We are running out of clinicians (Part 1: Problems)

In Europe we are experiencing a loss of health workers [1], the WHO has identified a need for 10 million more health workers by 2030, mainly in low and lower middle income countries [2]. Some argue that this is just a consequence of the abnormally stressful experience of Covid-19, which required doctors and nurses to face unprecedented schedules and psychologically damaging scenarios, such as being in contact with patients affected by a novel, unknown and highly contagious disease, which pushed most of the rest of the population into lockdown to avoid interpersonal interactions [3].

Personally, I missed the opportunity to contribute during the first and most dramatic phase of the pandemic, when the OMS recorded a 62% increase in doctors’ absenteeism and an 80% increase in nurses’ mental health problems. I did not have the opportunity to work as a doctor until 2021, when vaccinations became available and the fear of contagion was greatly reduced. However, I saw the fear and anxiety in the eyes of my colleagues throughout the pandemic. We should all be deeply grateful for their work, professionalism and sacrifice, especially those who faced the unknown without proper equipment and support.

Although I do not believe that this is the main reason why so many young people have not chosen a career in health care in recent years. Strikes and protests organised by health professionals have increased throughout Europe. On 22 March 2023, the OMS proposed an eleven-point programme called the “Bucharest Declaration on the Health and Care Workforce” [4], which was signed by 50 of its 53 countries. Its aim is to support and improve the working conditions of this broad category, recognised as “the backbone of any health system”.

The aforementioned OMS document is certainly an important milestone, but I see a lack of pragmatism… so I wrote this piece in the hope of starting a critical conversation on the topic. I love bullet points, so in the short list below I’ll summarise what I’m going to focus on in this article. Then, in the next article, I’ll give my opinion on how we can mitigate the problem.

Reasons why potential doctors are less inclined to enter the profession:

a. Long time to obtain a licence

b. Terrible working hours

c. Low recognition

d. High responsibility and legal implications

e. Lack of flexibility

Depending on the country, it can take between four and six years to obtain a medical degree. After that, systemic differences increase, as compulsory traineeships, licensing exams and specialisation have a significant impact on the length of training. On average, it takes between ten and fourteen years [5]. This sounds painful, no matter how curious and eager to learn you are, because your (financial) independence is longly postponed compared to your peers who are doing something else. In fact, several other professions require only a three-year bachelor’s degree to start work, which gives a considerable time advantage for collecting experience and promotions, over a doctor of the same age. It should also be borne in mind that doctors may have to move during their training to continue their education, and then move again because of employment contracts. Of course, this is a common problem in many fields, but the difference is that in this case the choice is made more often and at an older age, which makes it a difficult decision for those who want stability or to start a family.

In several European countries, the idea of a 4-day working week is becoming more popular, which seems to lead to better life balance and productivity [6]. Clinicians, on the other hand, have to work weekends and holidays, which affects their leisure time and ultimately their social life. It is therefore not surprising that marriages are common among health professionals [7]. But they are also expected to work nights and, depending on their speciality, longer than the standard 8-hour day, and to be called in for emergencies. I will never forget a cousin of mine telling me how sad it was that his father was not around for most of his childhood birthdays because of the constant emergency calls.

Once upon a time, being a doctor was a source of remarkable socio-economic recognition. The local doctor was known and respected by the community and was seen as a rewarding and successful career. Nowadays, the amount of medical knowledge has grown exponentially (I still remember my old biochemistry professor teasing us about having to study two huge manuals on his subject, when in his day all the formulas to be studied were contained in one poster); but at the same time society has stopped dreaming and valuing this kind of profession as it once did. Have you watched “Catch me if you can”, a film from 2002 with Leonardo DiCaprio and Tom Hanks? The protagonist pretended to be the most ambitious professionals: a pilot and a doctor. It seems that the former is still a dream job in several countries, but what about the latter [8]?

There are many professions where the pressure of responsibility is constant. However, very few of them also require making quick and vital decisions as often as a doctor or surgeon. No less, they have to make these decisions with the patient, a human being, right in front of them. Certainly, we can get used to everything we experience regularly, but making a mistake in a similar scenario can cause mental and legal trauma for everyone, and burnout is always just around the corner [9]. Talking about responsibility in health care, we cannot avoid mentioning the difficult relationships that clinicians have to deal with the anxious relatives of patients and the army of vulture lawyers who can easily trigger escalations. Some medical specialities face even more critical conditions. One of these is the emergency room, where clinicians are also exposed to the fear, anger and — sometimes — violence of patients and their relatives who find themselves in unexpected and dramatic situations.

We have already talked about the pandemic that we would all like to forget, but if there is one good thing that is likely to remain from this tragic experience, it is the concept of remote working. Personally, I love meeting and engaging with colleagues, but I also clearly see the benefits to both employers and employees of this novel approach, especially in its mixed/hybrid forms. After all, the opportunity to take advantage of a relaxing home environment without having to rush into the office, or even better, to work from a tropical location for a while, is certainly intriguing. Among the types of jobs that are not allowed to enjoy the benefits of remote working are, of course, clinical ones. The lack of flexibility doesn’t end there! Clinicians are required to adhere to a strict schedule to ensure that not a single minute of the day is spent without them on the ward. Taking into account these aspects and those already mentioned, we can say that this type of profession is anti-flexible.

Now think -for example- about a software engineer who could aspire to a well paid and growing career all over the world, while working from the Bahamas, and after only three years of study… doesn’t that sound fair, does it?!

So how can we reverse this situation, how can we make clinical work more attractive and less stressful? I believe that the core of change should be a prospective shift: from mission to profession. I believe that motivation, enthusiasm and passion are the main drivers of excellence, but we should stop looking for personal sacrifices from healthcare professionals.

This article, originally published on Medium, is already longer than I expected, so in the next one I will talk about some possible solutions that might be worth implementing. In the meantime, you can read another perspective on the topic in this article from McKninsey [10]. Thanks for reading!

PS. Clinicians with a problem-solving and entrepreneurial mindset: read more about Doctorpreneurs in my previous article, available on LinkedIn and Medium.

References:

[1] https://www.socialeurope.eu/health-and-social-care-staff-shortages-critical#:~:text=For%20a%20long%20time%20the,19%20only%20exacerbating%20the%20problems.?

[2] https://www.who.int/health-topics/health-workforce#tab=tab_1?

[3] https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-022-00764-7?

[4] https://www.who.int/europe/publications/i/item/bucharest-declaration?

[5] https://www.indeed.com/career-advice/finding-a-job/how-long-does-it-take-to-become-a-doctor#:~:text=Doctors%20must%20complete%20a%20four,become%20a%20fully%20licensed%20doctor

[6] https://www.weforum.org/agenda/2023/03/four-day-work-week-uk-trial/?

[7] https://www.ama-assn.org/medical-residents/medical-resident-wellness/why-doctors-marry-doctors-exploring-medical-marriages?

[8] https://www.businessinsider.com/dream-jobs-world-revealed-based-google-searches-2023-1?r=US&IR=T?

[9] https://www.weforum.org/agenda/2023/01/medical-recruitment-crisis-davos23/#:~:text=There%20will%20be%20an%20estimated,of%20the%20global%20healthcare%20workforce?

[10] https://www.mckinsey.com/industries/public-and-social-sector/our-insights/care-for-the-caretakers-building-the-global-public-health-workforce