Cohort study of 2006 medical graduates

Transcription

Cohort study of 2006
medical graduates
Ninth report
June 2015
British Medical Association
bma.org.uk
20150418 Ninth Cohort Report 2015.indd 1
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Cohort study of 2006 medical graduates – Ninth report
1
Contents
List of figures................................................................................................................................................................. 2
Summary......................................................................................................................................................................... 4
1
Introduction............................................................................................................................................ 6
2
Methodology........................................................................................................................................... 7
3
Respondent profile............................................................................................................................... 8
4
Career movements.............................................................................................................................. 9
Career movements of cohort doctors......................................................................................... 9
5
Attitudes to work................................................................................................................................
Desire to practise medicine..........................................................................................................
Workplace motivations and morale...........................................................................................
Work related stress............................................................................................................................
Working environment......................................................................................................................
Workplace culture..............................................................................................................................
Changes to work over time............................................................................................................
Awareness of issues facing the medical profession...........................................................
Role-related responsibilities.........................................................................................................
6
Working as a Specialist Trainee – Professional development/education................ 23
Working environment...................................................................................................................... 23
Undertaking specialty training.................................................................................................... 26
The impact of working on a rota.................................................................................................. 28
Overall experience of specialty training.................................................................................. 29
7
Working as a General Practitioner.............................................................................................. 30
Current post......................................................................................................................................... 30
Portfolio careers................................................................................................................................. 31
The pressure of working as a GP.................................................................................................. 32
The general practice workforce.................................................................................................. 33
Work-life balance working as a GP.............................................................................................. 33
12
12
14
16
17
18
19
21
21
8
Career expectations.......................................................................................................................... 35
Specialty choice................................................................................................................................. 35
Career change..................................................................................................................................... 35
Career goals.......................................................................................................................................... 37
Career advice and support............................................................................................................. 38
Job security........................................................................................................................................... 39
Intentions to practise medicine outside the UK.................................................................. 39
Intentions to work part-time......................................................................................................... 40
References................................................................................................................................................................... 42
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List of tables
Table 1
Table 2
Table 3
Table 4
Table 5
Table 6
Table 7
Table 8
Table 9
Table 10
Characteristics of respondents............................................................................................... 8
Marital status of respondents.................................................................................................. 8
Tenancy status of respondents............................................................................................... 8
Career movements during the last year.............................................................................. 9
What was your specialty as of August 2013?.................................................................. 10
Current hospital specialty....................................................................................................... 10
What was your grade as of August 2013?......................................................................... 11
Desire to practise medicine during academic year 2013/14.................................. 12
Please rank your top three sources of stress within your workplace.................. 16
Why has your experience of specialty training so far not allowed you
to develop your career to the best of your ability?...................................................... 29
Table 11
Reasons for change in career intentions during the last year................................ 36
Table 12Preferred career option of cohort doctors who had changed their career
intention during the last year (by current specialty August 2013-2014)........... 37
Table 13
Career goals 2013/14............................................................................................................... 37
Table 14
Which of the following is your ultimate career goal by which of the
following best describes your main current role (only cohort doctors
currently working as a GP)...................................................................................................... 38
Table 15
Intention to practise medicine outside the UK, either temporarily or
permanently in the future...................................................................................................... 39
List of figures
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
Figure 7
Figure 8
Figure 9
Figure 10
Figure 11
Figure 12
Figure 13
Figure 14
Figure 15
Figure 16 Figure 17
Figure 18
Figure 19
Figure 20
Desire to practise medicine since 2006........................................................................... 13
Desire to practise medicine by gender eight years after graduation (%).......... 13
Please indicate to what extent you agree or disagree with the
following statements................................................................................................................ 14
How would you say the following factors affect your morale as a doctor?....... 14
How would you generally describe your level of morale?........................................ 15
Level of morale by desire to practise medicine............................................................ 15
Please rank your top three sources of stress within your workplace.................. 16
How would you generally describe your level of work-related stress?............... 17
Please indicate to what extent you agree or disagree with the following
statements relating to your working atmosphere...................................................... 17
Generally the atmosphere in my workplace is positive............................................. 18
statements relating to the culture of your place of work......................................... 18
Compared to the last annual BMA cohort survey, how would you describe
the change in your:.................................................................................................................... 19
Compared to one year ago, please indicate if you are now more or less
likely to work anti-social hours?........................................................................................... 19
likely to work above your contracted hours................................................................... 20
likely to be:..................................................................................................................................... 20
In general, would you agree that:........................................................................................ 21
Would you consider taking on a managerial role in the future?............................ 21
Have you undertaken any formal management training?....................................... 22
Per cent of cohort doctors who reported they were asked to undertake
tasks they felt were beyond their capability since graduation.............................. 23
Experience in relation to team and overall working environment during
specialty training 2013/14, compared to 2012/13 and 2011/12......................... 24
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Figure 21
Figure 22
Figure 23
Figure 24
Figure 25
Figure 26
Figure 27
Figure 28
Figure 29
Figure 30
Figure 31
Figure 32
Figure 33
Figure 34
Figure 35
Figure 36
Figure 37
Figure 38
Figure 39
Figure 40
Figure 41
Figure 42
3
How would you describe NHS culture during your last year
(2013/14 compared to 2012/13)?...................................................................................... 25
How would you rate the following educational aspects of your specialty
training programme?................................................................................................................ 25
Which of the following most negatively affects your work-life balance
as a doctor?................................................................................................................................... 26
How would you generally rate your work-life balance?............................................. 27
Rank the top three factors you attribute this pressure to........................................ 27
If yes, how frequently have there been gaps on your rota over the
last year? ........................................................................................................................................ 28
What were the impacts of these rota gaps?.................................................................... 28
Has your experience of specialty training so far allowed you to develop
your career to the best of your ability? (by specialty)................................................. 29
Which of the following best describes your main current post?
(2011/12 to 2013/14)............................................................................................................... 30
If you are currently working as a salaried or freelance GP, what is the
main reason for this?................................................................................................................. 31
Are you currently working as a portfolio GP?................................................................. 31
How would you describe the general level of pressure that you felt
during your working days during the last year?............................................................ 32
Please rank the top three factors you attribute this pressure to.......................... 32
statements on the general practice workforce in your geographical
area of work................................................................................................................................... 33
Which of the following most negatively affects your work-life balance
as a GP?........................................................................................................................................... 33
How would you generally describe your level of work-life balance as a GP?.... 34
To what extent are you happy with your choice of specialty?
(by specialty category)............................................................................................................. 35
Have your experiences during the last year changed career intentions?
(by specialty category)............................................................................................................. 36
Career goals by gender 2013/14 (%)................................................................................. 38
To what extent do you envisage getting a job in your chosen specialty
once you have completed your training? (Excludes qualified GPs)..................... 39
Are you working/training part-time? (by gender)........................................................ 40
Are you working/training part time? (by specialty)..................................................... 41
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Summary
General trends
–– T
he BMA cohort study of 2006 medical graduates is a 10 year longitudinal study of
the career paths of 431 doctors. This is the ninth annual cohort report and it provides
information on the work and experiences of cohort doctors who, eight years postgraduation, are mostly progressing through specialty training or are working as qualified
GPs. This report also provides insights into career choice and working environments.
–– T
he vast majority of cohort doctors have worked in the UK within the previous year;
the number of cohort doctors who have worked overseas increased slightly compared
to the previous year. As per the results of the previous annual cohort survey, three in
10 intend to work overseas temporarily and one in 10 say they plan to work overseas
permanently in the future. Cohort doctors were most likely to say they plan to work
overseas temporarily or permanently post CCT (certificate of completion of training).
–– O
ne-half of cohort doctors continue to remain training or working in a hospital speciality
and half of all cohort doctors aspire to work as a consultant.
–– E
ight years post-graduation three-quarters of cohort doctors are happy with their choice
of specialty. This was most likely to be the case for cohort doctors who were undertaking
research or academic medicine. For the one-fifth of cohort doctors who said that their
experience during the last year had changed their career intentions, the main reasons
were work conditions, domestic circumstances and hours of work.
–– T
here has been an increase in part-time working in the past year. Although this increase
is apparent for both male and female cohort doctors, part-time working continues to be
more common for female cohort doctors.
Attitudes to work
–– C
ohort doctors continue to describe their level of workplace morale as moderate.
Positive interactions with patients have the biggest positive influence on workplace
morale whilst press coverage has the biggest negative effect on morale.
–– T
hree-quarters of cohort doctors said they regularly work additional, often unpaid hours,
to deliver the quality of care that patients deserve.
–– A
s per previous the results of the previous annual cohort survey, the biggest barrier to
having a good work-life balance was cohort doctors’ willingness to work additional, often
unpaid, hours. Cohort doctors training or working in emergency medicine, higher surgical
training and obstetrics and gynaecology reported having the worst work-life balance.
–– T
he biggest cause of work-related stress identified by cohort doctors were work-life
balance responsibilities, a shortage of doctors and high levels of paperwork.
–– T
he vast majority of cohort doctors felt they had an open and honest working culture;
however, one in ten felt this was not the case.
–– J ob security has continued to improve. 48% of cohort doctors who have not yet qualified,
now feel they will get a job once they have finished their training, compared to 45% in
2012/13 and 42% in 2011/12.
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Cohort doctors who were undertaking specialty training
–– 6
0% of cohort doctors who were working on a rota indicated there are or have been
long-term gaps on their rota. Alarmingly, more than one-half of cohort doctors who
worked on a rota said that they regularly had staff shortages as a result of rota gaps.
–– T
he amount of variety cohort doctors’ who are undertaking specialty training experience
in their jobs, and the complexity of work, are two of the most positive aspects of their
team and working environments. However, there was a slight deterioration in working
atmospheres over the past year.
–– T
he majority of specialty trainees (58%) felt that their specialty training programme
had allowed them to develop their career to the best of their ability. However, one-fifth
felt this was not the case. For those who felt that specialty training limited their career
progression, the reasons were primarily having to provide too much service provision and
insufficient exposure to training opportunities.
–– T
here has been a shift in general practice specialty trainee’s opinions about specialty
training during the last year. In 2012/13, 75% of cohort doctors who were undertaking
specialty training felt that their specialty training programme had so far allowed them to
develop their career to the best of their ability, falling to 56% in 2013/14.
Cohort doctors working in general practice
–– T
hose cohort doctors who aspire to work in, and who are working in, general practice
are more likely to be female. Cohort doctors are most likely to now work as a partner GP
(48%); however, this is much more likely to be the case for male (73%) than female (32%)
cohort doctors. There has been a slight decline in the number of cohort doctors who
are working as and who aspire to work as a salaried GP (from 47% in 2011/12 to 44% in
2013/14). There has been an even more dramatic reduction in the proportion of cohort
doctors who worked as a freelance GP (from 27% in 2011 to 13% in 2013/14). No male
cohort doctors reported working as a GP locum whereas one in 10 (11%) of female cohort
doctors work as a GP locum.
–– C
ohort doctors have reported an increasing shortage of GPs. 80% (compared to 46% in
2012/13) of cohort doctors said there is already a shortage of GPs in their area.
–– T
hose cohort doctors who are working as a newly qualified GP have reported a fall in
morale since the previous annual survey. This group of doctors are also the most likely to
say that their working atmosphere is generally negative.
–– C
ohort doctors who work as a GP have reported an increase in the frequency where they
are required to work above their contracted hours. Cohort doctors who work as a GP were
also most likely to report an increase in their work-related stress levels in the past year
and reported the lowest level of morale of all cohort doctors.
–– I n contrast to the previous annual cohort survey where cohort doctors who were working
as a GP principal were much more likely to indicate they had a poor work-life balance
(47%), the results of this survey suggest that cohort doctors who work as a salaried GP
were more likely to report a poor or very poor work-life balance (40%).
–– C
ohort doctors who work in general practice were most likely to indicate they are
currently (50%), or want to (17%) work part-time in the future.
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1
Introduction
The current BMA cohort study is a 10 year longitudinal study of 431 doctors who graduated
from UK medical schools in 2006. The study aims to provide information on the careers of
doctors, and particularly to:
–– identify doctors who leave medicine as a career, or who choose to work in another
country and to assess the factors which influence it;
–– identify patterns of workforce participation and specialty choice of doctors who remain
in the UK, and the factors which influence them;
–– investigate career progression, especially those factors which influence variation
between doctors
The cohort study provides essential information on the careers, experiences, views and
aspirations of the new generation of doctors and is of interest to those involved in medical
workforce planning and policy development, and others interested in medical careers.
Eight years post-graduation the cohort doctors are at varying points of their careers; some
are working as qualified GPs, some are up to six years into specialty training, a few are
working in non-training posts and some cohort doctors are taking a break from practising
medicine in the UK for various reasons. The current survey was designed to gain some
understanding of the impact of these different career stages on cohort doctors’ attitudes to
work whilst also assessing the impact of working within the NHS.
This years’ survey not only continues to monitor the cohort doctors’ career paths and future
career intentions, but also continues to include questions monitoring cohort doctors’
workplace morale, work-related stress and work-life balance.
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2Methodology
The study began in May 2006 when an invitation to participate was mailed to final year medical
students in the UK. A response indicating a willingness to participate was received from 557
and these formed the cohort sample. The first questionnaire was mailed in October 2006.
The mailing received a response rate of 87 %, giving a cohort size of 435; however, since 2006,
five cohort members have requested to opt out of the study, leaving 430 cohort members.
The collection of data is conducted primarily through an electronic questionnaire sent
to the cohort participants every summer. This process is designed to be both continuous
and longitudinal. Information is collected on the preceding 12 month period and linked
from year to year using a numerical identifier. This design allows for the career paths of the
respondents to be tracked over time.
The annual questionnaire is combined with focus groups, which are conducted with a
random sub-sample of the cohort each year. These allow for questions to be examined in
greater depth and also serve as a measure of reliability and validity. They also play a role in
determining the direction of future research.
Although every effort is made to contact each cohort member, it is inevitable that some
respondents are either untraceable or do not return their questionnaire. This year there
were 55 non-respondents.* Those cohort members who have not responded will continue
to be tracked and their responses entered into the database.
Care is taken to ensure confidentiality at all times. A full account of the project’s
methodology is given in the first report.1
Attention has only been drawn to subgroups within the analysis where there is a base
containing more than 20 respondents.
* 7 surveys were received after this year’s survey was closed.
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3
Respondent profile
The most recent questionnaire was emailed to cohort doctors in September 2014,
paper surveys were sent if requested. The response rate for the eighth cohort report was
85% (368 of 430). Female cohort doctor respondents are continually over represented;
therefore, the data is weighted to account for a response bias. When weighted,
43% of cohort doctors are males and 57% females.† Cohort doctors of white ethnic
origin are over represented within this sample.‡,2
Table 1 – Characteristics of respondents
Ethnic origin
Male
Female
Total
%
White
146
202
348
85.1
Black African
0
2
2
0.5
Indian
14
6
20
4.9
Iranian
0
3
3
0.7
Pakistani
4
2
6
1.5
Chinese
5
5
10
2.4
Other
5
15
20
4.9
Total
174
235
409
100.0
The age of cohort doctors ranged from 30 to 54 with an average age of 33. The majority of
doctors are married (67%). There has been a marked rise in the number of cohort doctors
who have children in the past year (46%; 200 of 430 compared to 31% in 2012/13). Most
cohort doctors are either homeowners (77%) or tenants (12%) (tables 2 and 3).
Table 2 – Marital status of respondents
Marital status
Male
Female
Total
%
Single
48
39
87
20.3
Married
114
173
287
66.9
Living with partner
18
30
48
11.2
Divorced/separated
5
2
7
1.6
Total
185
244
429
100.0
Table 3 – Tenancy status of respondents
Tenancy status
Frequency
%
Tenant
53
12.4
Homeowner
328
76.6
Tenant & homeowner
39
9.1
Living with parents
7
1.6
Other
1
0.2
Total
431
100.0
†
To ensure that the cohort is representative of the final year 2006 UK medical graduate population, as a whole,
the data are weighted to account for a response bias in the original cohort according to gender. The data are
reported here as weighted.
‡
When compared to the results of the 2014 GMC National Training Survey
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9
Career movements
Career movements of cohort doctors
The number of cohort doctors who worked as a doctor in the UK at some point during the
previous year has remained consistent year on year (91%; 390 of 430 in August 2013 to
August 2014). There has been a slight rise in the number of cohort doctors who worked
overseas (plus eight cohort doctors) and the number of cohort doctors who took a break
from medicine (plus three cohort doctors) in the past year. The number of cohort doctors
who have left medicine (not necessarily in the past year) is unchanged at four out of
430 cohort doctors (table 4).
Table 4 – Career movements during the last year (multiple response)
Career movements
(n=431)
Continued
to work as a
doctor within
the UK
Worked
overseas
(either as
a doctor
or other
occupation)
Taken a
break from
working
for other
reasons
Travelled
overseas
(other than
for annual
leave)
Left
medicine as
a career
Continued to work as a
doctor within the UK
343
6
39
2
0
Worked overseas (either
as a doctor or other
occupation)
6
27
0
1
0
Taken a break from
working for other
reasons
39
0
9
0
0
Travelled overseas
(other than for annual
leave)
2
1
0
0
0
Left medicine as a
career
0
0
0
0
4
Total
390
34
48
3
4
‘Total’ does not equal the number of career movements indicated in the column. 383 cohort doctors indicated that
they had undertaken one career route during the last year and 48 cohort doctors had undertaken two of these in
the last year.
Table five illustrates that of those cohort doctors who continued to work as a doctor within
the UK in the past year, cohort doctors were most likely to be working in hospital practice
(50%) and general practice (36%) as in previous years. However, there has been a slight fall
in the number of cohort doctors working in hospital practice (minus 33 cohort doctors).
Conversely, the biggest rise in other areas of medicine was found in research or academic
medicine (plus 14 cohort doctors compared to 2012/13) with slight increases in public
health (plus three cohort doctors), community health (plus two cohort doctors) and other
specialties (plus five cohort doctors).
As per the results of previous annual surveys, male cohort doctors are more likely to work in
hospital practice (54%) than female cohort doctors (47%). Similarly, female cohort doctors
are still more likely to work in general practice (45% of female cohort doctors work in general
practice compared to 24% of male cohort doctors). The percentage of female cohort doctors
who work in general practice has remained the same compared to the previous year
(45% in 2013/14 and 2012/13). There has been a slight reduction in the number of female
(minus 14) and male (minus 11) cohort doctors who are working in hospital practice in the
past year. Female cohort doctors were more likely to have changed to smaller specialties
such as public health, community health and ‘other’ specialties whereas male cohort
doctors were more likely to change specialty to research or academic medicine
(plus 17 cohort doctors).
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Table 5 – What was your specialty as of August 2013?
Male
Female
Frequency
%
Hospital practice
91
103
194
50.1
General practice
41
98
139
35.9
Public health medicine
3
3
6
1.6
Research or academic medicine
27
8
35
9.0
Community health
0
2
2
0.6
Other
7
2
9
2.3
Total
170
217
387
100.0
Those cohort doctors who were working in hospital specialties were most likely to be
undertaking higher medical specialty training (22%); most commonly geriatrics (eight of 43)
and respiratory medicine (five of 43). This was followed by anaesthetics (17%) and higher
surgical training (14%); of which, the most common sub-specialty was general surgery
(eight of 28) (table 6).
Table 6 – Current hospital specialty
Frequency
%
Acute Care Common Stem
1
0.7
Anaesthetics
34
17.2
Clinical radiology
13
6.4
Core training
2
1.1
Emergency medicine
19
9.6
Higher medical specialty training
43
22.0
Obstetrics and gynaecology
11
5.5
Ophthalmology
2
1.2
Paediatrics and child health
17
8.8
Pathology
1
0.5
Psychiatry
10
5.4
Higher surgical specialty training
28
14.4
Other
14
7.1
Total
195
100.0
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30% of cohort doctors are now working as qualified GPs and a further 7% of cohort doctors
are undertaking GP specialty training (29 of 390). As per previous years, female cohort
doctors were slightly more likely to have qualified as a GP whereas male cohort doctors
were more likely to be in specialty training. Male cohort doctors are also slightly more
likely to be working in a research/academic post than female cohort doctors
(7% compared to 4% respectively) (table 7).
Table 7 – What was your grade as of August 2013?
Male
Female
Total
Frequency
%
Qualified GP
41
72
113
29.4
ST6
34
25
59
15.3
ST5
33
28
61
15.8
ST4
23
26
49
12.7
ST3/CT3 (including ACFs and GPs)
8
33
41
10.6
5
5
10
2.6
3
7
10
2.6
Locum post
1
2
3
0.8
Trust grade/specialty doctor
5
5
10
2.6
Non-standard research/academic post
12
9
21
5.5
LAT/LAS
0
2
2
0.5
Armed forces post
3
0
3
0.8
Other
1
2
3
0.8
Total
169
216
385
100.0
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5
Attitudes to work
The NHS has recently been going through a period of significant change and challenges
ranging from the extensive reorganisation of the structure of the National Health Service
in England as legislated by the Health and Social Care Act in 2012,3 austerity measures4
and widely publicised criticism of NHS culture.5
In response to the aforementioned uncertainties facing the medical workforce, and in-line
with 2011/12 and 2012/13 cohort surveys, the 2013/14 questionnaire included questions
on workplace motivations and morale and workplace well-being as well as the long-term
cohort measure; the desire to practise medicine. Where possible, comparisons have been
made based on the results of previous cohort surveys.
Desire to practise medicine
Postgraduate medical training and the early post qualification years can be stressful and
pressurised for doctors. An integral part of this study is to track the motivation of doctors to
practise medicine during the early years of their careers. Cohort doctors who had worked in
the UK in the previous year were asked to rate their desire to practise medicine.
Currently the majority of cohort doctors (78%) have a strong or very strong desire to practise
medicine, encouragingly no cohort doctors regret becoming a doctor. Figure 1 shows the
pattern of cohort doctors’ desire to practise medicine since graduation (table 8).
The proportion of cohort doctors who have a very strong or strong desire to practise medicine
is at a similar level to last year (81%); however, the desire to practise medicine continues to fall
slightly year on year, from its highest peak at graduation. Male cohort doctors continue to be
more positive about practising medicine than female doctors (figure 2).
Table 8 – Desire to practise medicine during academic year 2013/14
Frequency
%
Very strong desire to practise medicine
89
22.7
Strong desire to practise medicine
217
55.5
Lukewarm desire to practise medicine
67
17.1
Weak desire to practise medicine
9
2.4
Regret becoming a doctor
9
2.2
Total
391
100.0
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Figure 1 – Desire to practise medicine since 2006
60%
50%
40%
30%
20%
10%
0%
Regret
becoming a
doctor
Weak desire
to practise
medicine
At graduation
Three years post-grad
Six years post-grad
Lukewarm
desire to
practise
medicine
Strong desire
to practise
medicine
One year post-grad
Four years post-grad
Seven years post-grad
Very strong
desire to
practise
medicine
Two years post-grad
Five years post-grad
Eight years post-grad
Figure 2 – Desire to practise medicine by gender eight years after graduation (%)
70%
60%
50%
40%
30%
20%
10%
0%
Very strong desire to
Strong desire
practise medicine to practise medicine
Lukewarm
desire to practise
medicine
Male
Weak desire
to practise medicine
Regret becoming
a doctor
Female
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Workplace motivations and morale
Cohort doctors were asked to indicate the extent that they agreed with a number of
statements relating to their working lives. Figure 3 illustrates the responses of all cohort
doctors who had worked within the UK within the previous 12 months.
Cohort doctors were most likely to indicate that they strongly agreed or agreed with the
statement that they have to work extra hours to deliver the quality of care that patients
deserve (72%). Nonetheless, 67% of cohort doctors said that they look forward to going to
work. Cohort doctors were most likely to disagree with the statement that their workload has
a negative impact on the quality of care that patients deserve (22%) (figure 3).
Figure 3 – Please indicate to what extent you agree or disagree with the following statements
I feel I have to work extra hours to deliver the
quality of care that patients deserve
My job duties seem to never end
I feel listened to in my place of work
I look forward to going to work
My workload has a negative impact on the quality
of care that patients deserve
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Strongly agree
Agree
Neither agree or disagree
Disagree
Strongly disagree
Cohort doctors were provided with a list of potential factors that could affect their morale as
a doctor and were asked to indicate how, if at all, these factors affected their morale. As per
previous findings, the vast majority indicated interactions with patients very positively or
positively affected their morale as a doctor (88%). However, the majority of cohort doctors
felt that press coverage about doctors had a negative effect on their morale (77%) (figure 4).
Figure 4 – How would you say the following factors affect your morale as a doctor?
Interactions with patients bolster my morale
Press coverage about doctors has a negative
effect on my morale
My remuneration or pay has a positive
impact on my morale
My terms and conditions of service (eg sick pay or
study leave) negatively effects my morale
Public opinion about doctors has a positive
effect on my morale
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Strongly agree
Agree
Disagree
Strongly disagree
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As per previous annual cohort surveys, approximately one-half of cohort doctors rated
their level of morale as moderate (52%). Whilst speciality trainees’ reported levels of morale
remain constant compared to previous years (32% indicated they had high or very high
morale in 2013/14 compared to 35% in 2012/13), cohort doctors’ who were working as a
qualified GP indicated deteriorating levels of morale. 30% of cohort doctors who work as GPs
stated they had low or very low levels of morale compared to 20% in 2012/13 (figure 5).
Figure 5 – How would you generally describe your level of morale?
Total
Non-standard research or academic post
Specialty trainee
Qualified GP
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Very low
Low
Moderate
High
Very high
As per previous findings, cohort doctors who reported higher levels of morale also reported a
higher desire to practise medicine (figure 6).
Figure 6 – Level of morale by desire to practise medicine
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Very low
Low
Moderate
High
Very strong desire to practise medicine
Strong desire to practise medicine
Lukewarm desire to practise medicine
Weak desire to practise medicine
Very high
Regret becoming a doctor
11/06/2015 11:46
16
Work related stress
Cohort doctors were asked to rank the top five sources of stress within their workplace from
a pre-determined list as illustrated in figure 7 (1 = the most influential factor). As in 2011/12
and 2012/13, cohort doctors indicated that work-life balance or family responsibilities were
the biggest source of stress within their workplace. Once again, high levels of paperwork and
shortage of doctors in the workplace remain within the top three sources of stress for cohort
doctors (table 9).
Table 9 – Please rank your top three sources of stress within your workplace (with 1 being the most
influential factor) (top three sources of stress only)
Rank
Source of stress
Frequency
1
2
3
1
Work-life balance or family responsibilities
73
43
51
2
A shortage of doctors
57
33
23
3
High levels of paperwork
42
34
32
Figure 7 – Please rank your top three sources of stress within your workplace (with 1 being the most
influential factor)
Work-life balance or family responsibilities
Shortage of doctors
High levels of paperwork
Being able to do my job to the best of my ability
Change attributable to Government policies
Clinical rationing or cuts
Decisions made by management (not applicable to GP contractors)
Uncertainty about my future remuneration or pay
Shortage of other health professionals
Negative press coverage about the medical profession
Threats to my terms and conditions (eg sick leave, study leave)
Perceived poor clinical leadership
0
1
20
2
40
3
60
80
100
120
140
160
180
Accumulative frequency
Figure 8 illustrates that in general, cohort doctors reported moderate levels of work-related
stress. Cohort doctors working as qualified GPs reported the highest levels of stress. However,
there has been a slight fall in the numbers of qualified GPs who are saying they have high or
very high levels of stress year on year (47% in 2013/14 compared to 53% in 2012/11). Cohort
doctors who work in a non-standard research or academic role reported the lowest levels of
work-related stress; 23% of this group reported low work-related stress levels.
11/06/2015 11:46
17
Figure 8 – How would you generally describe your level of work-related stress?
Total
Specialty trainee
Qualified GP
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Very low
Low
Moderate
High
Very high
Working environment
Cohort doctors were asked to indicate the extent that they agreed to a series of statements
relating to their working atmosphere. In-line with the results of the eighth annual cohort
survey, cohort doctors were most likely to agree with the statement that their working
relationships with their supervisors are positive§ (85%) (figure 9).
Figure 9 – Please indicate to what extent you agree or disagree with the following statements relating to
your working atmosphere
My working relationships with
my supervisors are positive
I feel a strong sense of team in my workplace
My working arrangements are
sufficiently flexible for my needs
Positive change is happening in my workplace
I do not detect feelings of
negativity in my workplace
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Strongly agree
Agree
Disagree
Strongly disagree
While the majority of cohort doctors felt that in general, their workplace is positive,
18% of cohort doctors described the atmosphere in their workplace as generally negative.
Those cohort doctors who worked in general practice were more likely to be negative
about the atmosphere in their workplace (24%) and cohort doctors working in an academic
medicine post were more likely to indicate their working atmosphere is positive (61%)
(figure 10).
§
Only applicable to those cohort doctors still in training
11/06/2015 11:46
18
Figure 10 – Generally the atmosphere in my workplace is positive
Disagree
15%
Strongly disagree
3%
Strongly agree
8%
Neither agree
or disagree
25%
Agree
49%
Workplace culture
The cohort doctors were asked to what extent they agreed with three statements relating to
the culture of their workplace. Cohort doctors were most likely to indicate that they agreed
with the statement that there is an open and honest culture in their working environment
(74%) but were least likely to feel that any concerns raised in their workplace are listened to
and action taken (12%) (figure 11).
Further analysis of note by grade reveals that cohort doctors working as qualified GPs
continue to be much more likely to indicate that there are effective methods of raising
concerns in their place of work (81%).
Figure 11 – Please indicate to what extent you agree or disagree with the following statements relating to
the culture of your place of work
There is an open and honest culture in
my working environment
There are effective methods of raising
concerns in my place of work
Any concerns raised in my place of work are
listened to and action is taken
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Strongly agree
Agree
Disagree
Strongly disagree
11/06/2015 11:46
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Changes to work over time
Cohort doctors were asked to retrospectively reflect on how various aspects of their working
lives had changed over the past twelve months. Overall, cohort doctors were most likely to
indicate that their stress levels are now worse or much worse compared to a year ago (49%).
This was much more likely to be the case for cohort doctors who were working as a qualified
GP (62%). Views about work-life balance were much more varied however; with 42% of
cohort doctors saying that their work-life balance is now worse or much worse and
28% saying that their work-life balance has actually improved in the last year. This trend
was apparent across the different roles (figure 12).
Figure 12 – Compared to the last annual BMA cohort survey, how would you describe the change in your:
Working environment or culture of workplace
Desire to practise medicine
Morale
Work-life balance
Stress levels
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Much worse
Worse
No change
Better
Much better
Cohort doctors were also asked to indicate how the number of anti-social hours and the
number of hours they now work above their contract, have changed.
Figure 13 shows that specialty trainees were most likely to report an increase in the number
of anti-social hours they work now, compared to a year ago. Conversely figure 14 suggests
that GPs are most likely to have experienced an increase in the number of hours they work
above their contracted hours compared to a year ago.
Figure 13 – Compared to one year ago, please indicate if you are now more or less likely to work anti-social hours
Total
Specialty trainee
Qualified GP
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Much more likely
More likely
No change
Unlikely
Very unlikely
11/06/2015 11:46
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Figure 14 – Compared to one year ago, please indicate if you are now more or less likely to work above your
contracted hours
Total
Specialty trainee
Qualified GP
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Much more likely
More likely
No change
Unlikely
Very unlikely
When asked about their future career choices, cohort doctors were generally much more
unlikely now to be reconsidering changing their future career path, compared to a year
ago. 67% of cohort doctors said that compared to one year ago, they are now less likely
to consider changing specialty and 51% said they are now less likely to consider leaving
medicine completely. However, 31% of cohort doctors are now more likely to be considering
working overseas in the future and 28% are now more likely to be reconsidering their career
goals (figure 15).
When considering the responses to this question by gender, male cohort doctors were more
likely or much more likely to say they are now planning to work overseas temporarily (37%)
or permanently (22%) or at some point in the future (38%) when compared to a year ago,
than female cohort doctors (18%, 10% and 25% respectively). Male cohort doctors were also
more or much more likely to be considering leaving the NHS compared to a year ago (31%)
than female cohort doctors (21%). However, there were very few gender differences of note
where it came to the likelihood of now reconsidering career goals, changing specialty or
leaving medicine completely.
Figure 15 – Compared to one year ago, please indicate if you are now more or less likely to be:
Considering changing your specialty
Planning to work overseas permanently
Considering leaving medicine completely
Planning to work overseas temporarily
Considering leaving the NHS, though
continuing to work in medicine
Reconsidering your career goals (ie grade)
Considering working overseas in the future
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Much more likely
More likely
No change
Unlikely
Very unlikely
11/06/2015 11:46
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Awareness of issues facing the medical profession
Cohort doctors were asked to what extent they agreed with a number of statements relating
to how different specialties work together. Cohort doctors were most likely to say that they
are aware of the challenges facing other specialties within their sector (76%) and other
sectors (57%). Cohort doctors were most likely to disagree with the statement that primary
and secondary care work collaboratively with social care (67% disagreed with this) and 59%
of cohort doctors disagreed with the suggestion that primary and secondary care work
collaboratively.
Figure 16 – In general, would you agree that:
I am aware of the challenges facing other
specialties within my sector
I am aware of the challenges facing other
specialties outside my sector
Hospital specialists work well
across different specialties
Primary and secondary care work collaboratively
Primary and secondary care work
collaboratively with social care
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Strongly agree
Agree
Disagree
Strongly disagree
Role-related responsibilities
When asking about management roles, as per the results of the previous annual survey,
cohort doctors who were working as a qualified GP were most likely to say that they already
hold a management position (18%). However, one-third of cohort doctors who work as a GP
(32%) said they would not consider taking on a management role in the future. Over one-half
of specialty trainees (55%) said they would consider taking on a management role at some
point (figure 17).
Figure 17 – Would you consider taking on a managerial role in the future?
Total
Specialty trainee
Qualified GP
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Yes
No
Don’t know
Already hold a managerial position
11/06/2015 11:46
22
Just less than one-half of cohort doctors (48%) said they had not undertaken any form of
management training. Those cohort doctors who had, were most likely to have received this
training within the curriculum of their specialty training programme (24%). This was most
likely to be the case for cohort doctors working in a research/academic post (40%).
Figure 18 – Have you undertaken any formal management training?
Yes – as part of my
medical graduate course
5%
No
48%
Yes – some management training
was included within the curriculum
of my specialty training programme
24%
Yes – I have undertaken
management training
outside of medicine
4%
Yes – I chose to undertake
management training post-CCT
2%
Yes – I chose to take some time
out of programme to undertake
management training
5%
Yes – I chose to undertake management
training whilst I was completeting
my postgraduate training
12%
11/06/2015 11:46
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6Working as a Specialist Trainee – Professional
development/education
61% (135 of 221) of cohort doctors who were undertaking specialty training indicated they
were on a run-through training programme and 31% (68 of 221) cohort doctors were training
on core or uncoupled specialty training programmes.
Reassuringly, the vast majority of cohort doctors in specialty training (95%; 212 of 222) were
of the view that they had not been asked to undertake tasks which they felt were beyond
their capabilities during the last year and just 5% of cohort doctors in specialty training
indicated they had. This trend is in line with the finding that the proportion of cohort doctors
who stated they had been asked to complete tasks they felt to be beyond their capabilities,
has generally fallen year-on-year since graduation (figure 19).
Figure 19 – Per cent of cohort doctors who reported they were asked to undertake tasks they felt were beyond
their capability since graduation
40%
35%
30%
25%
20%
15%
10%
5%
0%
One year
post-grad
Two years
post-grad
Three years
post-grad
Four years
post-grad
Five years
post-grad
Six years
post-grad
Seven years
post-grad
Eight years
post-grad
Working environment
Cohort doctors were asked about their experience of working in a team, the educational
value of their post and the general working environment of their placements. Figure 20
shows that cohort doctors remain typically most positive about the amount of variety in
their jobs, the complexity of their work and team spirit. The most negative aspect of their
experiences across all placements continues to be working conditions; however, experiences
of their working conditions were still most frequently positive.
Overall, there has been a slight shift in cohort doctors’ perceived working environments
over the past three years. The biggest change is a negative one; this relates to working
atmosphere which was an average of 2.7 in 2011/12 compared to 3.6 in 2013/14 where
on a scale of 1 to 9, 9 = bad (figure 20).
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24
Figure 20 – Experience in relation to team and overall working environment during specialty training, 2013/14,
compared to 2012/13 and 2011/12 (1 = good to 9 = bad)
5
4
3
2
1
0
m
Tea
spi
m
Tea
r it
com
m
ic
un
at i
on
Wo
s
rki
ng
d
con
it io
ns
Tea
up
ms
Am
2011/12
ou
n
po
rt
fv
to
ar i
et
y
y in
Pac
eo
2012/13
ou
r jo
e
f sp
b
cia
lt y
in
or
te n
sit y
Co
mp
le
o
x it y
fw
or k
rk
Wo
ing
at
sp
mo
he
re
2013/14
Eight years post-graduation, the working atmosphere for cohort doctors has remained at a
similar level to the previous year. On average, cohort doctors rated their working atmosphere
as 3.6 in 2013/14 and 2012/13 (where 1 = cooperative and 9 = competitive) compared to an
average score of 2.7 in 2011/12. There were no significant differences in how male or female
cohort doctors rated the NHS in their workplace.
When asked to rate NHS culture on a scale ranging from 1 (cooperative) to 9 (competitive),
cohort doctors averaged NHS culture as 4.6; slightly higher than the midway point. Cohort
doctors who were training in obstetrics and gynaecology were most likely to rate the NHS
at the competitive end of the scale (mean = 5.3) and were also more likely to have indicated
an increase in competitiveness in NHS culture in the past year. Cohort doctors training in
paediatrics and child health were most likely to rate the NHS culture as cooperative
(mean = 3.8). Cohort doctors who worked in research/academic medicine or who were
in a higher surgical training post were most likely to report a positive shift in NHS culture
in the past year, with suggestions that they are now working in a more cooperative
culture (figure 21).
11/06/2015 11:46
25
Figure 21 – How would you describe NHS culture during your last year (2013/14 compared to 2012/13)?
Clinical radiology and oncology
Anaesthetics
Research/academic medicine
General practice
Emergency medicine
1
2
3
4
5
6
7
8
Cooperative
9
Competitive
2012/13
2013/14
Cohort doctors were asked to rate educational aspects of their specialty training on a scale
of 1 to 9; where 1 = good and 9 = bad. As in previous years, cohort doctors were generally
most positive about their clinical supervision (mean = 3.2). The most negative aspects
continued to be access to study leave funding (mean = 4.7) and feedback from workplace
based assessments (mean = 4.6). Both of these educational aspects of cohort doctors’
specialty training programmes were rated more negatively in 2013/14 compared to
2012/13 (mean = 4.4 and 4.2 respectively) (figure 22).
Figure 22 – How would you rate the following educational aspects of your specialty training programme?
(1 = good to 9 = bad)
Clinical supervision
Your ARCP (annual review of
competence progression)
5.00
4.00
Access to study leave time
3.00
Quality of feedback from
workplace based assessments
2.00
Access to study leave funding
1.00
0.00
Content of workplace based assessments
Ease of undertaking workplace
based assessments
Support and guidance from
your educational supervisor
Regular appraisal opportunities
Having clear achievable objectives
within your PDP
Support to complete your portfolio
11/06/2015 11:46
26
Undertaking specialty training
As per last year’s findings, when asked what factor most affected their work-life balance
as a doctor, cohort doctors in specialty training were most likely to indicate that their own
willingness to work additional, often unpaid hours, had the biggest negative impact on their
work-life balance (24% compared to 25% in 2013/14). On-call obligations and the impact of
studying for Royal College exams were once again identified as having significant negative
impacts on cohort doctors’ work-life balance (13% and 12% respectively) (figure 23).
Figure 23 – Which of the following most negatively affects your work-life balance as a doctor?
Overrunning shifts
7%
The amount of time I have to
travel to and from work
10%
My willingness to work additional
often unpaid hours
24%
Paperwork
14%
The time involved in studying
for royal college exams
13%
The frequency with which I am
scheduled to be on-call
13%
Poor advanced notice of rotas
7%
Insufficient rest periods
between rotas
4%
Backfilling long-term rota gaps
8%
When considering these findings for those cohort doctors who work in hospital specialties,
those undertaking higher surgical training were most likely to have indicated that their
work-life balance is most negatively impacted by their willingness to work additional, often
unpaid, hours (57%). In addition, 34% of cohort doctors who were undertaking higher
medical training indicated their work-life balance was most negatively affected by their
willingness to work unscheduled hours. Also of note, is that 38% of cohort doctors working in
paediatrics and 31% of cohort doctors who were training in emergency medicine indicated
that the frequency that they are scheduled to be on-call had the most negative impact on
their work-life balance. Cohort doctors who were training in anaesthetics (37%) were most
likely to indicate that the time involved studying for royal college exams most negatively
impacted on their work-life balance.
Cohort doctors undertaking general practice specialty training were most likely to indicate
that paperwork (43%) and their own willingness to work additional, often unpaid, hours
(22%) most negatively affected their work-life balance as a doctor.
When asked to generally describe their level of work-life balance, cohort doctors on average
rated their work-life balance as neither good nor bad (mean = 2.7 when 1 = very low and
5 = very high). There was some variation however, by specialty. 56% (14 of 25) of cohort
doctors who were undertaking higher surgical specialty training said their work-life balance
is very low or low. This coincides with the finding that cohort doctors undertaking higher
specialty training were most likely to report that their work-life balance is most negatively
impacted by their willingness to work additional, often unpaid, hours. Cohort doctors who
were undertaking a general practice specialty training programme had the best work-life
balance as 24% stated they had a high or very high work-life balance (figure 24).
11/06/2015 11:46
27
Figure 24 – How would you generally rate your work-life balance? (1 = very low, 5 = very high)
General practice
Anaesthetics
Emergency medicine
Total
0%
Very low
Low
20%
40%
Moderate
60%
High
80%
100%
Very high
Cohort doctors were asked to indicate the perceived levels of pressure they had felt during
their placements over the previous year. The majority of cohort doctors stated that work
pressure was steady with a burst of pressure (63%; 139 of 221). 25% (55 of 221) of respondents
said they experienced continuous work pressures and the minority (11%) said they
experienced minimal or no (1%) pressure. There is no suggestion that this result varies by year
of study and this finding is generally in-line with the results of the previous annual survey.
Cohort doctors were asked to rank the top three factors that they attribute this work
pressure to. The expectations of their specialty, the difficulty of maintaining a good worklife balance and working anti-social hours were the top three factors that cohort doctors
identified as having a negative impact on their perceived work pressure (figure 25).
Figure 25 – Rank the top three factors you attribute this pressure to
The expectations of my specialty
Difficulty maintaining a good work or life balance
Working anti-social hours
I put myself under pressure
Studying for exams in order to progress my career
Gaps on my rota
Personal financial pressures
Not having any bleep-free time to train in your specialty
Insufficient notice of rotas
0
10
20
30
40
50
60
70
80
90
100
Accumalative frequency
1
2
3
11/06/2015 11:46
28
The impact of working on a rota
The vast majority (171 of 222) of cohort doctors undertaking specialty training indicated
they worked on a rota. When asked to indicate the level of gaps on their rota, cohort doctors
most frequently indicated there are/have been long-term gaps on their rota (60% of cases).
This figure has increased from the results of the previous annual survey (where in 46% of
cases there were long-term rota gaps) (figure 26).
Figure 26 – If yes, how frequently have there been gaps on your rota over the last year? (multiple response)
There are rarely short-term gaps on my rota
There are sometimes short-term gaps on my rota
There are often short-term gaps on my rota
There are/have been long-term gaps on my rota
0%
10%
20%
30%
40%
50%
60%
70%
Per cent of cases
When asked to indicate the impact that rota gaps had, cohort doctors were most likely to
indicate that the Trust they worked for generally relied on locums to provide cover for rota
gaps (68% of cases). Worryingly over one-half (53% of cases) of cohort doctors who worked
on a rota indicated that there were often staff shortages as a result of rota gaps. One-third
(32% of cases) said that they were on-call more often as a result of rota gaps (figure 27).
Figure 27 – What were the impacts of these rota gaps? (multiple response)
My annual leave was disrupted as a result of rota gaps
I was often required to work on my rest days to
provide cover for rota gaps
My shifts often overran as a result of rota gaps
I was not able to take study leave if there were rota gaps
I frequently worked more than the average 48-hour week
I was on-call more often, as a result of rota gaps
There were often staff shortages as a result of rota gaps
The Trust generally relied on locums to provide
cover for rota gaps
0%
20%
40%
60%
80%
Per cent of cases
11/06/2015 11:46
29
Overall experience of specialty training
Cohort doctors were asked if their experience of specialty training so far allowed them to
develop their career to the best of their ability. Over one-half (58%) of cohort doctors felt
that their specialty training programme had allowed them to develop their career; however,
21% of cohort doctors felt this had not been the case (compared to 16% in 2012/13).
Figure 28 illustrates there was some degree in variation to the response to this question
dependent on specialty. Cohort doctors who worked in anaesthetics were most likely to feel
that their specialty training programme had allowed them to develop their career to the best
of their ability (75%). Conversely, just 38% of cohort doctors who were undertaking higher
surgical specialty training felt their specialty training programme allowed them to fulfil their
potential. There has been a noticeable shift in general practice specialty trainee’s opinions
about specialty training during the last year. In 2012/13 75% of cohort doctors who were
undertaking specialty training felt that their specialty training programme had so far allowed
them to develop their career to the best of their ability; this fell to 56% in 2013/14.
Figure 28 – Has your experience of specialty training so far allowed you to develop your career to the best of
your ability? (by specialty)
General practice
Emergency medicine
Anaesthetics
Total
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Yes
No
Don’t know
Those cohort doctors who indicated that their specialty training so far had not allowed
them to develop their career to the best of their ability were asked why. Table 10 shows the
main themes identified as a result of analysis of these responses. The most common theme
to emerge was that specialty training had not allowed them to develop to the best of their
ability as there had been too much emphasis on service provision during the course of
their specialty training (44% of cases). Furthermore, a further 42% of responses suggested
that their specialty training placements had not provided enough exposure to training
opportunities in their specialty.
Table 10 – Why has your experience of specialty training so far not allowed you to develop your career to the
best of your ability?
n= 45
Frequency
% of cases
Too much service provision
20
44.4%
Insufficient exposure to training opportunities in my specialty
19
42.2%
Problems finding time to study/accessing study leave
6
13.3%
Hours/frequency of being on call were too demanding
4
8.9%
Variation in quality of speciality training placements between trusts
3
6.7%
Other
10
22.2%
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7
Working as a General Practitioner
Current post
The number of cohort doctors who worked as a qualified GP in the UK has increased from
64 in 2011/12, 93 in 2012/13, to 108 in 2013/14.
In contrast to previous annual cohort surveys where cohort doctors who had qualified as a
GP were most likely to work in a salaried GP post, cohort doctors who have qualified as GPs
are now most likely to be working as a GP principal (48%). This was much more likely to be the
case for male cohort doctors (73%) compared to female cohort doctors (32%).
Conversely, the proportion of cohort doctors who had qualified as a general practitioner
working as a salaried GP has slightly fallen over three years, from 47% in 2011/12 to 44% in
2013/14. It remains the case that female cohort doctors are more likely to work in a salaried
GP role (54%) compared to male cohort doctors (24%).
There has however, been an even more dramatic reduction in the proportion of cohort
doctors who worked as a freelance GP (from 27% in 2011 to 13% in 2013/14). No male cohort
doctors reported working as a GP locum whereas one in 10 (11%) of female cohort doctors
work as a GP locum. Other GP roles included working as a GP retainer or as an out of hours
(OH) GP (figure 29).
Figure 29 – Which of the following best describes your main current post? (2011/12 to 2013/14)
Other
Freelance GP (locum)
Salaried GP
GP Principal (Partner)
0%
5%
10%
15%
20%
2011/12
25%
30%
2012/13
35%
40%
45%
50%
2013/14
Cohort doctors who worked as a salaried or freelance GP were most likely to say that the
main reason for working in these roles is the flexibility that this post affords for a good
work-life balance (42%). One-fifth (21%) of cohort doctors who work as salaried or a
freelance GP say that there is too much uncertainty facing general practice to commit
to a partnership. Other reasons include a lack of opportunities in their area to secure
a partnership or not being able to afford to buy into a GP partnership (figure 30).
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31
Figure 30 – If you are currently working as a salaried or freelance GP, what is the main reason for this?
Other
18%
The flexibility that this
post affords/the
desire for a good
work-life balance
42%
Working as a salaried/locum
GP allows me to work in a
number of different roles
4%
GP partners are too overworked
2%
There is too much uncertainty
facing general practice to
commit to a partnership
21%
I am not ready to financially
commit to one practice
8%
I wanted to work in a number of practices
before I commit to a partnership
5%
Portfolio careers
Those cohort doctors who were working as a qualified GP were asked if they are currently
working as a portfolio GP. This can be defined as working in one or more additional roles
other than medical general practice. The minority of cohort doctors who currently work as
a GP said that working as a portfolio GP does not interest them (32%). However, a further
21% of cohort doctors who are working as a GP are already working as a portfolio GP and an
additional 26% would like to do so in the future. This has potentially significant findings for
medical workforce planning as GPs who have a portfolio career path are more likely to work
less hours in their primary role as a general practitioner (figure 31).
Figure 31 – Are you currently working as a portfolio GP?
No, I’d like to, but my
workload does not currently
allow for this
21%
No, but I’d like to
in the future
26%
Yes
21%
No, working as a portfolio
GP doesn’t interest me
32%
Those cohort doctors who said they were currently working as a portfolio GP were working
in roles including medical education (11 of 22), working as a CCG representative (five of 22),
working as a GP with a special interest (six of 22), were undertaking voluntary work in a GP
capacity (three of 22) and running a sexual health clinic (one of 22).
The main attractions for working as a portfolio GP, for those who were currently doing so,
was the attraction of greater variety in their work (five of 22), an escape from the pressure
of working as a GP (three of 22), the needs of the patients/practice (three of 22).
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32
The pressure of working as a GP
Cohort doctors who had worked as a general practitioner during the last year were asked
to describe the general level of pressure they felt during the last year. Cohort doctors were
most likely to indicate experiencing continuous pressure (56%). There was not a great
variation in the reported levels of pressure by grades (figure 32).
Figure 32 – How would you describe the general level of pressure that you felt during your working days during
the last year?
Total
Salaried GP
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Continuous pressure
Steady with bursts of pressure
No pressure
When asked to rank the top three factors that they attributed this pressure to, cohort doctors
were most likely to identify unrealistic patient expectations, the volume of patients and
more complex work (eg the volume of multiple morbidity patients) as the main causes of this
pressure. These findings were broadly in line with the previous annual survey (figure 33).
Figure 33 – Please rank the top three factors you attribute this pressure to
Unrealistic patient expectations
The volume of patients I see in one day
More complex work (eg volume of multiple morbidity patients)
Volume of paperwork
Time pressures dictated by appointment slots
Not being able to give my patients sufficient time and attention
The struggle to maintain a good work-life balance
Staff management responsibilities
Gate keeper referrals
Personal financial concerns
0
10
20
30
40
50
60
Accumalative frequency
1
2
3
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33
The general practice workforce
Cohort doctors were asked to respond to a series of statements relating to the general
practice workforce in the region where they work. Most responses point to an increasing
shortage of general practitioners. For example, 80% (compared to 46% in 2012/13) of cohort
doctors said there is already a shortage of GPs in their area. One in five (21%) disagreed with
the statement that there are limited or no GP partnership opportunities in the area where
they work (figure 34).
Figure 34 – Please indicate to what extent you agree or disagree with the following statements on the general
practice workforce in your geographical area of work
There is a GP shortage – there are numerous GP
vacancies in practices in my area
I know of a number of partner GPs who have recently
retired or are planning to retire in the next year
GPs are increasingly resigning from
their practices to work as locums
GP partnership mergers or networks
have been created in my area
There are limited or no GP partnership
opportunities in the area where I work
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Strongly agree
Agree
Disagree
Strongly disagree
Work-life balance working as a GP
Cohort doctors were provided with a list of factors that could impinge on their work-life
balance and were asked what factor most negatively affects their work-life balance as a GP.
39% of cohort doctors indicated that paperwork most significantly negatively affected their
work-life balance. Salaried GPs were much more likely to indicate that their willingness to
work additional, often unpaid hours (27%), had the most negative impact on their work-life
balance whereas 22% of cohort doctors who worked as a principal GP felt that competing
demands on their time from patients and staff had the most negative effect on their worklife balance. These findings were generally in line with the results of the previous annual
cohort survey (figure 35).
Figure 35 – Which of the following most negatively affects your work-life balance as a GP?
Total
Salaried GP
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
My willingness to work additional, often unpaid, hours
Paperwork
The amount of time I have to travel to and from work
Meetings (eg practice meetings or CCG meetings)
Competing demands on my time from staff and patients
Overrunning surgeries
A lack of breaks or time between appointments
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34
In contrast to the previous annual cohort survey where cohort doctors who were working as
a GP principal were much more likely to indicate they had a poor work-life balance (47%), the
results of this survey suggest that cohort doctors who work as a salaried GP were more likely
to report a poor or very poor work-life balance (40%) (figure 36).
Figure 36 – How would you generally describe your level of work-life balance as a GP?
Total
Salaried GP
0%
10%
Very low
20%
30%
Poor
40%
50%
60%
Neither poor or good
70%
80%
Good
90%
100%
Very good
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8
35
Career expectations
Specialty choice
The majority (74%; 315 of 426) of cohort doctors indicated that they are confident that
they have chosen the right specialty for them; however, 21% (88 of 426) of cohort doctors
feel that although they are happy with their choice of specialty at this time, they are not
confident they will remain in that specialty for the rest of their careers. Just 5% (23 of 426)
of cohort doctors are not happy with their choice of specialty. These findings are in line with
the results of the two previous annual surveys.
Figure 37 illustrates that cohort doctors who worked in research or academic medicine
were most likely to indicate that they had chosen the right specialty (91%; 20 of 22).**
Cohort doctors who were working as a GP were more likely to indicate that they may
not remain in their specialty for their entire careers (25%; 28 of 113).
Figure 37 – To what extent are you happy with your choice of specialty? (by specialty category)
Total
Specialty trainee
Qualified GP
0%
10%
20% 30% 40% 50% 60% 70% 80% 90% 100%
I am confident that I chose the right specialty for me
I am happy with my choice of specialty at this time, but I am not sure I will remain in this specialty
I am not happy with the choice of my specialty
Career change
27% (113 of 426) of cohort doctors indicated that their experience during the last year has
changed their career intentions. This finding is slightly higher than last year when 22% of
cohort doctors said their experience in the past year changed their career intentions.
The trend that female cohort doctors are slightly more likely to change their career
intentions (28%; 67 of 240) compared with male cohort doctors (24%; 45 of 185)
remains though.
As per the previous annual survey, cohort doctors undertaking research or academic
medicine were slightly more likely to have changed their career intentions in the last year
(27%; six of 22) compared to other cohort doctors (figure 38).
** Due to the small sample size, it is not valid to analyse the results of this question by hospital specialty.
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36
Figure 38 – Have your experiences during the last year changed career intentions? (by specialty category)
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Qualified GP
Specialty trainee
Non-standard
research or
academic post
Yes
Total
No
As per previous surveys, the most common reason for a change in career intentions was
working conditions followed by domestic circumstances and hours of work. Other key
factors for change of career include not enjoying their current specialty, an interest in
academic medicine and personal circumstances (table 11).
Table 11 – Reasons for change in career intentions during the last year
n=111
Frequency
% of cases
Work conditions
67
60.6
Domestic circumstances
51
45.9
Hours of work
56
51.0
Future financial prospects
33
29.8
Career and promotion prospects
28
25.1
Projected oversupply of CCT holders in my previous specialty
13
11.9
Career outside of medicine
18
16.0
Advice from a senior doctor
11
10.3
Other
23
21.2
Note: multiple response question
Table 12 shows cohort doctors’ specialties as of August 2012 compared to their revised
changed career intentions. 43% of cohort doctors who have changed their career intention
during the last year have no idea on what their new preferred career option may be. 26% now
prefer an alternative career in hospital medicine and 11% prefer a career in general practice.
Of those cohort doctors who had changed their career intentions in the last year and who
had indicated that they would prefer a career in hospital medicine, cohort doctors were most
likely to indicate that they would prefer a career in a medical specialty (for example, acute
medicine, general internal medicine). Paediatrics and child health, emergency medicine and
surgical specialties were some of the more common specialty choices for cohort doctors.
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37
Table 12 – Preferred career option of cohort doctors who had changed their career intention during the last
year (by current specialty August 2013-2014)
Current specialty
Hospital
practice
General
practice
Public
health
medicine
Community
health
Research
or
academic
medicine
Other
Hospital
practice and
research/
academic
medicine
Total
Hospital practice
14
3
0
0
8
0
1
26
General practice
2
9
0
0
0
0
0
11
Public health
medicine
1
1
0
0
0
0
0
2
Community health
0
0
0
1
1
0
0
2
Research or
academic medicine
2
0
0
0
3
0
0
5
No clear idea
20
16
1
0
4
2
0
43
Other
3
6
0
0
0
1
0
10
Total
42
35
1
1
16
3
1
99
Career goals
Table 13 shows the ultimate career goals of all cohort doctors. Over one-half (51%; 218 of 424)
of cohort doctors aspire to the consultant grade, although this has dropped slightly from
55% in 2012/13. Around one in 10 are still undecided as to their ultimate career goal.
These findings are in line with the results of the previous annual survey; however, there is
evidence of a continued fluctuation in the number of cohort doctors who now have the
career goal of a salaried GP (5.2 % in 2011/12, 3.4 % in 2012/13 and 5.0% in 2013/14).
Two per cent of cohort doctors are now looking for a career outside of medicine
(compared to 0.5% in 2012/13).
Table 13 – Career goals 2013/14
Frequency
%
Consultant
218
51.4
GP principal
98
23.2
Salaried GP
21
5.0
GP Locum
2
0.5
Lecturer/Academic
22
5.3
Undecided
39
9.1
Specialty doctor
6
1.3
Other
8
1.9
Career outside medicine
10
2.3
Total
424
100.0
No reply
6
–
Whilst the table above indicates that just 23% of cohort doctors aspire to work as a GP
principal, this somewhat contradicts the earlier finding that cohort doctors who have
qualified as GPs are now most likely to be working as a GP principal. To understand the
ultimate career goals of qualified GPs, table 14 cross tabulates the ultimate career goals of
cohort doctors who are currently working as a GP by their existing grade. This shows that
although 48% of cohort doctors who are currently working as a qualified GP are working as
a GP principal (53 of 108), 29% of these cohort doctors do not see working as a GP principal
as their ultimate career goal (15 of 51). Indeed, 16% (eight of 51) of cohort doctors who are
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38
working as a GP principal say that they are still undecided as to their ultimate career goal.
Conversely, just 17% (eight of 48) of those cohort doctors who are working as a salaried GP
say that this is their ultimate career goal.
Table 14 – Which of the following is your ultimate career goal by which of the following best describes your
main current role (only cohort doctors currently working as a GP)
Ultimate career goal
Main current post
Total
GP Principal
(Partner)
Salaried GP
GP principal
36
32
75
Salaried GP
2
8
11
GP Locum
0
1
2
Lecturer/Academic
1
0
1
Undecided
8
4
12
Other
3
2
6
Career outside medicine
1
1
3
Total
51
48
110
No reply
2
2
4
Figure 39 shows that in-line with previous findings, female cohort doctors are more likely to
plan a career in any of the GP roles. Male cohort doctors are more likely to plan for a career as
a lecturer/academic. Cohort doctors aspiring to be a consultant remain fairly evenly divided
according to gender.
Figure 39 – Career goals by gender 2013/14 (%)
Total
Salaried GP
GP principal
Undecided
Consultant
Academic or Lecturer
0%
10%
20%
30%
40%
50%
Male
60%
70%
80%
90%
100%
Female
Career advice and support
Just 55% (235 of 425) of cohort doctors reported careers advice and support was available
to help them achieve their career goals. Hospital based cohort doctors were most likely to
indicate that careers advice and support is available to help them achieve their career goals
(71%; 137 of 195), closely followed by cohort doctors undertaking general practice specialty
training (64%; 16 of 25). Half of cohort doctors who have qualified as a GP said that they did
not feel that career support was available to them to help them achieve their career goals
(49%; 55 of 113). This is a potentially important finding as there is currently a predicted
shortage of GPs in the UK in the future, and optimising the existing workforce could be
essential to the sustainability of the general practice workforce.3
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39
The main sources of careers advice and support included senior colleagues (consultants,
GPs, senior registrars and academics), educational supervisors, GP trainers, Deaneries and
Royal Colleges and the BMA. The majority (150 of 235) of cohort doctors who reported that
careers advice was available to them indicated that it was useful.
Job security
Cohort doctors were asked to indicate their level of job security. 48% of cohort doctors
thought they would definitely get a job in their chosen specialty; a marked rise from 2012/12
when 42% of cohort doctors still in training thought they would definitely secure a post in
their specialty. One-third (81 of 248) of cohort doctors felt that they will possibly get a job
in their chosen specialty. Cohort doctors undertaking general practice specialty training
continue to be much more likely to think that they will definitely get a job in their chosen
specialty than cohort doctors working in a hospital specialty (figure 40).
Figure 40 – To what extent do you envisage getting a job in your chosen specialty once you have completed
your training? (Excludes qualified GPs)
Total
Hospital practice
General practice
0%
10%
20%
30%
40%
50%
60%
70%
80%
90% 100%
I will definitely get a job in my chosen specialty
I will definitely get a job, but not necessarily in my chosen specialty
I will possibly get a job in my chosen specialty
I will possibly get a job, but not necessarily in my chosen specialty
I don’t think I will get a job on qualification
Don’t know
Intentions to practise medicine outside the UK
As in previous years, male cohort doctors (47%) were more likely to indicate that they
plan to practise medicine outside of the UK than females (30%). Overall, eight years after
graduation, 37% of cohort doctors plan to practise medicine overseas either temporarily or
permanently. This finding is in-line with the results of the previous annual survey (table 15).
Table 15 – Intention to practise medicine outside the UK, either temporarily or permanently in the future
Frequency
%
Yes, temporarily
114
27.2
Yes, permanently
42
10.0
No present plans to practise overseas
263
62.8
Total
419
100.0
No response
12
–
Those cohort doctors who indicated they wanted to work overseas temporarily in the future
were most likely to intend to do so post-CCT (58 of 114). 23% (26 of 114) of cohort doctors
who indicated they intend to work overseas temporarily want to do so as a senior registrar
and 10% were not entirely sure of the timing (11 of 114).
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40
Cohort doctors who intend to work overseas permanently in the future were also most likely
to say they intend to do so post CCT (16 of 42). Three in 10 cohort doctors who said they
intend to work overseas on a permanent basis in the future said they are already doing so
(12 of 42).
The main reasons given for intending to practise medicine outside the UK include to
broaden or gain medical experience, better lifestyle, better working conditions, life
experience, fellowship opportunities and the experience of working in a different health care
system or humanitarian or development medicine or an ‘escape’ from working in the NHS.
Destination countries include Australia, New Zealand, the US, Canada and the developing
world. These findings are in line with the results of previous annual surveys.
Intentions to work part-time
There has been an increase in part-time working in the past year. 28% (119 of 421) of cohort
doctors in 2013/14 said that they are currently working part-time compared to 23% in
2012/13. Although there has been an increase in part-time working for both male and
female cohort doctors, part-time working continues to be more common for females
(41%; 98 of 238) compared to male cohort doctors (12%; 21 of 183). A further one-quarter
of female cohort doctors (23%; 55 of 238) intend to work part-time in the future.
Conversely, 79% (144 of 188) male cohort doctors are training or working full-time (figure 41).
Figure 41 – Are you working/training part-time? (by gender)
Total
Female
Male
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Yes – I currently work or train part-time
No – but I intend to work part-time in the future
No – I work or train full-time
When analysing the results of this question by specialty, cohort doctors who were working
as a qualified GP were most likely to already be working part-time (50%; 68 of 135).
This finding suggest an increase in part-time working in general practice over the past year
as 33% of cohort doctors who worked in general practice were working on a part-time basis
in 2012/13. Cohort doctors working in research or academic medicine were most likely to
intend to work or train part-time at some point in the future (28%; 10 of 36)†† (figure 42).
†† Due to the small sample size, it is not valid to analyse the results of this question by hospital specialty.
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41
Figure 42 – Are you working/training part time? (by specialty)
General practice
Hospital practice
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Yes – I currently work or train part-time
No – but I intend to work part-time in the future
No – I work or train full-time
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42
References
1
BMA. (2007) First report of the BMA cohort study of 2006 medical graduates.
Website. 2006. http://bmaopac.hosted.exlibrisgroup.com/F?func=findb&request=cohort+study&find_code=WRD&local_base=W-BMA01.
2
General Medical Council (2013) National Training Survey 2013. Website. 2013.
http://www.gmc-uk.org/education/national_summary_reports.asp.
3
Department of Health (2012). Modernisation of Health and Care. Website. June 2012.
http://webarchive.nationalarchives.gov.uk/20130805112926/http://healthandcare.
dh.gov.uk/category/health-and-social-care-bill/
4
BMA (2014). BMA Discussion Paper: Doctors at a Dead End? Medical Unemployment
and Underemployment in the UK. Website. March 2014.
http://bmaopac.hosted.exlibrisgroup.com/exlibris/aleph/a21_1/apache_media/
YQJIFMQ2VRC497S6S8LIC6YD5UTR3I.pdf
5
Francis. R. (2013). The Mid Staffordshire NHS Foundation Trust Public Inquiry.
Website. February 2013. http://www.midstaffspublicinquiry.com/
6
British Medical Association (2015). 2014 Medical Workforce Briefing. Website. May 2015.
http://bma.org.uk/-/media/files/pdfs/working%20for%20change/policy%20and%20
lobbying/uk%20medical%20workforce%20briefing%20may%202015%20final.pdf
11/06/2015 11:46
11/06/2015 11:46
Kylie Lewington
[email protected]
Health policy and economic research unit
British Medical Association, BMA House,
Tavistock Square, London WC1H 9JP
bma.org.uk
© British Medical Association, 2015
BMA 20150418
11/06/2015 11:46

Cohort study of 2006 medical graduates

Transcription

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