Stress, Lack of Child Care Driving Many Doctors to Quit

Posted February 15, 2024

Stress, Lack of Child Care Driving Many Doctors to Quit

Doctors are bailing on the profession for a reason that may surprise their patients.

It's not frustration with government rules or cumbersome insurance requirements, but problems securing suitable childcare for long and ever-changing working hours, a new survey published Feb. 15 in the BMJ finds.

Erin Dean, who wrote a summary of the survey results, noted that some doctors have quit or are considering doing so. Others have changed specialties in the hope that they will have more flexibility. And even more have altered their plans to have children.

The online survey, conducted in the U.K. and completed in November, included 533 respondents who identified themselves as doctors and medical students; 14 nurses; and 49 others. Of these, 548 were women. (The survey could be completed by anyone who clicked the link.)

Other studies have indicated that parenthood appears to have a bigger impact on the careers of female doctors, Dean noted.

More than 9 in 10 respondents said they had struggled to find suitable childcare for their work schedule. The No. 1 problem: Finding care that covers the full length of their workday.

Many respondents commented on the stress and guilt of trying to be on time for work in the morning and then to pick up their children at day's end.

Cost was the No. 2 problem, cited by 75% of respondents, followed by irregular schedules (65%). Some doctors noted that the cost of childcare was bigger than their mortgage.

A junior doctor with four young children said she pays $5,021 a month for childcare ($1,255 more than she makes).

Another said childcare costs may force a career change: "It is impossible to survive as a single parent on a junior doctor salary and pay for childcare."

Said another: "It is frankly a nightmare. I changed specialties to general practice to try to make it work. I am now considering leaving altogether."

Some doctors described how they, or their partners, had stopped working or left the U.K.'s National Health service.

"I have left medicine as [I] could not take additional time out of training, having done a PhD and had two children, to manage doing nights on call," a former surgeon told Dean. "Because of this, I have been forced to relinquish my training number as a senior surgical trainee and will never be able to return to the specialty. Not all doctors have helpful or supportive partners or families, which is the bare minimum required to be able to do on-calls and complete training."

For trainees, required rotations to learn about various medical specialties pose an added problem. They may have little time to sort out new care arrangements as they are assigned to move from one hospital and rotation to another. Of 231 junior doctors who responded to the survey, 71% said rotations were a problem and 82% cited irregular working hours.

Dean said there is a sense of fear and panic about how doctors will manage rotations. Some have family nearby but others said work has moved them away from loved ones who could help them out.

"We live in constant fear of being sent on rotations with long commutes as it will make pick-up and drop-off impossible, and in constant guilt that our poor child is the first to be dropped off and last to leave," said one doctor, whose partner is also a doctor.

Many respondents said they'd like to expand their families but could not imagine how they would find or afford childcare. Close to 7 in 10 said concerns about childcare had influenced their family planning.

Latifa Patel, workforce lead for the BMA, a workers' organization in the U.K., said Britain's overstretched National Health Service needs doctors who are parents more than ever, but balancing childcare and work is taking a toll.

"These figures are disheartening and reflect the profound impact that inadequate childcare options, and eye-wateringly high costs, are having on doctors and our families," she said in a journal news release.

Dean noted that a high number of female doctors return to work after having kids when compared to other sectors. But, she added, "that may be little comfort to the many doctors who responded in desperation to this survey, and described repeatedly the juggle they face."

Patel called on the British government to improve childcare for key workers and to support NHS nurseries. She added that the government must also look to offer financial support to help keep doctors working.

"It does not make economical sense for the government to sit back and watch droves of much needed doctors suffer from stress and require sick leave or leave the profession altogether due to a lack of childcare options," she said.

More information

The Agency for Healthcare Research and Quality has more on doctor burnout.

SOURCE: BMJ, news release, Feb. 14, 2024