Uncertainty surrounding junior doctors' contract affected career choice, study reveals

Fewer doctors are choosing to train in acute hospital specialties as a result of turbulence surrounding last year's junior doctors' contract, according to an academic survey.

The study was carried out by researchers at The University of Manchester's Division of Population Health and Economics, supported by staff at the UK Foundation Programme

It was funded by the National Institute for Health Research School for Primary Care Research

Recruitment was supported by staff at UK Foundation Programme Office and regional offices

The study is published in BMJ Open today.

All second-year foundation doctors in England were invited to take part in an online survey, and 819 responded. This represents 12.6 percent of the population of year two foundation doctors.

These doctors were at a pivotal point where they could apply for a specialty training (ST) programme leading to their preferred future career.

Email invitations to take part focused upon choice of career and did not refer to contractual issues. In addition, the team carried out 20 qualitative interviews to explore attitudes and experiences in more detail.

Respondents were asked if their career decision had been affected by recent uncertainties and proposed changes in contracts for junior doctors.

The survey did not ask any wider questions about the terms of the contract, nor did it address broader attitudes to the contract dispute. Interviews explored the factors which were affecting career choices.

On completion of two years of Foundation Programme training, doctors can progress directly to a specialty training programme, switch to a different ST programme, defer decision or entry to an ST programme, or quit medical work.

Of the sample, 64 percent attributed no career choice changes to the contract.

However, contract issues lay behind 11 percent changing specialty, 9 percent deferring application and 5 percent leaving the UK, with the remaining 11 percent indicating some combination of the three.

In addition, about 20 percent said that as a result of the contract they were uncertain about whether or not to switch specialty training programme.

Among the 819 survey respondents, those who chose to switch specialty training because of contract-related issues were less likely apply for hospital work (16.5 percent) and more likely to apply for community-based posts (30.1 percent) - mostly general practice.

The proposed new contract for junior doctors applying for training posts in hospital and community-based specialties in England was associated with an extended period of negotiation and uncertainty about the outcome.

Dr Sharon Spooner from The University of Manchester says many doctors do not go on to take specialty training posts immediately after they have completed their five year degree and two year Foundation Programme training.

Dr Spooner said: "From 2011 to 2015, the proportion of doctors not proceeding directly from Foundation training to specialist training increased from 29 percent to 48 percent.

"And it's also clear that the recently implemented junior doctors' contract has had an impact on an already worrying situation.

"Our survey shows that some newly qualified doctors have altered their career plans as a result of the contract.

"Junior doctors also reported feeling under-valued in the NHS, and were concerned that there could be less support during their training. They reported feeling uncertain about their future plans."

Dr Spooner added: "The NHS is at risk of losing some doctors in training, and uncertainty about their future is a factor in their decision.

"Doctors are aware that their skills have global value, and some are prepared to change their personal and career plans to achieve their goals, including working abroad, and some may leave medical work entirely."

"These findings are worrying because delivery of services depends on sufficient qualified staff for all roles within the NHS, and retaining doctors in training is an important contributor to this," she said

"Understanding the factors underlying career decisions is important in supporting action to improve retention."