The drop-out club for doctors: Why medics are leaving the NHS

Carol Midgley  reports June 2nd in The Times: The drop-out club for doctors: Why medics are leaving the NHS

In a recent previous report NHSreality comments: Keep on waiting – The money is running out and denial continues from all media and politicians. The solution is to focus the minds of the students on their lives, and their debt, (Medical Student debt – time for government to change policy on doctor recruitment) and also to aim at deliberate overcapacity! Undergraduates give much less value to the Regional Health Services than Graduates, and the sexes perform much more equally when students are more mature. Although it is often an advantage for a doctor to travel abroad, it seems to have become almost a right of passage, and then there is the risk of falling in love, emigrating, or dropping out entirely if not committed to the profession.

In addition there is a bullying culture in the NHS, (Kathryn Hopkins in The Times April 2nd 2014: Half of women bullied in the workplace) and with 80% of undergraduate entry (the dominant form) being women, it is not surprising that many of them revolt.  

Doctors will try to get posts in popular areas with good schooling and fewer social problems. Therefore, in order to attract them to relatively deprived, less popular areas, Regional decisions will need to be taken on housing and schooling subsidies unless there is sufficient overcapacity. With internet on line learning and using GP Training Practices we could bring on far more doctors. Indeed, we could adopt a policy that if a student was capable they should not be denied the opportunity, rather than a competitive entry between many all of whom are capable, and which leave most disappointed. (Safety fears over doctors who trained outside EU – open up more medical student and GP training posts urgently )

One left medicine to open a hair salon, another to design cars. Online clubs are helping growing numbers of physicians leave the profession

Evgenia Galinskaya remembers her “epiphany”, the realisation that she could no longer continue being a doctor. It was 8pm on a Friday last year and she had stayed behind after a clinic to complete some paperwork. Through the glass door of the registrar’s office she saw a senior colleague, still in her theatre scrubs, sitting cross-legged on a chair surrounded by patients’ notes. On the phone the colleague was telling her partner she’d try to come home soon.

In that moment all of Galinskaya’s frustrations about her medical career came to a head: things were not going to get any better. So the Cambridge-educated dermatologist who had yearned to be a medic from childhood decided to quit, joining a growing band of young doctors who despite years of study, sweat and sacrifice are walking away from medicine to pursue totally different careers.

A 2010 study found that nearly a quarter of junior doctors in England drop out of their NHS training after two years. Now many doctors from much more senior ranks seem to be joining them at the exit. Online forums and websites such as mywhitecoatisonfire.com and womenleavingmedicine.com suggest a growing dissatisfaction with the profession that is not owing simply to burnout. Former doctors I have spoken to express frustration that the job has become so protocol-driven there is little room for intellect or initiative.

“This is a profession that demands the brightest, most creative, most passionate people at entry level, then once you are there it systematically drills that out of you,” is how many describe it. Where medicine used to be a job for life in which doctors were almost pedestallised, now some say that, while they remain huge supporters of the NHS they feel unappreciated and disempowered, much of the job has been reduced to box-ticking.

It is not just a UK problem. In America, where a 2012 study found that nine in ten doctors wouldn’t recommend their job as a career, physician MBA programmes that guide doctors into management are flourishing. The Drop-Out-Club, a website that helps doctors into jobs at hedge fund and venture capital companies, has an ever stronger following. When Galinskaya attended a BMJ careers fair she noticed there was a seminar entitled: “What if it’s Not For You? Ten Principles of Career Change.” It was sold out. “Doctors pride themselves on making a meaningful contribution to society,” says Galinskaya, “but I think they no longer feel they’re making as much difference as they used to. It’s the managers now who run the show.”

Roger Tackley, a former consultant anaesthetist, certainly made a radical career change. He retrained as a hair stylist and now runs his own salon, RT Hair and Beauty, in Paignton, Devon. It was not that he ever “hated” his job, he says, but over the years became frustrated that he could use his own clinical judgment less and less.

“Instead of a consultant being someone whose views people respected, gradually it became more and more that you did what the guidelines told you to,” he says. “When you’re following guidelines you’re not allowed to be creative in any way, which when I first started as an anaesthetist you were. It means the job becomes a bit more like being a technician.”

Tackley qualified as a doctor in 1977, became a consultant anaesthetist in 1988 and then left medicine completely in 2007. He noticed an increasing pressure on doctors to do things that took them away from treating patients, “such as health and safety lectures [eg, manual handling], which I found as a consultant to be a little bit patronising”.

Tackley was also involved in a nationwide project to computerise hospitals, which floundered. “ I passionately believe the NHS can save billions through effective IT systems. I spent 15 years on various IT committees around the country and the world but it never came to fruition, largely, I believe, because clinicians’ comments were never taken seriously.” Many were surprised when he announced he was going into hairdressing, a job that he says allows him to be “more of an individual”. “I love the job. I get lots of thanks for it, which as an anaesthetist you don’t always do. It was something I’d always had an interest in.”

Farhana Safa made an equally dramatic transition. Until recently she was a surgeon at Moorfields Eye Hospital in east London. Now she is training at the Royal College of Art to design high-performance cars and other vehicles. She has always enjoyed art but plumped for medicine and found herself swept along in the medical “rat race”, a momentum of exams and high-achieving. Safa makes the pertinent point that when teenagers sign up for medicine they are too young to know if this is what they want for ever.

“You probably make the decision to commit to going to medical school when you’re about 13 or 14, gearing up with GCSEs, taking the right A levels,” she says, “before you know who you are.” She had picked eye surgery, notoriously hard to get into, because it was delicate, intricate and she was good with her hands. In the year she applied there were 23 jobs and 900 applicants. For a while she loved it. “I won’t lie, it was incredible,” she says, “but after about three years it hit me . . . where’s the creativity? I loved the patients, loved doing surgery, but often I felt I was almost pretending to be someone I wasn’t.”

One reason why doctors feel more straitjacketed now is a greater emphasis on evidence-based medicine, each step backed up by a plethora of journals. The idea, perhaps owing to an increasingly litigious culture, is to make fewer mistakes, which of course patients and doctors agree is desirable. “It’s obviously not necessarily a bad thing,” says Safa. “It’s just the feeling itself that the job is less experimental. Back in the day surgeons had a lot of autonomy [to do what] they thought was the right thing to do. Now it’s all research-based.

“The only bit I found gratifying was surgery because I was using my hands. I remember being on call once on my way into work; my mind was boggling with ideas of things I’d seen in a museum and elsewhere and I remember walking into hospital and thinking: ‘Right, switch your brain off now’.”

There was a time when just getting straight As was enough, but now a candidate’s CV must be ultra-sparkling. “They are taking on incredibly well-rounded people, types who are grade 8 piano by age 13,” she says. “You get somebody who’s got that many skills and talent then you stamp it out of them. You work so hard you give up every hobby you ever had.”

Eventually Safa took a year’s sabbatical and after taking various courses realised her heart lay in car design. It has been the toughest seven months of her life, starting from scratch, but already she has been chosen as a finalist for this year’s Salon Privé contest. “I do worry about what I’ve done — I’ve given up a very good job, good money, stability — but I know when I’m doing medicine that it doesn’t feel right for me.”

Having left medicine Evgenia Galinskaya works as a “talent transition specialist”, helping medical professionals navigate career changes. She is in the process of setting up a website, otheroptionsfordoctors.com. “I don’t want people to see my role as creating a brain drain from the NHS because that’s not true at all. Often it is only small adjustments that are needed to help doctors to stay in their current roles.”

Though Galinskaya loved working with patients, time constraints meant that she increasingly felt she was on a production line. Her appointment times were limited to ten minutes per patient. “Patients value time,” she says. “I wanted to give proper care and time to each one. “What was so frustrating was that conditions such as psoriasis, for example, are exacerbated by stress and if I could talk to patients about what is causing the stress that in itself could be a therapy that might save many other appointments in the future. Instead I felt like I was a robot just dispensing creams and other medications on a conveyor belt.”

Always a straight-A student, Galinskaya says, “It wasn’t until I hit 30 that I realised actually I had this amazing CV full of prizes and awards, as lots of doctors have, but I was still coming back to an empty flat with an empty soul. I had no one with whom to share my achievements because I had no time for relationships.” In her new job as a career consultant she believes there are seven important “pillars” to people’s work fulfilment: recognition, empowerment, wellbeing, passion, lifestyle, belonging and opportunity for growth. Her work with disenchanted doctors has revealed that lack of recognition, empowerment and wellbeing/lifestyle come up most regularly (doctors are known to be at a high statistical risk of suicide).

Some GPs may hit the headlines for earning more than £200,000 a year, but junior hospital doctors make a fraction of that. Money is not generally a main driver, says Galinskaya, which is why “doctor-bashing” upsets her. “When I left I was a registrar in dermatology and my basic salary was £35,952 — that’s after five years of working in the NHS.”

Doctors work long hours often to the detriment of their own health. “It sounds pathetic but if you’re on call in general medicine you could go for ten hours without a meal or loo break. When I worked in A&E [I saw] a doctor come into work with a temperature of 40 degrees and pneumonia. She still worked through her shift. There is a very strong work ethic.”

Doctors plan their whole life around the rota, often missing significant social events. Galinskaya is getting married in July yet her best friend, a doctor, is rostered to work that weekend. “For the past two months she’s being trying to swap that shift with somebody and she can’t.”

Matt Jameson Evans, a former orthopaedic surgeon who left medicine at registrar level and co-founded Health Unlocked, a health information social network that allows patients to connect with clinicians and each other, believes the breakdown of the team apprenticeship model is a major reason for doctors’ disillusionment. The European Working Time Directive changed the shift patterns of junior doctors so they no longer feel under the regular guidance of a senior consultant.

Jameson Evans, a fourth-generation surgeon, was still in practice when he founded Remedy UK, a pressure group representing junior doctors that campaigned against government-led training reforms. He says when he started in medicine practically every doctor operated in teams — “almost like a barristers’ chambers” — but now they are more “lone operators” in a hospital. “It’s a fragmented relationship,” he says. “There’s no natural pastoral bond any more.”

Is it NHS users’ fault? Has the compensation culture and our increasing intolerance of human error created a jobsworths’ climate in the NHS? Evans doesn’t think so. “I think the people most responsible are the leaders of the medical profession. It’s their duty to explain the value of individualism in partnership with protocol. You have to safeguard the opportunity for the brightest and the best minds to be able to express themselves. In my generation, I believe some of the brightest and most creative people left for that reason. When you look at the history of medicine I think that’s a really important segment of people that we are losing.”

Health Unlocked already has three million visitors a month and is about to launch in America. Still, it must be hard to leave medicine, after all the study, the status. “I liken it to leaving the priesthood,” he says. “I think people still see it as a calling, one of the last truly vocational careers.”

As Galinskaya says, none of this is about knocking the healthcare system. “I think the NHS is wonderful for the patient. However, more doctors would experience fulfilment if the system celebrated their contribution and allowed for greater flexibility.” If the NHS is to hold on to its brightest and best, surely it’s a conversation we need to have.