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Why are doctors quitting medicine? Annabel Ferriman reports on a mass professional exodus and talks to three who couldn't take the strain any more

Doctors are leaving the profession at an alarming rate, according to the British Medical Association, which has just set up an "Exodus Committee" to explore the reasons and formulate solutions. Thousands more are opting to work part-time.

Here we look at three doctors, two of whom left medicine and one of whom would like to work part-time permanently, if he could afford it, and explore the reasons for their malaise.

Top of the list for two of them, unsurprisingly, comes stress. A recent survey revealed that 90 per cent of doctors are suffering from work-related stress, a fifth have contemplated suicide and a third have increased their alcohol consumption. Many are bitter about their heavy workload, the culture of litigation and the Dial-a-Doctor mentality of some patients, which has been encouraged by the Government's Patient's Charter. The BMA has just set up a 24-hour stress counselling service to help doctors cope.

For the GP whom we interviewed, the monumental changes to the job, have proved a severe strain. GPs have been forced to become business people, with huge budgets, purchasing hospital care for their patients and computerising all records, so that they can carry out health promotion and surveillance tasks.

Another complaint, from our two former hospital doctors, was the lack of a proper career structure in hospital medicine. Like other junior doctors climbing the ladder, they were forced to chase round the country for posts, changing jobs every few years with the result that family life and friendships were disrupted or destroyed.

Are doctors worse at dealing with stress than the rest of us? Many professionals, after all, in both the public and private sectors have suffered from the increase in pressure that comes with restructuring and the demand for increased productivity.

Dr David Haslam, a GP from Cambridgeshire who has written a book on doctors and stress, says: "Whereas in the past doctors were used to being put on a pedestal - and we don't want a return to that - now they are used and abused and inappropriately criticised. You can tolerate a lot, if you feel appreciated.

"Doctors do not like seeking help. It is partly a macho thing; that they can cope. They often feel that they cannot go to their GP, because they know them personally. So this first line of help, which many other people use, is denied them."

Whatever the reasons for quitting, leaders of the profession are worried.

"The brightest and the best, young and old, are voting with their feet," says Dr Sandy Macara, chairman of the BMA council.

He attributes the problem to the "divisive and destructive" nature of the Government's "reforms" and says that it is no coincidence that stress levels are at a record high, just as we celebrate the fifth anniversary of their introduction. "The association's new stress counselling service comes not a day too soon," he adds.

It wasn't the stress of having too much to do that made me leave, but the boredom

Ferdinand Carabott, a 42-year-old photographer, left medicine because he had become bored with it. He had been a doctor for 11 years and was specialising in dermatology. "I felt it was not creative. I was not using all my energies and there was no time to express my creativity."

After training at Guy's Hospital Medical School and in hospitals around London, he ended up as a registrar at St John's Hospital for Skin Diseases in Soho. He loved the area and identified more closely with the artists and film-makers there than with the buttoned-up medical establishment.

"I was having to attend endless dermatology meetings, at which very rare cases were presented, which you were never going to see. The whole thing seemed irrelevant to an everyday clinic. I did not leave because of the stress of having too much to do, but because of the stress of ennui."

Dr Carabott, who was born in Malta, also faced the fear of having to take a job outside London, since there was a glut of junior doctors in dermatology in the late Eighties. As he was already married, with a child, and his wife was working as a GP in east London, he did not want to work in the provinces and only see his family at weekends.

"I went for an interview in Durham, and as I sat there, I asked myself what I was doing there. I had found myself applying for the job just to look keen."

He decided to become a photographer and found the transition surprisingly easy. Setting up a studio, however, was an expensive business which he financed by doing locums and acting as a medical chaperone for tourists who had to be flown home.

Now he has a flourishing practice as a commercial photographer, producing book and CD covers, advertisements and articles for technical photography journals. He was staggered to discover that people could earn a living without any training.

"The job satisfies a lot of needs. I find it more rewarding than medicine. I felt a greater sense of exhilaration when I had a one-man show in Malta in 1992, than I did when I qualified in medicine."

Now I only work three days a week plus a night on call, I feel so much better

Dr Declan Fox, a 41-year-old GP from Newtownstewart in Northern Ireland, had to take six months off last year, because he became "burnt- out, depressed and stressed".

He attributes his burn-out to an accumulation of problems over four years. He joined his practice, a progressive, forward-looking group, in 1990, after spending several years in hospitals overseas and completing his GP vocational training.

The practice was to move into new premises in 1991 but had to move into temporary accommodation until it was completed in 1992. Then the computer company the GPs were using went bankrupt, so they had to start all over again. Next the GPs decided to become fundholders, which took a year's intensive work, before going "live" in April 1994.

On top of all this, Dr Fox witnessed a number of personal tragedies which affected him. He was on a doctors' skiing trip to Val d'Isere in January, 1994, in which five people died. Shortly after returning, a friend's wife died and, a few months later, a friend's child died of meningitis.

"My own daughter was also diagnosed as having a dislocated hip at seven months, so she was in plaster for four to five months in 1994, which added to the stress. I felt very low and unsure of what I was doing. In October 1994, I became acutely stressed and took two weeks off. But then I struggled back and worked through the first half of 1995, although I was very unwell. I had patients with very difficult problems, and personalities.

"Come June 1995, I became very acutely depressed. I had to stop work. After four months off work, I began to feel my mood lift. I came back to work part-time in January and feel better than I have felt for a long time. I feel more in command of my work. I'm doing three days a week, plus a night on call. I work all day Monday, Wednesday and Friday. It is just magic. On my two days off, I can do something else, or nothing at all."

Dr Fox, who is married with one child, is self-employed, so any time off can be expensive, because the practice has to employ a locum.

"The time off cost me about pounds 25,000 and I have to go back to full-time work, because of financial commitments. But, in future, I think you will see more and more part-time work in general practice. Younger people will not commit themselves to such big mortgages. More men and women will see the light. They will realise there is more to life than slogging away in the surgery 12 hours a day."

These were my options: leave medicine, stay in medicine ... or kill myself

Kate Silvester, a 33-year-old management consultant, remembers sitting on her bed as a junior doctor and making a list of her options: "Leave medicine, stay in medicine, commit suicide."

What had brought her to this? "It was a combination of exhaustion, loneliness and frustration. I was working 120 hours a week and having to move jobs every six months, which meant I could not keep up with friends. And I was treated as just a body on the shop floor to be shouted at.

"I was on duty every other night and every other weekend. Sometimes I couldn't take holidays, because the hospital couldn't find a locum. Once I did a six-month locum for my hospital and was not paid for three months. It was dehumanising. I was getting angry and frustrated. I could only look forward to two things: going to the loo for a quiet pee and going home to wash my knickers. I was not treating my patients in the way I wanted to. None of us were nice to each other or the people round us."

Ms Silvester, who lives in Warwick, first went to St Thomas's Hospital Medical School, London, in 1980, as an enthusiastic l8-year-old, keen to study medicine. She enjoyed being a medical student and got a degree in physiology as part of her studies.

She qualified in 1986 and did junior hospital jobs all round the country. It was then that disillusionment set in. Although she found her chosen speciality (ophthalmology) interesting and did well in it, those years were exhausting and demoralising.

"We were given no career guidance. I discovered there was a career bottleneck in ophthalmology."

So she decided to get out. She talked to consultants and colleagues, some of whom were "arrogantly indifferent". Her family and those who had left medicine were the most helpful. In the end, she plumped for a masters in business administration at Warwick University in 1993/94, which she enjoyed. She is now a systems engineer with a management consultancy in Birmingham, which she loves.

"It's the system that is dehumanising. It has never been designed to be safe, friendly and effective. That's what I am learning to do now. I want to go back and help my medical colleagues sort it out.

"I miss the intellectual stimulation and the patients. But by leaving medicine, I regained my stability, my sanity, my sense of humour. And I have met something that I never found in medicine: love and respect from the people I work with. I've had a lot of help, guidance and mentoring. I know where I am going. It's a flexible path, not a treadmill."