The Headlines
Goodbye UK?
Medical students in the UK are planning on practising overseas after graduation, according to a study. What is the government doing to prevent them from fleeing?
By John O' Leary
Share this page
The global nature of graduate employment and student recruitment has been underlined in the challenges facing the United Kingdom’s National Health Service (NHS) and the consequent upheavals for medical schools.
With doctors taking periodic industrial action over claims that their salaries have fallen by 35 percent in real terms over a decade while declining staffing levels have added to workload, the biggest-ever survey of medical schools has shown almost a third of students plan to practise overseas. Over four in 10 do not expect to return. Working conditions, work-life balance and the lack of autonomy over training locations, as well as pay levels for junior doctors, were all important factors encouraging them to emigrate or leave the profession altogether.
More than a quarter of medical students in England took part in the research. The British Medical Journal (BMJ), which commissioned the survey, admitted that it might have appealed disproportionately to those who were not planning to continue in the NHS, but still found the numbers “alarming”.
The UK’s 3.2 doctors per 1,000 people is the lowest proportion among European countries belonging to the Organization for Economic Cooperation and Development (OECD). Little more than 17 percent of all those responding to the BMJ survey said they were satisfied or very satisfied overall with the prospect of working in the NHS.
“The causes of the problem are complex, and finding a solution will require a multifaceted approach."
Ankith Mannath, a 25-year-old in the fifth year of a medical degree at University College London, told the Daily Telegraph: “Most people I’ve spoken to in my year are considering doing a year or two in Australia or New Zealand, or somewhere else outside the UK. It’s come to the point where, although some say they would come back because of family, they wouldn’t be 100 percent sure they would carry on practising [in Britain].” Others had set their sights on consulting, research, medical technology or pharmaceutical companies, he told the paper.
Among the 2,543 students in the survey expressing a preference for practising in a particular country, Australia was mentioned most frequently (by 42.5 percent), followed by New Zealand (18 percent), the US (10.4 percent) and Canada (10.3 percent). Two Australian states have even launched efforts to lure UK doctors and other public servants at the height of the doctors’ strikes, highlighting better pay and the lower cost of living in Australia.
The UK government has come under pressure to introduce an obligation for medical graduates to work for the NHS, but Prime Minister Rishi Sunak has insisted that the number of doctors emigrating has been exaggerated. He told MPs that around 95 percent of those completing their foundation training stayed in the UK, although he promised that the government would take action if the position changed.
The authors of the BMJ report conceded that an intention to practise abroad might not translate into action. But they added the findings of the study “emphasise the urgency of addressing the factors that are driving the exodus of doctors from the NHS”. The authors also suggest that increased recruitment of medical students may not provide an adequate solution to staffing challenges. “The causes of the problem are complex, and finding a solution will 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.”
“Faced already with some 112,000 vacancies in all sectors of the NHS – a figure that could rise to 360,000 by 2037 – the government has promised to double the number of medical school training places by 2031 as part of its Long-Term Workforce Plan.”
Faced already with some 112,000 vacancies in all sectors of the NHS – a figure that could rise to 360,000 by 2037 – the government has promised to double the number of medical school training places by 2031 as part of its Long-Term Workforce Plan. It intends to allocate extra places to areas of shortage and is also introducing medical degree apprenticeships, with pilots starting next year, so that 2,000 medical students will eventually train via this route. The proposals, supported by £2.4bn for the first five years, will also see thousands more nurses, physician associates and other healthcare staff trained.
The start of the expansion has already been brought forward so that 200 medical places can be added to next year’s quota. Universities are urgently preparing to bid for the rest. Sunderland, which hosts one of the four new medical schools established in 2019, was first off the mark within weeks of the plan’s publication, proposing to triple the size of its intake to 300 a year.
The Workforce Plan has generally been welcomed in the health sector, but with reservations about its implementation. Dr Jennifer Dixon, chief executive of the Healthcare Foundation, says the commitment to expand training numbers was a “huge step forward”. But she adds: “Leaver rates among NHS staff are close to record levels and years of below inflation pay settlements mean the wages of many NHS staff have fallen behind comparable occupations. Training more staff is essential, but this will be little good if the NHS is unable to retain the staff it’s already got.”
Dr Billy Palmer, Senior Fellow at the Nuffield Trust, also welcomes the expansion of training, but warns that it carries some risks. “Nobody wants to see standards drop in selecting doctors and nurses. The time required for so much supervising by more senior clinicians will be an issue and could eat into efforts to clear the backlog – a risk I hope the plan will recognise,” he says.
Questions also remain about the plan’s affordability. The Institute for Fiscal Studies has estimated that the measures will require NHS spending in England to increase by around 2 percent of national income over 15 years, equivalent to around £50 billion at today’s prices.