• MEDICAL EDUCATION & TRAINING

In this issue, Surman and colleagues from the UK Medical Careers Research Group present longitudinal data on how job satisfaction and work–life balance have changed for junior doctors over a 16-year period (1996–2012).1 Half of the graduates seem satisfied with their jobs at 1 and 5 years after graduation. Disappointingly, the more recent data show that only one in five feel that they are ‘highly satisfied’ with the amount of time they have for leisure activities outside work, although this doubles by 5 years postqualification. Having said this, both job satisfaction and time available for leisure activities seem to have improved in successive cohorts over time, particularly for those who have been qualified for 1 year. Trainees in general practice (GP) are generally always more satisfied than their hospital counterparts. Other demographics such as sex, ethnicity and medical school attended do not have a significant influence.

Factors that may have a bearing on these parameters are discussed. Only a modest improvement in the perception of time for leisure is seen in recent years. This is perhaps surprising in the light of the introduction of the European Working Time Directive and subsequent increased rigour of junior doctor's hours monitoring and prohibitively expensive banding costs for trusts for intense rotas. Potential benefits may have been blunted by rota and staffing configurations that mean doctors work fewer, but less sociable hours and potentially the workload is more intense. Many feel that the consequential break-up of the ‘firm structure’ and fragmentation of teams has had an adverse effect on the camaraderie, continuity of care and support that made the day-to-day job of junior doctors bearable in the past. More recently, gaps in rotas resulting from unfilled posts has put pressure on both work and time for leisure. This may have diminished some of the beneficial intentions of recent change brought about by modernising medical careers (MMC), more robust quality management of weak placements and the introduction of surveys (eg, the annual general medical council (GMC) Trainee's Survey), which include questions about bullying which institutions strive to address when highlighted. Moreover, although MMC has streamlined education for very good reasons, it has also introduced a degree of inflexibility in the system—pressurising juniors to commit to a specialty earlier and allowing less geographical flexibility in training—both of which might impact work and leisure time.

The pace of change seems unrelenting in medical education and training, and it will be interesting to see how juniors feel about their job satisfaction and time for leisure now, as compared with the most recent data in Surman et al's data, which is now a few years old. There is a perception that job satisfaction and work–life balance are deteriorating—particularly among senior doctors in hard-pressed specialties such as emergency medicine and in primary care. Many of these are seeking early retirement and, for some, employment overseas. Seniors who express their dissatisfaction may influence the perspectives of junior doctors and medical students and arguably exacerbate these problems. The DoH and Health Education England are aware of these pressures and seek to encourage graduates to consider a career in these specialties, especially GP, as well as incentivise more senior doctors to return to practice for those who have left these specialties.

Resilience is increasingly recognised as an important quality for a sense of well-being. Medical students and junior doctors must be resilient to survive the long training and emotional stress of a career in medicine and remain adaptable in the face of adversity.2 A healthy balance of work and leisure is important for general well-being, which in turn promotes resilience and reduces the chance of mental health problems or career ‘burn-out’.3–5 It is difficult to predict the potential for resilience in candidates interviewed for medical school; many appear very accomplished academically and in their leisure activities on paper. New selection processes (multiple mini-interviews) are a more validated tool than traditional methods such as panel interviews to select for resilience and other desirable qualities of future doctors. The GMC believe that students and doctors need specific training in emotional resilience to develop coping strategies and protective mechanisms in the light of numerous tragic cases where doctors have taken their life while under investigation.6 Others argue that robust ‘support’ for doctors rather than ‘training in resilience’ is more important.7

When doctors are unhappy they tend to vote with their feet. In a recent survey of Foundation Year 2 (FY2) doctors (the ‘National F2 career Destination Survey 2015’), just over 75% of doctors stated that they are working or intend to work in a clinical or related (eg, anatomy demonstrator) capacity in the National Health Service (NHS) on completion of FY2.8 In the 2015 round of recruitment, only 52% of respondents were appointed to specialty training overall, and this has fallen dramatically over recent years (in 2014—58.5%, 2013—64.4%, 2012—67.0% and 2011—71.6%), an overall reported decrease of just over 19%. Increasing numbers of junior doctors are taking a career break (2011—4.6% vs 2015—13.1%) or a service appointment (2011—2.3% vs 2015—9.2%). A steady stream of FY2 doctors seek employment outside the UK but the numbers are relatively static at about 10%, and where this was investigated in one local education and training board (LETB), reassuringly around 90% of these return to training in the UK after one year (H Samuel. Career Development Specialist. HEE South West; personal communication). Currently, 33.9% are appointed to GP training (compared with 35.5% in 2014, 36.6% in 2013 and 36.1% in 2012, respectively). Perceptions of job and leisure satisfaction of more senior colleagues, career indecision and the currently unresolved issues around the Junior Doctor Contract may be playing a part in this.

Quality of life is important for healthcare professionals and their patients alike. It is clear that the healthcare system needs to provide educational and emotional support for these highly trained individuals if they are to provide a long-term service to the NHS system. After all, medical professionals are likely to provide a better service to their patients if they are motivated, satisfied with their jobs and maintain a healthy work–life balance.