The impact of junior doctor rotational training pathways on carbon footprint and wellbeing

Abstract

The NHS is the largest employer in England with 1.7 million employees.1 The organisation accounts for 4% of the UK's carbon footprint, requiring resources to maintain round-the-clock services. Around 9.5 billion miles of all road travel in England relate to patients, visitors, staff and suppliers to the NHS, contributing 14% of the system's total emissions, of which staff commuting contributes 4%.2 Junior doctors comprise a quarter of the medical workforce.3 For junior doctors, the nature of rotational training pathways can precipitate a nomadic work-lifestyle, influencing commuting distances within training deaneries. It is plausible that travelling required to complete a training job comes with a carbon footprint cost.In October 2020, the NHS pledged to achieve carbon neutrality by 2040, aiming for an 80% reduction by 2028 to 2032.4 The NHS outlined key steps in its 'Net Zero' policy, with one step focusing on transport and travel, emphasising the importance of green travel plans at a regional and local level. The plans advocate for interventions such as promoting active travel and improving infrastructure. Non-active and lengthy commuting is known to have negative consequences on physical and mental health, with those who commute for over an hour being 33% more likely to suffer from depression and 21% more likely to be obese.5 Therefore, encouraging active modes of transport and shorter durations, may improve staff wellbeing and reduce carbon emissions.A survey was completed by 72 junior doctors in Kent, Surrey and Sussex (KSS) deanery in 2023, with representation across training levels and 88% of responders being on a training scheme. The survey showed that 69% commuted by car, with petrol being the primary fuel source (62%). Over half (53%) had alternative commuting transport options, but reliability, longer traveling time and higher costs were noted deterrents. The graphs below demonstrate that both commuting distance (figure 1) and travel time (figure 2) to work could be significantly reduced if allocated training jobs in their local hospital to home.69% felt their commute impacted on their physical health, 68% felt it impacted on their mental health. 95% agreed that commuting distance influenced their decision when ranking job preferences. 97% agreed that commuting distance should be considered as part of rotational allocations. Despite recognising the benefits of rotational training, junior doctors advocated for more flexibility in rotation assignments to minimise commute distances with their preferences for shorter commutes.In conclusion, addressing commuting challenges for junior doctors should be considered by the NHS and training deaneries, to contribute to reducing the NHS's carbon footprint as well as to improve junior doctors physical and mental wellbeing. Recommendations include consideration of commuter distances when allocating jobs, exploring non-rotational training options, offering longer (e.g. 2-year) placements in training post, allowing more flexibility with inter-deanery transfers, and supporting alternative modes of transport. These efforts align with the NHS's broader goal of achieving carbon neutrality while enhancing workforce satisfaction leading to improved recruitment and retention.