Why doctors consider leaving UK medicine: qualitative analysis of                     comments from questionnaire surveys three years after graduation

Lambert, Trevor W; Smith, Fay; Goldacre, Michael J

doi:10.1177/0141076817738502

Cited by 45 publications

(62 citation statements)

References 9 publications

(14 reference statements)

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“…18,19 In the UK, the key outcomes associated with mental ill-health in doctors include presenteeism (doctors working despite being unwell), [20][21][22] absenteeism (doctors taking sickness leave frequently, which could result in gaps in the service) 23 and workforce retention issues (doctors leaving the NHS either temporarily or permanently). [24][25][26][27] There is growing interest among different organisations and journals in understanding and addressing the issue of mental ill-health in doctors. This spans from the British Medical Journal collection on doctors' well-being 28 to the Health Education England's NHS Staff and Learner's Mental Wellbeing Commission.…”

Section: Discussionmentioning

confidence: 99%

Interventions to minimise doctors’ mental ill-health and its impacts on the workforce and patient care: the Care Under Pressure realist review

Carrieri

Pearson

Mattick

et al. 2020

Health Serv Deliv Res

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Background The growing incidence of mental ill-health in health professionals, including doctors, is a global concern. Although a large body of literature exists on interventions that offer support, advice and/or treatment to sick doctors, it has not yet been synthesised in a way that takes account of the complexity and heterogeneity of the interventions, and the many dimensions (e.g. individual, organisational, sociocultural) of the problem. Objectives Our aim was to improve understanding of how, why and in what contexts mental health services and support interventions can be designed to minimise the incidence of doctors’ mental ill-health. The objectives were to review interventions to tackle doctors’ mental ill-health and its impact on the clinical workforce and patient care, drawing on diverse literature sources and engaging iteratively with diverse stakeholder perspectives to produce actionable theory; and recommendations that support the tailoring, implementation, monitoring and evaluation of contextually sensitive strategies to tackle mental ill-health and its impacts. Design Realist literature review consistent with the Realist And Meta-narrative Evidence Syntheses: Evolving Standards quality and reporting standards. Data sources Bibliographic database searches were developed and conducted using MEDLINE (1946 to November week 4 2017), MEDLINE In-Process and Other Non-indexed Citations (1946 to 6 December 2017) and PsycINFO (1806 to November week 2 2017) (all via Ovid) and Applied Social Sciences Index and Abstracts (1987 to 6 December 2017) (via ProQuest) on 6 December 2017. Further UK-based studies were identified by forwards and author citation searches, manual backwards citation searching and hand-searching relevant journal websites. Review methods We included all studies that focused on mental ill-health; all study designs; all health-care settings; all studies that included medical doctors/medical students; descriptions of interventions or resources that focus on improving mental ill-health and minimising its impacts; all mental health outcome measures, including absenteeism (doctors taking short-/long-term sick leave); presenteeism (doctors working despite being unwell); and workforce retention (doctors leaving the profession temporarily/permanently). Data were extracted from included articles and the data set was subjected to realist analysis to identify context–mechanism–outcome configurations. Results A total of 179 out of 3069 records were included. Most were from the USA (45%) and had been published since 2009 (74%). More included articles focused on structural-level interventions (33%) than individual-level interventions (21%), but most articles (46%) considered both levels. Most interventions focused on prevention, rather than treatment/screening, and most studies referred to doctors/physicians in general, rather than to specific specialties or career stages. Nineteen per cent of the included sources provided cost information and none reported a health economic analysis. The 19 context–mechanism–outcome configurations demonstrated that doctors were more likely to experience mental ill-health when they felt isolated or unable to do their job, and when they feared repercussions of help-seeking. Healthy staff were necessary for excellent patient care. Interventions emphasising relationships and belonging were more likely to promote well-being. Interventions creating a people-focused working culture, balancing positive/negative performance and acknowledging positive/negative aspects of a medical career helped doctors to thrive. The way that interventions were implemented seemed critically important. Doctors needed to have confidence in an intervention for the intervention to be effective. Limitations Variable quality of included literature; limited UK-based studies. Future work Use this evidence synthesis to refine, implement and evaluate interventions. Study registration This study is registered as PROSPERO CRD42017069870. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 19. See the NIHR Journals Library website for further project information.

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Section: Discussionmentioning

confidence: 99%

Interventions to minimise doctors’ mental ill-health and its impacts on the workforce and patient care: the Care Under Pressure realist review

Carrieri

Pearson

Mattick

et al. 2020

Health Serv Deliv Res

View full text Add to dashboard Cite

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“…Exemplar quotations are provided along with year the participant started their F3 and participant identifier. [1][2][3][4][5]…”

Section: Data Interpretationmentioning

confidence: 99%

“…There is limited qualitative research relating to reasons why UK junior doctors take time out of training. Lambert et al 4 conducted a cross-sectional questionnaire survey, aimed at establishing why doctors consider working abroad. The sampling frame was all UK doctors who graduated in 2008 and in 2012, with 5291 respondents.…”

Section: Introductionmentioning

confidence: 99%

Why are UK junior doctors taking time out of training and what are their experiences? A qualitative study

et al. 2019

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Objectives: The number of doctors directly entering UK specialty training after their foundation year 2 (F2) has steadily declined from 83% in 2010 to 42.6% in 2017. The year following F2, outside the UK training pathway, is informally termed an 'F3' year. There is a paucity of qualitative research exploring why increasingly doctors are taking F3s. The aim of this study is to explore the reasons why F2 doctors are choosing to take a year out of training and the impact upon future career choices. Design: This is an exploratory qualitative study, using indepth interviews and content analysis. Setting: UK. Participants: Fourteen participants were interviewed from one foundation school. Participants included five doctors who commenced their F3 in 2015, five who started in 2016 and finally four recently starting this in 2017. Main outcome measures: Content analysis was conducted to distill the themes which exemplified the totality of the experience of the three groups. Results: There were four predominant themes arising within the data set which can be framed as 'unmet needs' arising within foundation years, sought to be fulfilled by the F3 year. First, doctors describe exhaustion and stress resulting in a need for a 'break'. Second, doctors required more time to make decisions surrounding specialty applications and prepare competitive portfolios. Third, participants felt a loss of control which was (partially) regained during their F3s. The final theme was the impact of taking time out upon return to training (for those participants who had completed their F3 year). When doctors returned to NHS posts they brought valuable experience. Conclusions:This study provides evidence to support the important ongoing initiatives from Health Education England and other postgraduate bodies, exploring approaches to further engage, retain and support the junior doctor workforce.

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“…A recent systematic review of studies of motivations for early retirement suggested that high workload and burnout can lead to doctors' earlier retirement. 7 Given recent uncertainty around NHS contracts, 8,9 and the UK's impending exit from the EU, 10 it is timely to update knowledge in this area with regard to UK-trained doctors.…”

Section: Introductionmentioning

confidence: 99%

The characteristics and views of early retirees compared with doctors still in work: views of the UK medical graduates of 1983 surveyed in 2016

Smith

Lambert

Goldacre

2018

Future Healthcare Journal

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Questionnaires were used to compare the characteristics and views of early retirees with those of doctors who were still working. Of doctors aged under 60 years, 88% were still working in medicine, 5% were fully retired and 7% were 'returners' (had retired and returned to do work). More women (8%) than men (4%) were fully retired. More GPs (13%) than hospital doctors (8%) had retired: male hospital doctors had a low retirement rate of 5.3%. More working doctors (28%) than fully retired doctors (20%) agreed that there were good prospects for improvement of the NHS in their specialty. More fully retired doctors (67%) and returners (67%) than working doctors (55%) referred to adverse health effects of working as a doctor. Early retirement decisions were motivated by the doctors' views of what is happening in their own specialty and by adverse health effects that they attributed to their work.

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Why doctors consider leaving UK medicine: qualitative analysis of comments from questionnaire surveys three years after graduation

Abstract: Objective: To report the reasons why doctors are considering leaving medicine or the UK.

Cited by 45 publications

References 9 publications

Interventions to minimise doctors’ mental ill-health and its impacts on the workforce and patient care: the Care Under Pressure realist review

Interventions to minimise doctors’ mental ill-health and its impacts on the workforce and patient care: the Care Under Pressure realist review

Why are UK junior doctors taking time out of training and what are their experiences? A qualitative study

The characteristics and views of early retirees compared with doctors still in work: views of the UK medical graduates of 1983 surveyed in 2016

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Why doctors consider leaving UK medicine: qualitative analysis of comments from questionnaire surveys three years after graduation

Abstract: Objective: To report the reasons why doctors are considering leaving medicine or the UK.

Cited by 45 publications

References 9 publications

Interventions to minimise doctors’ mental ill-health and its impacts on the workforce and patient care: the Care Under Pressure realist review

Interventions to minimise doctors’ mental ill-health and its impacts on the workforce and patient care: the Care Under Pressure realist review

Why are UK junior doctors taking time out of training and what are their experiences? A qualitative study

The characteristics and views of early retirees compared with doctors still in work: views of the UK ­medical graduates of 1983 surveyed in 2016

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The characteristics and views of early retirees compared with doctors still in work: views of the UK medical graduates of 1983 surveyed in 2016