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Stick or twist? Career decision-making during contractual uncertainty for NHS junior doctors
  1. S Spooner1,
  2. Jon Gibson1,
  3. Dan Rigby2,
  4. Matt Sutton1,
  5. Emma Pearson1,
  6. Kath Checkland1
  1. 1Division of Population Health, The University of Manchester, Health Services Research & Primary Care, Manchester, UK
  2. 2Economics, The University of Manchester, Manchester, UK
  1. Correspondence to Dr S Spooner; sharon.spooner{at}


Objectives To examine the extent, and nature, of impact on junior doctors' career decisions, of a proposed new contract and the uncertainty surrounding it.

Design Mixed methods. Online survey exploring: doctors' future training intentions; their preferred specialty training (ST) programmes; whether they intended to proceed immediately to ST; and other plans. Linked qualitative interviews to explore more fully how and why decisions were affected.

Setting Doctors (F2s) in second year of Foundation School (FS) Programmes in England.

Participants Invitations sent by FSs. Open to all F2s November 2015–February 2016. All FSs represented. Survey completed by 816 F2s. Sample characteristics broadly similar to national F2 cohort.

Main outcome measures Proportions of doctors intending to proceed to ST posts in the UK, to defer or to exit UK medicine. Proportion of doctors indicating changes in training and career plans as a result of the contract and/or resulting uncertainty. Distribution of changes across training programmes. Explanations of these intentions from interviews and free text comments.

Results Among the responding junior doctors, 20% indicated that issues related to the contract had prompted them to switch specialty and a further 20% had become uncertain about switching specialty. Switching specialty choice was more prevalent among those now choosing a community-based, rather than hospital-based specialty. 30% selecting general practice had switched choice because of the new contract. Interview data suggests that doctors felt they had become less valued or appreciated in the National Health Service and in society more broadly.

Conclusions Doctors reported that contract-related issues have affected their career plans. The most notable effect is a move away from acute to community-based specialities, with the former perceived as more negatively affected by the proposed changes. It is concerning that young doctors feel undervalued, and this requires further investigation.

  • Career choice
  • Medical staff
  • Contracts
  • Education, Medical, Continuing

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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  • Contributors SS, JG, DR, MS and KC designed and organised distribution of the survey questionnaire and analysis of findings. EP and SS conducted interviews. EP analysed comments and transcripts in discussion with SS. All have contributed to writing, reviewing and finalising this manuscript. SS is Principal Investigator for this study and the guarantor.

  • Funding This paper presents independent research funded by the National Institute for Health Research School for Primary Care Research (NIHR SPCR) Grant No 260. The views expressed are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research of the Department of Health.

  • Competing interests None declared.

  • Ethics approval Ethics approval was granted through the University of Manchester Research Ethics Committee 6, Ref: ethics/15370.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data in this study is drawn from a larger study. Within constraints from NHIR, and any publishing or ethical considerations restrictions, we will endeavour to respond to requests for additional data. Any such requests should be directed to the first author.

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