The UK's Doctor Drain

In the past two months, I’ve gotten eight emails from physician recruiters asking me to go work as a physician in the UK. That’s eight more than I’ve ever gotten in my life. So it got me to thinking, What the heck is going on in the UK?

Turns out, in a growing European trend dubbed “Drexit,” doctors are now leaving the United Kingdom in record numbers. According to an NIH report, from 1974–2002, an impressive 98.8% of physicians were still working in Great Britian’s National Health System (NHS) at least ten years after training completion. By 2019, that number had dropped to a troubling 37.7%. An even more recent survey revealed that over 1,000 doctors plan to leave the NHS within the next three years.

The physician exit accelerated after the January 2020 British withdrawal from the European Union known as “Brexit.” Brexit took a negative toll on the British economy, GDP, and average wages. What is the connection to doctors? And why should the United States care?

Although burnout is often cited as one reason for the United Kingdom’s doctor exit, most of our physician colleagues across the pond who leave their home country actually continue their work as doctors in other counties. The top destinations include Australia, The United States, and The United Arab Emirates (UAE). Most of the departing British physicians cite internal push factors “pushing” them out of the country. These factors include significantly declining wages, lack of respect, a reduced investment in training and mentoring, inflexible schedules, lack of consistent teamwork, an understaffed service, more admin work, and increasing work hours with less pay. They also cite external “pull factors” enticing or “pulling” them out of the country including higher wages, more job choices, more support staff, increased respect, and greater schedule autonomy as reasons for pursuing medicine in other countries.

The mass British physician departure is a cautionary tale. It is a stark reminder that competitive salaries, teamwork, mutual respect, schedule autonomy, reduced administrative burden, and active investment in long term training and mentoring are requirements for retaining a highly educated, highly competitive workforce. While we don’t have a mass exodus of American doctors (yet), we do have a growing shortage of American military pilots, doctors, and teachers. Like the British docs, these crucial parts of the American workforce are also leaving their current jobs in large numbers for similar opportunities with better pay and greater flexibility.

For more than five years, the U.S. Air Force has deemed its growing pilot shortage an “official crisis.” To try and solve the problem, it has established a task force and approved large-scale increases in pilot retention bonuses to try and solve the problem. Despite these efforts, most Navy bases are now operating with 40–50% less pilots than they were just 20 years ago.

Chief of Navy Personnel Vice Admiral Robert Burke testified before the Congressional Subcommittee on Military Personnel in July 2019 that, “While mid-level officer retention represents our greatest challenge, resignations have also increased among junior and senior aviators due, in part, to intense competition from private industry.” He cited this trend beginning since 2009. One Navy commander fighter pilot summed it up by saying, “They ask for more and more each year with less and less people. Meanwhile, I can go make triple my salary while working less for the commercial airlines. And they actually respect me.”

According to a 2022 report by the U.S. Department of Education, 41 states and the District of Columbia are facing significant teacher shortages in more than one subject area. Like the British physicians and American military pilots, teachers cite stagnant wages, longer hours, and more administrative burdens as key reasons for leaving education.

No matter the country, whether the job is performing open heart surgery, teaching kids how to tell time, or flying people from LA to New York, employees want to feel valued, supported, fairly compensated, and equipped to do the actual job they trained to do. The more educated the workforce and the more competition available, the more important these retention principals become. Hopefully, we can learn lessons from the UK on how to nurture and retain our own American workforce, and what happens when this is not done. In the meantime, I’ll continue reviewing my growing number of email inquiries from vacant hospital positions in London. I have always wanted to see Big Ben…

Dr. Grawert is the Chief Medical Officer at Aware Recovery Care. If you or someone you love is suffering from a substance use disorder, reach out today.