Why medical interns are chronically dissatisfied

Why medical interns are chronically dissatisfied

Professor Richard Koopmans’ farewell speech

01-11-2023 · Interview

Demotivated medical interns, and a dire shortage of GPs and specialists outside the Randstad. There is a lot awry with the training to become a medical specialist, says departing professor and trainer Richard Koopmans. "But the solutions are unmentionable."

“It is actually inconceivable that we are allowing this to happen,” says Richard Koopmans, when he takes stock at the end of the interview. “A gloomy story, isn’t it? I sometimes think: did I myself do enough?”

Koopmans was professor of General Internal Medicine as well as a trainer in the Southern Netherlands region since 2005, and so he was responsible for the content of the study programme to become a medical specialist and for the supervising of these medical interns.

He recently said farewell to UM with a speech about the flaws in the programme, and the problems that stem from them. Medical interns are chronically dissatisfied, says Koopmans. It is there in every evaluation report, complaints about poor supervision, the excess overtime, high workload and limited freedom to organise their own time.

“Burnouts, demotivation, and cynicism have become more prevalent and for about five years now, I have noticed that there are always a few doctors who drop out halfway through the programme. Annual national surveys show that a quarter of all medical interns – two thirds of whom are female – consider stopping."


Medical interns – or trainee medical specialists – learn and work at the same time, and after six years, they may call themselves medical specialists, such as neurologists, surgeons, or lung specialists. This training takes place at eighty hospitals in the Netherlands, where medical interns participate in the daily routine and sometimes do training or work placements. University hospitals have more trainees than regional hospitals; MUMC has 350. On a national level, there are a total of ten thousand.

They are being trained, but in actual fact, these medical interns keep the place running during the evening, in the weekend and during the night. They take care of patients, prescribe medication, and deal with complications. These shifts, however, eat into so much of their time that learning has to take a back seat. Koopmans: "The operational management in the hospital always takes precedence. And if two medical interns drop out somewhere, the others have to make up for it. They feel like they are playthings in operational management and complain about too little autonomy. Rightfully so.”

National Ombudsman

Hospitals cannot survive without medical interns, also in financial terms: the government pays a hospital 144 thousand euro for every medical intern. “That by no means all goes into training; it is used to plug holes in the budget. So not only are medical interns a cheap source of labour, they also bring along a bag of money. I once tried to move medical interns from one hospital to another, for diversity reasons, but the board of governors immediately blocked it.”

So, is the quality of these studies not evaluated? Yes, it certainly is, there are audits and official visits, but they are carried out by representatives from the medical profession. It is a case of the fox guarding the chickens. The National Ombudsman put his finger on the pitfalls in 2021, says Koopmans. "One of them is that medical interns are hesitant when it comes to being critical, because they are dependent on the presiding specialists and managers for a job later on."


Koopmans sees two solutions, although they are inconceivable in the medical world at the moment. The first is to distribute medical interns differently over the hospitals. "At the moment, one hospital receives more medical interns than the other, as a result of historical developments. That has to change. Let a committee of medical interns, hospital personnel and independent third parties assign medical interns based on the quality of the training programme in that hospital, on the amount of autonomy in the work and on overtime. That way, you would create an incentive for hospitals to meet the medical interns some of the way."

The second inconceivable solution has to do with the length of the training, which, including the initial study programme, easily takes fifteen years. "After that, you are in your mid-thirties, you have children, and are no longer mobile. A job in Alkmaar, which is initially often for just a few days a week, is not very attractive if you live in Maastricht."

That is why Koopmans suggests shortening the training to become a specialist to three years and to offer as many medical interns as possible a job at that time in the same hospital. In that way, you would keep your specialists for the region and prevent the shortage of specialists and GPs rising even further."


Halving the training has another advantage. "In the first three years, medical interns mainly train in general knowledge and skills within the specialism. In the second half, it becomes even more specialistic. But all reports show that the Netherlands is not looking for even more superspecialists, but primarily for doctors who can treat frequently occurring disorders and carry out common operations."

But with a shortened training, hospitals will receive less money per medical intern. "And that is why this plan is also inconceivable for the time being. At the same time, the problems will continue to be subject of discussion."

Photo: Pixabay

Categories: news_top, Science
Tags: medical interns, education, burnout


Werner Teeling

You can watch his farewell lecture on the UM Youtube channel: https://www.youtube.com/live/_tzVpam3gNc

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