Why NHS Doctors Are Searching For Non Clinical Careers (2019)

Why are NHS doctors searching for non-clinical careers? If you are a doctor who is considering a non-clinical career, and especially if you’ve ever dared to stick your head up above the parapet and confess your thought-crime to a colleague (or even a family member), you will undoubtedly have heard the inevitable knee-jerk response:- "Give up? After all that training? What a shame!! Why would you do that?" Sound familiar?

I would vouch that all doctors that have even considered stepping off the clinical career treadmill have heard something along these lines. Maybe you are even asking yourself this question.

Although this response often demonstrates a simple lack of understanding of a doctor’s real situation, along with a healthy dose of clinical medicine idealisation, there is an interesting question in there somewhere: just why are so many doctors considering a different career?

Afterall, medicine is one of the best paid professions around with – despite arguments to the contrary – excellent job security, prestige, stimulation, rewards, and a real voice in crafting policy and spending decisions.

The 2018 NHS Foundation Programme F2 Careers Destinations Report states that a staggering 43% of doctors in the UK do not go onto higher training after Foundation Year 2.

Even if 15% or so of these leavers go on to pursue a clinical career in the antipodes, as some figures suggest, that still leaves a considerable percentage of clinical doctors hanging up their stethoscopes for good. What drives doctors to do this?

In my view, the following factors contribute to this exodus:-

• Hours and conditions
• Benefits
• Boredom (read: a desire for change)
• Disillusionment
• NHS Management

As a doctor that has left clinical practice myself, I remain deeply concerned about the apparent clinical exodus, especially amongst junior doctors who haven’t been practising long enough for long-held grudges to become manifest.

Something more fundamental is going on. I should say that this article is intended more as a discussion medium than as a rant. Maybe you strongly agree or disagree – if so, please get in touch and let us know.

Hours & conditions

Let’s be honest – working in clinical medicine is tough. Nearly all roles involve substantial commitments out of hours with inevitable consequences for private and family life.

Even during normal hours the intensity of clinical work is increasing all the time, with supposed winter pressures now becoming almost a year-round phenomenon.

Many medics appear to be forced into an almost "trench warfare" mentality, talking about whether they can "hack it" or are "tough enough". It’s perhaps only a minority who ask themselves seriously whether it is correct to feel like a job must be endured rather than enjoyed.

Benefits

When I used to speak with professionals from other sectors, it always struck me that they regarded benefits like an annual bonus, a car allowance and private health insurance almost as the norm.

As doctors, we seem to be one of very few professional groups who do not routinely have access to such perks. I think I can remember a discount at the cinema with my NHS card, but beyond that I can’t recall many financial incentives to working in healthcare.

Is the reward of the job enough in its own right? Maybe for many. But a clear comparison with other professional groups leaves the remunerative rewards of working in healthcare looking somewhat sparse, especially given the level of commitment required by the job.

Boredom

Humans thrive on change. As a species we have evolved to meet new challenges and overcome new obstacles. And yet, medicine increasingly calls for super-specialisation with doctors having a more in-depth knowledge in a small area, at the expense of a broader portfolio.

While undoubtedly producing more consistent results, this super-specialisation unavoidably leads to over-exposure to the same conditions and procedures day after day. In my view, a degree of boredom is almost inevitable.

Disillusionment

Many doctors enter medical school as the pride of their school. The prestige associated with medical school entry is easy to get carried away with, and young impressionable people being hailed as the intellectual elite is almost certain to produce a degree of rose-tinting in the early years.

And yet, for many doctors, this initial positive outlook may begin to clash quite sharply with the reality of healthcare provision. Is it therefore unsurprising to meet doctors who are disillusioned with their career choice?

Managment

Doctors are highly trained, highly intelligent professionals. We thrive on autonomy; on applying our knowledge to solve complex clinical problems and improve the lives of others.

Add into this mix a rigid management framework focused on saving money and driving "efficiency", and a degree of conflict is inevitable.

To further this sense of frustration, in many cases the power for decision making has increasingly moved away from doctors and towards management. It’s very difficult for many doctors to find the time around direct clinical care to address this imbalance. Instead, a "them and us" mentality may begin to prevail.

Tell Us What You Think

What do you think is behind the apparent exodus from clinical practice? Many doctors find enough enjoyment in their work to outweigh these frustrations; and of course, many doctors may not find these to be frustrations at all.

But the statistics show that something is driving many doctors away from the wards. If you are a doctor who is searching for other careers beyond clinical practice my message is this: you are not alone, and there is nothing wrong with looking for other careers.

The NHS will be just fine without you. Look after yourself – you have worked hard enough to deserve what you really want.