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Investigation: The GP brain drain

New figures show GP emigration is accelerating with potentially significant implications for those left behind, finds Madlen Davies

‘I work five days a week. The surgery is open at 8am and closes at 6pm. There’s no on-call at night and the consultation time is 15 minutes. It’s just brilliant… there are no home visits, no scripts to be signed. All your referrals you do in the consultation with your patients.’

Dr Otto Olivier is describing his new life as a GP in Perth, Western Australia. Having formerly worked as a salaried GP in Wilmslow in Cheshire, he decided just over three months ago to pack up and leave the UK with his wife and two young children. He now lives near to the beach, about a 5km cycle ride from his practice and says his quality of life has ‘tripled’ since moving.

Dr Olivier is not alone. There are indications that more GPs than ever are considering emigrating – a brain drain which, according to the GPC, represents ‘a significant danger’ to the profession.

The number of GPs who have requested Certificates of Good Standing (CGS) from the GMC – which are necessary for doctors looking to move abroad – increased by 13% last year, from 639 GPs in 2011 to 722 in 2012. All told, the number of CGSs requested has risen by 39% since 2008, when there were 521 applications.

Dr Otto Olivier - online

Dr Otto Olivier

A recent trend

There are no official figures on the number of GPs emigrating, but Anna Payne, managing director of Head Medical, a recruitment agency that places GPs in posts abroad, says that in 2009 it helped eight GPs find jobs in Australia and New Zealand. In 2012, 43 GPs were placed in those two countries. This year, she expects to triple the 33 GPs she has already placed – with their destinations extending to countries such as Kazakhstan, Tajikistan, the Falkland Islands and St Helena in the South Atlantic Ocean.

Mr Gary Taylor, chief operating officer at recruiter GP World, agrees: ‘The increase has been in the last 18 months. Younger doctors are entering into the primary care space. It’s attractive to go to New Zealand or Australia. There’s more of a demand from overseas countries for family doctors.’

Figures obtained by Pulse suggest New Zealand is the up-and-coming destination. Medical Council of New Zealand statistics show a 49% increase in registrations of both primary and secondary care doctors from the UK and Ireland between 2007/08 and 2011/12, with 624 doctors registered with the council in 2011/12, compared with 420 in 2007/08.

The Australian Medical Council, on the other hand, has recorded steady numbers of doctors from the UK applying to be registered, with 974 in 2008 and 939 in 2011.

There could be another destination emerging over the next few years, Mr Taylor predicts; the US will require 20,000 more GPs next year with the introduction of ‘Obamacare’, which will significantly widen access to healthcare. He says: ‘The US doesn’t have enough doctors, the demand is going to be unheard of. We’re going to see a mass exodus to the US.’

 

‘A significant danger’

The GP emigration statistics are worrying the BMA. ‘I’m not sure the impact of this is being recognised. This is a significant danger,’ says Dr Mary McCarthy, the GPC’s representative on the BMA’s international committee.

But others counter that with the ever-increasing demands on GPs, it should not come as much of a surprise.

Working in Australia, Canada, New Zealand would be very tempting

Dr Tony Grewal

Dr Tony Grewal, medical director of Londonwide LMCs, says GPs ‘are fleeing the sinking ship’. He adds that if he was completing his training now, ‘working in Australia, Canada, New Zealand would be very tempting’.

‘In Australia, the view is that professionally, personally and financially, you get out of it what you put in. If you work hard and well, you get good clinical outcomes. If you choose to control your workload you get a good work-life balance.’

This is in contrast to the UK, he says, where ‘the regular 12-hour day is not a myth from GPC propaganda’.

Dr Mark McCartney, a GP and former GPC member who emigrated to Queensland, Australia, from Cornwall last year, says there are multiple incentives: ‘I have met a few other recent refugees from the NHS and all appear to be settling into professional life in Australia. We have escaped from CCGs, CQC, the QOF, LATs, out-of-hours, falling income, pension cuts and adverse taxation changes. No doubt some of these things will catch up with us here in Australia, but we might be better equipped to deal with them.’

 

Financial sense

But, while Australasia has always appealed to emigrants for its quality of life, another reason seems to be emerging for moving abroad. Rosemary Smith, senior partner at RS Medical Accountancy, says it makes financial sense for salaried GPs to head overseas – despite figures from the Organisation for Economic Co-operation and Development (OECD) showing British GPs are among the best paid in the OECD countries.

This year, for the first time, four of her clients asked for advice on moving to work in Australia.

Ms Smith worked out that her clients, who are all salaried GPs, would increase their earnings by an average of 22% if they moved to Australia.

She said: ‘The highest increase was 25% and the lowest 19%. Taxation is slightly less in Australia. They’ll save 13.3% on their pension, but they’re losing the 14% paid on their behalf by the NHS.

‘Financially it all makes sense to go to Australia. Most are going on sabbatical. They are doing it to make money for a few years and then they might come back. Whether they will actually come back or not is a different question.’

The bigger picture is that it is the British taxpayer who is losing out, given it takes an average of £237,000 to train a doctor, says Dr Krishna Kasaraneni, chair of the GPC trainees subcommittee. 

‘We’re losing well-qualified GPs. From a taxpayer’s point of view, they’re not getting a good deal,’ he says.

Financially, it all makes sense to go to Australia

Rosemary Smith

He adds that the Government’s plan simply to increase the number of GP trainees to 50% by 2015 is not sufficient: ‘You have to train them and retain them. Simply training more is only half the solution. There’s no obligation to stay. If the working conditions continue to deteriorate, this will only get worse. The process is just beginning.’

Restoring morale

So what’s the answer? It’s simple – make GPs want to stay, says GPC deputy chair Dr Richard Vautrey.

He says: ‘With increasing workload leading to high levels of burnout, constant media attacks on GPs and a Government that shows no understanding of the issues but just imposes more of the same, it is no surprise that increasing numbers of GPs are looking to work abroad.

‘It is time the Government woke up to reality and started to work with us to restore the morale of GPs and deal with our unsustainable workload.’

GP Pay Aug 2013 map

Readers' comments (13)

  • Are these figures real? Why are we not working in Ireland? £192,000 pa ????????!!!!!

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  • Mark Purvis

    The UK mostly benefits from the migration of doctors. Some of our most challenging working environments are served by committed and enthusiastic GPs who had at least some part of their training from outside the UK. We have always had a small number of GPs who emigrate overseas. Small increases in outflows of trained GPs could, however, make a large difference to workforce supply and destabilise primary care in the UK.

    According to Lambert et al. most graduates choose to work in UK General Practice because of commitment to the specialty (the chance to make a difference) and opportunities for a sustainable work life balance. Final career earnings are not high on the list of motivating factors for GP career choice.

    I agree with Dr Richard Vautrey that we need to tackle morale, workload and career prospects: ensuring that General Practice is rewarding career where we can make a real difference to the lives of ordinary people in the communities we serve.

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  • Pipin Singh

    How are these salaries calculated? Partner? Salaried? FTE?

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  • We will quickly lose the enthusiasm of the doctors migrating into the UK if they see the CSA as a huge obstacle

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  • Two points if I may:
    Firstly, that the essence of the problem is an unreasonable approach by the Government to a reasonable solution to a National problem - getting better value for money in a declining economy. So the draconian, revolutionary and destructive abandon with which the Health secretary inflicts change is completely unhelpful and demoralising to all.
    Secondly, the grass, as ever, is not always greener. The cost of living in Australia, especially Western Australia, has escalated beyond belief in the past 5 years causing most basic elements of life to cost about 20-30% more than the UK. Petrol is considerably cheaper however!

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  • What I love is the national newspapers and public.....apparently we are all lazy, greedy bastards.....if so why would anybody want to leave.....some convoluted fantasy then has to be conjured up to explain the massive discrepancy!!!

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  • Not only the GP's. A substantial number of my son's F2 cohort - including him - don't yet feel ready to make the career choices mandated by the current UK system and are heading for the Antipodes.For the first time, as a GP educator, I now feel quite anxious.

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  • I'm a GPSTR, and definitely the prospects of sun, better life for my entire family, space, and cleaner more effective system is number one on the list. The current situation in the uk will guarantee my departure, I know 5 others that have already applied from my program of 15 traniees.

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  • The medical recruitment market has been a global market for many years and in fact the UK has benefited greatly from that, with many doctors joining our hospitals and health services from overseas. Just as some doctors come, others go. And whilst some go overseas permanently, many more go for a sabbatical / working holiday type experience; or do a year post retirement from the NHS. So to simply give figures and for these to be used in the context of growth in emigration would not be accurate in my view. Our agency arranges such placements and the vast majority of doctors who we place overseas go for a fixed term contract of 1-3 years. Some contracts are as short as 2-3 months. There is no doubt that many GPs are interested in relocating abroad for a period and there are many push and pull factors for doing so. But again, almost every ‘long term’ GP contract we recruit to is for a fixed term of between 1 and 3 years. We know that some GPs will stay longer term, but we also know that many return to the UK, having gained new clinical perspectives and having had a great experience.

    Lastly, with regards to the way I am quoted in the article, whilst the number of doctors we have placed each year has increased, this is partly due to us growing market share rather than a growing market.

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  • How will the requirements for revalidation and license to practice affect the ability for trained GPs going abroad to return?

    If a doctor is out of practice recognised by GMC for more than 12? 24? months, don't they have to retrain?

    It might appear that if that is the case, any return to the UK might be extremely difficult if not impossible - and I can't see any advantage to Australasia in making a return to the original country easier!

    There are future workforce implications: have these been considered in the mesh of professional qualifications, recruitment/retention and regulatory requirements

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