Does regulation increase the rate at which doctors leave practice? Analysis of routine hospital data in the English NHS following the introduction of medical revalidation

Hospital doctor turnover and retention: a systematic review and new research pathway

PURPOSE

Society is critically dependent on an adequate supply of hospital doctors to ensure optimal health care. Voluntary turnover amongst hospital doctors is, however, an increasing problem for hospitals. The aim of this study was to systematically review the extant academic literature to obtain a comprehensive understanding of the current knowledge base on hospital doctor turnover and retention. In addition to this, we synthesise the most common methodological approaches used before then offering an agenda to guide future research.

DESIGN/METHODOLOGY/APPROACH

Adopting the PRISMA methodology, we conducted a systematic literature search of four databases, namely CINAHL, MEDLINE, PsycINFO and Web of Science.

FINDINGS

We identified 51 papers that empirically examined hospital doctor turnover and retention. Most of these papers were quantitative, cross-sectional studies focussed on meso-level predictors of doctor turnover.

RESEARCH LIMITATIONS/IMPLICATIONS

Selection criteria concentrated on doctors who worked in hospitals, which limited knowledge of one area of the healthcare environment. The review could disregard relevant articles, such as those that discuss the turnover and retention of doctors in other specialities, including general practitioners. Additionally, being limited to peer-reviewed published journals eliminates grey literature such as dissertations, reports and case studies, which may bring impactful results.

PRACTICAL IMPLICATIONS

Globally, hospital doctor turnover is a prevalent issue that is influenced by a variety of factors. However, a lack of focus on doctors who remain in their job hinders a comprehensive understanding of the issue. Conducting "stay interviews" with doctors could provide valuable insight into what motivates them to remain and what could be done to enhance their work conditions. In addition, hospital management and recruiters should consider aspects of job embeddedness that occur outside of the workplace, such as facilitating connections outside of work. By resolving these concerns, hospitals can retain physicians more effectively and enhance their overall retention efforts.

SOCIAL IMPLICATIONS

Focussing on the reasons why employees remain with an organisation can have significant social repercussions. When organisations invest in gaining an understanding of what motivates their employees to stay in the job, they are better able to establish a positive work environment that likely to promote employee well-being and job satisfaction. This can result in enhanced job performance, increased productivity and higher employee retention rates, all of which are advantageous to the organisation and its employees.

ORIGINALITY/VALUE

The review concludes that there has been little consideration of the retention, as opposed to the turnover, of hospital doctors. We argue that more expansive methodological approaches would be useful, with more qualitative approaches likely to be particularly useful. We also call on future researchers to consider focussing further on why doctors remain in posts when so many are leaving.

Doctors' attitudes to maintenance of professional competence: A scoping review

CONTEXT

Recent decades have seen the international implementation of programmes aimed at assuring the continuing competence of doctors. Maintenance of Professional Competence (MPC) programmes aim to encourage doctors' lifelong learning and ensure high-quality, safe patient care; however, programme requirements can be perceived as bureaucratic and irrelevant to practice, leading to disengagement. Doctors' attitudes and beliefs about MPC are critical to translating regulatory requirements into committed and effective lifelong learning. We aimed to summarise knowledge about doctors' attitudes to MPC to inform the development of MPC programmes and identify under-researched areas.

METHODS

We undertook a scoping review following Arksey and O'Malley, including sources of evidence about doctors' attitudes to MPC in the United States, the United Kingdom, Canada, Australia, New Zealand and Ireland, and using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) as a guide.

RESULTS

One hundred and twenty-five sources of evidence were included in the review. One hundred and two were peer-reviewed publications, and 23 were reports. Most were from the United Kingdom or the United States and used quantitative or mixed methods. There was agreement across jurisdictions that MPC is a good idea in theory but doubt that it achieves its objectives in practice. Attitudes to the processes of MPC, and their impact on learning and practice were mixed. The lack of connection between MPC and practice was a recurrent theme. Barriers to participation were lack of time and resources, complexity of the requirements and a lack of flexibility in addressing doctors' personal and professional circumstances.

CONCLUSIONS

Overall, the picture that emerged is that doctors are supportive of the concept of MPC but have mixed views on its processes. We highlight implications for research and practice arising from these findings.

Interviews with Global Pharmacists and Healthcare Professionals in Great Britain to Establish Personal Experiences around Professional Development Activity

Professional development activity is needed to ensure practitioners are up to date and providing optimal patient care. This includes, but is not restricted to, mandatory continuing professional development (CPD) or continuing education (CE) requirements, which differ by professions globally and within countries. This study aimed to investigate perceptions, participation, and individual practice for healthcare professionals in Great Britain (GB) and pharmacists globally to identify similarities and differences after the introduction of revalidation for pharmacists in GB. Qualitative data was received through interviews, which was analysed using content analysis. In total, 24 interviews were completed with pharmacists registered globally, and healthcare professionals registered in GB. A culture of CPD was seen for healthcare professionals in GB and globally for pharmacists; there was no consistent model. Face-to-face activity was common, with an increase in online provision, especially where large geographies were seen. Most learning was completed in the professional’s own time. Multiple providers were seen, with the evaluation of events using questionnaires being commonplace. Different formats of learning were useful for different topics, with skills learning being better when face-to-face. Although varied requirements were in place, regulation should support patient-based practice outcomes. This study showed that commitment to learning was similar in different professions in GB and by pharmacists globally, with similar benefits and challenges.

Recent research into healthcare professions regulation: a rapid evidence assessment

BACKGROUND AND AIMS

Over the last decade, regulators have taken significant steps towards tackling perceptions that regulatory systems are burdensome. There has been much international research activity in the regulation of health and care professionals. This article reports a review of studies on health professions regulation between January 2011 and March 2020. Its chief object was to provide robust and up-to-date evidence to assist regulators in policy development and implementation. The main objectives of this study were to: 1. Identify and retrieve research in the field of health and care professions regulation in English since 2011; 2. Evaluate the published research, exploring its utility to regulators and practitioners, and drawing out any key messages; 3. Draw conclusions concerning the scope and limitations of the research literature and identify areas for further research.

METHODS

We undertook a rapid evidence assessment (REA) of the international literature on health and care professions regulation, including reviewing ten UK regulators' websites to identify issues of concern and strategic priorities. We retrieved 3833 references, using a four-stage screening process to select the 81 most relevant.

RESULTS

Results are reported within six key themes: harm prevention and patient safety; fitness to practise; quality assurance of education and training; registration including maintenance of registers; guidelines and standards and relations with regulatory bodies.

CONCLUSIONS

Regulation of professionals in health and care is comparatively undeveloped as a field of academic study. Consequently, the published evidence is diffuse and small-scale. Most work presents relatively weak data of low relevance to regulators, mainly reporting or describing the current position. Few studies are able to show the impact of regulation or demonstrate a causal link between regulation and its effects. To inform their research and policy agendas health and social care regulators need to commission, interpret and apply the scholarly literature more effectively; academics need to engage with regulators to ensure that their research provides high-quality evidence with practical relevance to the regulators' agendas. Further study is needed to explore how effective academic collaborations between regulators and researchers may be created and sustained.

Doctors' maintenance of professional competence: a qualitative study informed by the theory of planned behaviour

BACKGROUND

Medical regulators worldwide have implemented programmes of maintenance of professional competence (MPC) to ensure that doctors, throughout their careers, are up to date and fit to practice. The introduction of MPC required doctors to adopt a range of new behaviours. Despite high enrolment rates on these programmes, it remains uncertain whether doctors engage in the process because they perceive benefits like improvements in their practice and professional development or if they solely meet the requirements to retain medical registration. In this study, we aimed to explore the relationship between doctors' beliefs, intention and behaviour regarding MPC through the lens of the Theory of Planned Behaviour (TPB) to make explicit the factors that drive meaningful engagement with the process.

METHODS

We conducted a qualitative study using semi-structured interviews. From a pool of 1258 potential participants, we purposively selected doctors from multiple specialities, age groups, and locations across Ireland. We used thematic analysis, and the TPB informed the analytic coding process.

RESULTS

Forty-one doctors participated in the study. The data analysis revealed doctors' intention and behaviour and the factors that shape their engagement with MPC. We found that attitudes and beliefs about the benefits and impact of MPC mediated the nature of doctors' engagement with the process. Some participants perceived positive changes in practice and other gains from participating in MPC, which facilitated committed engagement with the process. Others believed MPC was unfair, unnecessary, and lacking any benefit, which negatively influenced their intention and behaviour, and that was demonstrated by formalistic engagement with the process. Although participants with positive and negative attitudes shared perceptions about barriers to participation, such perceptions did not over-ride strongly positive beliefs about the benefits of MPC. While the requirements of the regulator strongly motivated doctors to participate in MPC, beliefs about patient expectations appear to have had less impact on intention and behaviour.

CONCLUSIONS

The findings of this study broaden our understanding of the determinants of doctors' intention and behaviour regarding MPC, which offers a basis for designing targeted interventions. While the barriers to engagement with MPC resonate with previous research findings, our findings challenge critical assumptions about enhancing doctors' engagement with the process. Overall, our results suggest that focused policy initiatives aimed at strengthening the factors that underpin the intention and behaviour related to committed engagement with MPC are warranted.