Intended for healthcare professionals


Retention in the British National Health Service of medical graduates trained in Britain: cohort studies

BMJ 2009; 338 doi: (Published 03 June 2009) Cite this as: BMJ 2009;338:b1977
  1. Michael J Goldacre, professor of public health,
  2. Jean M Davidson, research officer,
  3. Trevor W Lambert, statistician
  1. 1UK Medical Careers Research Group, Department of Public Health, University of Oxford, Old Road Campus, Oxford OX3 7LF
  1. Correspondence to: M J Goldacre, Unit of Health-Care Epidemiology, Department of Public Health, University of Oxford, Old Road Campus, Oxford OX7 3LF michael.goldacre{at}
  • Accepted 11 May 2009


Objective To report the percentage of graduates from British medical schools who eventually practise medicine in the British NHS.

Design Cohort studies using postal questionnaires, employment data, and capture-recapture analysis.

Setting Great Britain.

Subjects 32 430 graduates from all British medical schools in nine graduation cohorts from 1974 to 2002, subdivided into home based medical students (those whose homes were in Great Britain when they entered medical school) and those from overseas (whose homes were outside Great Britain when they entered medical school).

Main outcome measures Working in the NHS at seven census points from two to 27 years after qualification.

Results Of home based doctors, 88% of men (6807 of 7754) and 88% of women (7909 of 8985) worked as doctors in the NHS two years after qualification. The corresponding values were 87% of men (7483 of 8646) and 86% of women (7364 of 8594) at five years; 86% (6803 of 7872) and 86% (5407 of 6321) at 10 years; 85% (5404 of 6331) and 84% (3206 of 3820) at 15 years; and 82% (2534 of 3089) and 81% (1132 of 1395) at 20 years. Attrition from the NHS had not increased in recent cohorts compared with older ones at similar times after graduation. Of overseas students, 76% (776 of 1020) were in the NHS at two years, 72% (700 of 972) at five years, 63% (448 of 717) at ten years, and 52% (128 of 248) at 20 years.

Conclusions The majority of British medical graduates from British medical schools practise in the NHS in both the short and long term. Differences between men and women in this respect are negligible. A majority of doctors from overseas homes remain in Britain for their years as junior doctors, but eventually about half leave the NHS.


  • Acknowledgements: We thank the doctors who participated in the surveys, and we thank Emma Ayers, Janet Justice, and Alison Stockford for data preparation and administration.

  • Contributors: MJG and TWL planned and designed the surveys. MJG and JMD planned the data analysis. JMD undertook the data analysis. TWL provided statistical support. JMD and MJG wrote the first draft of the paper. All authors contributed to further drafts and approved the final version. All had full access to all the data in the study and had final responsibility for the decision to submit for publication, and all are guarantors.

  • Funding: The UK Medical Careers Research Group is funded by the Policy Research Programme of the English Department of Health. The Unit of Health Care Epidemiology is funded by the English NIHR Coordinating Centre for Research Capacity Development.

  • Conflict of interest statement: None declared.

  • Ethical approval: Study approved by Central Office for Research Ethics Committees (COREC), after referral to Brighton Mid Sussex and East Sussex local research ethics committees.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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