Quit your job, leave the country, move to Australia. This may once have sounded like a hastily-planned midlife crisis, but in 2023 these life plans are more representative of doctors’ across the country. Four in ten junior doctors plan to leave the NHS as soon as they can find another job, a survey by the British Medical Association (BMA) has found.
The poll asked over 4,500 junior doctors about their plans for the future. A third want to leave the country within the next year to work abroad, Australia often being their number one destination. Over 80 per cent cited real-term pay cuts as the reason they wanted to leave the health service. A similar number referenced poor working conditions.
This follows a recent BMA survey of 3,819 junior doctors in England, which found that 65 per cent of respondents have, over the last year, ‘actively researched’ leaving their NHS jobs. Nearly 80 per cent of this cohort ‘often think about leaving the NHS’.
In a few weeks, the BMA will ballot junior doctors in England for industrial action. BMA Cymru has, in recent weeks, announced that junior doctors in Wales are considering taking industrial action; while doctors in Scotland are looking to ballot for strike action in 2023. What would it take to stop these strikes going ahead? Wage increases of 26 per cent.
The health service would not be able to cope if so many doctors left the NHS to work abroad or in a different field of work, warned Professor Philip Banfield, the Chair of the BMA Council, in a New Year address to BMA members. ‘We will not tolerate the chaos that we contend with every day at work or acquiesce to those looking to slash pay and drive down living standards.’
With clear routes out of the NHS to foreign health services, there has to be a certain level of compromise if we want to retain our medical workforce.
To ask for 26 per cent is a considerable demand, especially when other public sector workers are striking for significantly less – and their requests are still not being met. Yet there is no doubt that doctors in the UK are not paid adequately for the hours they work. A recent BMA survey found that many are having to cut back on food shopping and central heating as they struggle to cover their own medical exams and student debt on insufficient pay. In Scotland, some junior medics are being paid a wage that equates to £14 per hour, according to Dr Chris Smith, chair of the BMA’s Scottish Junior Doctor Committee. In England, it is thought that junior doctors are paid less still than their Scottish counterparts, with many starting on around £29,000.
But sympathy for healthcare workers is not universal. Health secretary Steve Barclay has been accused of turning his back on striking staff, including nurses and ambulance drivers. Oliver Dowden told Laura Kuenssberg that the government was ‘resolute’ on not giving in to nurses’ pay demands. Does the BMA believe that the government will really think differently if doctors walk out? Even shadow health secretary Wes Streeting has accused the BMA of being ‘on another planet’, calling the union ‘hostile’ to the idea that patients should expect better standards from their doctors and health service.
Who will get their way? After their first two years in the NHS where they gain their full GMC registration by working as foundation doctors, more and more medics are simply deciding to pack their bags and move elsewhere. As I wrote recently, the UK provided Australia with 13 per cent of its GPs and 22 per cent of its specialists in 2011. There was a 17 per cent increase in the number of British doctors working in Australia and New Zealand between 2014 and 2016. Today, the pattern continues to disastrous effect across the UK. Earlier this afternoon, BMA Scotland chair Dr Iain Kennedy warned that the NHS in Scotland is in crisis, saying: ‘There simply is too small the workforce in the NHS in Scotland.’
Australian cities like Melbourne, Brisbane and Sydney offer a more relaxed working environment, with better hours and better pay. It’s not necessarily a simple move however, as visa applications and registration with Australian health authorities can slow the process. Not to mention that the Australian government outlined plans to reduce the number of overseas doctors coming over to work in primary care by 10 per cent in 2019, to ensure Australian-trained medical graduates had more opportunities. That hasn’t, however, deterred medics from making plans to locum, or apply for specialty jobs, abroad.
One junior doctor approaching the end of their foundation programme in the UK told me that they were planning a move to Australia. ‘It offers an opportunity to work abroad in a non-failing healthcare system, and to work within a rota that doesn’t rely on silly hours. Even if I wasn’t to go to Australia, I wouldn’t work for the NHS. I’d work as a locum, to get better paid, and paid more fairly, for working shifts.’
Another doctor approaching the end of their foundation training said: ‘Going to Australia means more flexible working hours, a better work-life balance, better pay and ultimately a better lifestyle. The UK system feels broken. A&Es are overrun, there’s no hospital bed capacity and ultimately this leads to patient care being compromised. When you’re working within all this and still facing a real terms pay cut, the job here no longer feels worth it.’
A Health Education England document detailing ‘F2 destinations’ - where junior doctors end up after they finish the second year of their foundation programme - provides data to evidence this changing behaviour, from 2011 to 2019. It found that there has been ‘a steady decline’ in doctors who intended to progress directly into UK specialty training, from 71.6 per cent in 2011 to 34.9 per cent in 2019. In 2011, 74 per cent of F2 doctors planned to remain in the NHS; in 2019, this reduced to 57.4 per cent. And, while in 2011 only 0.1 per cent of F2 doctors decided not to practice medicine, this figure rose to 0.5 per cent in 2019 who had chosen to leave the profession.
Is it true that being too hardline on the pay demands of junior doctors may simply fuel a mass exodus? Very possibly. But is a 26 per cent pay increase really feasible right now? That’s less certain. It may be more likely that that if serious pay negotiations start, doctors would settle for a little less. A number told me that they'd happily take 20 per cent. But this still requires significant movement from the government. With junior doctors in the UK feeling undervalued and overstressed, and with clear routes out of the NHS to foreign health services, there has to be a certain level of compromise if we want to retain our medical workforce.
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