Objective: To summarize trends over time in the percentage of British medical graduates who subsequently practise in Great Britain in the National Health Service (NHS), in Great Britain outside the NHS, outside Great Britain, or do not practise medicine.
Design: Questionnaire-based postal surveys and government employment records.
Setting: Great Britain.
Subjects: All British medical graduates of 1974, 1977, 1983, 1988, and 1993.
Main outcome measures: Type and location of employment at successive years after graduation.
Results: Differences in career destination between cohorts were generally small. Combining data from all cohorts studied, 85% of doctors were working in the NHS 2 years after graduation, 82% after 5 and 10 years, 81% after 15 years, and 77% after 20 years. Part-time working was much higher among women than among men. Allowing for loss and part-time working, the whole-time equivalent available to the NHS at 15 years after graduation was 60% of women and 80% of men. More men than women worked in medicine outside the NHS in Britain and abroad. Loss from medicine altogether was small, and higher among women.
Conclusions: Medical workforce planning in Great Britain should assume that 15-20% of home-trained doctors will not be working in the NHS within a few years of graduation. Comparing cohorts at the same career stage showed no evidence of increased loss from the NHS in recent times. Although a higher percentage of women than men were not working in medicine at all, recent trends suggest that this percentage is falling.