23rd November 2012, Volume 125 Number 1366

Heather Jane McCluskey, Edward G Spilg

There have been a number of news reports suggesting that up to a quarter of doctors were leaving England after completing foundation training in the UK.1 Goldacre et al summarised trends in career destination of graduates in 1974, 1977, 1983, 1988, and 1993. They found that 6–9% of medical graduates trained in Great Britain were working in medicine outside Great Britain.2

Moss et al used postal questionnaires to explore the reasons for doctors considering leaving UK medicine.3 This questionnaire was sent to doctors, who graduated in 1999, during their first postgraduate year.

Of those who were considering leaving the UK but staying in medicine, 65% cited lifestyle choices as a reason and 41% cited working conditions; 78% of those probably or definitely leaving the UK but continuing medicine attributed their decision to lifestyle choices and 32% to working conditions.

An online questionnaire was sent via email to 165 UK graduates in 12 out of 20 District Health Boards from April 2011. In total 54 doctors responded; 21 working as house officers, 29 as registrars and 4 in other posts.

The length of time in postgraduate training in the UK prior to working in New Zealand ranged from 0–12 years, with 70% having worked 1–2 years. The majority of responders, 57%, had worked in New Zealand for less than 1 year with 85% less than 2 years.

Of the 54 doctors who responded, 65% strongly agreed that travel opportunities and opportunity to live in another country affected their decision to move; 43% strongly agreed that the wish to broaden their medical experience was a factor; and 47% and 42% respectively agreed job satisfaction and the chance to work in a chosen field influenced their decision to move. This is supported by a number of comments:

“(I) did not want to be pushed into training programme when I was unsure what area I would like, needed more exposure before this decision could be made!”

“(I) did not know what speciality to apply for in UK. (I) decided to move to NZ with the intention of trying several HO (house officer) runs.”

“(My) main reason for moving is that nowadays you need to go into a training programme after your foundation years of work. I feel you are pressurised to do this and it is difficult to have a secure post without training in Scotland.”

“I think another factor at the moment is that general discontent in the NHS makes working in clinical areas less fun. No one seems to enjoy their work in the NHS! I also think that New Zealand offers an opportunity to work in your chosen field, on a good salary, at a 3rd-year house officer level. It seems very difficult and culturally unacceptable to want to broaden your experience before getting on a training scheme, in the UK—they're missing out!”

The majority of participants felt New Zealand was better for working hours, pay, job satisfaction, job intensity and research opportunities. However one comment stated that “Pay and conditions for House Officers are far in excess of those in the UK. However personal responsibility and professional development is less.”

Only 20% of participants applied to enter a UK training programme in the same year they came to New Zealand. This is important as it suggests the decision to move to New Zealand was not as a result of being unable to get a post in the UK.

New Zealand has much to offer in terms of a medical career as well as travel and lifestyle opportunities. A number of UK medical graduates working in New Zealand felt discontent with the NHS system in the UK and cited this as a reason for leaving the UK. However, the majority of participants questioned intended to return to the UK to re-enter a training programme.

Heather J McCluskey
House Officer, Waitemata District Health Board
Auckland, New Zealand

Edward G Spilg
Consultant Geriatrician, Gartnavel General Hospital
Deputy Director of Medical Education, NHS Greater Glasgow & Clyde
Glasgow, Scotland

Author Information

Heather J McCluskey, House Officer, Waitemata District Health Board, Auckland, New Zealand, Edward G Spilg, Consultant Geriatrician, Gartnavel General Hospital, Deputy Director of Medical Education, NHS Greater Glasgow & Clyde, Glasgow, Scotland

Correspondence Email



  1. Junior doctors 'leaving NHS training'; BBC news website; 06/09/2010; http://www.bbc.co.uk/news/health-11199099
  2. Goldacre, Lambert & Davidson; Loss of British-trained doctors from the medical workforce in Great Britain; Medical Education. 2001;35:337-344.
  3. Moss, Lambert, Goldacre & Lee; Reasons for considering leaving UK medicine: questionnaire study of junior doctors’ comments; BMJ. 2004;329:1263.