Why doctors consider leaving UK medicine: qualitative analysis of comments from questionnaire surveys three years after graduation
Why doctors consider leaving UK medicine: qualitative analysis of comments from questionnaire surveys three years after graduation
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DOI：
10.1177/0141076817738502
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发表时间：
2018-01-01
影响因子：
17.3
通讯作者：
Goldacre, Michael J.
中科院分区：
文献类型：
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作者：
Lambert, Trevor W.;Smith, Fay;Goldacre, Michael J.
目的：报告医生考虑离开医学界或英国的原因。设计：问卷调查。地点：英国。参会人员：研究对象为英国2008年和2012年的医学毕业生，研究者在毕业三年后向他们发送问卷。主要观察指标：医生对他们考虑离开医学界或英国（或两者）的主要原因的评论。在60%不打算留在英国医学界的受访者中，50%的人考虑在英国以外的医学界工作，10%的人考虑离开医学界。在那些考虑在联合王国以外从事医学工作的人中，最常提到的原因是获得更广泛的经验，其他地方的情况会“更好”，以及对国民保健服务及其文化、国家和政治的负面看法。其他原因包括更好的培训或工作机会，更好的工资和条件，家庭原因和更高的期望。毕业三年后，2015年接受调查的医生比2011年接受调查的医生更有可能引用与国民医疗服务，薪酬和条件，他们的期望以及对工作与生活平衡和病人护理的影响有关的因素。在那些考虑离开医学界的人中，离开医学界的主要原因是对国家卫生服务体系的负面看法（这一组中有一半的人提到了这一点）。毕业三年后，2015年接受调查的医生比2011年接受调查的医生更有可能提到这一原因，以及额外的工作时间和工作量以及经济原因。许多医生对在国民保健制度中担任初级医生的经历的许多方面持越来越消极的看法，以及在许多人认为资金不足的系统中提供高质量患者护理的困难。旨在鼓励更多医生留下来的政策改革，应该以解决这些关切的愿望为动力，对资源、人员配备和工作条件进行真实的改善。
Objective: To report the reasons why doctors are considering leaving medicine or the UK.Design: Questionnaire survey.Setting: UK. Participants: Questionnaires were sent three years after graduation to all UK medical graduates of 2008 and 2012.Main outcome measures: Comments from doctors about their main reasons for considering leaving medicine or the UK (or both).Results: The response rate was 46.2% (5291/11,461). Among the 60% of respondents who were not definitely intent on remaining in UK medicine, 50% were considering working in medicine outside the UK and 10% were considering leaving medicine. Among those considering working in medicine outside the UK, the most commonly cited reasons were to gain wider experience, that things would be ` better' elsewhere and a negative view of the National Health Service and its culture, state and politics. Other reasons included better training or job opportunities, better pay and conditions, family reasons and higher expectations. Three years after graduation, doctors surveyed in 2015 were significantly more likely than doctors surveyed in 2011 to cite factors related to the National Health Service, to pay and conditions, to their expectations and to effects on work-life balance and patient care. Among those considering leaving medicine, the dominant reason for leaving medicine was a negative view of the National Health Service (mentioned by half of those in this group who commented). Three years after graduation, doctors surveyed in 2015 were more likely than doctors surveyed in 2011 to cite this reason, as well as excessive hours and workload, and financial reasons.Conclusions: An increasingly negative view is held by many doctors of many aspects of the experience of being a junior doctor in the National Health Service, and the difficulty of delivering high-quality patient care within what many see as an under-funded system. Policy changes designed to encourage more doctors to remain should be motivated by a desire to address these concerns by introducing real improvements to resources, staffing and working conditions.