The mysterious doctor shortage

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There’s been a lot in the media recently about the UK’s doctor shortage.

If you follow medical news, you’ll have heard phrases like “rota gap” and “brain drain” being bandied about. You’ll have heard that European doctors and nurses are planning to leave Britain as they feel unwelcome. You’ll have heard headlines about GPs planning to retire, emigrate, or just quit.

Does the UK really have a doctor shortage?

Within Europe, a couple of years ago, Britain ranked 24th out of 27 countries in doctors per population, with 2.7 doctors per 1000. By comparison, Germany, France and Italy all have over 3 per 1000. And in the last 2 years things have got worse.

But what number should we be aiming for? Perhaps more important than any metric is the fact that hospitals are increasingly struggling to find doctors to fill gaps in their workforce, either permanently or on a temporary basis to cover empty shifts. It’s not just that we have fewer doctors than Germany, it’s that we have fewer doctors than we know we need. These “rota gaps” or unfilled posts increase the stress on the remaining doctors who have to cover extra work during their shifts. In the worst cases, understaffing is dangerous for patients. There have been recent examples of hospitals or departments temporarily closing because of a lack of doctors.

The UK has some of the world’s most prestigious medical schools and teaching hospitals, and is the origin of plenty of ground breaking medical research. Surely we shouldn’t be short of doctors?

famous five

Five and The Mysterious Doctor Shortage

How can you get more doctors?

Firstly, you can train more new doctors. There are more people who want to be medical students than places at medical school, so we could train more doctors by increasing the number of places available.

Of course, it isn’t quite that simple. Each medical student needs teaching. It’s not just about lectures (you could always use bigger lecture theatres), but also about time spent in small groups doing practical work, like examining patients. Many doctors give their time for free to teach medical students, but as the workforce becomes more stretched this becomes a bigger and bigger ask. Even if you can create more space in medical schools, it still costs quite a bit of money to train a new doctor. And even if you find the money, it takes 5-6 years to create a doctor, and once created, they are still junior and inexperienced.

An alternative approach would be to find fully trained doctors elsewhere, and import them. Immigration seems rather unpopular at the moment, but historically the NHS has recruited a lot of its workforce from abroad. Foreign trained doctors haven’t always had the same rigorous training as UK doctors (although in many cases they have), they may not always speak perfect English (but in many cases they do), and they may take time to settle in the UK and the NHS. Another downside is that the countries that these immigrant doctors come from, which often pay for some or all of their medical training, are often very short of doctors too. So poaching their doctors isn’t necessarily a friendly or ethical thing to do.

A final possible source of doctors is to identify doctors who are in the UK, but not currently working, and persuade them to re-join the medical workforce. There are more people in this group than you might imagine. For example, they might be having a career break, on maternity leave, doing research, or working in another industry. In the same way, part-time workers could be persuaded to extend their working hours.

How about reducing the number of doctors leaving?

We’ve established that it’s not simple to find new doctors to join the workforce. So perhaps we should focus on the other side of the equation.

One reason that doctors leave the workforce is to retire. You can push up the retirement age, and keep doctors working a bit longer. This is a strategy being rolled out all around the public sector, and it may help a little, but it’s only a short-term solution.

Another reason people leave the NHS is to move abroad. UK medical graduates are easily employable in many other countries. Canada, Australia and New Zealand are popular destinations, with a reputation for better wages, cheaper living costs, a more fulfilling work environment and a generally better quality of life for doctors.

doctor with bags

Some people quit medicine altogether and go and work for banks, pharmaceutical companies, universities or consultancies. They have varying reasons for leaving clinical medicine. Some may simply feel that they are not cut out for it. Others leave in search of better wages, better lifestyle (working for a University or a pharma company usually doesn’t involve night shifts), or a reduction in stress.

Another group of people walk out of clinical medicine temporarily. People step out to do research, to do higher degrees, to learn about non-clinical topics like management or education. Some come back, others do not.  There’s a growing trend for people to have a “year out” – a bit like a university gap year, to go travelling, or simply to unwind after years of slogging away at medical school and on the junior doctor treadmill.

It’s also worth considering people switching to part-time working. If two people switch to “half time” working, that is the equivalent of a doctor leaving the workforce.

Don’t give me problems, give me solutions!

Deciding to train more doctors would only create the first additional doctor in 5 years’ time, and it would then take an additional 5 years to turn that rookie doctor into, for example, a GP. So increasing supply via the medical school route is a bit like trying to turn around a huge oil tanker, where you have to start the manoeuvre 10 years in advance. And not only is the oil tanker hard to manoeuvre, the target is moving. What will the NHS look like in 10 years’ time anyway? And when did a Government ever sincerely plan 10 years in advance?

The UK has historically imported some of its doctors from the Indian Subcontinent, and more recently from the EU. But this flow has slowed a little, perhaps due to stagnating wages and low morale in the NHS. It’s possible that anti-immigrant sentiment is also having an effect. Perhaps if we could be a bit more welcoming this trend might reverse?

How about stemming the flow of doctors out of the NHS? The government hasn’t done a brilliant job there recently, picking a fight with doctors over their contracts, bad-mouthing them to the press, freezing pay or offering below-inflation pay rises. We’ve seen record numbers of doctors quitting medicine, or looking for greener pastures in which to practise. There’s a vicious cycle here – as doctors leave, the remainder become more stretched, morale falls, more leave and the cycle begins again.

This exodus of talent needs to be stopped. The causes are complex, but the solutions don’t have to be. The Government needs to make being a doctor in the NHS a more attractive proposition. That might involve better contracts, pay and working conditions. It might involve a little more respect. It might involve quietening down some of the absurd anti-immigrant rhetoric that is scaring away many excellent foreign doctors. It might be as simple as putting the necessary resources into an organisation that is creaking with overuse and underinvestment, so that every shift doesn’t feel like a struggle.

It shouldn’t be that hard to sell medicine as a career to people who have already chosen to spend years training to be doctors. In many ways, being a doctor is the best job in the world.

Give us the resources to do our jobs properly, and the mystery of the shrinking medical workforce might solve itself.

 

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