Trainee doctors are at higher risk of burnout now than during the pandemic, with some describing how they have struggled with unsustainable workloads and inadequate support.
The most recent figures published by the General Medical Council (GMC) in its national training survey of junior doctors and their trainers reveal the proportion of trainees feeling “at a high or moderate risk” of burnout is 63%.
This is higher than in 2020 and 2021 during the pandemic, when the figures were 43% and 56% respectively, although a slight fall on last year.
Mike Greenhalgh, deputy co-chair of the British Medical Association (BMA) junior doctors committee, said: “The burnout statistics from the GMC are shocking but sadly unsurprising – as too is the increasing trend of doctors taking time out of training, or choosing careers abroad and outside the NHS.”
The GMC survey – the largest annual survey of doctors in the UK – asked 74,000 physicians about their working environments, quality of training, wellbeing at work and workloads. It found 32% of trainees in emergency medicine were at high risk of burnout, the highest figure of any specialisation.
“The survey results remain very concerning,” the report said. “A third of trainees in emergency medicine posts [are] measured to be at high risk of burnout, suggesting unsustainable workplace pressures have become the norm in this speciality.”
The warnings over the pressures faced by trainees come as the health secretary, Wes Streeting, hopes to resolve the dispute with junior doctors. The government and the BMA, the doctors’ union, have struck an improved pay deal for junior doctors in England worth about 22% on average over two years. Members will now vote on whether to accept the deal.
Victoria Selwyn, 27, a junior doctor, said that in addition to better pay, there needed to be more recognition that trainees were feeling burned out, as well as improved support. She said she was well trained, but that nothing can prepare a junior doctor caring at night for “two or three hundred patients” with one registrar across seven floors of a hospital.
She described trying to stabilise deteriorating patients at night until her registrar was available. “Everyone is stretched … and on these nights, your bleep is just constantly going off,” she said. “Your job ends up being multiple jobs and you’re trying to split yourself a million different ways. You’re wondering how you are meant to get through and prioritise the patients. You feel like you’re spread too thin.”
She said there were challenges of a lack of staff during her training, with several colleagues needing time off from burnout.
Selwyn added it could be demoralising that after such an intensive training environment it was often difficult to find a job in a chosen specialism. She hopes to train in psychiatry and believes more training posts would help create a better job structure for junior doctors.
Michael West, professor of work and organisational psychology at Lancaster University, said: “If you wanted to design about the worst possible job at the start of somebody’s career, the job of a junior doctor is it.”
West, co-author of the 2019 GMC report Caring for Doctors, Caring for Patients, said a lack of autonomy, poor working conditions and a culture of blame had contributed to a “toxic cocktail” for junior doctors. He said: “It’s hard to be effective and treat every patient as a human being.”
More than 9,000 junior doctors start work in hospitals each year across England, Wales, Scotland and Northern Ireland. Many take time off during or after their initial two years of work, with significant numbers complaining of stress and overwork.
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Nathan Robinson, 28, said he took time off from stress within six months of starting as a junior doctor in the summer of 2021. He said there was a “mismatch” between how medical students envisaged their profession and the reality of frontline roles.
Robinson said while the workloads were gruelling, he found it particularly difficult that there was a lack of support and a blame culture when things went wrong. “I never knew what I was going into,” he said. “Is it going to be understaffed? Is someone going to deteriorate?”
On one occasion in his second year of hospital training, he was the only doctor in his emergency unit dealing with “majors” – patients attending with moderate to serious health complaints. He said he was assessing “patient after patient” with no time to stop and think. “We forget sometimes there are lives on the line,” he said. “You are working 150% pretty much all the time, but no one seems to appreciate it.”
Robinson said there was no support or learning after particularly difficult shifts. “I would come home, sit down and think: ‘Wow, what even just happened?’” he said. “The next day, it’s like everything that happened the day before is a clean slate. No debrief. Nothing.”
A survey of 10,000 medical students by the British Medical Journal last year found that one in three UK medical students planned to leave the NHS within two years of graduating – either to practise abroad or to abandon medicine altogether.
Some trainees say the frustrations and discontent have been compounded this year by a new system of allocation for their hospital training programme. While most get their top preference location, others are asked to move hundreds of miles from their home.
Prof Colin Melville, medical director and director of education and standards at the GMC, said: “Our analysis shows high risk of burnout is strongly associated with high workloads, a lack of or disruption of time to train, and feeling unsupported.”
An NHS spokesperson said: “The findings from this report demonstrate the continued need to support the training and working lives of doctors and the importance of recognising the risk of burnout for doctors in training and the doctors who train them. We know there is more to do and so we are strengthening occupational health services and reviewing our mental health and treatment offer for staff to ensure everyone working in the NHS has the right support they need.”
A Department of Health and Social Care spokesperson said: “The deal being put to doctors will increase pay for junior doctors and see the BMA, NHS England and government work together to improve conditions, including by reviewing the current rotation system.”