By Samena Chaudhry, Stoke

Doctors may want to work abroad for many reasons ranging from a desire for adventure to missionary fervour; or from scientific curiosity to a desire for greater practical experience. However, a recent paper in the BMJ indicates that dissatisfaction with the UK system is one of the main driving forces behind British doctors' desire to move overseas (BMJ 2004;329:1263).

In the study, of the 65% of junior doctors who did not intend to study medicine in the United Kingdom, two fifths cited UK working conditions as the main reason for wanting to leave--they wanted to stick with medicine but practice abroad. Two thirds gave reasons related to lifestyle choices. This was in contrast with the doctors who intended to leave medicine altogether, where three quarters stated a reason related to working conditions in the United Kingdom.

Michael Goldacre, one of the authors of the study, is a member of a Department of Health funded research group charged with studying doctors' career intentions, progression and factors influencing their choices. He said, "A skilled medical workforce is the most important component of the health service which makes it very important to know about the future supply of, and views of, doctors."

The study forms part of a series of graduate surveys dating back to 1974. Michael Goldacre is currently involved in surveying the 1977 cohort to elucidate what specialties and careers those graduates have actually ended up in. "The biggest single finding which has remained consistent throughout the years of surveying is--regardless of whether doctors are certain or not about staying in the UK, most end up staying in medicine wherever they go."

The study suggests that doctors are motivated to leave the workforce temporarily by both positive and negative factors. Positive factors include the desire to broaden experience, to see another health care system, the love of travel, and to seek personal development. Negative factors include wanting to escape unsatisfactory working conditions, work related stress, and illness.

Many positive reasons are not only unavoidable but also desirable. Doctors who undertake overseas work, for example, have been found to return to the NHS with "enhanced, clinical, organisational and managerial skills."

These surveys have also shown that those who go abroad express a higher level of job satisfaction to those staying in the United Kingdom. Michael Goldacre acknowledges that this of course may be due to the fact that doctors who do work abroad are the very personality types who enjoy adventures and the opportunity to travel.

The surveys have also shown that the proportion of preregistration house officers who have reported their intention to "continue practising medicine in the United Kingdom for the foreseeable future" declined from around 90% in the 1980s to 75% in the 1990s.

But David Rosin, vice president of the Royal College of Surgeons in England expressed concern about the way the study had grouped together pay, working environment, and job satisfaction, as working conditions: "Someone wanting to work in America may well be accepting an 80 hour week. It would have been more useful to have individual figures of the reasons doctors gave for wanting to leave."

He added, "The figure of 279 (22%) doctors wanting to leave medical school reflects a high level of dissatisfaction. We should ask universities to look at their selection criteria as they tend to select on the basis of good A levels more than how suited people are to medicine. The study reflects the complete deprofessionalisation of doctors. People do not feel valued--but more like technicians."

Simon Eccles, of the BMA said, "I suspect the situation in 1999 may have been marginally worse than now in some respects, especially overall hours, but better in others.

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