Should I stay or should I go?

Authors: Kathy Oxtoby 

Publication date:  12 May 2016

Kathy Oxtoby investigates how to decide if it’s time to quit medicine – and what to do next

“If the contract is imposed I will leave medicine.” “Junior doctors to quit NHS because they can’t pay their bills under new contracts.” “5000 doctors a year consider leaving the UK to emigrate abroad.” These are just some of the headlines predicting an exodus from the NHS by doctors disaffected with their careers. And it seems that rarely a week goes by without another story or statistic highlighting how clinicians are looking to leave the health service, or to quit medicine altogether.

An increase in pressure

While it is not clear how many doctors are currently considering leaving the profession, the imposition of the junior doctor contract could be “the last straw in a long line of damaging developments to the morale of junior doctors,” says Alex Langford, a specialist trainee year 4 psychiatry registrar based in Oxford.

“There has been an increase in pressure on services and workload, but without increased resourcing from government,” he says.

The junior doctors’ contract is just one of a variety of reasons that doctors may consider leaving the NHS or medicine altogether. Medicine can be all consuming, and the stress and fatigue that accompanies long hours and irregular shifts may prompt doctors to seek a better work/life balance. They may also have health issues, have not completed their competencies or exams, or may just want to try out new career options. Doctors also cite an increasingly litigious work environment, the physical challenges of working nights as they get older, and not being able to spend time with their families as reasons to quit.

A difficult decision

But the decision to leave medicine is not an easy one. Having invested a huge amount of time, money, and commitment into becoming a doctor, it is important to consider fully the reasons that you are dissatisfied with your role. “It is unwise to take a decision to give up the profession altogether when you’re at a crisis point—such as when you’ve had enough of a run of nights or are trying to balance your career and personal responsibilities,” says Mala Rao, senior clinical fellow, department of primary care and public health, Imperial College, London.

Aside from the obvious concern of losing a regular income, there are psychological barriers to overcome when considering leaving medicine. “The ‘medical sense of self’ in doctors is very ingrained. If you have spent your life working towards that goal of being a doctor, it can be difficult to find your personal self again,” says Clare Gerada, medical director of the Practitioner Health Programme.

Doctors should consider whether quitting the profession will be a “one way trip” because it can be difficult to return to medicine, says Simon Clark, Royal College of Paediatrics and Child Health officer for workforce planning, and a neonatal consultant at Sheffield Teaching Hospitals NHS Foundation Trust.

“Medicine moves on at a dramatic pace, and if you return to the profession after time out you may find a huge amount has changed. It can be hard to get up to speed with new procedures,” he advises.

If you are having serious doubts about your career you should aim to discuss your thoughts with the most appropriate person. This can include your educational supervisors, clinical tutor, head of school or postgraduate dean, trusted colleague, or family and friends. You should also talk it over with a professionally qualified careers adviser.

“If your concerns are all consuming and affecting your health and your ability to care for patients then it could be time to quit medicine,” says Ellie Mein, medico-legal advisor at the Medical Defence Union.

Having made that decision it is important to “think positively,” advises Gerada. “Remember you are very skilled, you can work again, and don’t lose confidence just because being a doctor hasn’t worked for you,” she says.

Skills transfer

The skills and experience doctors have developed, such as working in difficult and stressful situations, decision making, communication, and leadership, are highly valued in the world outside medicine. Careers in teaching, business, finance, and law are typical options for clinicians looking to use their experience elsewhere.

Having decided to leave medicine, Mein completed a part time law conversion course, and as a medico-legal advisor for the Medical Defence Union she now supports other doctors. The work is not only “very interesting, but it also fits into my home life,” she says.

While doctors have many other potentially satisfying career options, they have also devoted a considerable amount of time and effort to the profession, so a decision to quit deserves time for reflection, rather than it being a knee jerk reaction. As Rao advises, “Having a successful alternative career is only likely to happen after careful consideration—and a hasty decision to leave medicine is truly unwise.”

Where to seek careers advice

Medical Forum provides career guidance programmes either on line, face to face or via the telephone for those who are thinking about a change in career direction. [Link]

Medical Success provides information and education specifically for doctors interested in learning more about non-traditional career paths inside and outside of medicine. [Link]

Support 4 Doctors, a project of the Royal Medical Benevolent Fund, provides advice to doctors on a variety of issues including: money and finance, health and wellbeing and career options. [Link]

NHS Careers provides information on the various careers within the NHS. [Link]

I have read and understood BMJ’s policy on declaration of interests and have no relevant interests to declare.

Kathy Oxtoby freelance journalist

Cite this as BMJ Careers ; doi: