The exodus of young doctors from the NHS: when a system loses sight of its own value

The article published by *Il Sole 24 Ore* on 8 October, “The exodus from the NHS begins with young doctors”, highlights a crucial issue: the National Health Service’s difficulty in attracting and retaining the professionals it needs. In the recent call for applications for medical specialisms, out of 15,503 available places, 24.9 per cent remained unfilled, with particularly acute shortages in emergency medicine. There is no shortage of people with a calling for the profession: young people continue to choose medicine, but increasingly they do not see the public sector as the place to build their future. The issue is not merely how many doctors we train, but what future we are able to offer them.

Training a doctor requires investment and an ecosystem comprising universities, hospitals, tutors and research. If the system fails to retain them, expertise may be lost to other sectors whilst the costs of training remain a burden on the community. This does not mean forcing doctors to work in the public sector, but rather questioning the conditions that are making it an increasingly unattractive option. This is where the concept of the Systemic Social Dividend comes in: value arises from shared resources and relationships and is sustained by preserving the conditions that generate it. In healthcare, this resource is the human and professional capital, without which no technology can guarantee high-quality care. Decisions depend on pay, career prospects, the quality of training, workloads and work-life balance. A sense of duty cannot indefinitely compensate for organisational shortcomings, nor can a vocation justify a lack of financial and social recognition. An A&E department cannot choose to have fewer complex patients, nor can a community choose to have fewer frail elderly people. Planning must be based on people’s needs. Losing an experienced professional means losing experience and decision-making capacity: staff are the human infrastructure of the service, not merely a cost item.

Applying the Systemic Social Dividend to the healthcare sector means preventing staff from leaving: taking action before a department becomes overwhelmed, shifts become unsustainable or a young specialist decides to leave. ‘Capitalism of Meaning’ also poses a fundamental question: does the organisation of work enhance human capabilities or drain them? Adequate salaries are essential, but they are not enough. We need sustainable working environments, prospects for growth, the recognition of skills and doctors’ involvement in decision-making. It is not a question of preventing people from choosing to work in the private sector or abroad, but of ensuring that leaving the public sector does not become the only way to work in decent conditions. Data on patient caseloads, resignations and recruitment must be made transparent and translated into verifiable measures. It is not enough simply to count new hires: we need to understand how many doctors manage to build a satisfying career in the public sector. Increasing funding without changing working conditions may yield only temporary results. The crisis in the sector’s appeal presents us with a political choice: to intervene only when shortages arise, or to recognise that training, attracting and retaining professionals is a key indicator of the system’s health.

The National Health Service is one of the most important instruments of equity established by our country. Its sustainability depends on its ability to protect the human and professional capital on which it is founded. The exodus of young doctors is neither an individual failing nor a betrayal of their vocation: it is a signal that the institutions must understand. The question is not why they choose to go elsewhere, but what we must change so that working in the public health service once again becomes desirable and sustainable. A new staffing policy must not be based on an obligation to stay, but on the system’s ability to make that choice worthwhile. A system that trains the professionals it needs but fails to offer sufficient reasons to stay is not merely losing staff: it is squandering public value.

*Vascular surgeon