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9–11 Recently, there have been significant concerns that already high levels of emotional exhaustion and burnout in doctors will increase as a result of changes to the junior doctor contract in the UK and this will cause trainee doctors to leave the UK to work in other countries 1, 12 causing significant problems for a health system already suffering a recruitment and retention crisis, particularly in specialties like General Practice and Psychiatry. 8 Doctors' well-being has a significant impact on healthcare provision and directly influences patient care, including patient satisfaction, adherence to treatment and interpersonal aspects of care.
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3 It is unsurprising that medical training is associated with mental health problems, 4–7 with a recent review concluding that lack of work–life balance, long hours, lack of job satisfaction, female sex and younger age are important predictors of burnout in doctors. 1, 2 Doctors in training have to undertake competitive job applications and numerous assessments and examinations, while managing frequent job, role, team and hospital changes. Medicine is a prestigious and valued career, but it can be arduous: doctors are required to work long hours, make difficult decisions in the face of uncertainty and cope with death and distress while maintaining compassion. There is the possibility of response bias those most dissatisfied may have been more likely to volunteer however, trainees mostly described positive as well as negative experiences of their time as a trainee. Not all specialties and locations in the UK were represented, meaning potential differences could not be fully explored. It also includes 41 trainers, including course directors and postgraduate deans. This qualitative study has a large and diverse population with 137 participants, including 96 trainees from all grades, UK and International Medical Graduates from White and Black and Minority Ethnic backgrounds, 6 medical specialties and 4 geographical areas in England and Wales. There are increasing concerns about incidence of burnout and the lack of work–life balance in doctors in the UK this study provides a timely account of junior doctors' experiences given fears that this may deteriorate further as a result of changes to junior doctors' contracts introduced in 2016. The proposed junior doctor contract was felt to exacerbate existing problems. Female trainees frequently talked about having to choose a specialty they felt was more conducive to a work–life balance such as General Practice. Work–life imbalance was particularly severe for those with children and especially women who faced a lack of less-than-full-time positions and discriminatory attitudes. Low morale and harm to well-being resulted in some trainees feeling dehumanised. This made it challenging to cope with personal pressures, the stresses of which could then impinge on learning and training, while also leaving trainees with a lack of social support outside work to buffer against the considerable stresses of training. Trainees regularly moved workplaces which could disrupt their personal lives and sometimes led to separation from friends and family. Long hours at work were typically supplemented with revision and completion of the e-portfolio.
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