Abstract
UK healthcare is in the throes of a workforce crisis. There are 10,000 fewer doctors and over 50,000 fewer nurses than are required to run a safe and sustainable service. Multiple factors from removal of nursing bursaries, introduction of university fees, poor working conditions, under-resourcing of healthcare services, unmanageable workloads, learned helplessness of clinical risk and a culture of incivility or blame is driving the workforce of the future away from NHS. Several governmental agencies, arm’s length bodies and trade unions have been grappling with this challenge. A few solutions have been recommended under the new contract for junior doctors, reintroduction of support for nurses and expansion of medical school places, but some are yet to be implemented. NHS leaders continue to support blue-sky thinking in terms of workforce innovations but tend to drag their feet when it comes to adoption. This reluctance by senior clinicians, managers and policy makers may be related to a lack of understanding of the values that drive the millennial generation that most younger healthcare workforce belong to. This article will explore the challenges and solutions from a generational perspective and offer an insight to guide future decision-making.
Highlights
I’m scared, I’m exhausted, and I hate being a doctor.[1]Over half of junior doctors in the United Kingdom (UK) do not continue their training straight after Foundation years, choosing a career break, flexibility in work schedules, in less than full time positions or switch specialities. 2, 3 leading to an expanding crisis in the safe staffing of hospital rotas.[4]
Despite the considered re-design of medical training pathways, since the time of the Calman review[5], postgraduate training is failing to persuade a significant proportion of junior doctors to commit to higher specialty training
Those in specialty training are delaying their transition into consultant posts, a large number of unfilled consultant vacancies persist, with notable geographical variation
Summary
Over half of junior doctors in the United Kingdom (UK) do not continue their training straight after Foundation years, choosing a career break, flexibility in work schedules, in less than full time positions or switch specialities. 2, 3 leading to an expanding crisis in the safe staffing of hospital rotas.[4]. Junior doctors value job security after years of investment of time and incurring huge debts, yet are faced with uncertainty about the future of their careers, dependent on passing postgraduate exams, fulfilling demanding training requirements and annual revalidation criteria, as well as making a positive impression on their supervisors, whose mentoring they rely on. HEE, Care Quality Commission (CQC) and GMC attach considerable value to league tables about the quality of services including education, most junior doctors make decisions about their training based on advice from their mentors and peers This ‘influencer culture’, which is rooted in the experience, supervision and encouragement from senior colleagues acting as role models and mentors, has a larger impact on career choice than any formal reports of training surveys, which are less accessible and wholly irrelevant in practice. They are able to experience a different level of productivity, if they are motivated to do so
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