'Drexit': Can More Be Done to Understand Why Doctors Leave the NHS?

Peter Russell

February 11, 2020

Doctors who leave the health service early should be interviewed to find out about their motivation to help stem the UK's medical brain drain, according to an opinion piece in The BMJ .

The authors said leaving interviews for health professionals were rarely carried out but could help politicians and health managers understand the reasons behind 'Drexit', shorthand for Doctor-Exit, an "exponentially growing trend for doctors to walk away from their jobs in the NHS".

Dr Hannah Wilson, an academic junior doctor at Harvard Medical School, who coined the term Drexit to describe the phenomenon, and Dr Arabella Simpkin, an assistant professor in medicine at Harvard, wrote that there had never been a more urgent need to understand driving forces and motivating factors for the exodus from the UK's medical training programmes which had contributed to a "workforce now at breaking point".

Since the authors first raised the idea of exit interviews for departing health professionals in 2019, some key themes for why health professionals left the NHS had started to emerge, they said.

Those included loss of respect, lack of value, and fragmented teamwork.

"Pay, recruitment, and chaotic rotation scheduling are frequent reasons doctors cite as catalysing their decisions to step away from UK training into more flexible, better paid, and more personalised approaches to their training overseas" they said.

The findings echo many of the themes from a 2018 survey of health professionals carried out by Medscape UK.

It found that 32% of respondents said they felt burnt out at some stage. Top of the requests for helping to improve working life was reducing patient loads, more manageable hours, and gaining more respect from managers, staff, and colleagues.

In December 2019, a survey by the General Medical Council (GMC) into the state of medical education and practice in the UK found that young doctors were pursuing different career paths from their older colleagues, including taking time out of UK practice, reducing hours, or leaving clinical work in the NHS earlier.

Dr Arabella Simpkin

We spoke to Dr Simpkin, associate director of the Center for Educational Innovation and Scholarship at Massachusetts General Hospital, currently completing a DPhil at the University of Oxford, who co-authored the BMJ opinion piece.


We began by asking whether she thought that medical authorities had now begun trying to ask the important questions about why doctors were abandoning the NHS, and even the country.

Dr Simpkin: I think they have, informally, in a way.

I know that the GMC, Health Education England, and all sorts of bodies in the UK are definitely very worried about what does seem to be an accelerating process.

There's no doubt that there's a huge amount of time and effort being put into trying to understand how we can better retain and recruit physicians, recognising that they really are the backbone of the UK's healthcare service.

Clearly, the future of medicine depends on them.

Does your own research resemble the findings from our own survey of why so many health professionals report being burned out?

We were very interested in actually trying to look at doctors who have left the UK but are still practising as doctors overseas.

Sometimes these people get labelled as having 'burned out'. Maybe they are burnt out of the NHS, but burned out of practising medicine? It appears not, given the fact that many of these people are working a far greater number of hours overseas.

Certainly in the United States, the working hours in the week are 80, so nearly double the 48 hour week of the UK.

I think as [Medscape UK] found as well, there was the idea of the sense of value and respect.

In other research that I've done out of Massachusetts General Hospital, was a piece in JAMA Internal Medicine last year that looked at trying to understand the key variables that affect satisfaction at work.

Perhaps unsurprisingly, intuitively, as someone who was at the frontline of healthcare for 8 years in the UK, a sense of value and respect is just critical.

One of the core things we need as a human is to feel appreciated.

What we found from the survey we did in the States – and I think a lot resonates for the UK – is that fundamentally we're tribal beings, we want to be part of a community, and we want to feel that we work in a socially supportive environment.

From my own personal experience I think that sense of value and respect has gone.

I think in a way, what's heartening about this is that actually it suggests that investment in social capital would perhaps go a long way, and that large amounts of money are not necessarily needed to fix the problem.

Now, I'm not saying that we don't need some money; clearly we need investment in restructuring and rethinking our training programmes. But certainly in the States, we found there was no significant correlation between how fairly compensated faculty felt they were and how satisfied they were.

All the things that correlated to satisfaction was to do with whether they felt they worked in a socially supportive environment, whether they felt valued by their leadership, and whether they felt cared about as a person.

And you have gone through the experience of leaving the NHS and the UK yourself?

I'm born and bred British, trained in Oxford, worked in the frontline of the NHS for 8 years as a paediatrician in London, and came out to Boston for what was meant to be only 6 months – and that was 6 years ago.

I think that's one of the other challenges that I know the GMC and Health Education England are very aware of, is that a lot of people who leave – and we've certainly found this – leave thinking they're only going to go for a year. Most people don't leave wanting to leave forever.

But I think you suddenly see a different system, and it's very hard then to return to the NHS, as it is at the moment, that feels like a faltering system, not one that's growing.

Why are so many doctors quitting the NHS?, February 6th 2020, Wilson H, Simpkin A, BMJ Opinion


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