Around one in three UK medical students plans to leave NHS within two years of graduation

Around one in three UK medical students plans to leave the NHS within two years of graduating—either to practice abroad or to abandon medicine altogether—suggest the results of the largest survey of its kind, published in the open access journal BMJ Open.

Pay, work-life balance, and working conditions are the key drivers behind the decisions to leave, the responses indicate.

The UK has 3.2 doctors for every 1,000 people, ranking 25th among the Organization for Economic Co-operation and Development (OECD) countries. This figure also represents the lowest number of doctors per head among European countries in the OECD, note the researchers.

In response to the shortage of doctors amid rising health care demand, the British government has opened new medical schools and expanded the student capacity of existing ones. But without addressing the issue of retention, increasing the number of medical students is unlikely to provide a sustainable long-term solution, they point out.

In a bid to understand current career intentions after graduation and on completion of the two-year Foundation Program, the researchers surveyed 10,486 medical students—around 25.5% of the total—from across 44 UK medical schools between January and March 2023.

The survey included sections on intended career immediately after graduation and after foundation training (if applicable), as well as the factors influencing decision-making.

Respondents' average age was 22; around two thirds (66.5%) were women. All students were asked their career intentions after graduation with most (8,806; 84%) saying they planned to complete both years of the UK's foundation training after graduating.

But around one in 10 (10.5%;1101) intended to complete year one of foundation training and then emigrate to practice medicine: completion of the first year of foundation training provides doctors with full registration with the UK's medical regulator (GMC), which is recognized internationally.

Another over 2% (220) planned to emigrate to practice medicine immediately after graduation while just over 1% (123) intended to take a break or undertake further study.

Just over 1% of respondents (132) planned to complete their first foundation year and then leave the profession, while just under 1% (104) intended to leave medicine permanently immediately after graduation.

Among the 8,806 respondents intending to complete both foundation years, nearly half (49%;4,294) planned to enter specialty training in the UK immediately afterwards.

Around a fifth (21%;1,859) intended to enter a 'non-training' clinical job in the UK such as junior clinical fellowship or clinical teaching fellowship, or working as a locum doctor).

A further 23.5% (2,071) intended to emigrate to practice medicine abroad, while around 6% (515) planned to take a break or undertake further study. Just 67 planned to leave medicine permanently after completion of year two of foundation training.

Around half (49.5%;1,681) planned to return to UK medicine after a few years, while nearly 8% (267) intended to return after completion of their medical training abroad. But 42.5% (1444) indicated no intention to return.

Of those favoring emigration immediately after graduation, just under 81% didn't intend to return to the UK. This fell to 60% (661) among those planning to emigrate after completing year one of foundation training and 29% (605) among those planning to emigrate after year two.

Among the 2543 medical students expressing a preference for destination country, Australia was the most commonly mentioned (42.5%), followed by New Zealand (18%), the U.S. (10.4%) and Canada (10.3%).

In total, around a third of medical students (32.5%;3,392) plan to leave the NHS within two years of graduating, either to practice abroad or to pursue other careers.

Remuneration at junior level, work-life balance, lack of autonomy over choice of training location, and the working conditions of doctors in the NHS were cited as the most important factors for those respondents intending to emigrate to continue their medical career.

These reasons were also given by those planning to abandon medicine altogether, with nearly 82% of them also listing burnout as an important or very important reason.

Only just over 17% of all respondents said they were satisfied or very satisfied with the overall prospect of working in the NHS.

Intention doesn't necessarily translate into action, and minds may change, say the researchers. And while the 25% response rate is relatively large, that still means a substantial proportion of the medical student body weren't surveyed.

But they highlight, "This study highlights that an alarming proportion of surveyed medical students intend to leave the profession or emigrate to practice medicine," emphasize the researchers, "representing a potential loss of valuable medical talent."

They continue, "The findings of this study emphasize the urgency of addressing the factors that are driving the exodus of doctors from the NHS and 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."

They conclude, "Undoubtedly, the continued loss of skilled professionals from the NHS represents a significant concern, so it is critical to consider means of reversing this trend."