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The toll of rotational training and uncertainty over first jobs may drive more future doctors to abandon medicine altogether, experts have warned.

For the Hospital Consultants and Specialists Association (HCSA), which represents hospital doctors, these contribute to what it describes as “an ongoing mental health crisis” among resident doctors.

“It can be very lonely and very bleak at times,” explained Dr Matt Church, chair of the HCSA’s resident doctors committee. 

“At a time of life when many people would expect to settle down or start a family, the rotations system is a huge barrier. Moving every few months means it’s close to impossible to build a support network outside of work. While you’re on a placement, the wider team know you are only there temporarily, so the support isn’t there either.” 

Church said he has experienced rotational placements where “people don’t even take the time to remember your name. Relationships are important — if I’m struggling with my mental health, who is going to notice that?” he asked.

Filling the Staffing Gaps

While the HCSA’s resident doctors committee recognises the value of gaining experience in different working environments, Church is concerned that rotations are being misused to fill staffing gaps.

“It should be about attracting people to work in these areas, not forcing them to,” he said. “The general impression is that resident doctors are pawns being shifted around on a chess board with little consideration for the massive impact it has on their lives and well-being.”

The current rotations system is “short-changing” resident doctors, Church added, preventing the deeper learning and stability that longer-term placements would provide.

“All this needs to change,” he urged. “Resident doctors were promised a review of the rotations system as part of the pay deal to end strikes last year. Yet, we are still waiting for decisive action on this commitment.”

Potential Strike Action

The British Medical Association’s (BMA) resident doctors committee has echoed these concerns. It recently announced a ballot for renewed industrial action, with doctors in England set to vote on whether they want to take strike action over pay. The ballot will open on 27 May and close on 7 July.

Speaking exclusively to Medscape News UK, committee co-chairs Dr Melissa Ryan and Dr Ross Nieuwoudt said: “Rotational training, as it currently functions, is an unnecessary burden on the health and happiness of resident doctors. We should not need to be bounced up and down the country — miles from family, stability, and support — simply to progress in our careers.

“Uprooting our ways of working every 6 months creates unnecessary stress and worry for doctors at the start of our careers. Our goodwill has too long been exploited at the expense of our mental health.”

They added that “as part of last year's pay deal, we’re negotiating with the government to reform the [rotations] system into something that works in the interest of doctors’ well-being.” 

First Job Uncertainty for Final-Year Students

In April, the BMA’s medical students committee wrote to Health Secretary Wes Streeting urging him to take action to prevent first job uncertainty for final-year medical students.

Around 700 final-year students across the UK have been assigned only a "placeholder" position for their first job as a doctor this summer. They have been told which medical deanery they will be in, but not the hospital or location — often leaving them unable to plan ahead. 

Some students may not receive details of their exact placement until just weeks before their start date in August. 

“This happens year on year,” explained Callum Williams and Elgan Manton-Roseblade, deputy co-chairs for education for the BMA’s medical students committee. “Final-year medical students face months of uncertainty and stress, and for some it’s during their final medical exams. It is unacceptable.”

To avoid this happening to future students, the BMA has requested that students receive their programme details and work schedules at least 8 weeks prior to their start dates. Increased funding to the UK Foundation Programme Office would help deaneries to avoid last-minute scrambles, they said, and priority should be given to UK medical school graduates.

“It’s essential that we keep doctors in the NHS,” Williams and Manton-Roseblade added. “When this is a new doctor’s first experience with NHS employment, it increases the risk that they’ll join so many of their colleagues in moving abroad or leaving medicine entirely.”

Mental Health Toll of Systemic Uncertainty

Church said the ongoing lack of workforce planning plays a central role in job placement delays.

“We’ve seen demand for first jobs created to grab headlines for governments to show they are doing something about medical staffing,” he said. “But they’ve not built capacity in the system to absorb the numbers being trained. It’s a woeful situation that’s creating tension at every part of the training pipeline.”

Resident doctors are also affected, often waiting months to discover their next placement. This uncertainty makes planning difficult and can lead to risk, according to Church.

“If you do try and stay based in one home, then rotation placements can often mean long drives to work, which is especially dangerous after a night shift,” he explained.

For future doctors, first job uncertainty is making their final months as medical students even more challenging from a mental health perspective.

“The fact that so many doctors haven’t been getting a confirmed placement is making the already tough first years of medicine even tougher,” Church said. 

“With trainers reporting burnout and unsustainable workloads, they are also likely to get worse training in underfunded and underresourced systems. All this takes its toll on mental health.”

Julie Penfold is a freelance journalist specialising in healthcare and medical content. Her work regularly appears in titles such as Medscape, Doctors.net.uk, and Hospital Healthcare Europe.