Posted by Evgenia Galinskaya on 13 April, 2017
One of the most ridiculous comments I hear about doctors leaving clinical practice is “Doctors who leave medicine have wasted taxpayers’ money”. This statement is invariably followed by a guesstimate “Doesn’t it take more than £500k* to train one doctor?”.
Whenever someone spends 5-6 years at medical school, plus however many years as a junior doctor, but later chooses to (or has to) leave clinical practice, it creates a whirlpool of strong emotions, moral judgement and unfounded assumptions – both within the medical profession as well as among the general public. Somehow, a vet, dentist or lawyer leaving the profession doesn’t attract as much negativity.
On the face of it, it is indeed a huge investment to train the medical work force, but I believe it is important not to view the impact of doctors leaving the profession on the taxpayer as a black-and-white case.
First of all, the money.
In my experience, many non-medics think that the cost of £500k* that the government pays for “a doctor’s training” covers everything between their first day at medical school until they are a fully qualified GP or Hospital Consultant. In reality, medical students in the UK pay the same fees as other students, and because their course is one of the longest, they end up with the highest debt. Once qualified, each doctor in the UK has to pay out of their own pocket for mandatory memberships, numerous post-graduate exams and certifications, revalidation, GMC license to practice, indemnity cover as well as attendance of most courses and conferences. A typical postgraduate exam for a clinician is over £650 for each attempt, and there are several of those to clear. Preparation for exams can cost several thousand pounds (typical cost of just one such course is £1000-£2000). GMC fees range from £425/year to maintain a license to practice to £1600 to register as a new Consultant or GP. Mandatory medical indemnity cover can run into thousands of pounds each year for senior doctors. So there are huge expenses absorbed by the individual doctors during and after their training.
When a doctor starts a new career or own venture, they will still be contributing to the economy and the wider society through fruits of their labour as well as by paying tax. More often than not such doctors end up working in health and medicine related areas thus contributing their background, knowledge and skills to patient care, albeit indirectly.
Secondly, when someone has enough self-awareness to recognise that their career is damaging their health or emotional wellbeing and (hopefully after careful consideration) chooses to change direction, they may in fact be doing a favour to the taxpayer for a number of reasons.
Medicine is a profession with one of the highest rates of stress and burnout, mental health (MH) illness (Department of Health report) including anxiety, depression and eating disorders, and suicide. According to the mental health charity Mind, almost 9 in 10 (88%) primary care workers find their work life stressful, significantly higher than the wider UK workforce (56%) . According to MPS report, 85% doctors experience MH issues. It is not surprising there are many services providing support for doctors in difficulty. Practitioner Health Programme for doctors with mental health illness and addictions in London has been run on a commissioned budget of approximately £1m per annum since April 2011. The focus of this programme is on early intervention, to support the health of doctors and dentists so that wherever possible they can continue providing safe and valued care to their patients. They estimate that the cost of doctors and dentists ill health in London alone exceeds £21m per annum.
It is clear that remaining in a career that is a poor fit has a high cost to the taxpayer in terms of doctors’ sick leave, suicide, prescription medicines to treat conditions resulting from stress, and support services to help doctors deal with stress, mental health illness (including anxiety and depression), addictions and substance misuse.
Another important factor to consider when saying that everyone with a medical degree should be in clinical practice is a possibility that when a clinician has grown to resent their job/career, their lower motivation could result in less productivity and could sometimes have a detrimental effect on patient care. I have heard many times from clinicians that although they do enough to be safe, stress has reduced their empathy. Needless to say that dissatisfaction at work has a knock-on effect on family and personal relationships, the cost of which is difficult to estimate.
For me personally, the tipping point when I decided to leave the profession was when I started resenting my patients because I could not give them enough time during overbooked clinics. I was still welcoming to each of my patients but I felt immense guilt looking at my clinic list and praying there would be some DNAs (“Did not attend”).
As a patient myself, I would far rather be seen by a doctor who looks forward to their next day instead of wondering how to get through the week, and whose wellbeing is not affected by a sense of dread of going to work.
I believe that anyone who says that a doctor leaving clinical practice has “wasted taxpayer’s money” or has deterred “another medical student from attending medical school” has a very narrow-minded view of the world. Teenagers considering career options cannot make a truly informed decision at the age of 15-17. They have to make the best shot at guessing what their life would be like as a doctor based on (often biased) advice from family or school, what they’ve seen on TV, limited work experience and role models in their network.
If you look at your own life, you will probably see that many things that were important for you at 20 are different to some of the things important to you in your 30s, 40s, etc. As you grow, you change, and it takes a great deal of self-awareness to learn what works for you and what doesn’t, and more importantly to change the things that do not work. It is never an easy decision to leave clinical practice precisely because so much has been invested into becoming a doctor (financially, emotionally, physically and in many other ways).
It takes a lot of courage to step off a well-trodden path and start a new journey and only relatively few are lucky enough to have the resources (and the strength) to endure a transition. If a new role/career provides a better fit for one’s talents, skills and values, the likelihood is there will be higher levels of wellbeing, greater engagement, motivation and productivity. Isn’t it what any employer would want for their workforce and a taxpayer would want for their money?
* UPDATE: Since this article was written, I have learnt fullfact.org data on the actual cost of training a doctor in the UK. They show that the cost to “the taxpayer” is closer to £163,000.