Medical Association. Survey report found at: https://www.bma.org.uk/collective-voice/policy-and-research/education-training-and-workforce/quarterly-survey/quarterly-survey-results/quarterly-survey-q1-2019 (May 2019). Last accessed February 2020.
10. Sansom E, Terry R, Fletcher E, Salisbury C, Long L, Richards S.H. et al.  Why do GPs leave direct patient care and what might help to retain them? A qualitative study of GPs in South West England: BMJ Open, 2018, v. 8, p. e 019849
11. Sharma A, Lambert TW, Goldacre MJ. (2012).  Why UK-trained doctors leave the UK: cross-sectional survey of doctors in New Zealand: J R Soc Med, v. 105, p. 25-34.
12. Smith SE, Tallentire VR, Pope LM, Laidlaw AH, Morrison J. Foundation Year 2 doctors’ reasons for leaving UK medicine: an in-depth analysis of decision making using semi-structured interviews: BMJ Open, 2018 v.8, p. E019456.
13. West M, Coia D. Caring for Doctors, Caring for Patients: How to transform UK healthcare environments to support doctors and medical students to care for patients. 2019. https://www.gmc-uk.org/-/media/documents/caring-for-doctors-caring-for-patients_pdf-80706341.pdf