Stop tying young occupational health physicians to restrictive contracts

Medical graduates who want to become occupational health physicians are increasingly being offered employment contracts that tie them to an employer for as long as eight years. Leave earlier, and they can face repayment demands of up to €150,000. The result? Young physicians feel trapped, with all the consequences that brings. It's time for a more positive approach.

Becoming an occupational health physician takes time. After completing medical school, doctors undertake a four-year specialist training programme. Broadly speaking, they spend four days a week working under supervision from their employer and one day a week studying at university. The programme costs around €50,000, which in many cases is initially paid by the employer. The employer and the doctor in specialist training then agree how those costs will be repaid if the doctor leaves. Typically, the longer they remain with the organisation after completing their training, the less they have to pay back.

So far, so reasonable.

But I'm increasingly seeing occupational health providers add other costs on top – for supervision, for example, and even for the hours the doctor spends on their training. Those costs can quickly add up to as much as €150,000. For a young physician who wants to leave before the end of their contract, that's an impossible amount to repay. And few prospective employers will be willing to take on a debt of that size.

It starts to look like profiteering

This trend concerns me. In the short term, because doctors in training can find themselves effectively trapped with an employer they'd rather leave. That can't be good for the quality of their work. And in the longer term, because practices like these do nothing for the reputation of what is, after all, a fantastic profession.

Now, I can already hear the response: “But Maarten, these doctors signed the contract themselves.” Absolutely. But that doesn't mean they fully understand the implications when they sign it. Newly qualified doctors are pleased to have landed their first job. They assume their new employer knows what they're doing – and, more importantly, has their best interests at heart.

And that's precisely the problem. This increasingly looks like making money at the expense of young doctors, justified by the argument that too few occupational health providers are willing to take responsibility for training them.

Just look at what the industry association has to say on the subject: “It is important that members carefully consider the financial implications of providing training to ensure that enough organisations remain willing to act as training providers. Training requires a considerable investment and involves substantial costs, which must remain economically viable.”

The industry association even turns the argument around: “There are a number of occupational health providers that recruit primarily from this group of physicians while providing little or no specialist training themselves.”

Right.

The wrong thing to focus on

That argument simply doesn't hold up. Of course, a doctor in specialist training costs more than a fully qualified occupational health physician. But that doesn't mean they operate at a loss. Quite the opposite: when a doctor in training is working normally, they can generate a margin of around €100,000 a year. That seems more than enough to me.

More broadly, I find this entire focus on costs rather odd. To put it into perspective, we lose around 800 to 900 billable hours a year because a doctor in training attends university. But we also lose around 500 hours when physicians go on holiday, and another 500 or so through parental leave. We don't charge them for that either, do we?

Fortunately, the professional association for occupational health physicians also recognises the lack of consistency in the way these costs are calculated, as well as the lack of transparency. It acknowledges that this creates “an additional barrier to starting specialist training” and can “undermine the safety of the learning environment for doctors in training”. The association is now considering the issue further.

From financial ties to a workplace people want to stay in

It's time we started looking at this differently. Training young doctors is genuinely rewarding. It keeps you connected with universities, gives you access to the latest thinking and brings an enormous amount of fresh energy into your organisation. What more could you want?

And if you want physicians to stay, don't try to keep them there by tying them to a huge financial obligation. Create a workplace they genuinely want to be part of. That's better not only for young doctors, but for everyone around them. It creates a positive cycle in which job satisfaction and quality reinforce one another. And believe me: the financial results will follow.