How to retain junior doctors in the NHS? Make it pay to stay
MY FRIEND is everything you’d want in a doctor. He’s kind, caring and very knowledgeable. He won awards as a student and came top in many exams. He’s the kind of doctor I’d want to treat me.
Unfortunately he’ll never help a single patient. Why? He’s just quit training as a surgeon to become a banker. I’m distraught that the profession has lost him, but sadly this is becoming more and more common.
Of course, when I was at medical school people dropped out or left because they failed their exams. But the idea that you would get a degree in medicine with no intention of being a doctor was unheard of. This, however, is becoming a real problem.
Last year I gave a talk at a medical school and afterwards, some of the staff and students took me for dinner — halfway through the meal the admissions tutor told me that about 10 per cent of their students didn’t go on to work as a doctor. Instead, they left the profession after graduation.
I stared at him in disbelief (this was before my friend dropped out). ‘What do they do instead?’ I asked. ‘Oh, mainly banking, management consultancy or start-ups. The usual’.
Andincreasing numbers of doctors are also eschewing the NHS for work abroad — there is a massive brain drain — or to work as a locum, for which the pay and conditions are so much better.
This year, only half of junior doctors completing their first two years went on to train in a speciality in the NHS.
We are haemorrhaging doctors. So this week Health Secretary Jeremy Hunt announced his proposals to tackle this. doctors will be required to work for a minimum of five years in the NHS or they will have to pay back a proportion of the £230,000 that it is claimed it costs the taxpayer to train them.
I feel very torn by this. It seems to me perfectly reasonable that doctors should be value for money. In the armed forces, people have to work for a minimum period.
But is the best way to tackle the retention crisis to effectively hold the junior medical workforce as hostages for five years? Besides, City firms will think nothing of paying off the remaining fees owed if they really want someone.
Surely a better way is to address why doctors are leaving the profession in the first place. There is a lot of talk about conditions in the NHS, and while these play a role, I think a large part of the crisis has been an unintended consequence of the introduction of tuition fees.
When I was at medical school, there were no fees and, because my family were poor, I got a full grant of £5,000 a year. I was incredibly grateful: without it, I wouldn’t have gone to university, let alone done a six-year medical degree.
But fees have turned this degree from a vocation into a commodity. Regardless of the fact that the taxpayer still subsidises the actual cost, students now think that as they’re landed with about £80,000 of debt, why shouldn’t they take lucrative offers?
When I was a junior there was free hospital accommodation for your first year. There was a doctors’ mess with hot drinks and newspapers and rooms to sleep in when on call. There were even budgets for training courses.
This helped to forge a strong sense of vocation. We felt indebted to society and the NHS.
Yet over the past few years, all of this has been gradually taken away. It’s contributed to a feeling of disenchantment among juniors, made all the worse by the new contract imposed last year.
I fear the same will happen with nurses. The government has now scrapped bursaries and introduced fees, so they will accrue significant debt — a disaster for the nursing profession.
THesolution is to acknowledge the vital jobs that nurses and doctors do. I think there should also be increased bursaries available to help medics with their degrees — perhaps with part of their debt from loans written off if they complete a minimum period in the NHS. As for nurses, who have lower earning potential, tuition fees must be scrapped and the bursary reinstated.
It’s not that a sense of vocation comes only if you’re subsidised, but if we expect people to feel obligated to the NHS, we have to demonstrate that society will invest in them. Otherwise medical degrees will become like any other: a commodity to trade.