Health-care students: committed to improving health but frustrated

• Published in: The Lancet (British edition) 2024-04, Vol.403 (10435), p.1429-1431
• Main Author: Bagenal, Jessamy
• Format: Article
• Language: English
• Subjects: Burnout; Careers; Clinical medicine; COVID-19; Curricula; Delivery of Health Care; Global health; Health care; Health Facilities; Health services; Humans; Medical personnel; Medical students; Nurses; Nursing; Nursing care; Outsourcing; Pandemics; Patients; Preventive medicine; Private sector; Professions; Public health; Public sector; Shortages; Students; Surveys; Workforce; Young adults
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(23)02757-5

There are obvious flaws to the survey, including selection bias, generalisability, and the commercial nature of the endeavour, but some of the findings highlight crucial concerns that need to be addressed. 58% of all students surveyed globally (54% medical students, 62% nursing students) see their studies as a stepping stone into a career that will not involve directly treating patients.2 Similarly, in the UK, one survey of 10 486 students (about 25% of the UK medical student population) indicated that one in three students plan to leave the National Health Service (NHS) within 2 years of qualifying, and 3% of students planned to quit medicine altogether.3 There might be several reasons for these findings. A global Ipsos survey in 2022 of 23 507 people indicated that three in five respondents reported their health-care system was overstretched.5 Overstretched health systems result in tired and overworked health-care workers, as evidenced by increasing rates of burnout and resignations among the health workforce.6,7 And burnout in students is, if not getting worse, certainly not getting better;8,9 in the Clinician of the Future 2023 report, 60% of health-care students were worried about their mental health.2 These challenges are being exacerbated by a growing global health workforce shortage, with recent estimates putting this shortage somewhere between 43 million in 201910 and 15 million health workers in 2020.11 The gap is large and continues to grow, despite increases in investment.12 Frenk and colleagues reported that the global annual number of medical graduates had almost doubled and the number of nursing graduates had tripled between 2008 and 2018.12 However, if a substantial number of health-care students are so deterred by the daily grind of caring for patients in overburdened and under-resourced health systems that they do not see their future in direct patient care, then we have entered a dangerous downward spiral that needs urgent attention. Here, Mazzucato's Mission Economy philosophy on public sector policy making offers instructive insights.21 Health-care systems and departments of health must build internal capacity in health technology, stop outsourcing services and contracts, and not be afraid to regulate and shape the health technology market to ensure equitable partnerships with the private sector that have the public good as their major outcome rather than private profits.