UK doctors in Australia – Why they won’t be going home any time soon

UK doctors in Australia

UK doctors are leaving their country en masse. Image: Pixabay.com

The numbers are telling: About 1,500 UK doctors move to Australia and New Zealand each year. This exodus is causing havoc in England. A GP-shortage creates high workloads and overstretched doctors, and a survey showed that over half of UK GPs plan to retire before the age of sixty. This stressful situation has prompted a coming home campaign to entice doctors to go back to the United Kingdom.

Why are doctors leaving, and, will they move back to save the NHS?

Dr Nathalie Departe is a UK-trained GP working in Fremantle, Western Australia. “I moved to Australia in 2009 for a change of scenery. I had visited Australia before and loved it, so when my husband found himself in a career hiatus, we thought we would enjoy the sunshine for a few years.”

“Working in Australia was a breath of fresh air. Patients were pleased to see me, understanding if I ran late, and I was rewarded and not penalised if I spent time with a complex patient to sort out their management. Access to pathology and radiology services was prompt, rather than a standard 6-8 week wait for an ultrasound, and access to allied health services didn’t compare – good luck trying to see a clinical psychologist on the NHS.”

“Initially it was a bit odd to bill patients and not provide free care at the point of need, but I soon came to value the transparency of the transaction. The integration between private and public care makes private care accessible and affordable in Australia, rather than in the UK where private care has to be funded in full.”

Escaping the NHS

“In Australia I can arrange imaging quickly, receive the results the next day and organise appropriate and timely care

Dr Janaka Pieris moved to Brisbane in 2010 to ‘escape’ the NHS: “When I think back to my working life as a GP in South East London, I have two overriding memories: there was never enough time in the day to do the work asked of me, and there was no means of limiting my workload. NHS General Practice is a sink for everything no-one else will take responsibility for. Many GPs feel unable to decline these demands – many of which are not NHS work and therefore unfunded – and as a result, are drowning in work.”

“When a patient presents with painless obstructive jaundice in the UK, I have no option but to refer in to hospital, because I have no access to appropriate imaging, or I cannot get it done in a timely fashion. In Australia I can arrange the imaging quickly, receive the results the next day, discuss the case with a specialist and organise appropriate and timely care. It is much more satisfying from a professional perspective.”

Dr Tim Leeuwenburg made the move in 1999, immediately after his internship in the UK. He is now a GP at Kangaroo Island in South Australia. “I was married to an Aussie and always knew I’d be coming to Australia for love and a better lifestyle.”

“That was 15 years ago. Since then I’ve vicariously witnessed the demise of UK medicine – and am anxious that Australia doesn’t make the same mistakes: Other professions trying to do doctors’ work, capitation and performance payments, privatisation, walk-in clinics, phone advice lines, revalidation. They are all seemingly good ideas, but not evidence-based and all have served to emasculate the profession and increase the number of doctors seeking to retire, locum or emigrate from the cesspit that is the NHS. None of these measures have reduced costs or increased quality.”

“The myth of the ‘fat cat’ wealthy GP laughingly enjoying his round of golf whilst poor patients helplessly waited for his attentions was regularly portrayed in the media

Departe: “Despite working in a nice area and enjoying my job, I had a growing sense of unease with the way UK general practice was going. There seemed to be ever changing targets to qualify for practice payments with increased red tape and less time for consultations.”

“There was a general loss of respect for the role of a GP; it was not unusual for patients to demand medication, tests and home visits inappropriately, then to be outraged if you questioned the need for it. The myth of the ‘fat cat’ wealthy GP laughingly enjoying his round of golf whilst poor patients helplessly waited for his attentions was regularly portrayed in the media, and I felt that general practice was being devalued in the eyes of public and politicians alike.”

Dr Mark McCartney left the UK in 2013 because he was not happy with the working conditions in the NHS, but moved back to England after 12 months because of family circumstances. “There is a huge cultural difference in Australia, where there is a mixed health economy of private and state-subsidised services. The NHS is free at the point of access for patients, and service always struggles to meet the demand and prioritise appropriately. UK hospitals are dysfunctional places and the effects of this trickle into General Practice.”

“UK GPs are mostly paid on the basis of capitation payments depending on the number of patients registered, with additional payments for reaching clinical targets and a small amount of fee for service payments. There is now a shortage of GPs and we work in an environment of running faster and harder just to meet demands, without additional incentives or resources.”

“Australian GPs have the luxury of earning a high proportion of income from fee-for-service payments, including patient fees and Medicare payments. The more patients they see and the more services they provide, the more they earn. Clinical practice is also more interesting with rapid access to x-rays and scans. It is a professionally motivating environment to work in.”

Would you move back to the UK?

Dr Pieris is sceptical about the fully funded induction and returner scheme: “Firstly, it is manifestly insulting to suggest that doctors who have worked in similar systems, such as Australia, need retraining to work in UK general practice. I do more medicine in Australia than ever I did in the UK.”

“Secondly, if people are leaving because of a failed system, a sensible approach would be address those failings, not try to tempt people back into the same environment they left.”

“To return would require most GPs to undertake 6-12 months of supervised training, and to surrender to ridiculous bureaucratic imposts

Departe: “Why would I return to a role where I am restricted in my clinical practice by financial constraints, strangled by paperwork, stressed out by time pressures, undervalued by patients and politicians and where I would earn less money for more work and more stress?”

“To return would require most GPs to undertake 6-12 months of supervised training, and to surrender to ridiculous bureaucratic imposts,” says Leeuwenburg. “The reason doctors are leaving the NHS is because of unfettered demand from patient ‘wants’ not ‘needs’, and reduced income as a result of capitation. Why on earth would you go back?”

McCartney: “Very few GPs will return, unless they have personal or family reasons. UK GPs are retiring early, but this does not seem to be the case in Australia. There are also huge barriers to doctors wishing to move back to the UK in terms of medical registration and licensing to practice. The NHS is wasting resources trying to recruit in Australia and they look foolish because of that.”

Doctor’s advice

“My message for governments,” says Departe, “would be Stop undervaluing good general practice! Good general practice has been proven to provide better value for money and a more integrated care approach than secondary care. By all means, regulate general practice to maintain appropriate standards of care but then pay us accordingly and let us get on with being general practitioners.”

Leeuwenburg: “Listen to grassroots doctors, not NHS managers who have destroyed the NHS and are now sprucing their wares in Australia. Nor to academics who think things like capitation and revalidation are necessary. Our Australian system is marvelous and we should be proud. Sure, there is fat in the health system that could be trimmed, mostly in hospitals and specialists, but primary care is overall incredibly efficient and GPs do a great job.”

“The UK government needs to stop attacking GPs and listen to doctors and the BMA, who have been largely ignored for the last ten years

“Ofcourse there are some outliers, but there are many more who are hard working and ethical, doing the right thing for patients and Medicare. Alienate GPs and risk the collapse of a great primary care system. It will cost more if we surrender to the failed experiments of the UK or privatise us with private health funds.”

“The UK government needs to stop attacking GPs and listen to doctors and the BMA, who have been largely ignored for the last ten years,” says McCartney. “Doctors want to work in an effective service so that they can focus on caring for patients. Learn from Australia that good access to radiology for GPs can keep people away from hospital until they really need to be there.”

Pieris: “The UK Government should let us do our jobs. Trust us. Stop interfering. No-one is saying regulation and scrutiny are not required. However, GPs are not some malign enemy. Stop treating us as if we are.”

Follow me on Twitter: @EdwinKruys

18 thoughts on “UK doctors in Australia – Why they won’t be going home any time soon

  1. Excellent article read with great interest and after 12 months as a strained and undervalued GP can’t see my UK career into a second year. packing bags as we speak. Where do I sign……?

    Like

  2. True and depressive read. How do we nudge our representatives and ‘unions’ to be more vocal. Time to tell things as they are and become a bit more radical I think

    Andreas, GP

    Like

  3. The constant NHS bashing by expats is tiring. Tim Leeuwenburg, amongst others, is entitled to his opinion but describing my profession, career, employers, employees, colleagues and patients as, collectively, “the cesspit that is the NHS” is just plain rude.

    It’s also pretty rich coming from someone who (a) confesses that their main reason for moving to Australia was nothing to do with medicine: “I was married to an Aussie and always knew I’d be coming to Australia for love and a better lifestyle”; (b) has never, as far as I can tell, actually experienced sustained substantive clinical practice in the UK and (c) works on Kangaroo Island (yep, I’ve been there).

    I wonder if there is anything a little less shallow and insulting that could inform this debate…. What about the Commonwealth Fund’s comparison of healthcare systems around the world at http://www.commonwealthfund.org/publications/fund-reports/2014/jun/mirror-mirror?

    Like

    • “Good, fast, cheap. Pick any two.” is the business maxim. Yet the Commonwealth Fund 2014 Mirror, Mirror report suggests England has all three. I suspect the cheap part (in British pounds) comes at the expense of job satisfaction as suggested by Jonathan Brown’s informal poll (infra vide). The former is of importance to governments. The latter is important to the work force.

      Like

  4. Sounds more like Stockholm syndrome to me. Certainly am a fan of the ideals of the Nash – and was too polite to describe the bastardry of my intern year there (involving Liz Paice, no less, she of Scott Junior infamy), let alone the almost daily ongoing litany of complaints from family/friends who require care in the UK…as well as the comments from colleagues who remain in the UK and are desperate to get out.

    But we are each entitled to our opinions. The topic under debate was whether one would return to the UK to work as a doctor. The answer is a resounding no….in my case, because of the ridiculous bureaucracy that requires a period of supervision…as well as informed by colleagues who are desperate to RLE (retire, locum, migrate) as the Nash collapses around them.

    Forgive my plain speaking, I have clearly gone native…

    Liked by 1 person

  5. Rod, no one was calling your profession (we’re doctors here, too), career, employees, colleagues or patients “the cesspit that is the NHS”. But the politicians, first and foremost, followed by the employers, “blue sky thinkers”, privitisers etc have made it a very difficult place to work, and a very difficult place to be a patient.

    Liked by 1 person

  6. The NHS experience is heavily dependent on where you are within it. There are some specialisms in tightly defined geographical or administrative areas where things are very tolerable, thank you. Then there are others which are pure hell. Overall, however, only the blinkered and deluded are unable to see the consistent, unremitting, unfair, sinister and Machiavellian undermining, the ritual humiliation of the medical profession as a whole in the UK. Tim is quite correct: there is overwhelming denial and embarrassing obsequiousness, justified by defence of the nobility of the NHS as an ideal. The latter is not in question: the maintenance of the illusion that the NHS is not an abusive employer relies on complicity: omertà might be an apt description…….
    Parts of the NHS remain very good. Other parts are functioning, but tottering. Cardio thoracic surgery has been virtually annihilated. Almost entirely on the back of a perverse insistence on publishing individual surgeon mortality rates. Creating a statistical league table that has as much relevance to predicting numbers on a roulette wheel as anything else. Everything is on hold till the May elections. Thereafter, predict a renewed wave of frenetic reorganisations, all completely useless, and an exponential increase in internal angst, the vast majority of the public having no idea what is going on, but happy to have a moan about any or everything. ‘Its my right – innit? ‘
    DOI: left the UK last year. Ex NHS consultant surgeon, clinical and later medical director. Just attended a depressing society conference in UK: won’t be making the journey over again anytime soon.

    Liked by 1 person

  7. Revalidation has not only driven many doctors away due to the extreme paperwork and assessments, on a much darker note it also forces all doctors to agree to be vaccinated against all common illnesses and forbids them to speak to their collegues and patients about the drawbacks of vaccinations.They even have to prove this in writing before they can be revalidated! So much for a balanced view and free speech….. So what ever your views on vaccines, this will only undermine patient confidence in doctors when this gets out that all revalidated practicing doctors in the UK have effectively become pimps for big Pharma

    Like

  8. in case you don’t read as far as the Health section of (the CIA-founded) SERCO’s infiltration of the UK govt, here’s a snip:
    ‘In health services, Serco’s difficulties include the poor handling of pathology labs and fatal errors in patient records. At St Thomas’ Hospital, the increase in the number of clinical incidents arising from Serco non-clinical management has resulted in patients receiving incorrect and infected blood, as well as patients suffering kidney damage due to Serco providing incorrect data used for medical calculations.[49] A Serco employee later revealed that the company had falsified 252 reports to the National Health Service regarding Serco health services in Cornwall.[50]
    It emerged in November 2013, Serco, which won a contract for Suffolk Community Healthcare in 2012, had 72 vacancies after earlier cutting 137 posts. Problems identified by Ipswich and East Suffolk Clinical Commissioning Group include “staff capacity, skill mix, workload, succession planning and morale, training, communication, mobile working, care co-ordination centre processes, incidents and near miss incidents”

    Like

  9. Pingback: Competency checks on doctors could become a costly mistake | Doctor's bag

  10. Pingback: So you have a sore knee Mrs Smith? | Dr Thinus' musings

  11. I wish to seek your advice please? I am looking to attract UK doctors to fill a variety of roles in Australia, in most states and also with the Royal Flying Doctor Service (RFDS). I have a solid network within the UK Military MO cohort, but not within the NHS. Any assistance is very welcome. Cheers, Graham

    Like

  12. I am disappointed to see this article but not surprised as it is an English cultural attitude to complain rather than act and make a change. I am Australian born and bred, lived and worked in every part of my country both city and Outback and work as an emergency physician in the UK due to family circumstances. I have been working in the NHS for the past 5 years in various parts of the country. Back in Australia, apart from 15 years in the hospital system in various specialities, mainly ED, I also worked as a locum fulltime GP both in city and rural practices. I am one of the multiskilled Australian docs of which there are many in Oz who still exist. Firstly, I see a great cultural difference between the way patients and doctors are in the UK compared to Australia. I have worked alongside English trained docs in Australia and found their practices occasionally peculiar but mainly inferior to the standard that we have in Australia. That is not a criticism, it is because of the system that exists for them. The GPs in the UK work as hard as those in Australia, as do the emergency physicians, however there is a large Big Brother approach enforced on them. Having said that, there is no point complaining, they should take a stand within their country because the UK needs its UK doctors. The Australians need their Australian doctors. I am sorry to say this, but enough complaining and coming over to Oz expecting to have a relaxed life and creating issues for Australian patients. If UK GPs really feel so insecure about their jobs in the UK, it is not going to get any better in Australia. One thing us Aussies do is complain directly to their GP if they think they are being shortchanged. UK patients sadly do not, and so their GPs provide reduced service and default to the ED physician because of the belief that things can happen quicker in the ED. All that is doing is overstretching the EDs in the UK. I see that on a daily basis and see a lot of poor quality referrals too. There are systems in place for GPs to manage patients but what I see is a lot of GPs not using them. By the way Graham – take care in using UK doctors. From the doctors firsthand, those who have been down and done stints with RFDS and rural hospitals – they come back shaking, feeling quite overwhelmed about their experiences, and they are not that good at managing patients in retrievals (I also have international retrieval and disaster medicine experience)…….Stick to trying to recruit Aussie doctors. Oh, may I add that the number of UK locum agencies that have opened up in Australia is sickening. I have dealt with them and they are as bad as the ones in the UK. All trying to make a quick buck out of Australian hospitals and practices.

    Like

    • What a load of BS! Plenty of high quality UK trained GPs and Specialists working in Oz. they’re well respected by patients and colleagues and generally fit in well with the Australian system.

      Like

I'd love to hear from you! Please leave a comment:

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s