I recently stayed with a good GP friend of mine in London. He is an excellent clinician, a compassionate human being and, above all, an incurable optimist. I was sad, therefore, to find him preoccupied with the decline of the NHS and disillusioned with his career working for it.
It could be mid-career cynicism, I suppose, but when one reads articles about record numbers of UK doctors applying to work overseas - 4500 to be precise - up by 40% - it is clear that he is not alone.
I wanted to blog about this but rather than speculate, I thought I would contact some of the British GPs that we have placed in Australia to ask them to compare working as a doctor in the two countries. No single issue dominated but it all adds up to something of a one-sided picture. Here is a brief list of gripes:
- Administration: All agreed that the NHS has become severely overburdened with paperwork with the amount of admin in the UK about twice that in Australia. Many referred to their frustration at so much non-clinical work, which they find demotivating.
- Funding: It is no secret that the UK government wants to spend less on healthcare - and doctors feel it. Aside from the downward pressure on personal earnings, they also feel the pinch for funding of clinical tests and referrals. Clinical decisions are increasingly being informed by budget considerations. Funding models in Australia are freer so doctors can order tests based on clinical grounds, not financial.
- Patient Attitude: Sad to say, patients in the UK seem to share the malaise surrounding the NHS and despite having to pay less (or not at all) for the service, there seems to be dissatisfaction - or at least a lack of appreciation for the treatment that the NHS provides. Doctors are the first point of complaint and many referred to the emotionally draining effect of managing patients expectation. Doctors in Australia seem to enjoy a higher level of respect as professionals.
- Waiting Lists: Australia has significantly lower waiting times for specialist attention so anxious patients don't clog up GP surgeries, taking out their frustrations on their doctor. Also, clinical outcomes are better because problems are dealt with swiftly rather than festering.
- Morale: A number of respondents talked about a negative culture in the NHS. There is a general feeling that UK staff are suffering from a crisis of morale. This is not the case in Australia where a sense of esprit de corp and purpose is more focussed on the practice and immediate team of colleagues rather than the system as a whole.
- Income: There was clear agreement that earning potential in Australia is currently much greater than in the UK for GPs. One respondent reported earning three times the salary that he earned in the UK.
- Lifestyle: It was generally reported that there was more time off work and that it was more flexible to arrange. Of course, many talked about enjoying Australia as a country, with all that it has to offer over the UK vis-a-vis weather, culture, beaches etc (though that's a subject for another blog).
Granted, the members of my sample group have already made the move so are inclined to talk positively about their decision, though none came back saying that they had regretted their most recent career move (except the ones who have already returned to the UK).
It is truly sad to hear about the toxic environment for doctors in the UK. I trained there and remember the pride and confidence in the British public health system felt by all staff, as well as the community. Some of that pride remains - one comment that stood out was this: "the NHS is a fantastic institution, but very abused and undervalued...", which I think sums up current sentiment.
A couple of people, now back in the UK, made the observation that they would consider leaving the profession, though some, closer to the end of their careers are just counting down to retirement. "8 years and 26 days" in one case, at the time of writing.
Dr John Bethell
Director, Wavelength International