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Junior doctors increasingly backing out of job offers they’ve already accepted

July 08, 2002

Junior doctors are increasingly backing out of accepted job offers, often with less than a month to go, finds a study in Emergency Medicine Journal.

The problem, which has been increasing steadily since 1995, is widespread, but particularly acute in emergency (A&E) medicine, orthopaedics, paediatrics, and obstetrics and gynaecology, the study shows.

Researchers surveyed 203 hospital medical staffing departments in England, enclosing a questionnaire for the senior house officers who had withdrawn from a post after accepting it. The researchers also surveyed A&E consultants in each of the hospitals, as this specialty was the most badly affected. The survey was timed to obtain information for the February 1998 intake of junior doctors.

Of the 203 medical staffing departments, responses were received from 140 (69%), and 142 A&E consultants also replied. Only three responses were received from junior doctors.

Almost four out of 10 (39%) medical staffing departments reported that junior doctors had withdrawn from a post after having accepted it. This affected 14 specialties, but A&E, orthopaedics, paediatrics, and obstetrics and gynaecology accounted for 90 per cent of the problem.

Over a third of A&E departments had experienced sudden withdrawal from a post, and in one in four departments, this had happened more than once. The length of notice given was available for only 55 posts, but in 29 per cent of cases this had been less than a month. In one department three doctors had done this. Almost three quarters of consultants took no further action.

Between 1995 and 1998, almost three quarters of the A&E departments for which data were available, had experienced abrupt withdrawal from an accepted post. The problem has been steadily getting worse over that period, particularly since 1997. Over a third of those who withdrew from an A&E post took up a job in a different specialty.

Over half the consultants and medical staffing departments agreed that junior doctors were using their first job offer as security against unemployment while still continuing to apply elsewhere. Most (80%) thought that this behaviour was ‘unprofessional.’ And virtually all of them felt that clear advice on appropriate behaviour for job applications was required.

The authors say that a shortfall in the numbers of senior house officers at any stage, but particularly at the August and February hand-overs can have a substantial impact on patient care. And the withdrawal from a post can be costly in terms of re-advertisement, convening interview panels together, and providing locum cover.

But they also suggest that the traditional system of recruitment is partly to blame. It’s unpredictable and uncoordinated, and unlike most other professions, the candidate is expected to accept or refuse the job on the spot, they say. Nevertheless, doctors have a professional responsibility, they say, and should realise that a verbal agreement is legally binding.

British Medical Journal (BMJ)

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