News Release

Researchers call for improvements to working culture and conditions for junior doctors

Peer-Reviewed Publication

University of Birmingham

Researchers are calling for changes to working culture and conditions for junior doctors in the UK after their new research has highlighted a lack of access to clinical and emotional support.

The call comes as a University of Birmingham-led team of researchers, including experts from Keele University, University College London, Oxford University Hospitals NHS Foundation Trust, the London School of Hygiene and Tropical Medicine, and the Universities of Leeds and Manchester, carried out a qualitative study using in-depth interviews with 21 NHS junior doctors.

All participants, 16 of whom were women and five were men, self-identified as having chronic stress and/or mental health problems, including anxiety and depression.

The National Institute for Health Research-funded study, detailed in two papers published today (June 24) in BMJ Open, examined the psychological, cultural and occupational contexts associated with reduced psychological wellbeing in junior doctors, and protective factors which may mitigate against this.

The findings showed four key themes relating to work-related stress - workload and working conditions; toxic work cultures including abuse and bullying, sexism and racism, and a culture of blaming and shaming; lack of support; stigma and a perceived need to appear invulnerable.

Analysis from the interviews also pin-pointed themes that protect junior doctors and facilitate support, with these including emotional and practical support from work colleagues to help manage workloads; supportive leadership strategies including those that challenge stigma; and access to professional support such as counselling, cognitive behavioural therapy and medication.

First author and Chief Investigator of the research Dr Ruth Riley, of the University of Birmingham, said: "Normalising vulnerability through disclosure and creating emotionally open cultures where vulnerability is accepted and understood, allows junior staff greater confidence to be open about factors affecting their own wellbeing and to seek and receive support when needed.

"Supporting doctors who request time out or time off and facilitating access to support could reduce the potential for isolation in the workplace and reduce stigma-related barriers to seeking help.

"Examples of effective interventions and solutions to minimise distress and support staff are evidenced in existing leadership and collegial support, but need to be more consistently practiced across the NHS."

Co-author, Carolyn Chew-Graham Professor of General Practice Research at Keele University, said: "Participants reported stress and distress attributable to working conditions, such as unrealistic workloads and long hours, toxic work cultures including bullying, sexism and discrimination, a 'blame and shame' culture, and fear of whistleblowing.

"We call for a cultural shift within medicine to more supportive and compassionate leadership and work environments, and a zero-tolerance approach to bullying, harassment and discrimination."

The research is the first study to qualitatively examine how junior doctors view their working conditions, work cultures, and the factors which may protect them from psychological distress or offer them support.

There are currently 115,376 doctors working in the NHS, almost half of whom (56,404) are termed 'junior doctors', which includes doctors in specialist training or at pre-Consultant grade, and Foundation Year doctors.


For interviews with Dr Riley, please contact: Emma McKinney, Communications Manager, University of Birmingham, email: or call +44 7815607157. Alternatively, contact the Press Office out of hours on +44 (0)7789 921165.

For interviews with Professor Chew-Graham, please contact: Abby Swift, Senior Communications Officer, Keele University, email:

Notes to Editors

* Riley et al (June, 2021). 'The sources of work related psychological distress experienced by United Kingdom-wide foundation and junior doctors: a qualitative study'. BMJ Open.
* Riley et al (June, 2021). 'Protective factors and sources of support in the workplace as experienced by UK foundation and junior doctors: a qualitative study'. BMJ Open.
* The University of Birmingham is ranked amongst the world's top 100 institutions, and its work brings people from across the world to Birmingham, including researchers and teachers and more than 6,500 international students from nearly 150 countries.
* The National Institute for Health Research (NIHR) is the nation's largest funder of health and care research. The NIHR:
- Funds, supports and delivers high quality research that benefits the NHS, public health and social care
- Engages and involves patients, carers and the public in order to improve the reach, quality and impact of research
- Attracts, trains and supports the best researchers to tackle the complex health and care challenges of the future
- Invests in world-class infrastructure and a skilled delivery workforce to translate discoveries into improved treatments and services
- Partners with other public funders, charities and industry to maximise the value of research to patients and the economy
- The NIHR was established in 2006 to improve the health and wealth of the nation through research, and is funded by the Department of Health and Social Care. In addition to its national role, the NIHR supports applied health research for the direct and primary benefit of people in low- and middle-income countries, using UK aid from the UK government.

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