A record number of young medics including Asians are now quitting the profession or moving to work private after long hours, high work pressure and lack of appreciation (from patients) in the NHS- which is driving them to a breaking point. The NHS currently appoints 1.2mn people, becoming the country's largest employer and ranks number five globally. According to statistics published by The Daily Telegraph, there are around 440,000 medical professionals, with 140,000 doctors, 300,000 nurses and midwives. Yet there are 50,000 vacancies across all types of clinical staff found by the National Audit Office in 2014. 43% of junior doctors have stuck to their NHS profession in comparison to 71% in 2011. More and more young doctors are opting to take a break, work abroad or leave the profession entirely, to combat rising toll of mental illness, many suffering from mental health condition.
Dr Diana Suja Madanraj left for New Zealand, 9 months after becoming a GP after years of rigorous training in the UK. Speaking to Asian Voice, she said, “I always wanted to work abroad for the experience but partly also because of the NHS situation- the way doctors are getting affected by long hours and stress. Spending cuts have made it so hard, and it became so stressful, I could not work more than 3 days in a week, but I am not a pro-privatisation person. However I generally feel London patients are much more unappreciative. Especially the younger patients. Moreover with the large number of immigrants from EU and non-EU countries, many don't get how actually NHS works. The ignorance or their inability to adapt to the system makes it harder for us.”
Though Diana has returned to working in the NHS, and stuck to medicine even after working abroad, many decide otherwise. Some feel working abroad especially in developing countries could be harder, more challenging, sometimes even resources are minimum. But they have somehow felt happier, and have quit medicine entirely after coming back to the UK.
Careers advice
Dr Abeyna Jones, founder of Medic Footprints, a careers advice for junior doctors reportedly said that many are looking to leave the profession as more and more people have become demoralised. Jones founded this enterprise after four years of battling the situation in South East. She told The Daily Telegraph how understaffing at hospital wards made the doctor fatigue situation extremely vicous. She gave an example of how she has heard of doctors who come to work with appendicitis, finish their shift and then checked into A&E. Medic Footprints connects young doctors with top private sector employers such as Deloitte, Babylon, Virgin. It has advised 11,000 doctors since 2014.
Asian doctors also fear to be additionally blamed for unavoidable mistakes, so some have also gone and done medical negligence degree in law, to ensure they don't get victimised for something completely out of their hands.
Karan Mathoor* told Asian Voice, though a medical degree would cost on average £220,000 of tax payer's money, but Asian families don't always adapt well to the delay in success in medical careers.
“In our culture there is always a rush to get a house, get married, have children, move jobs, earn better and better with years. And medical career in current situation delays this by many years. That does not get appreciated at all by our families. So the pressure is immense from both ends, and we burn out both ways.
Speaking about his own experience, “I struggled to finish my degree as it became harder to work as a junior doctor. Burn outs is not only common, you are practically driven to the brink of mental break down with the lack of sleep and work stress. But then you don't want to go and report it to your senior, in fear of being referred to the General Medical Council (GMC).”
Burn out
Dr Jahangir Alom, who grew up in Tower Hamlets and eventually wants to return there and serve the local population is now a junior doctor in East Midlands. He told the newsweekly how he has witnessed his colleagues suffering, amidst pressure to specialise and progress as doctors. “Burn out is very common amongst junior doctors. In my short time as a doctor I have noticed many of my colleagues burn out', he said. “In fact I approached one of my seniors a few months ago and told her I think she’s burnt out. She would not accept my statement. I described some of the features of burn out (tiredness, lack of enthusiasm, poor communication, low mood) and told her she should have some time off.
“Given the nature of our careers and the competitiveness of the progression, doctors are substituting their days off for courses and conferences to boost their chances of getting into a speciality training programme. We of course have a separate study leave for this, but I find that doctors I’ve worked with take more study leave than annual leave.”
While organisations such as BMA, BAPIO, BIDA & DAUK are running campaigns to support the mental health of doctors, stress is not the only issue that affects these junior doctors. International medical graduates additionally suffer from loneliness for being entirely alienated in remote locations, without any support.
Dr Alom added, “One major mental health issue I find amongst junior doctors, especially international medical graduates, is loneliness. Doctors are spread out across the country and sometimes have to choose between location over specialty training. The training of a doctor is intense and moving to somewhere on your own means you’re without support which can be very detrimental to your health.”
Dr Dev Chauhan, Chair of the Indo-UK Healthcare Policy Forum in BAPIO (British Association of Physicians of Indian Origin), told Asian Voice, “Junior doctor morale is at an all time low, driven by the imposition of the new context in 2016. The number of suicide amongst doctors and number of sickness absenteeism have all increased. This is a vicious cycle which compounds and has a negative impact on the workforce. We have a profound problem of doctors not applying for speciality training and also dropping out of training. The Health Education England need to address the problem of junior doctor morale. GMC have acknowledged this as a problem and are investigating.”
GP pressures
BMA has also warned that a survey from the Royal College of GPs found the extent of pressures on these doctors are ‘alarming’. Responding to the survey, BMA GP committee chair, Dr Richard Vautrey, said: “These findings are alarming and will cause a great deal of worry for patients who would be forced to find a new practice. While GPs strive to provide high quality care to all of their patients, statistics such as this speak volumes to the huge amount of pressure they are under; rising demand from a growing population with increasingly complex conditions means that workload is nearing insurmountable levels.
“Given the stress this causes and impact that it has on doctors’ wellbeing, it is unsurprising that many are questioning their own futures and the future of their practices.
“For the last 70 years general practice has been the foundation on which the NHS is built, but without proper support, investment and a plan to tackle the current retention crisis, it is in serious risks of crumbling. The BMA is therefore urging the government, using its long-term plan, to drastically increase the share of the NHS budget that general practice receives to guarantee its ability to continue to provide high-quality, person-based care from within the community for years to come.”
State of Medical Education and Practice
Responding to the General Medical Council report ‘State of Medical Education and Practice 2018’, which raised the current concerns about the workforce crisis, Dr Chaand Nagpaul, BMA council chair, said, “This report echoes our continued warnings on the scale of the workforce crisis facing the NHS, and should serve as a wake-up call to the Government, policymakers and health bosses as to what we can expect from the future.
“The GMC’s findings that large groups of doctors want to reduce their hours, or are considering leaving clinical practice altogether, due to the often unbearable pressures they face on a daily basis, reflects what we hear from our own members – the doctors doing their best to provide high quality care to patients in GP practices, hospitals and in the wider NHS across the four nations all year round.
“Demand for the NHS is rocketing, and patients are often suffering from a number of complex conditions, which is having a huge effect on doctors’ workloads. Indeed, as this report finds, the majority are now working beyond their rostered hours at least once a week – a situation that is completely unsustainable.
“That doctors say they are having to refer unnecessarily or bypass clinical protocols in order to prioritise only the most urgent cases, makes for concerning reading and exposes the desperate situation many medics are findings themselves in.
“More than 90 per cent of doctors we asked earlier this year said that system pressures prevent the delivery of safe patient care, and this intervention from the GMC, whose responsibility it is to guarantee patient safety, is welcome.
“Of course, in just under four months’ time there is a great spectre on the horizon. We have been clear of the devastating impact Brexit is likely to have on our health service, and not least on its workforce. In a recent BMA survey we found that a third of EEA doctors working in the UK are considering leaving, and that more than three-quarters had no faith in the PM’s pledge to protect their rights going forward. This has significant implications for the sustainability of our medical workforce in the future.
“It is positive to see the GMC recognising the pressures doctors are under, noting that the profession is on the brink of ‘breaking point’, and laying out ways to begin addressing this. There must be a UK-wide approach to tackling the workforce crisis and the underlying system pressures that are compounding the retention of highly-skilled doctors.
“In the coming weeks the Government is set to announce its long-term plan, and while £20bn a year is likely to fall short of what the NHS really needs, it is imperative that any new funding is invested in such a way that makes a real difference on the frontline. It is vital that the government provides the resources, workforce and facilities to enable doctors to fulfil their professional duty to provide safe, quality care to patients.”
Brexit
With Brexit approaching, the already decaying work force of NHS is meant to suffer further. According to a research by the parliament, while the majority of NHS staff in England are British – but a substantial minority are not. Around 144,000 out of 1.2 million staff report a non-British nationality. This is 12.7% of all staff for whom a nationality is known, or one in every eight. Between them, these staff hold 200 different non-British nationalities. Around 63,000 are nationals of other EU countries - 5.6% of NHS staff in England. Around 49,000 staff are Asian nationals, with 19,000 Indians.
Nationals of other EU countries make up 9.7% of doctors in England's hospital and community health services. They also make up 6.8% of all nurses and 5.6% of scientific, therapeutic and technical staff. The percentage of doctors and nurses with EU nationality grew between 2009 and 2016. Since 2016, the percentage of EU nurses has fallen. 37% of hospital doctors gained their primary medical qualification outside the UK. 20% qualified in Asia and 9% qualified in the EU. For GPs, 4% qualified in the EU and 13% qualified in Asia.
In 2015/16, 11% of those joining the NHS were EU nationals. In 2016/17, this fell to 9%, and in 2017/18 the figure was 7.9%. For nurses the percentage of EU joiners fell from 19% in 2015/16 to 12.4% in 2016/17, then further to 7.9% in 2017/18. In 2017/18, 13% of nurses leaving the NHS were EU nationals, up from 9% in 2015/16.
Chauhan added, “Brexit may have an adverse impact on workforce compounding this. The workforce needs to be addressed, and NHS needs to hire more. The number of Medical Training Initiative places needs to be increased urgently as a short term measure. The proposed new medical schools when opened will help in the long term. Regulation of physician assistants will help support doctors. We need to look at scaling up the number of medical associate professionals in supporting doctors.”
(*name changed on request)
