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The Telegraph
The Telegraph
15 Apr 2023

The job ads are hardly subtle. “Are you a UK-based junior doctor who wants job stability, great remuneration and the clinical support you need to develop your career?” runs one for the Tasmanian Health Service on the British Medical Journal website. “Base salaries”, the ad wastes no time in declaring, “range from $79,578 to $138,593 AUD”. That’s £42,805 to £74,509, a tempting rise for striking juniors in England, who make from £29,384 to £58,398. 

Other medical vacancies Down Under prefer to talk up the “life” component of “work-life balance”. One hospital boasts its employees enjoy “a fantastic mix of restaurants, night-life and cafe culture” with “pristine beaches” and “national parks”. No need to mention the weather – the job on offer is at the Sunshine Coast Hospital in Queensland.

NHS junior doctors, who this week walked out on a four-day strike to demand a 35 per cent pay rise, causing an estimated 350,000 appointments to be cancelled (on top of the more than seven million already waiting for treatment), are signing up in their droves. Last year, a poll by the British Medical Association (BMA), which represents 45,000 junior doctors, found that more than a third planned to move abroad in 2023. And where are they going? Some 42 per cent said they were heading to Australia. 

The BMA described it in biblical terms, as an “exodus”. Roger Kirby, president of the Royal Society of Medicine, notes that in 2022, “6,950 UK doctors applied for a certificate to work abroad, rising from 5,576 in 2021”. Up by a quarter, in other words. To put that into context, of the NHS’s approximately 1.4 million staff about 135,000 are hospital doctors. So the current outflow, were it plugged, would fill the NHS’s current 9,000 doctor vacancies in just over a year. “A few thousand can make a very real difference, particularly in certain specialities,” says Prof Jim Buchan at the Health Foundation.

Such medical migration is helping to fuel a record rush to Australia – a reported net inflow of more than 35,000 a month, the most since statistics were first taken a century ago. Even experienced officials are taken aback by the surge. “I’ve never seen anything like this in 30 years,” says Abul Rizvi, who worked at Australia’s Department of Immigration for 15 years from the early 1990s, noting how visitor inflows are outpacing exits. “It’s out of the realm of anything we’ve seen before.”

Online groups and message boards positively hum with activity as UK-based doctors wonder whether to take the plunge and move to the other side of the world. “Is Australia really the land of milk and honey?,” wrote one on a Facebook forum for UK Junior Doctors in Australia recently. “To what extent is it better than the UK? We poor NHS souls often hear of Australia as the promised land with tons more money, free time, and cooler things to do. Beaches, lovely weather, and better quality of life? But how true is this picture?” 

It didn’t take long for the responses to start flooding in. “Everything you heard is accurate, better pay, negotiable leave, manageable workloads,” replied one psychiatrist, adding, “Has great work life balance but if you are interested and motivated, you can also progress quickly. Myself and the majority of the other [senior doctors] at my metropolitan Health Service are from the NHS.”

“Left the NHS approx 5 years ago,” wrote another. “Aus has undoubtedly better work life, better quality of life, better pay. Best decision I ever made.” Then a GP chipped in: “Pay in my experience has been 4x better than UK for similar hours and MUCH less stress. Workload is manageable and up to you. Very chill lifestyle. Love living here.” There was, they tended to agree, just one drawback: “It’s a long way back to visit friends and family!”

That certainly tallies with the experience of Michael Mrozinski, 37, who left Britain to work as a GP in Australia in 2016. “My life is probably as good as I thought it could be,” he says. Mrozinski, whose grandparents came to Britain as refugees in the Second World War, says he agonised about the decision to leave, but since going has not looked back. “I think the sun and all that stuff helps,” he says. 

But it is the quality of the healthcare system that is the big difference. “I’m happy that I’m making a difference – the patients that I see are very happy with the care that I give them, and I feel respected,” he says. As a result: “Four or five people from my year at university alone have come to Australia. I’ve been to departments where everyone’s from the UK. I’ve been in an emergency department where there’s about nine or 10 staff and we’re all from the UK. It’s no coincidence that we are all here. People are so fed up with working in the UK, it’s just madness.”

If that wasn’t enough, Australian hospitals offer significant perks to win over the hesitant, including help with visas, offers of free flights and, to begin with at least, housing. The Tasmanian job mentioned at the beginning, for example, pays up to £8,000 relocation costs, while the trip to the Sunshine Coast is eased with free flights and three weeks’ initial accommodation. Some Australian hospital groups now even run recruitment drives in the UK, and can scoop up hundreds of doctors, midwives and nurses in a single trip.

But it’s not just doctors who are being tempted by these marketing campaigns. In February a delegation from the vast state of Western Australia visited Britain and Ireland in an attempt to fill 30,000 jobs – not just doctors, but teachers, police officers and plumbers too. “We are here to steal your workers by offering them a better life in one of the most beautiful places on the planet,” Police and Defence Industry Minister Paul Papalia, who led the delegation, said at the time. “Our wages are higher and our cost of living is lower,” he added. 

It is a pitch that is sure to further swell the UK-born population in Australia, which already stands at 1.2 million – 4.6 per cent of Australia’s total. The question now is can anything stop the brain drain to Australia? Poaching staff from other countries is hardly novel in healthcare, as any patient at an NHS hospital will know. 

NHS statistics show there are 214 nationalities represented among its own workforce. “There’s increased pressure on all health systems coming out of the pandemic, and all countries are competing for staff,” says Lucina Rolewicz, from the Nuffield Trust think tank. “It takes so long to train doctors. So your quick win is to recruit qualified doctors from elsewhere.”

Australian hospitals and the NHS here are both at it, with each system recruiting about one third of its doctors abroad. “We cannot complain that people are taking our youngest and brightest because we are doing exactly the same,” says Buchan. The difference is that while in Australia one in five foreign-trained doctors is from the UK, in Britain, only one in 100 is from Australia. Indeed, there are more doctors from Russia or Myanmar here than from Australia. So just what is it that makes Australia so much more of a draw?

Well, that extra money is a big help. But it’s made all the more attractive because it’s more for less. “The pay is significantly better, and there are more generous enhanced rates for overtime,” says Christopher Kurwie, co-founder of Messly, a medical job-finding app that has seen “a dramatic increase” in those weighing up a move to Australia. “But that’s all based on a 35- to 38-hour week, whereas most NHS doctors are rostered for a 48-hour week.”

Pay, Kurwie reckons, is only one of the three big lures. “Another is the Australian lifestyle and sunshine, but the final thing that really matters is the working conditions,” he points out. Key, he says, is that “hospitals in Australia are much more likely to be fully staffed than an NHS hospital. That has a whole cascade of benefits. Patients are happier, you leave work on time, senior doctors have time to train you. Generally, morale and job satisfaction is higher, and there are far fewer stories of a toxic culture and burnout.”

Mrozinski agrees. “In the UK I would turn up for an emergency department rotation and there were supposed to be 20 junior doctors on the rota. Then they said, ‘Oh, we’ve only got 13 guys on the roster, so everybody’s just going to have to work harder.’

“One Saturday, when I was seven months in as junior doctor,” he continues, “I dealt with 300 patients on my own – I actually thought I was going to quit medicine.” It is staff pressure that, he adds, makes “the NHS the biggest recruiter for Australia. That’s the honest truth.”

In contrast, full-staff rosters in Australia mean senior doctors have more time to supervise juniors, who are also able to take time off to train further. “In the UK they will often say ‘you can’t take any time off to go to that course,’” says Mrozinski. As a GP, he now has half as long again with each patient he sees as he would back in Britain. “I can spend time getting to know people and digging into backgrounds to work out if there is something going on that we need to look at in the future,” he explains. “We get to spend a lot more time on the preventative stuff. Whereas in the UK, it’s just dealing with that acute problem, which means patients will come back.”

Perhaps critically, not only is the money better in Australia, but it is tied both to region (as states set their own pay) and to performance. “I think what really is good in Australia is the harder you work, the more you earn,” says Mrozinski. “It’s not like in the UK where I would get a set rate per hour and I was getting absolutely smashed by appointments being squeezed in. It was really, really tough. In Australia, you can pick how hard you want to work.”

Then there is Covid. The pandemic, according to Buchan, has caused many younger doctors to reflect on their careers, just at a time when post-pandemic demand is soaring. “Covid has given young doctors pause about work-life balance,” he says. “Many are talking about reducing working hours. But that’s not easy to do in the NHS. So it’s either up, out or abroad.”

The effects are palpable. Last year, after a long absence during the pandemic, Mrozinski returned to the UK for the summer and helped out in his former emergency department. “It was sad to see the people who were so bright and happy and passionate before just broken,” he says. “The system was broken. The hospitals were a mess worse than I’ve ever seen. I don’t really think the NHS will [bounce] back.”

But how does Australia finance this utopia? The answer, ironically, is by turning its back on the universal free-at-the-point-of-care system that is proving ever more creaky back in Britain and which junior doctors are striking so disruptively to defend. Instead, Australia has an insurance programme called Medicare that is financed through general taxation and which entitles patients to universal free public hospital care and many consultations and medicines. 

On top of that, however, about half of Australians buy private supplementary insurance to pay for private hospital care, dental services and greater choice. Rather than being stigmatised, however, those who buy such insurance are rewarded by the government for relieving pressure on Medicare, with rebates offered. 

Indeed, rich Australians who do not buy extra insurance face tax penalties. It is a system which sees just over 10 per cent of Australia’s GDP spent on healthcare, according to the OECD, with the public purse picking up about 70 per cent of the tab. That is only fractionally more than the UK has spent in the past decade (in the last two pandemic years, spending has shot up here to 12 per cent of GDP). Moreover, private contributions here account for less than a fifth of total spending. 

Faced with such figures it is hard to escape the conclusion that it is not money, but the system that is the root of the UK’s healthcare woes. Not that Australia’s system was uncontroversial to set up. Far from it. Medicare took a decade of political infighting, and several elections, to iron out in the late 1970s and early 1980s.

Almost half a century on, however, it has led to a system that is highly rated and generates huge patient satisfaction. Almost 90 per cent of older patients, for example, report that hospital doctors listen carefully, treat them with respect, and spend enough time on their case. That is a far cry from 12-hour waits in A&E and beds in corridors, the likes of which have seen public satisfaction with the NHS plummet to record lows. Today, only 29 per cent state that they are satisfied with the health service. So will we ever be able to lure back some of those who have fled Down Under?

The answer, somewhat surprisingly, is yes. “Some call it a working holiday,” says Kurwie. “You’re in your 20s, it’s an adventure, a one- or two-year project. For people worried we have this massive outflow, well a lot of them come back.” He adds that a generation ago, heading abroad would have been frowned on back in the NHS, notably by consultants used to “straight line training to become a cardiologist, say, in the fastest time possible”. Now that is considered “quite old-fashioned” and “attitudes are changing. If you worked abroad you used to be seen as a slacker not committed to the profession. Today, there’s a significant trend towards doctors having portfolio careers, gaining different experiences.”

Yet figures reveal that a worrying number do stay away. A couple of years ago, the General Medical Council polled 13,000 doctors who had left the UK, in an attempt to understand why they had gone, and if they might come back. Just 24 per cent were likely to return, while 59 per cent said they were both unwilling and unlikely to do so. The top reason for leaving – cited by 35 per cent – was “dissatisfaction with role/place of work/NHS culture”. In third place – at 27 per cent – was “burnout/stress”. Sandwiched between these two figures – with 32 per cent – was “returning to previous country of residence”.

It is this last figure that serves as a crucial reminder that the NHS does not just lose doctors to other countries – it is a vast recruiter from abroad, too. In fact, in a world with an estimated shortage of 6.4 million doctors, there is a global race to recruit. Doctors are in demand everywhere. Increasingly, if they are willing to travel, they can pick and choose. And what is now being revealed is that in the past decade there has been a large increase in the proportion of doctors migrating to the UK from middle and lower income countries, and a reduction from higher income countries. In 2013, some 62 per cent of foreign doctors registering in the UK came from rich countries; just six years later that figure had fallen to 28 per cent. Does that mean the UK is falling down the pecking order?

“I love the UK and I miss it,” says Mrozinski. “But [coming back] is really not worth my health. In fact, if I was coming back to the UK I’d probably look at doing something else apart from being a doctor to be honest. Even my worst day ever here is still better than the best day ever in the NHS.”

With additional reporting by Shannon McGuigan