Intentions of newly qualified doctors to practise in the United KingdomBMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7094.1591 (Published 31 May 1997) Cite this as: BMJ 1997;314:1591
- Trevor W Lambert, statisticiana,
- Michael J Goldacre, unit directora,
- James Parkhouse, study consultanta
- a Medical Careers Research Group, Unit of Health-Care Epidemiology, Department of Public Health and Primary Care, University of Oxford, Oxford OX3 7LF
- Correspondence to: Mr Lambert
- Accepted 12 November 1996
In a series of cohort studies of newly qualified British medical graduates, respondents were asked about intentions to practise in the United Kingdom.1 2 We compared the intentions of those who qualified in 1993 with the intentions and subsequent employment of earlier cohorts.
Methods and results
The studies were undertaken by mailed questionnaires. Members of each cohort was asked in their preregistration year, “Apart from temporary visits abroad, do you intend to practise in the United Kingdom for the foreseeable future?” There were five possible responses: “yes–definitely,” “yes–probably,” “undecided,” “no–probably not,” and “no–definitely not.” For this report, these five categories were reduced to three by combining the “yes” and the “no” categories.
Of those qualifying in 1993, 75.7% (1969/2600) definitely or probably intended to practise in the United Kingdom (75.1% (967/1287) of men, 76.3% (1002/1313) of women) compared with 89.2% (2812/3154) of those qualifying in 1983 (table 1), a decrease of 13.5% (95% confidence interval 11.5% to 15.4%). This 1993 figure is lower than that for any cohort previously surveyed. The large percentage in the “undecided” category in 1993, compared with earlier cohorts, is notable. The increase since 1983 in those who probably or definitely do not intend to practise in the United Kingdom is more modest and is no higher than in 1974. The percentage of those of non-British nationality who definitely or probably intended to practise in the United Kingdom was roughly constant across the cohorts. The decrease in intention to practise in the United Kingdom occurred among those with British nationality and residence.
The response rate for the 1993 cohort was lower than for earlier cohorts. Even if every non-respondent in each cohort intended to practise in the United Kingdom, the percentage of the whole 1993 cohort intending to practise in the United Kingdom was still historically low, at 82.7% (3031/3662) compared with 85.7% (2014/2350) for the 1974 cohort, 86.9% (2724/3136) for 1977, 92.1% (3167/3437) for 1980, and 91.1% (3503/3845) for 1983.
We analysed the association between expressed early intentions and later career destinations for the three cohorts that we followed for at least nine years (1977) or 11 years (1974 and 1983). In the combined cohorts, 91.2% (4994/5473) of doctors who said in their preregistration year that they probably or definitely intended to practise medicine in the United Kingdom eventually did so. This compares with 77.9% (300/385) of those who were undecided and 62.5% (250/400) of those who said that they would definitely or probably not practise in the United Kingdom. The table also shows, for each of the four earlier cohorts, the number and percentage of respondents employed in medicine in the United Kingdom five and nine years after graduation. These comparisons of intentions in the preregistration year with later employment show that in previous cohorts early intention to practise in the United Kingdom has been a reasonable indicator of subsequent employment.
The wording of the question that was asked combined the idea of working in medicine with that of working in the United Kingdom. It was evident from the replies in full, however, that most of those who were not committed to practising in the United Kingdom were committed to practising medicine. Although early intentions do not invariably correspond with future careers, the doctors' responses show an increased lack of commitment to a medical career in the United Kingdom, which may be an “early warning” of either higher loss or higher disenchantment in the future. The large group of “undecided” doctors may be open to persuasion, through good subsequent experience of work, to remain in Britain to practise.