Doctors who are newly qualified form a growing proportion of the thousands of British medics seeking jobs abroad each year, triggering concerns that the NHS is heading for a staffing crisis.

Specialist recruitment agencies and GPs’ leaders say doctors, many of whom have just finished their training, are becoming disillusioned with the state of their profession and seeking fresh starts in countries such as Australia, where they can earn double what they are paid in Britain. Figures given to the Observer by the General Medical Council show that an average of 2,852 certificates enabling British doctors to work abroad were issued annually between 2008 and 2014 – a total of 19,522.

So far this year the council has issued a further 2,008 certificates of good standing, the document that enables doctors to register with an overseas regulatory body or employer, taking the total who have applied to work overseas in the last eight years to almost 22,000. “Medicine is a global profession and the UK has long relied on doctors coming to work in the UK from other countries and some UK-trained doctors have taken the opportunity to experience working overseas,” said Niall Dickson, chief executive of the GMC.

“Annually over the past six years, more than 2,500 doctors who graduated from a UK medical school have been issued with a certificate of current professional status, which they need if they want to register to work in another country. We do know that not all of these doctors will actually go and work abroad.”

The fact that the figures, which do not include the thousands of doctors from overseas working in the UK, show no sign of diminishing is a concern at a time when the NHS is trying to fill vacancies. Anecdotal evidence suggests that young doctors now comprise an ever larger proportion of those seeking work abroad. Their full training can cost the taxpayer up to £1m – a figure which includes university fees, tuition costs over six or seven years, salaries while reaching a competent level after two or three further years, insurance and indemnities.



Guy Hazel, the managing director of austmedics.com, which looks to place British doctors in posts in Australia, said he receives between 30 and 40 enquiries a month, many from young doctors. “They are newly qualified doctors, reassessing their future, saying ‘this does not look like my cup of tea’, and who are now seeking alternatives abroad,” said Hazel. “Not every doctor can pick up sticks and fly to Australia – they have children in school or elderly parents, for example, but younger doctors are more likely to have the flexibility.”

He added that a number of factors were prompting British doctors to consider moving abroad. One was anger at the overly bureaucratic revalidation process, in which all doctors regularly undergo a series of checks so that they can retain their licence to practise.

Another was the issue of medical indemnity insurance, which Hazel said costs between six and 12 times more in the UK for a GP than in Australia. “While this cost is ‘covered’ by the NHS for salaried GPs, freelance GPs would need to cover this themselves,” Hazel explained. “A full-time GP can expect to pay between £5,000 to £12,000 for insurance, whereas in Australia they would pay under A$2,000 (£1,000). And the Australian insurance policy covers much more in terms of procedures than a UK policy.”

Hazel said he currently had three positions for consultant radiologists in Perth, Western Australia, with salaries paying £250,000. Someone in the same job in the NHS would get around £100,000.

Changes to the way in which British GPs will be expected to work is another push factor. “I have 40 positions in all the major capital cities in Australia for GPs, all earning around £160,000 with no out-of-hours work,” Hazel said. “The NHS offers a salaried GP around £80,000.”

Hazel pointed out that property prices are also lower in states such as Western Australia. “For £500,000 you get a house with a double garage, swimming pool and four to five bedrooms,” he said. “Petrol is 60p a litre and you don’t spend a lot on heating bills.”

Stemming the exodus abroad would help the Department of Health to meet its commitment to filling GP vacancies. GP leaders recently warned the government that its plans to recruit 5,000 new GPs and introduce seven-day opening at surgeries are undeliverable. They highlighted figures released by the GP National Recruitment Office that show more than 600 places are currently unfilled, meaning that around one in five GP trainee places are left vacant.

“GPs face increasingly challenging and stressful work environments, due to a combination of increasing demand and falling resources,” said Dr Richard Vautrey, deputy chair of the British Medical Association’s GP committee. “The result has been fewer junior doctors choosing general practice as a career, more senior GPs choosing to retire early and more doctors choosing to work abroad.” This has contributed to a workforce crisis and means existing doctors are struggling to meet the needs of the rising number of patients walking through their surgery doors. To stem this problem we urgently need to address issues around workload pressures, resourcing and work-life balance.”

CASE STUDY THE OZ FACTOR

Dr Ben Molyneux, 31, a London GP, is debating whether to move to Australia

“There are a number of pull factors: an increasing number of my friends and families have emigrated, lots of them doctors. It has a similar healthcare model, so it would be easy to fit in and the training environment is better than in the UK and the pay is better and the weather is better.

“In my practice we feel we are stuck in a hamster wheel. I see around 50 or 60 people a day on my on-call day. It’s very difficult to do that in a sustained fashion without getting really fatigued. I don’t want to be a tired and grumpy doctor. I want to be the kind of doctor who enjoys what they are doing, but sometimes you can’t do that because you’re too tired.

“The workload is going up at a rate of knots. We have 8,000 patients at our practice. We used to do 24,000 consultancies a year; now it’s 50,000. Once, if you had a cold, a family member would give you advice. Now people don’t know who to ask, don’t seem to be resilient enough to cope themselves.

“I enjoy my job. I have to work really hard, but feel privileged that I get to do what I do. I’d be really sad to leave my patients, but I feel guilty jumping ship when all my peers are here fighting on a sinking ship. there’s little positivity among all doctors at the moment. It’s a very negative environment.”



• This article was amended on 3 September 2015 to clarify the £1m figure given to train a doctor.

