Why so many Junior Doctors are choosing to practice their profession abroad
The United Kingdom is globally respected for its healthcare. Last year the UK’s National Healthcare System (NHS) was declared to be the best healthcare system out of the top 11 industrialised nations by an international panel of experts conducted by the respected commonwealth fund foundation. Having been a receiver of its free services all of my life I’d proudly count myself as one of its supporters. I was inspired by the recent events in Britain, over a controversial new contract which is to be imposed by the current Conservative government on junior doctors in August 2016, to get the opinion of the professionals who would be affected by its implementation.
I asked 75 doctors who work for the NHS and questioned them if they were satisfied with their lives whilst currently working within the service; the answer was a resounding ‘no’.
Why do you feel overworked, demoralised or stressed within your profession?
“A few years ago, I almost couldn’t even attend my own wedding because my request for unpaid leave was denied even though I had requested this many months in advance. Reason given was that it would cost too much to hire locums to cover my on-calls and also they would have left the ward I was on uncovered, again as locums would be ‘too expensive’”.
From the people I talked to, statements such as these were commonplace; a melancholy tone surrounded every response to my inquiries. For Britain it seems, the pillars that make up the medical profession are at risk of collapsing into crisis, and it is the UK Health Secretary, Jeremy Hunt’s new contract that is providing the wrecking ball.
The main point of contention is the proposition of changing the definition of the working week from 9am-7pm Monday – Friday, to 9am-10pm Monday-Saturday. The effects of this would amount in a direct pay cut; many employees already work past the standard working week due to staff shortages which entitles them to overtime pay. So many doctors who already work Saturdays out of necessity would no longer receive the extra pay for working out of regular hours. Working extra hours out of the regular working week has become the de-facto standard of employment, so if these changes are implemented many doctors could face a 30% pay cut.
British doctors regularly work more than 60 hours a week and longer shifts than their comparable international counterparts, who not only manage to preserve the full time average of 40-45 hours a week, but are also allowed to attend their own weddings. The effects of this contract will damage the already extremely difficult job of maintaining a happy work life balance, which allows time for family and friends – staples of a happy and prosperous life that are seemingly hard to come by when you practice medicine in England.
If this contract is imposed in August 2016, all 75 doctors I talked to said they would definitely consider leaving. This isn’t an isolated view; surveys by the British Medical Association have shown that half of NHS staff regularly think about quitting, with many of them beginning to look at their options abroad. When a timetable for implementation of the new contract was announced in the middle of September, the number of doctors who were applying for ‘Certificates of professional status’ – a key certification for those looking to work abroad – went up from 20-25 a day to over 1000.
Britain is facing a mass exodus of their newest doctors, who instead of being enticed to stay by the government are being extorted. Only 3 of the 75 I talked to said they would never consider leaving and 6 said they already had plans to leave. 95% of the doctors I asked said they believe the NHS will be privatised if the government continues the way it is. The public needs to know the plight that our current medical professionals are facing, otherwise our country’s health services will be taken from us.
Australia and New Zealand are the prime destination for the under appreciated English doctor. I endeavoured to find out why. Why would a British medic wish to travel as far as possible for the chance at a better life? Distance-wise you can’t get much further away from Britain than these two Australasian countries, yet the cultural and historical ties the three nations share through their joint commonwealth have made them all relatively similar societies.
Yet the ease at which acclimatisation within Australia or New Zealand can be achieved only forms the basis of appeal for emigration for struggling British doctors. The real motives for moving up to 11,000 miles away lies in the amount of respect attributed to the medical profession seen through governmental policy in these countries.
The Australian government offers many benefits to their doctors that the UK does not. Simple things that an outsider could mistakenly assume would be provided by their employer are lacking. Many of my participants highlighted small touches such as the provision of beds to sleep in for staff who are working 2 shifts consecutively, proper parking for staff and free lunches are all provisions provided by our Southern Hemisphere partners which the UK government does not. Yet it is the bigger picture where the differences are most striking.
What makes Australia or New Zealand an appealing choice?
‘By the 7th nightshift in a row I am not able to make as sensible or as timely decisions as on night 1. Australia understands that you need a minimum of 23 hours off a week’,
‘Britain is overworked understaffing of hospitals in general – having to cover the role of 3 doctors when the rota is already short staffed’.
‘I get several job offers a month [from Australia and New Zealand]. They promise to double my current salary and a better life/work balance.’ ‘There is no question, when I’m qualified I will move to Australia to be a GP. 1) 2-3 times higher pay 2) less out of hours commitments means more time with family. 3) more respect from the people and media. 4) more emphasis on learning. I get the feeling sometime that the public here feels that they “own me” and can talk to me in a horrible way’.
In both Australia and New Zealand, hospitals and medical facilities guarantee time off as a reward for working unsociable hours. Yet in the UK, the government wishes to remove the ‘unsociable’ label from Saturdays, further impeaching the employee’s individuality.
The very worst feature of the contract put forward by Jeremy Hunt truly exemplifies the dire relationship Britain has with its medical professionals. The contract wishes to remove paid leave for those who need time out of their profession, including: Maternity leave, cancer research and examination preparation. Meanwhile, Australia pays for all of their staff’s education, sponsors their research inquiries and guarantees their pregnant staff are paid time off – it is 2015 after all, not 1910.
Many media outlets within the UK have tried to attribute doctors’ desire to move abroad as a selfishly economic enterprise and waste of taxpayer money – it costs over £600,000 to train a doctor. However, my research showed that money was only one facet of the appeal of emigration, in my questioning, not a single respondent stated money as their sole or primary motive for leaving.
Respect, or rather lack thereof, was a common theme of my enquiries, placing second behind ‘better work life/balance’. Because of attacks by the media and the government, many doctors feel like they aren’t appreciated members of society, and that their altruism isn’t as respected as it would be in another country.
In light of my investigation, it’s hardly surprising that the newest and increasingly in-demand generation of doctors in the UK feel let down by their employers and society as a whole. The accusatory line taken by the government and the media, that professional medical exodus is driven purely by economic self-interest is an easy line to promote in order to convince the general public to support the proposed contract. However this view only takes the face value of the issue – it is easy to see on a piece of paper that an emigrant will be paid more for working abroad – but this method fails to look at the real issues. Beneath the surface it is clear to see a generation of demoralised workers who, rather than being appreciated, feel as if they are under attack by their government, the media, and the very people they exist to help.
Australia and New Zealand offer huge benefits, from guarantees of time off, paid research leave and up to triple the salary offered by the UK. Yet back in Britain, we are faced with the frightening prospect of someone being employed by the British government with no access to maternity leave. Many of the labour movements of the early 20th century that fought for rights such as these were born here – their lessons shouldn’t so soon be forgotten. My research has shown the enormity of the crisis the UK is currently facing. I intend to carry on trying to work with doctors in order to reveal their side feelings because it is vital for Britain to sit up and take note of the needs of our doctors, because the threat of an exodus if this contract is implemented is alarmingly real.
Connor Parker is a History graduate from Sheffield Hallam University and was awarded scholarship for a Masters in Sociology and Policy and the end of his undergraduate studies. He has a keen interest in British domestic issues and has previous experience carrying out a array of independent research within the sector and working for the University of Sheffield Political Economic Research Institute.
Cover image ‘One of the huge NHS billboard ads that are going up across the country today‘ by 38 degrees