Why Are UK-Trained Doctors Leaving?

The NHS has long depended on internationally trained doctors to keep Britain's healthcare system running. According to the GMC Workforce Report (2022), nearly half of all new NHS joiners (46%) were International Medical Graduates. By 2023, that proportion had grown to 68% of new joiners, and in some categories — such as specialty and associate specialist doctors — the figure reached 81% (State of Medical Education and Practice in the UK – Workforce Report 2024).

Yet while thousands of doctors arrive, thousands also leave. Between May 2021 and May 2022 alone, 4,843 doctors emigrated from the UK, a loss estimated at £2.4 billion in training investment and replacement costs (General Medical Council; BMA, 2024).

Why would doctors leave a country that actively recruits them, trains them, and needs them more than ever?

At Northstar Physicians, we've been listening closely to the voices of UK-trained migrant doctors — and drawing on new research, including master's-level study into this very question.

The findings show that migration is not simply about chasing higher salaries. It's about dignity at work, professional autonomy, and the ability to build a life that feels sustainable for doctors and their families.

This three-part series uses insights from migration scholar Jørgen Carling's aspiration–capabilities framework to explore the real story:

• Part 1: How the NHS is manufacturing aspirations to leave through institutional failures.
• Part 2: How professional networks and overseas opportunities provide the capabilities to turn those aspirations into action.
• Part 3: Why some doctors stay, and why their loyalty to the NHS is often conditional — or, in the words of one doctor, simply about choosing “the devil you know.”

Whether you are a doctor weighing your own future, or simply curious about what drives onward migration, this series offers an evidence-based look at a pressing issue for the UK — and an urgent question for the global healthcare workforce.

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Part 1: Understanding Aspirations to Move On

The question of why doctors leave the UK has often been reduced to a simple equation of pay: earn more abroad, and people will move. But research shows the reality is far more complex. To really understand why many UK-trained doctors are choosing to continue their journey elsewhere, we need to look at how their aspirations are shaped within the NHS itself.

Migration scholar Jørgen Carling explains that migration starts with aspirations — the desire or wish to live and work somewhere else. These aspirations don't appear out of thin air; they emerge from lived experiences in day-to-day life. For many doctors in Britain, the aspirations to move are increasingly being manufactured by the very institutions meant to support them.

The Making of Migration Aspirations in the NHS

From my research with UK-trained migrant doctors, several themes stood out:

• The “10-Minute Consultation Trap”
  Doctors spoke of feeling unable to practise good medicine within the rigid ten-minute consultation system. Instead of focusing on holistic care, they felt pressured into fragmented treatment that eroded both professional pride and patient trust.

• Unpaid Overtime as the Norm
  Doctors described regularly working far beyond contracted hours, handling urgent test results and referrals late into the evening — with no compensation. Over time, this silent expectation creates exhaustion and disillusionment.

• Erosion of Autonomy and Career Pathways
  Many found their clinical skills underused and their opportunities for progression blocked. Salaried GPs carried heavy responsibilities without the financial recognition, while changes in locum policy closed off alternative paths.

• A Culture of Fear
  Several felt exposed to heavy-handed regulation, with the constant worry that one mistake could lead to suspension. For migrant doctors, this was felt even more sharply, as they sensed an added layer of vulnerability.

Taken together, these experiences represent what I call the institutional manufacturing of migration aspirations — the system itself produces the desire to leave.

Why This Matters

Carling's framework reminds us that aspirations are just the first step. Some doctors act on them, others don't. But the fact that so many are now imagining life beyond the NHS is significant. It signals a loss of confidence in Britain's ability to provide not just a fair wage, but a dignified environment in which doctors can thrive.

For many, this isn't about seeking greener pastures — it's about finding a place where they can practise medicine with autonomy, respect, and support.

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Part 2: From Aspiration to Action — How Doctors Gain the Capability to Leave

In Part 1, we looked at how daily realities inside the NHS — from the ten-minute consultation trap to unpaid overtime — create what Carling calls aspirations to migrate. But an aspiration alone doesn't guarantee movement. To leave, doctors also need capabilities: the resources, networks, and opportunities that make migration possible.

My research found that professional networks — both formal and informal — are the bridge between aspiration and action.

The Power of Professional Networks

• WhatsApp and Digital Communities
  Doctors described closed WhatsApp groups and online forums where peers share step-by-step advice on licensing, visas, and job applications. These digital “safe spaces” provide both information and reassurance. One doctor said, “If you have any problem at all in the journey from the UK to Canada, you bring it into the group, and you get timely responses.”

• Mentorship and Friendship Pipelines
  Established migrants often mentor colleagues considering the move. In some cases, friends who had already set up clinics abroad directly offered employment to newcomers. This support dramatically reduces the risks and uncertainty of moving.

• Institutional Outreach
  Unlike the UK, where departures are often met with indifference, Canadian institutions actively court UK-trained doctors. Recruitment events, prompt replies from medical associations, and clear licensing pathways all signal: “You are wanted here.”

Migration as Collective, Not Individual

Carling's framework also highlights that migration decisions are rarely made in isolation. Family expectations add another layer. Supporting relatives back home transforms migration from a personal choice into what one doctor described as a “survival instinct.”

Migration becomes not just about career advancement, but about securing stability for extended family networks.

Why This Matters

When aspirations meet capabilities, migration becomes not just possible, but likely. Digital platforms, peer mentorship, and overseas recruitment have combined to create a powerful migration infrastructure.

For UK-trained doctors who feel trapped within the NHS, leaving appears less like a gamble and more like a sensible next step.

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Part 3: Why Some Stay — Conditional Loyalty and “The Devil You Know”

In the first two parts, we explored how NHS working conditions create aspirations to leave, and how professional networks and overseas opportunities enable that movement. But not everyone goes. Many UK-trained migrant doctors, despite frustrations and viable alternatives, choose to remain.

Carling reminds us that to explain why people leave, we must also explain why others stay. What my research found is that staying rarely reflects deep satisfaction — it is usually a matter of conditional loyalty, and often, of preferring “the devil you know.”

Conditional Loyalty

Doctors who remain often do so because of strong anchors: family, children in school, or long-standing professional ties. One participant explained that after six years in the NHS, he knew the system's “ins and outs” and had built a community of colleagues. Starting over elsewhere felt daunting.

Yet these commitments are not unconditional. Several doctors described their decision to stay as contingent on securing the right opportunities. If career progression stalls or institutional conditions worsen, they admitted they would reconsider. Retention is fragile, not permanent.

“The Devil You Know”

Another reason doctors remain is scepticism. While many peers share glowing stories about life abroad, some stayers doubt whether the reality matches the narrative. As one doctor put it, “the devil you know is better than the angel you don't.”

This wariness makes migration seem like a leap into uncertainty — and, for some, it feels safer to manage frustrations within a known system than to gamble on the unknown.

Why This Matters

These findings suggest that staying is not evidence of a healthy system. Many doctors who remain are still deeply dissatisfied — they simply feel more anchored in the UK, or more sceptical of what lies ahead abroad.

Their loyalty to the NHS is conditional: it lasts only as long as their personal circumstances outweigh the institutional pressures to leave.

For policymakers, this should serve as a warning. Relying on inertia and attachment is a risky strategy. Without meaningful reform, today's stayers could become tomorrow's leavers.