One in five resident doctors have kept silent when witnessing unsafe clinical practices, often for fear of repercussions for their career, new research has found.
Researchers surveyed more than 1,100 resident doctors in 25 hospitals in England and found that 20% agreed with the statement that, ‘Due to fear of conflict, I have kept silent about some unsafe clinical practices’, during the previous year.
They also found that 22% agreed with the statement, ‘Since I feel it would be futile to raise concerns, I have kept silent about unsafe clinical practices’, and 26% agreed that, ‘due to fear of repercussions on my career, I have kept silent about unprofessional behaviour’.
The research project was funded by the British Academy (2023-2024) and was led by Dr Wen Wang, of the University of Leicester. The research findings were written with Dr Jennifer Creese, University of Leicester, Dr Zhenduo Zhang, Dalian University of Technology, China, and Professor Roger Seifert, University of Wolverhampton.
The project also interviewed 35 resident doctors. One woman doctor said: “You simply just start, there’ll be no introduction, no hierarchy, no safety netting or guidance, no protocol to view. You just simply have to do it.”
Another said: “We wrote a letter saying we need more supervision, we’ve had these clinics where there’s no seniors, but were told to shut up and put up.”
One said: “You need to know that there’s safe support behind you. Sometimes that doesn’t happen – it’s unreasonable.”
A male doctor said: “In foundation training there was zero work life balance. A lot of the things that we had to do were illegal, if you ask me. You often work in an unsafe environment.”
Dr Wang told the British Sociological Association’s conference on Work, Employment and Society in Bath today [Thursday, 10 September] that “In the NHS, clinical negligence costs have surged from £14 billion in 2014 to £60 billion in 2025.
“While patient safety is an absolute for all hospital staff, it is resident doctors who are on the front line and most likely to observe patient safety concerns or unsafe working conditions.
“However, these doctors, who make up 50% of the medical workforce, frequently fail to report workplace or patient safety concerns, because they fear the consequences for their careers or they don’t believe action will be taken.”
Dr Wang analysed the data and found that when doctors complained of experiencing bullying, harassment or discrimination, they were 25% more likely to keep silent when they saw unsafe clinical practices.
When doctors were worried about their career progression or finding a job, they were 8% less likely to speak up. When they felt they had ‘burnout’, the figure was 11%.
“The research shows that bullying, harassment and discrimination, and career precarity and burnout, are significantly and negatively associated with keeping silent when witnessed unsafe practice,” said Dr Wang.
“Doctors used to have well-defined, nationally coordinated training and career progression paths, but are now confronted with unemployment and falling real pay in the UK.
“When early-career doctors experience the fear of employment uncertainty, they exhibit anxiety and adopt a survival mode. The survival mode triggers a cognitive response focused on professional risk aversion and personal career preservation.”
However, if they perceived effective anti-bullying human resource practices, the likelihood of them keeping silent fell by 13%. Supportive senior leadership and fair employment conditions helped protect doctors from burnout, empowering them to speak up.
For more information, please contact:
Tony Trueman
British Sociological Association
Tel: 0044 (0)7964 023392
tony.trueman@britsoc.org.uk
Notes:
- Survey data was collected from early-career doctors in 25 NHS Trusts (75 hospitals) in England. The survey took place between May and July 2023. There were 1,151 valid responses from early-career doctors: 45% were in their Foundation years (first 1-2 years of training), 9% were clinical fellows (doctors on a pause from training), the rest (46%) were senior resident doctors.
- The researchers found that 16.2% agreed with the statement, ‘Due to fear of conflict, I have kept silent about some unsafe clinical practices’ during the previous year, and 3.6% strongly agreed with it. For the statement, ‘Since I feel it would be futile to raise concerns, I have kept silent about unsafe clinical practices’, 16.8% agreed and 5.1% strongly agreed. For the statement, ‘Due to fear of repercussions on my career, I have kept silent about unprofessional behaviour’, 19.9% agreed and 6.0% strongly agreed.
- The British Sociological Association’s Work, Employment and Society Conference takes place from 9-11 September 2026 at the University of Bath, with more than 200 papers presented. The BSA is a company limited by guarantee, registered in England and Wales. Company Number: 3890729. Registered Charity Number 1080235 www.britsoc.co.uk