GP training: How can the NHS retain doctors at the start of their careers?

Reflecting on her own experiences, Dr Patrice Baptiste looks at how medical training could change to help the NHS retain doctors.

Being a doctor is tough. Whatever the specialty there is a significant level of sacrifice, be it personal, financial or otherwise. However, medicine can be the most rewarding and intellectually stimulating job.

So why did the most recent report from the UK Foundation Programme Office show that only 50.4% of doctors completing the foundation programme carry on with specialty training?[1] This figure is a drop from 52% in 2015, 58.5% in 2014, 64.4% in 2013, 67% in 2012 and 71.3% in 2011.

Why are we having problems retaining doctors?

When I decided to take a year out of training after completing the foundation programme I felt disillusioned with medicine; I was ‘burnt out’. There were a number of reasons why I was frustrated and considered leaving.

I did not feel appreciated or part of a team
When I started my first post I was filled with enthusiasm. However, I soon became unhappy. I did not feel I was part of a team, working for the greater good of my patients.

I felt like a workhorse being used to do laborious, albeit necessary, jobs. I understood that as the most junior of the ‘team’ I would have to ‘work from the bottom up’, but I was unprepared for how this would grind away at my enthusiasm for medicine.

If I was unwell, I was afraid to take any time off – I would come in and colleagues did the same. If I did take time off, I was made to feel guilty both while I was away and on my return.

I did not choose medicine to receive gratitude, but when you are working beyond your contracted hours time and again it would be nice if you were told thank you by senior colleagues.

I wasn’t learning as much as I thought I would
On entering foundation training I felt I quickly began to lose the knowledge I had acquired during medical school. I did consolidate some knowledge and I learnt how to manage a ward and acutely unwell patients, but there was a whole host of things I forgot.

I did not have the time or motivation to read about interesting patients I saw or topics I wanted to learn about. I had ‘protected teaching’ during my training, but how could I concentrate or even have the chance to attend when I knew I had a plethora of jobs to compete on the ward?

My mental and physical health suffered
The amount of annual and study leave varies depending on rotation, specialty and grade but I believe that if junior doctors were able to have more time away from medicine to enjoy personal lives and creative pursuits more doctors would stay in the NHS.

There are opportunities to take time out of training but some do not want to take months or years away, so why can’t we have more flexible time within training pathways?

Working full-time as a doctor can take a toll on health. Taking a year out was the best decision I made because I was able to think about what I wanted long-term.

I am aware that future rotations may leave me feeling drained, but I now feel certain that I want to continue working as a doctor and am therefore prepared for some personal sacrifice to succeed.

Cultural issues and attitudes
Within medicine there are deep-rooted beliefs about the change to shift patterns and junior doctors’ workloads. Some senior colleagues believe junior doctors today have it easier because we work less hours than they did.

However, we still work very long hours and the work is intense. There have been significant changes politically, culturally and socially and some would argue the junior doctor role is even harder today. We need more support from our seniors, and a change of attitudes would be a start.

We also need more general support. Support services need to be more widely advertised and doctors encouraged by colleagues, family and friends to speak about their difficulties and seek help.

Our shift patterns are not normal. Normalising, a twelve-day stint, or working sixty-plus hours a week is wrong and if someone is struggling they should be supported, not stigmatised or frowned upon.

I truly believe that if we as health professionals can have more compassion and understanding for each other and work as teams more doctors will continue to work within the NHS.

  • Dr Baptiste is a ST1 GP trainee in Romford, Essex

Reference
1. The Foundation Programme Career Destination Report 2016. December 2016.

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