Brexit, the junior doctor contract, and medical student intentions
Authors: Robin J Borchert, Ha Bao Trung Le, Craig W Ritchie
Journal: The Lancet Public Health (2017)

The UK's European Union (EU) referendum and the introduction of the new junior doctor contract in England have raised the question of how these events will affect staffing in the National Health Service (NHS). Survey findings have shown that the career plans of NHS doctors have been negatively influenced by the new contract,1Spooner S Gibson J Rigby D Sutton M Pearson E Checkland K Stick or twist? Career decision-making during contractual uncertainty for NHS junior doctors.BMJ Open. 2017; 7: e013756Crossref Scopus (19) Google Scholar and four in ten European doctors in the NHS are now considering leaving the UK following the Brexit vote.2Torjesen I Four in 10 European doctors may leave UK after Brexit vote, BMA survey finds.BMJ. 2017; 356: j988Crossref PubMed Scopus (12) Google Scholar However, how UK medical students feel about the current climate is unclear. We sought to determine how these events have influenced where medical students intend to practice medicine after graduation. Medical students across all years of the University of Edinburgh 2016–17 cohort (N=1265) were invited, via email, to take part in an online survey (Bristol Online Survey tool) on this topic; 236 (19%) students completed the survey. With regards to the introduction of the new junior doctor contract, 182 (77%) students said they were now less likely to practice medicine in England. This finding did not vary significantly between English, Scottish, International, and EU students (p>0·05) and no respondents were more likely to practice in England due to the new contract. Of students who were now less likely to practice in England, 169 (93%) cited working conditions as a contributing factor and 131 (72%) cited salary, with 163 (90%) considering clinical practice instead in Scotland, 105 (58%) in Australia, 101 (55%) in New Zealand, 81 (45%) in Canada, and 44 (24%) in Northern Ireland. Of 204 students still considering clinical practice in England, 81 (40%) were now more interested in private practice as a result of the new contract. In terms of the EU referendum, 79 (33%) of all respondents said they were now less likely to practice medicine in the UK following the Brexit vote, while 11 (5%) said they were more likely to stay. Reasons provided by those less likely to stay included concerns surrounding working conditions (n=62 [78%]), salary (n=44 [56%]), future immigration laws (n=31 [39%]), and research opportunities (n=28 [35%]). These students were considering Australia (n=58 [73%]), New Zealand (n=54 [68%]), Canada (n=52 [66%]), Ireland (n=24 [30%]), USA (n=17 [22%]), France (n=15 [19%]), and Germany (n=14 [18%]) as alternatives for clinical practice. This survey suggests that UK medical students feel that Brexit and the new junior doctor contract have disadvantaged their future careers, which could have a great effect on the number of doctors in the NHS, and their distribution within the UK, in the years to come. We declare no competing interests. Ageing: a 21st century public health challenge?Ageing populations, with increasing physical and mental multimorbidities, and therefore care needs, will grow by 25% within a decade in England and Wales, according to Maria Guzman-Castillo and colleagues' study published in this issue of The Lancet Public Health. The societal, economic, and public health implications of their predictions are substantial. Are we prepared? Full-Text PDF Open Access