Estimated read time: 4 mins
We are a group of researchers from the Caribbean and the UK who share a common interest and passion in physician well-being with expertise in both quantitative and qualitative research design.
The decision to leave a workplace or a profession can be a difficult and emotional one for an individual; doctors are no exception to this, However, in the face of rising levels of burnout, exhaustion and resultant job dissatisfaction, this may be a decision that some feel compelled to make.1 The phenomenon, more formally known as an intent to leave,2 has significant implications, including furthering burnout, high levels of employee turnover and low staff morale.3
Physicians working in emergency departments are among the highest risk medical specialties for burnout and intent to leave as a result of the high stress, high volume environment.4 Studies have shown emergency physicians in the Caribbean similarly experience high levels of burnout even pre-COVID5, therefore it may be expected that high levels of intent to leave the profession will also exist. However, regional literature on the topic is sparse.
Now more than ever, in the face of changing health systems, we need to strengthen our health force capacity. The United Nations, in seeing the importance of this, has highlighted several good health and wellbeing needs – the need to ‘substantially increase the recruitment, development, training, and retention of the health workforce in developing countries, especially in least developed countries and small island developing States’.6
Barbados and the twin island Republic of Trinidad and Tobago, as two small island developing nations (SIDS) in the Eastern and Southern Caribbean, sit poised to benefit from the achievement of this goal. Population vulnerability has increased with climate change and natural disaster. Due to an aging population, the rise in non-communicable diseases (NCDs) and their complications, , our healthcare requires these nations to function at their optimum with retention of healthcare workers.7
Emergency medicine sits at the frontline of health response systems. It is therefore important that we know how many physicians working in emergency departments intend to leave and what are the driving factors for this decision.
This study aims to address these questions, specifically focusing on physicians working in emergency departments in Barbados and Trinidad and Tobago. The first step is to identify the extent of the problem, that is, the proportion of physicians who intend to leave. The second is to explore the motivations for the decision, the answers to which should provide much needed insight into the phenomenon.
In order to address this complex phenomenon, a holistic approach to the investigation is required. We intend to leverage the strengths of both quantitative and qualitative methods in a convergent mixed methods design.
Self-administered online surveys will primarily focus on evaluating professional fulfilment, wellbeing, and intention to leave. The survey will also provide insight into motivations for leaving current workplaces and professional roles, as well as the factors influencing physicians' decisions to leave.
Complementing this will be a qualitative exploration using virtual focus groups. A range of issues will be explored including initial decisions to pursue working in emergency departments, reasons for contemplating leaving either the workplace or the professional role, and reasons for deciding to stay. We will also cover the broader personal vision for their careers. To ensure sufficient depth and an understanding of varying professional dynamics and nuances, these focus groups will be composed of a diverse group of physicians based on gender, professional experience, qualifications, and workplace setting.
We envision that the findings will provide a clearer view of the extent to which physicians intend to leave clinical practice or their workplaces, identify the factors influencing their decision, and uncover explanations as to why physicians may want to leave clinical medicine. Obtaining this information will augment the evidence base in the Caribbean region and has the potential to impact healthcare workforce planning within the emergency department setting. There is potential for the findings to be extrapolated to other specialties within clinical medicine as well as other health professionals such as dentists, nurses, and pharmacists.
We hope the findings will also spur health care organisations to closely examine the phenomenon and develop strategies to support retention of physicians in emergency departments as well as in the medical profession generally, and foster positive workplace environments. Furthermore, we anticipate that the study outcomes will also encourage physicians and workplaces to identify champions who can support prioritisation of self care, promote alignment of personal goals with career goals while maintaining good wellbeing of physicians.
