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A Third of Medical Students Plan Early Exit from the NHS

Around one in three UK medical students plan to leave the NHS within 2 years of graduating, either to practise abroad or because they will abandon medicine altogether, a new survey revealed.

The UK has the lowest number of doctors per head among European countries in the Organisation for Economic Co-operation and Development (OECD) - 3.2 doctors for every 1000 people, ranking it 25th among the OECD countries. To try and address the "critical workforce shortage" faced by the NHS, the NHS's Long Term Workforce Plan pledged that the number of places in medical schools would rise from 7500 to 10,000 by 2028, and could reach 15,000 by 2031. 

However, the findings of a study, published in BMJ Open, suggested the career plans of many of today's medical students could undermine the Government's ambition of having more doctors working in the NHS.

Fewer Skilled NHS Doctors

In a cross-sectional, mixed-methods survey, University of Cambridge researchers set out to understand current career intentions of UK medical students after graduation, and on completion of the 2-year foundation programme, as well as the factors influencing their decision-making.

Between January and March 2023, they surveyed 10,486 (around 25.5% of the total) medical students — average age 22 years, around two thirds (66.5%) women — from 44 UK medical schools.

The majority (83.98%) of respondents said they planned to complete both years of the UK's foundation training after graduating. 

Overall, around a third of medical students (32.5%) planned to leave the NHS within 2 years of graduating, either to practise abroad, or to pursue other careers. Of those students planning to go abroad, 42.57% indicated they were "not planning to return".

Over 2% planned to emigrate to practise medicine immediately after graduation – and of those, just under 81% didn't intend to return to the UK. 

Around 1 in 10 (10.5%) intended to complete year 1 of foundation training, then emigrate to practise medicine, with 60% not intending to return. Of those planning to emigrate after completing both foundation training years, 29% were not intending to return.

The authors said that 2.89% of the medical students expressed intentions to "quit medicine" – just under 1% immediately after graduation, just over 1% after completing year 1 and just under 1% after completing year 2 of foundation training.

Among respondents intending to complete both foundation years, only half (48.76%) planned to enter specialty training in the UK immediately afterwards. Around one in five (21%) intended to enter a 'non-training' clinical job in the UK.

The authors pointed out that the training of medical students "heavily relies" on clinical exposure, which in turn is dependent on availability of clinical teaching staff. The increasing proportion of students intending to take up non-training clinical positions could reduce the availability of highly skilled doctors in the NHS, they warned.

"This study highlights that an alarming proportion of surveyed medical students intend to leave the profession or emigrate to practise medicine," alerted the authors, which they highlighted represented a "potential loss of valuable medical talent".

The authors acknowledged some limitations of the study. These included that it captured a 'snapshot' in time, and thus was unable to reflect future changes in students' career intentions. Also, despite being the largest study of UK medical students, only around one in four participated, which might have introduced selection bias.

Exodus Drivers "Must Be Addressed"

Approximately 60% of respondents were either not satisfied or not at all satisfied with the prospect of working in the NHS, with only 17.26% being satisfied or very satisfied.

Pay, work-life balance, and working conditions were the key drivers behind decisions to leave, commented the authors. Nearly 82% of respondents identified 'burnout' as an important or very important reason.

"Our results indicate that increases in medical student places via expansion of existing medical schools or the establishment of new medical schools may not result in proportionate increases in doctors wishing to remain in the NHS," cautioned the authors. 

That conclusion was shared by Dr Latifa Patel, the British Medical Association's representative body chair, who told Medscape News UK, that increasing medical school places alone was not enough to "turn the tide on the growing workforce crisis".

The study findings emphasised the "urgency" of addressing the factors that were "driving the exodus of doctors" from the NHS, the authors underlined.

They stressed that the causes of the problem were "complex", and that solutions would require a "multifaceted approach". Steps could include improving work-life balance, increasing salaries, addressing the growing competition for specialty training posts, and promoting greater flexibility in career pathways, they suggested.

The continued loss of skilled professionals from the NHS represented a "significant concern", so it was "critical to consider means of reversing this trend", the authors emphasised.

"Without addressing the issue of retention, increasing the number of medical students is unlikely to provide a sustainable long-term solution," they warned.

It was "disheartening" that medical students already recognised the extent to which "our profession has been devalued", and to have "their enthusiasm and commitment crushed out of them", commented Dr Patel.

Miriam Deakin, director of policy and strategy at NHS Providers, told Medscape News UK that "more must be done to make the medical profession in the UK desirable".

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