Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-12T20:31:54.598Z Has data issue: false hasContentIssue false
  • English
  • Français

A Closer Look at the Junior Doctor Crisis in the United Kingdom’s National Health Services: Is Emigration Justifiable?

Published online by Cambridge University Press:  30 May 2018

WENDY ZI WEI TEO
Get access Rights & Permissions [Opens in a new window]

Abstract:

This article attempts to tackle the ethically and morally troubling issue of emigration of physicians from the United Kingdom, and whether it can be justified. Unlike most research that has already been undertaken in this field, which looks at migration from developing countries to developed countries, this article takes an in-depth look at the migration of physicians between developed countries, in particular from the United Kingdom (UK) to other developed countries such as Canada, Australia, New Zealand, and the United States (US). This examination was written in response to a current and critical crisis in the National Health Service (NHS), where impending contract changes may bring about a potential exodus of junior doctors.

Keywords

National Health ServiceNIHjunior doctorsimmigration of physiciansUnited Kingdom
Type
Special Section: Bioethics Beyond Borders
Information
Cambridge Quarterly of Healthcare Ethics , Volume 27 , Issue 3 , July 2018 , pp. 474 - 486
Copyright
Copyright © Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Notes

1. Sharma A, Lambert TW, Goldacre MJ. Why UK-trained doctors leave the UK: cross-sectional survey of doctors in New Zealand. Journal of the Royal Society of Medicine 2012;105:25–34, at 25–6.

2. Campbell D. Almost half of junior doctors reject NHS career after foundation training. The Guardian, Dec 5, 2015; available at https://www.theguardian.com/society/2015/dec/04/almost-half-of-junior-doctors-left-nhs-after-foundation-training (last accessed 6 Feb 2018).

3. Campbell D. Junior doctors contract row: an explainer. The Guardian, September 29, 2015; available at http://www.theguardian.com/society/2015/sep/29/junior-doctors-contract-row-nhs-explainer-health (last accessed 6 Feb 2018).

4. Jeremy Hunt “misrepresented weekend deaths data.” British Broadcasting Corporation News, October 22, 2015; available at http://www.bbc.com/news/health-34598335 (last accessed 6 Feb 2018).

5. Junior doctors’ row: the dispute explained. British Broadcasting Company, April 6, 2016; available at http://www.bbc.com/news/health-34775980 (last accessed 6 Feb 2018).

6. Siddique H, Mason R. Boseley S. Junior doctors defy health secretary with three 48-hour strikes. The Guardian, Feburary 23, 2016; available at http://www.theguardian.com/society/2016/feb/23/junior-doctors-announce-three-48-hour-strikes?CMP=share_btn_fb (last accessed 6 Feb 2018).

7. See note 2, Campbell 2015.

8. El-Sheikha S. The new junior doctors’ contract is unfair, archaic and discriminates against women. The Guardian, October 1, 2015; available at http://www.theguardian.com/commentisfree/2015/oct/01/junior-doctors-contract-unfair-archaic-discriminates-women (last accessed 6 Feb 2018).

9. What is the junior doctors row about. British Broadcasting Corporation, September 29, 2015; available at http://www.bbc.com/news/health-34383677 (last accessed 6 Feb 2018).

10. See note 6, Siddique 2016.

11. BMA Briefing: Junior Doctor Contract. British Medical Association. 2015 Oct 23. [cited 6 Feb 2018]

12. Moberly T. News article, ‘Nine royal colleges warn government about damaging effects of new junior doctors’ contract,’ British Medical Journal 2015;315(1):1.

13. Khomami N. Junior doctors contracts are a threat to NHS, warn royal colleges. The Guardian, September 24, 2015; available at http://www.theguardian.com/society/2015/sep/24/junior-doctor-contracts-are-threat-to-nhs-warn-royal-colleges (last accessed 6 Feb 2018).

14. Al-Othman H. 20,000 protesters march in opposition to changes to junior doctors contract. Evening Standard, October 17, 2015; available at http://www.standard.co.uk/news/london/20000-protesters-march-in-opposition-to-changes-to-junior-doctor-contracts-a3092931.html (last accessed 6 Feb 2018).

15. Triggle N. Junior doctors row: 98% vote in favour of strikes. British Broadcasting Corporation News, November 19, 2015; available at http://www.bbc.com/news/health-34859860 (last accessed 6 Feb 2018).

16. Stone J. Junior doctors overwhelmingly vote for NHS strike next month with 98% in favour, The Independent, November 19, 2015; available at http://www.independent.co.uk/news/uk/politics/nhs-junior-doctors-have-overwhelmingly-voted-to-strike-next-month-a6740201.html (last accessed 6 Feb 2018).

17. Campbell D. Junior doctors overwhelmingly vote for NHS strikes. The Guardian, November 19, 2015; available at http://www.theguardian.com/society/2015/nov/19/nhs-strikes-junior-doctors-vote-action-bma (last accessed 6 Feb 2018).

18. Castle S. Junior doctors’ strike in England disrupts care for thousands. New York Times, January 12, 2016; available at http://www.nytimes.com/2016/01/13/world/europe/doctors-strike-national-health-service.html (last accessed 6 Feb 2018).

19. Triggle N. Operations hit as doctors strike again. British Broadcasting Company, 10 February 2016: available at http://www.bbc.com/news/health-35535704 (last accessed 6 Feb 2018).

20. Triggle N. Junior doctors’ strike: All-out stoppage ‘a bleak day’. British Broadcasting Company. April 26, 2016, available at http://www.bbc.com/news/health-36134103 (last accessed Feburary 6, 2018).

21. Triggle N. Junior doctors plan week of all-out strikes. British Broadcasting Company, August 31, 2016; available at http://www.bbc.com/news/health-37229680 (last accessed 6 Feb 2018).

22. Cooper C, Henderson E. Numbers of NHS doctors registering to work overseas could reach unprecedented record. Independent, September 21, 2015; available at http://www.independent.co.uk/life-style/health-and-families/health-news/numbers-of-nhs-doctors-registering-to-work-overseas-could-reach-unprecedented-record-10511755.html (last accessed 6 Feb 2018).

23. Campbell D. Junior doctors: 7 in 10 to leave NHS if Hunt pushes through new contract. The Guardian, October 20, 2015; available at http://www.theguardian.com/society/2015/oct/20/junior-doctors-thousands-to-leave-nhs-if-hunt-pushes-through-new-contract (last accessed 6 Feb 2018).

24. Cooper C. Ninety percent of junior doctors would resign over new contract, poll finds. The Independent, Febuary 9, 2016; available at http://www.independent.co.uk/news/uk/politics/ninety-per-cent-of-junior-doctors-would-resign-over-new-contract-poll-finds-a6863796.html (last accessed 6 Feb 2018).

25. Stone J. The number of doctors applying to work abroad surged by 1,000 per cent on the day Jeremy Hunt imposed new contract. The Independent, February 17, 2016; available at http://www.independent.co.uk/news/uk/politics/doctors-leave-country-work-abroad-leaving-nhs-jeremy-hunt-contract-1000-per-cent-a6878776.html (last accessed 6 Feb 2018).

26. Wards dangerously understaffed, say nurses in survey. British Broadcasting Corporation, February 3, 2015; available at http://www.bbc.com/news/health-21310735 (last accessed 6 Feb 2018).

27. Campbell D, Elgot J. Addenbrooke’s Hospital in special measures after ’serious staff shortages.’ The Guardian, September 22, 2015; available at http://www.theguardian.com/society/2015/sep/22/prestigious-nhs-hospital-in-special-measures-after-serious-staff-shortages (last accessed 6 Feb 2018).

28. Hennessy P, Donnelly L. Seventeen NHS hospitals have dangerously low numbers of nurses. Telegraph, January 12, 2015; available at http://www.telegraph.co.uk/news/health/heal-our-hospitals/9797839/Seventeen-NHS-hospitals-have-dangerously-low-numbers-of-nurses.html (last accessed 6 Feb 2018).

29. Ferracioli, L, De Lora, P. Primum nocere: medical brain drain and the duty to stay. Journal of Medicine and Philosophy 2015;40:601–19, at 601.CrossRefGoogle Scholar

30. Raustol, A. Should I stay or should I go? In: Shah, RS, ed. The International Migration of Health Workers: Ethics, Rights and Justice. Basingstoke: Palgrave Macmillan UK; 2010:175–88, at 179.CrossRefGoogle Scholar

31. Dwyer J. What’s wrong with the global migration of health care professionals? Individual rights and international justice. Hastings Centre Report 2007;37(5):36– 48, at 36; Snyder J. Conflicting obligations. In Shah 2010 (see note 30), 62–77, at 66.

32. Brock, G. Whose responsibility is it to remedy losses? In: Brock, G, Blake, M, eds. Debating Brain Drain: May Government Restrict Emigration? New York: Oxford University Press; 2015:60–84, at 65.Google Scholar

33. Blake M. The right to leave: looking back. In Brock, Blake 2015 (see note 32), 111–54, at 114.

34. Shah RS. The right to health, state responsibility and global justice. In Shah 2010 (see note 30), 78–102, at 80.

35. Sager A. Brain drain, health and global justice. In Shah 2010 (see note 30), 103–17, at 107.

36. Dovlo D, Nyonator F. Migration by graduates of the university of Ghana Medical School: a preliminary rapid appraisal. Human Resources for Health Development Journal, 2003;3(1):34–7, at 34.

37. World Health Organization. Constitution. October 2006; available at http://www.who.int/governance/eb/who_constitution_en.pdf (last accessed 6 Feb 2018).

38. Mann JJ et al. Health and human rights. In: Mann JJ et al., eds., Health and Human Rights: A Reader. Routledge; 1999:7–8.

39. Shah RS. The Right to Health, State Responsibility and Global Justice. in Shah 2010 (see note 30), 78–102, at 80.

40. Daniels N. Equity and population health: toward a broader bioethics agenda. Hastings Centre Report 2006;36(4):22–35, at 24–5.

41. Cole P. The right to leave versus a duty to remain justice. In Shah 2010 (see note 30), 118–29, at 125.

42. Gawande, A. Complications: A Surgeon’s Notes on an Imperfect Science. New York: Picardor; 2002, at 23.Google Scholar

43. Articles 13, 23. and 25 of the Universal Declaration of Human Rights, United Nations Office of the High Commissioner for Human Rights. (December 10, 1948).

44. Ross SJ, Polsky D, Sochalski J. Nursing shortages and international nurse migration. International Nursing Review, 2005;52:253–62, at 260.

45. See note 13, Khomami 2015.

46. Triggle N. Junior doctors’ row: the dispute explained. British Broadcasting Corporation News, March 7, 2016; available at http://www.bbc.com/news/health-34775980 (last accessed 6 Feb 2018).

47. Mortimer C. Junior doctors: hospital could refuse to impose Jeremy Hunt’s new contract. The Independent, Febuary 12, 2016; available at http://www.independent.co.uk/news/uk/politics/junior-doctors-hospitals-could-refuse-to-impose-jeremy-hunts-new-contract-a6871401.html (last accessed 6 Feb 2018).

48. Campbell D. Female doctors may be forced to quit over new contract, experts say. The Guardian, April 1, 2016; available at http://www.theguardian.com/society/2016/apr/01/female-doctors-new-contract-medical-royal-colleges (last accessed 6 Feb 2018).

49. Cooper C. Junior doctors outraged over new contract that ‘discriminates against single women.’ The Independent, April 1, 2016; available at http://www.independent.co.uk/news/uk/politics/junior-doctors-outraged-over-new-contract-that-discriminates-against-single-women-a6963356.html (last accessed 6 Feb 2018).

50. British Medical Association. London: British Medical Association [cited February 8, 2017]. Transition pay and FAQs. Available from: https://www.bma.org.uk/advice/employment/contracts/junior-doctor-contract/transitionBritish Medical Association.

51. See note 46, Triggle 2016.

52. Wertheimer A. Coercion. Marshall Cohen, editor. Princeton, NJ: Princeton University Press; 2014, at 31–46.

53. See note 36, Wertheimer 2014, at 40-41, Berman M. Coercion without baselines: unconstitutional conditions in three dimensions. Georgetown Law Journal 2001;90(1):1–112, at 16.

54. R (Justice for Health Ltd) v Secretary of State for Health [2016] EWHC 2338 (Admin).

55. Brock G. Prosperity in developing countries. In Brock, Blake 2015 (see note 32), 36–59, at 40.

56. Packer C, Runnels V, Labonte R. Does the migration of health workers bring benefits to the countries they leave behind?’ In Shah 2010 (see note 30), 44–62, at 44.

57. See note 35, Sager 2010, at 107.

58. Cole P. The right to leave versus a duty to remain. In Shah 2010 (see note 30), 118–29, at 125.

59. See note 58, Cole 2010.

60. Bueno de Mesquita J, Gordon, M. The International Migration of Health Workers: A Human Rights Analysis. London: Medact; 2005.

61. See note 21, Blake 2015, at 141; Lesser AH. The right to the free movement of labour. In Shah 2010 (see note 30), 130–6, at 134.

62. Eyal N, Bärnighausen T, Conditioning medical scholarships on long, future service. In: Cohen IG, ed., The Globalization of Health Care: Legal and Ethical Issues. Oxford: Oxford University Press; 2013:220–32, at 220–1.

63. See note 35, Sager 2010, at 107.

64. See note 35, Sager 2010, at 107.

65. Elgot J, Campbell D. Seven-day NHS may not eat death rates, say Hunt’s own officials. The Guardian, Febuary 15, 2016; available at http://www.theguardian.com/society/2016/feb/15/weekend-effect-on-hospital-deaths-not-proven-say-hunts-own-officials?CMP=Share_iOSApp_Other (last accessed 6 Feb 2018).

66. See note 1, Sharma et al. 2012, at 25–6.

67. Matthews-King A. Junior doctors hit back at suggestion those who quit NHS ‘should pay back training costs’. The Independent, January 22, 2018; available at http://www.independent.co.uk/news/health/junior-doctors-nhs-quit-training-costs-repay-pay-back-health-department-medics-medical-school-a8172141.html (last accessed 6 Feb 2018).

68. Campbell D. NHS finances in crisis due to rising demand and budget cuts. The Guardian, October 5, 2014; available at http://www.theguardian.com/society/2014/oct/05/nhs-finances-crisis-rising-demand-budget-cuts-30-billion-pound-deficit-2020 (last accessed 6 Feb 2018).

69. Cohen IG. Conscientious objection, coercion, The Affordable Care Act and US states. Ethical Perspectives 2013;20(1):163–86, at 172.

70. Campbell D. Jeremy Hunt to impose contract on junior doctors. The Guardian, February 11, 2016; available at http://www.theguardian.com/society/2016/feb/11/jeremy-hunt-to-impose-contract-on-junior-doctors (last accessed 6 Feb 2018).