Wilson Hannah C P, Abrams Sarah, Simpkin Begin Arabella
Department of Medical Education Harvard Medical School Boston Massachusetts USA.
School of Medicine Imperial College London London UK.
Health Sci Rep. 2021 Oct 8;4(4):e419. doi: 10.1002/hsr2.419. eCollection 2021 Dec.
Drexit ("Doctor-Exit") is the exponentially growing trend for junior doctors in the UK to walk away from their jobs in the National Health Service (NHS). Our objective was to identify the reasons why junior doctors in the UK leave their NHS training programs to train overseas.
A simultaneous and convergent mixed-methods study was performed to analyze both an online survey and semi-structured interviews from junior doctors who had left the NHS. Social media, online professional media, and networks of junior doctors were used to recruit doctors. All were UK medical school graduates who had left the NHS within the last 15 years (2003-2018).
96.1% (149/155) of respondents reported not being offered an exit interview on leaving the NHS. 94.8% (147/155) of respondents did not regret quitting the NHS. Participants were more satisfied with their pay and work life balance in their overseas posts when compared to training in the NHS ( < 0.05). Burnout was variably defined and was prominent in doctors who left 53.8% (113/210) but was reversed when they practiced medicine overseas in 89.2% (74/83) of cases. Qualitative data identified four key themes which were categorized into push factors, which were lack of interest in retention and bleak outlook; and pull factors, which were financial vs social capital and things are different overseas.
Listening to the frontline junior doctors' voices lend insights into a better understanding of the push and pull factors that appear to be exacerbating the exodus of junior doctors from the NHS. Our results indicate that exit interviews should be performed routinely. There needs to be a shift to focus on the training of doctors rather than service provision, with efforts to support, appreciate, and value junior doctors. Further exploration is needed to identify what is happening in training programs overseas to improve retention within the NHS. Furthermore, identifying issues perceived by junior doctors in the UK in the context of workforce planning may be applicable to healthcare systems across the globe.
“医漂”（“医生离职”）指的是英国初级医生离开国民医疗服务体系（NHS）工作岗位的人数呈指数级增长的趋势。我们的目标是确定英国初级医生离开NHS培训项目去海外培训的原因。
开展了一项同步且趋同的混合方法研究，以分析对已离开NHS的初级医生进行的在线调查和半结构化访谈。利用社交媒体、在线专业媒体以及初级医生网络招募医生。所有受访者均为英国医学院校毕业生，且在过去15年（2003 - 2018年）内离开过NHS。
96.1%（149/155）的受访者表示在离开NHS时未得到离职面谈的机会。94.8%（147/155）的受访者不后悔离开NHS。与在NHS培训时相比，参与者对其海外岗位的薪资和工作生活平衡更为满意（<0.05）。职业倦怠的定义各不相同，在离开的医生中较为突出，占53.8%（113/210），但在他们海外行医时，89.2%（74/83）的情况出现了反转。定性数据确定了四个关键主题，分为推动因素，即缺乏留任意愿和前景黯淡；以及拉动因素，即经济资本与社会资本，且海外情况不同。
倾听一线初级医生的声音有助于更好地理解似乎正在加剧初级医生从NHS流失的推动和拉动因素。我们的结果表明应常规开展离职面谈。需要将重点从服务提供转向医生培训，努力支持、认可和重视初级医生。需要进一步探索海外培训项目的情况，以提高NHS内部的留用率。此外，在劳动力规划背景下确定英国初级医生所察觉到的问题，可能适用于全球医疗系统。
