Factors affecting the UK junior doctor workforce retention crisis: an integrative review

Abstract

ObjectivesTo determine the factors contributing to the junior doctor workforce retention crisis in the UK using evidence collected directly from junior doctors, and to develop recommendations for changes to address the issue.DesignIntegrative review.Data sourcesSearches were conducted on Ovid Medline and HMIC to locate evidence published between January 2016 and April 2021. This was supplemented by publications from relevant national organisations.Eligibility criteriaEnglish-language papers relating to UK junior doctor retention, well-being or satisfaction which contained data collected directly from junior doctors were included. Papers focusing solely on the pandemic, factors specific to one medical specialty, evaluation of interventions, or numerical data with no evidence relating to causation were excluded. Review papers were excluded.Data extraction and synthesisData were extracted and coded on NVivo by FKL, then thematic analysis was conducted.Results47 papers were included, consisting of academic (qualitative, quantitative, mixed and commentary) and grey literature. Key themes identified were working conditions, support and relationships, and learning and development, with an overarching theme of lack of flexibility. The outcomes of these factors are doctors not feeling valued, lacking autonomy, having a poor work–life balance, and providing compromised patient care. This results in need for a break from medical training.ConclusionThis review builds on findings of related literature regarding working environments, isolation, stigma, and desire for autonomy, and highlights additional issues around learning and training, flexibility, feeling valued, and patient care. It goes on to present recommendations for tackling poor retention of UK junior doctors, highlighting that the complex problem requires evidence-based solutions and a bottom-up approach in which junior doctors are regarded as core stakeholders during the planning of interventions.

Regional survey of foundation trainee doctors’ views on a career in gastroenterology: implications for diversity and inclusion

“…In the past 5 years, there has been a relatively new phenomenon, with 69% of FDs opting to take a ‘FY3, with many opting for the flexibility of adhoc locum work, fellowships or working in healthcare abroad, rather than applying for training 18–20. This presents an opportunity to allow more doctors to experience working in gastroenterology.…”

Qualitative study to explore UK medical students’ and junior doctors’ experiences of occupational stress and mental health during the COVID-19 pandemic

“…[22][23][24] Poor working conditions, inadequate support mechanisms and a lack of flexibility have contributed towards record numbers of trainee doctors leaving the profession altogether. 25 The mental health burden of junior doctors and medical students working during the pandemic has been the subject of interest in quantitative 12 13 26-28 and qualitative research studies. 6 13 29-34 However, to the author's knowledge, no qualitative studies have simultaneously examined the mental health of medical students and junior doctors during COVID-19.…”

“…In doing so, retention issues may be addressed, which threaten patient safety, and the future of health services. 25 This study aimed to explore medical students' and junior doctors' experiences of occupational stress and mental health during the COVID-19 pandemic in the UK. Specifically, this study addressed the following three research questions.…”

“… 22–24 Poor working conditions, inadequate support mechanisms and a lack of flexibility have contributed towards record numbers of trainee doctors leaving the profession altogether. 25 …”

“…In doing so, retention issues may be addressed, which threaten patient safety, and the future of health services. 25 …”