Negotiations with the UK government about salaries are at an impasse
In the last two years, junior doctors in the UK have striked multiple times to make their dissatisfaction and demands heard by the government. Doctors in the NHS, the UK's public healthcare system, can remain qualified as “junior doctors” for up to 10 years until they gain enough experience.
Their main trade union, the British Medical Association (BMA), states that junior doctors' salaries have stagnated since 2008/2009, which makes it difficult to cope with an inflation rate of over 3% and the cost of living crisis. A BBC investigation from late 2023 found that some junior doctors have a standard hourly rate of merely £14, which is barely higher than the minimum wage. Without working overtime and weekends, these junior doctors cannot make a living or pay off their student loans (a high of £50,000–90,000 per medical graduate, according to Money Advisor).
The BMA is demanding a pay rise of 35% over the next few years. However, the government awarded a pay rise of only 8.8% in 2023, arguing that a higher pay rise would cost the Treasury too much. While, as reported by the BBC, the government and BMA have agreed to reinitiate negotiations in May, the overall situation remains at a standstill.
Young GPs want to leave the UK much more than older, specialist doctors
Not all doctors are equally affected by the crisis of dissatisfaction in the NHS; it mainly concerns early-career and less specialized doctors. This includes those undergoing their two years of foundation training (after medical school) and those who have already become GPs but are still in their early careers. They are generally under the age of 40.
In November 2023, the General Medical Council (GMC), the regulatory body of medical practitioners in the UK, released a detailed report titled Identifying Groups of Migrating Doctors Research. Their study is based on a survey of 13% of all practicing doctors in the country. Their responses about their level of professional satisfaction and desire to move abroad were classified into the following categories: Deep Discontent, System Skeptics, Burnt-out, Mobile Career Developers, Open to Opportunity, and Happy in the UK.
Alarmingly, nearly 60% of all doctors surveyed ended up in the first three categories of poor professional satisfaction. Only 8% were “Happy in the UK”, i.e., unlikely to leave under any circumstance. Meanwhile, around 35% of those who are “Mobile Career Developers” and “Open to Opportunity” would only relocate because of factors unrelated to their satisfaction within the NHS, such as family reunification, an exciting opportunity, or the desire to discover new cultures. These are called “pull factors” (attractive aspects of life abroad) in contrast to “push factors” (wanting to leave one's home or current country because of dissatisfaction). It is clear that push factors are mainly driving the exodus of the UK's doctors.
Doctors who are satisfied with their lives in the UK or who would only move because of pull factors tend to be specialists older than 40 or even 50. Furthermore, the majority obtained their first medical degree outside of the UK. They are mainly expats or immigrants, not British citizens by birth. They often leave the UK only to reunite with their families and reconnect with their cultures back home.
Meanwhile, the desire to leave the UK is strong among doctors who were born and raised in the UK or who have at least been living there since their university years. These younger, more generalist, UK-born or UK-trained doctors cite the following reasons as push factors:
- Their pay is insufficient.
- Their workload is too high, which has led to poor work-life balance and often burnout. This has made it challenging to start families or care for their children if they already have them, in their 20s or 30s.
- They are deeply skeptical about the government's policies for the NHS and feel that these policies make providing high-quality patient care increasingly difficult.
- There are too many administrative barriers to being promoted to GP, from the status of a junior doctor to becoming a consultant or specialist doctor.
- They do not feel valued and respected at work. Some of them have even been bullied and discriminated against at work.
Pay, language, the immigration system and work-life balance issues
Where are these young doctors moving or hoping to move? Most of them want to move Down South or to Canada. Australia is by far the favorite destination, with 51% of the GMC study's respondents choosing it. This is followed by Canada, the preferred destination of 29%, and New Zealand, the choice of 26% of those surveyed. The UAE comes in fourth place with 16%. While it is not technically a country where most residents are native English speakers, English is still widely spoken in professional circles there.
The lack of language barriers is clearly a strong motivating factor. It is not difficult for doctors to communicate with patients in other countries where English is the main language. This explains why few British doctors move to nearby European countries like Spain or France, where they would need to master medical terminology in French or Spanish to work in public healthcare. Furthermore, the medical training systems of English-speaking countries of the Commonwealth are quite similar to each other, which makes it easier to get their qualifications approved.
Advantageous immigration systems are also another reason for choosing these three top countries. Like the UK, these countries are also experiencing a labor shortage in healthcare and have eased the immigration procedure for these highly qualified professionals.
Canada's immigration goal is to attract a total of 1 million skilled expats between 2024 and 2025. UK-based doctors are able to immigrate there via multiple routes, notably the Express Entry Federal Skilled Worker Program (FSW) and the Provincial Nominee Program (PNP). Express Entry is based on a points system that doctors can easily score high on due to their advanced degree and work experience. Furthermore, as most of the UK-based doctors who want to leave are in their 20s or 30s, they also score points because of their young age (i.e. they are far from retirement age).
Of course, there are steps to follow to get licensed to practice in Canada, but that is the case with regulated professions in any country. Doctors from the UK should be prepared to have their degrees evaluated, to take exams, and even to do some further residency training. The only language barrier exists in Quebec, where they need to show proof of French proficiency to practice. In the rest of the country, being a native English speaker is enough. In the General Medical Council's study, UK doctors who had already left for Canada cited both a higher quality of life (72%) and better pay (67%) as reasons they are happy about their decision.
In Australia, doctors from the UK have multiple immigration routes, even more so than in Canada. The Skilled Independent Subclass 189 Visa is ideal for highly-skilled expats who have not been sponsored by an Australian employer. The Skilled State Sponsored Subclass 190 Visa is the equivalent visa for doctors who have already been sponsored by an Australian healthcare provider. They both give the expat permanent residency.
The Skilled Work Regional Provisional Subclass 491, meanwhile, is a temporary work that can allow a British doctor to work for 5 years in only one specific Australian territory. The expat must be nominated by the relevant territorial government to obtain it. After 3 years on this visa, the expat can apply for permanent residency. There also exists the Temporary Skill Shortage Subclass (Medium-Term Stream) 482 Visa, which is a temporary visa for professions affected by labor shortages. This visa tends to be easy to get, as many employers are willing to nominate expats for it. While there is no age restriction for the 482 Visa, the other visas listed above have an age limit of 45 (which isn't a problem for early-career British doctors!).
Doctors' salaries in Australia are significantly higher than in the UK. In the UK, GPs earn between £70,000 and £105,000, with younger GPs earning at the lower end of that spectrum. Junior doctors often make less than £40,000 before they get promoted to the GP register, which can be for a decade. This data comes from the British recruitment platform Prospects. Meanwhile, as reported by the medical recruitment firm Alecto Australia, the average GP in Australia makes over the equivalent of £100,000, with some earning around £200,000. This represents a significant pay disparity between the two countries even when the high cost of living in cities like Sydney and Melbourne is taken into consideration.
Expat doctors who move to underserved, rural areas of Australia earn at the upper end of that spectrum. As explained by Medrecruit, another recruitment agency, doctors in rural Australia benefit from financial incentives granted by the state for moving there, other relocation and retention grants, as well as little competition because of a low doctor-to-patient ratio. In the General Medical Council's report, the overwhelming majority of UK doctors who had already moved to Australia reported higher quality of life (87%) and pay (80%).
New Zealand might have the most favorable work-life balance for doctors. The HR company Remote ranked New Zealand as the country with the best work-life balance worldwide, with Australia following closely behind at the 4th place. In the General Medical Council's report, 87% of British doctors in New Zealand said their quality-of-life had improved.
The official government site Te Whatu Ora | Health New Zealand has a jobs section with both short-term/locum and permanent vacancies. Kiwi Health Jobs is also a great platform for looking for vacancies in both public and private healthcare. The Hauora Taiwhenua Health Network facilitates the placement of expat doctors in both rural and urban sites across the country via their NZLocums and NZMedJobs teams. Like in Australia, expat doctors who move to underserved areas of rural New Zealand can receive financial incentives and higher pay. Salaries for junior doctors start at least at the equivalent of £40,000, while more experienced GPs earn at least £85,000.
Doctors of all kinds, from GPs to specialists, are classified as Green List Tier 1 professions in New Zealand. This means that they are eligible for straightforward permanent visas. The Straight to Residence visa and Work to Residence visa are both good choices for doctors under 55 who already have an employment offer from an NZ provider. These visas also allow them to bring their families as permanent residents.
The UK's brain drain of doctors is a decades-old problem that is intensifying
Australia, New Zealand and Canada are not the only top destinations, of course. A smaller number of UK doctors are also choosing the UAE and the US. The inexistence of personal income tax in the UAE is a significant advantage for them, and the reign of private healthcare combined with comparatively low taxes in the US allows them to be very high earners.
The brain drain of doctors from the UK to other highly developed countries isn't a recent trend. However, it has intensified in recent years. The UK has been a net exporter of doctors among highly-developed countries since at least the early 2000s. A 2012 study published in the Journal of the Royal Society of Medicine by Avinash Sharma, Trevor W. Lambert and Michael J Goldacre shows that this trend had started a good twenty-five years ago.
The study, titled, “Why UK-trained doctors leave the UK: cross-sectional survey of doctors in New Zealand,” found that UK doctors were already moving to New Zealand from around 2005 because of overwork; poor work-life balance; and disagreement with the new system of promotions installed at the turn of the century. However, this trend's recent intensification is more serious because, as reported by the National Health Executive, it could soon cost the NHS £5 billion per year if not solved.
Of course, the gap left by doctors leaving the UK can represent an opportunity for expat doctors from developing countries. An increasing number of doctors have been moving to the UK from South Asia, Nigeria and Egypt, as well as from less wealthy countries of Europe like Romania and Greece. The cost of hiring new doctors from abroad still remains more expensive for the NHS than retaining the doctors it already has.
Useful links:
Junior doctors guide to industrial action in England (bma.org.uk)
How much do junior doctors really get paid in England? - BBC News
Identifying groups of migrating doctors - GMC (gmc-uk.org)
Working as a doctor in Canada (bma.org.uk)
Working as a doctor in Australia (bma.org.uk)
Working as a doctor in New Zealand (bma.org.uk)
General practice doctor job profile | Prospects.ac.uk
GP Salary UK - General Practitioners Salary in United Kingdom (alectoaustralia.com)
How much do rural and remote doctors make in 2024? (medworld.com)
