The "vicious cycle" of unmanageable workloads, dissatisfaction, and burnout that is causing UK doctors to take steps to quit, "must be broken", demanded the General Medical Council (GMC) after publication of the regulator's latest report, The state of medical education and practice in the UK: Workplace experiences 2023, that revealed 77% of doctors are likely to make a career change.
The report surveyed a representative sample of 4269 doctors – GPs, specialists, doctors in training, specialty and associate specialist (SAS) doctors, and locally employed (LE) doctors – during September and October 2022.
The regulator found that half of doctors (50%) were satisfied in 2022, down from 70% in 2021. Compared to 2021, when 59% of doctors reported working beyond their rostered hours on a weekly basis, in 2022 this figure had risen to 70%.
Difficulty taking breaks each week had increased by around 40% from 2021 (to 68% in 2022 from 49% in 2021) and feeling unable to cope with their workload each week was up by around a third (from 30% in 2021 to 42% in 2022).
"More doctors than ever said they were likely to leave the UK workforce and had taken 'hard steps' towards doing so," the GMC alerted. This, they said, did not include doctors of retirement age who were planning to retire.
More than twice as many doctors said they had taken steps to leave compared to the previous year (15% in 2022 versus 7% in 2021).
"Doctors are changing their working patterns, places of work, or even re-thinking their careers because they increasingly feel unable to cope," a GMC spokesperson said. "In effect, it creates a vicious cycle that threatens patient safety," the regulator cautioned.
From 2021 to 2022, the proportion of doctors who said they were likely to make a career change in the next year grew significantly from 58% to more than three-quarters (77%). This included a large increase in those likely to leave the UK profession permanently. In 2021, only around 1 out of 10 (11%) said they intended to leave. By 2022, this rose to nearly 1 out of 5 (18%), the GMC said.
Other steps doctors were considering were: Reducing their hours (24%), taking a break (7%), making another change (23%).
The GMC remarked that it was "not surprising" that more doctors had taken steps to leave UK practice. But as clinicians "vote with their feet, the gap they leave behind compounds workload pressures, feeding into a vicious cycle," they warned.
British Medical Association (BMA) Workforce Lead, Dr Latifa Patel, said: "These are not threats but rather show that doctors are putting plans in place to leave – the Government cannot afford to let this happen."
Charlie Massey, GMC chief executive, worried about the impact of so many experienced doctors leaving would have on medical students and new doctors: "More clinicians than ever are telling us they are taking steps to leave the profession. It’s especially worrying to see the impact on trainers, who are critical for ensuring that our doctors in training develop the skills and confidence they need. Any government commitments to expand medical training places, whilst welcome, will flounder if the needs of the trainer workforce are not urgently met."
Dr Sabira Hughes, medicolegal consultant at Medical Protection Society (MPS), said that the GMC was right to stress the need to focus on retaining passionate doctors currently in the workforce but on the verge of quitting, as well as increasing the number of doctors. "Many are exhausted and burnt out, and the effects of moral injury on mental wellbeing should not be underestimated," she stressed.
In 2022, over half of doctors (57%) found their work emotionally exhausting to a high degree, close to half (45%) found it frustrating, and 4 out of 10 (40%) reported that they felt burnt out because of their work. A quarter of doctors surveyed (25%) were categorised as being at high risk of burnout in 2022, compared with 17% in 2021, and 10% in 2020, the GMC pointed out. At the same time, the percentage of doctors at very low risk of burnout had dropped from 60% in 2020 to 32% in 2022, which the GMC warned was "a cause for concern".
GPs reported poor workplace experiences, causing issues filling vacancies and reducing service capacity. In 2022, 38% of GPs said they were satisfied, fewer than other doctors and down from 51% in 2021.
Miriam Deakin, director of policy and strategy at NHS Providers, commented: "Right across the NHS, people report suffering burnout and low morale while stress, anxiety, and depression remain the top reasons for sickness absence with thousands of staff off work as a result."
Coping and Caring Struggles
With regards to who was struggling with their workload, 38% of all doctors reported this, with it being the case for over half of GPs (55%).
Whilst, overall, 34% of ethnic minority doctors were struggling, the survey highlighted differences in workload struggles according to ethnicity: White doctors (42%), Asian/Asian British doctors (34%), Black/Black British doctors (27%). This pattern – a higher proportion of White doctors struggling than their ethnic minority peers - was evident among GPs and SAS and LE doctors, but the differences were not notable among specialists and trainees, the GMC pointed out.
The report noted 47% of disabled doctors were struggling, compared with 37% of non-disabled doctors – this pattern was seen in all registration types except GPs, in which no notable difference was found.
There were also differences by speciality area, with doctors in some specialty areas less likely to be struggling than doctors overall (38%): Psychiatry (29%), paediatrics (28%), radiology (23%), and anaesthetics (13%). These four speciality areas also tended to report higher levels of satisfaction and were less likely than the average (42% of all doctors) to have felt unable to cope with their workload.
However, GPs (58%), those working in acute medicine (50%), and doctors working in emergency medicine (48%) were more likely than the average to have felt unable to cope with their workload.
Doctors under 30 years of age were more likely than older doctors to be struggling – with 44% of doctors in this age group struggling, compared with 38% of those aged 30-49 years, and 34% of those aged 50 years and over.
A more positive finding was that in 2022 around 9 out of 10 (88%) doctors reported having positive relationships with their patients. However, 7 out of 10 doctors (70%), and more than 8 out of 10 GPs (82%), 'always or often' felt worn out at the end of the day. Half (50%) of GPs said that they 'always' felt worn out at the end of the day, compared with a third(33%) of all doctors.
More than two-fifths of doctors (44%) found it difficult to give their patients the care needed at least once a week, with 21% struggling to achieve this on a daily basis. This was a "considerable" increase since 2021, when 25% faced this challenge at least once a week, and 9% daily, emphasised the GMC.
Immediate and Longer-Term Solutions
In their report the GMC suggested some immediate actions to help break the cycle, as well as longer-term strategic priorities that should be considered by healthcare leaders and policymakers.
- Developing flexible rota designs, with fair and flexible rotas that took account of doctors’ personal circumstances and life events
- Providing workplace rest and refreshment facilities, provision for parents and carers, and car parking that was safe and subsidised or free
- Making work intensity more sustainable by increasingly overall capacity to deliver patient care
- Strengthening support for primary care to protect patient safety and staff wellbeing
The GMC believed these changes could be "instrumental in creating more virtuous cycles", and in helping to retain the healthcare professionals that were "needed to provide safe patient care".
Mr Massey stressed that addressing these concerns, and improving doctors' wellbeing, required "concerted action" across the UK healthcare system. He underlined that the findings of the report should "bolster the resolve of others" to tackle both the immediate and longer-term challenges the profession and the health system faced.
"This is a time of unparalleled pressure in the healthcare sector," stressed the GMC, and the testimony heard from doctors was "stark". Workloads were up, stress-related absence and risk of burnout had increased, and large numbers of doctors felt unable to cope, it reiterated, and warned that this not only had a "damaging" impact on clinicians, but also on the patients in their care.
Ms Deakin remarked that the GMC's findings were "difficult reading", and "lays bare the huge pressure" facing an overstretched NHS and staff.
"The government’s long-awaited workforce plan for the NHS, which needs to be fully funded, can’t come soon enough," she said.
The BMA said the Government should treat the GMC report as a "final warning" and predicted that things will only get worse as doctors "buckle under the weight" of ever-growing waiting lists, unless critical steps were taken.
"If the workforce crisis is not addressed urgently then we fear that the NHS will experience the largest exodus of doctors in its history," said Dr Patel.