Doctors in training are at greater risk of burnout now than during the pandemic, with some reporting unsustainable workloads and inadequate support.
The most recent figures released by the General Medical Council (GMC) in its national education survey A survey of young physicians and their trainers found that 63% of trainees felt they were at ‘high or moderate risk’ of burnout.
That is higher than in 2020 and 2021 during the pandemic, when the figures were 43% and 56% respectively. It is a slight decrease compared to last year.
Mike Greenhalgh, deputy co-chair of the British Medical Association (BMA) junior doctors committee, said: “The GMC’s burnout statistics are shocking, but sadly not surprising – as is the increasing trend of doctors taking time off to interrupt their training, or choosing a career abroad and outside the NHS.”
The GMC survey – the largest annual survey of doctors in the UK – asked 74,000 doctors about their working environment, the quality of training, wellbeing at work and workload. It found that 32% of emergency trainees were at high risk of burnout, the highest rate of any speciality.
“The findings of the study remain very concerning,” the report said. “A third of emergency department trainees are at high risk of burnout, suggesting that unsustainable workloads have become the norm in this specialty.”
The warnings about the pressures trainees face come as Health Secretary Wes Streeting hopes to resolve the dispute with junior doctors. The government and the BMA, the doctors’ union, have agreed an improved pay deal for junior doctors in England, which averages around 22% over two years. Members will now vote on whether to accept the deal.
Victoria Selwyn, 27, a junior doctor, said that as well as better pay, there needed to be more recognition of trainee burnout and better support. She said she had been well trained but nothing could prepare a junior doctor who is looking after “two or three hundred patients” at night with one registrar on seven floors of a hospital.
She described trying to stabilize deteriorating patients overnight until her registrar was available. “Everyone is overloaded … and on those nights your beep is constantly going off,” she said. “You end up doing multiple jobs and you’re trying to split yourself up in a million different ways. You’re wondering how to get through and prioritize the patients. You feel like you’re biting off more than you can chew.”
She shared that during her training she had to deal with a staff shortage and that several colleagues needed a time-out due to burnout.
Selwyn added that it can be demoralising that after such an intensive training environment it is often difficult to find a job in a chosen speciality. She hopes to train in psychiatry and believes that more training places would help to create a better job structure for junior doctors.
Michael West, professor of work and organisational psychology at Lancaster University, said: “If you want to design the worst possible job at the start of someone’s career, it’s the job of a junior doctor.”
West, co-author of the 2019 GMC report Care for doctors, care for patientssaid a lack of autonomy, poor working conditions and a culture of blame had contributed to a “toxic cocktail” for young doctors. He said: “It is difficult to be effective and treat every patient as a human being.”
More than 9,000 junior doctors join hospitals in England, Wales, Scotland and Northern Ireland each year. Many take time off during or after their first two years in the job, with a significant number complaining of stress and overwork.
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Nathan Robinson, 28, said he took a break from the 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 saw their profession and the reality of frontline roles.
Robinson said that while the workload was grueling, what he found most difficult was the lack of support and a culture of blame when things went wrong. “I never knew what I was getting into,” he said. “Was it going to be understaffed? Was someone going to go backwards?”
Once, in his second year of hospital residency, he was the only doctor in his emergency department dealing with “majors”—patients with moderate to severe health conditions. He said he was evaluating “patient after patient” without time to stop and think. “We forget sometimes that lives are at stake,” he said. “You’re working 150 percent almost all the time, and no one seems to appreciate that.”
Robinson said there was no support or learning opportunities after particularly difficult shifts. “I would come home, sit down and think, ‘Wow, what just happened?’” he said. “The next day, it’s like everything that happened the day before is a blank slate. No debriefing. Nothing.”
A survey of 10,000 medical students by the British medical journal Last year, it emerged that one in three British medical students planned to leave the NHS within two years of graduating – either to work abroad or give up medicine altogether.
Some interns say frustrations and dissatisfaction have been exacerbated this year by a new system of assignment for their hospital training program. While most are assigned to their preferred location, others are asked to move hundreds of miles from home.
Prof Colin Melville, medical director and director of education and standards at the GMC, said: “Our analysis shows that a high risk of burnout is strongly associated with high workloads, a lack or disruption of time to train and feeling unsupported.”
An NHS spokesperson said: “The findings from this report demonstrate the ongoing need to support doctors’ training and working lives and the importance of recognising the risk of burnout for junior doctors and the doctors who train them. We know there is more to do and that is why we are strengthening occupational health services and reviewing our mental health and treatment provision for staff to ensure everyone working in the NHS gets 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.”