Drop-out doctors cost NHS pounds 70m

DOCTORS could be forced to serve a minimum time in the health service after qualifying, under plans being urgently drawn up by the Government to tackle the soaring drop-out rate which is costing the tax payer more than pounds 70m a year.

Medical graduates who fail to complete the required period would be asked to reimburse the state for their education, under the proposals being studied by Health Secretary Frank Dobson.

Ministers alarmed at the number of graduates who are using their prestigious degrees to secure highly-paid jobs outside medicine are considering a range of options to crack down on the drop-outs.

New figures show that almost 10 per cent of last year's 4,500 medical graduates dropped out after training.

The Department of Health, estmates that it costs around pounds 200,000 to train each doctor and the cost of wastage to the tax payer last year was around pounds 72m - enough to pay for a medium-sized hospital.

According to the British Medical Association, in 1997, 8 per cent of medical graduates left the profession before even completing their first year as a house doctor. Research by the Medical Workforce Standing Advisory Committee found that an additional 1 per cent quit after their probationary period to go into another career.

A sense of vocation is one of the key criteria applied when picking would- be students from the high number of applicants and yet the Medical Careers Research Group found that some trained doctors have gone on to become accountants, solicitors, film directors and pilots in recent years.

One option being considered by the Government is to force medical staff to complete a minimum period of work in the NHS before leaving. This is similar to the system under which people who are funded through university by the Army have to serve in the forces for a specified length of time.

Under the plan, graduates who refused to dedicate themselves to the state for the specified length of time after graduating could be required to refund the taxpayer for some of the cost of their training. Medical students, who study for five years, have been given a special exemption which means that they do not have to pay tuition fees of pounds 1,000 for their final year. They could lose this right if they do not go on to practise in the NHS.

But not all measures are punitive. Ministers also want to ensure that doctors are given the option to work more flexible hours, as a way of encouraging them to continue working for the NHS. They are concerned that there are particularly high drop-out rates among women because at the moment it is virtually impossible to work part-time. Increasing numbers of doctors are choosing to work as locums rather than dedicating themselves to a particular practice because this is the only way they can have flexibility.

Mr Dobson has ordered his officials to investigate the extent of the problem. According to the Medical Careers Research Group, based at the Institute of Health Services in Oxford, the number of doctors going on to other careers more than trebled in recent years. Of those graduating in 1993 - the latest group on which figures have been published - 4.9 per cent said they intended to leave medicine, compared with 1.7 per cent previously. A separate group went on to practise in the private sector.

Trevor Lambert, a researcher for the Group said: "The numbers leaving early on in their careers are still quite small but they are larger than they used to be ... 50 years ago medicine was seen as a high-prestige, high- profile job. That is less so now. Patients are more informed about medical matters, the doctor as god is a less powerful image."

The Government is already concerned about the lack of qualified doctors available to treat patients. It has launched an initiative to boost the number of medical graduates by 25 per cent over the next few years.