Going Full-Time Private: Why Most Doctors Say ‘No Thanks’

Private work has its perks, but the NHS offers things money can’t buy.

As doctors, we’ve all heard the hushed conversations about private practice—the promise of fewer night shifts, higher pay, and a full lunch break. Given the financial incentives, it’s no wonder people ask, "Why don’t more UK doctors in private-friendly specialities go full-time private?"

It sounds simple, but the reality is far more complicated. For many doctors, medicine is more than just a career—it’s an ethical commitment to a system that accepted us as medical students, supported us through training, and continues to shape the future of healthcare. The NHS isn’t just a workplace; it’s a principle. The idea that healthcare should be free at the point of need is deeply ingrained for most doctors, and for many, stepping away completely feels like turning their back on the values that brought them into medicine in the first place.

Beyond ethics, there’s also the question of professional fulfilment. While private practice can be lucrative, it often limits the complexity of cases. The NHS is where doctors typically tackle the most challenging, high-risk conditions. The major trauma that requires intensive care, or complex multi-specialty cancer resection surgeries. These cases require the kind of teamwork, resources, and infrastructure that the majority of private hospitals simply can’t match. Private practice thrives on straightforward, low-risk procedures, which, while profitable, may not get you out of bed in the morning in the same way.

Then there’s the question of career stability. The NHS offers structured career progression even at the consultant level, with appraisals, revalidation, and study budgets. Salaries are guaranteed, pensions are generous, and benefits like sick pay provide security that private practice doesn’t. Running a private clinic also means taking on financial and legal risks—paying for indemnity insurance, clinic space, admin support, and marketing. And let’s not forget the social aspect. While the NHS is a pressure cooker at times, the camaraderie among colleagues is a huge part of what makes the job bearable. Private practice can be an isolating experience, with fewer opportunities for peer support.

Ironically, maintaining an NHS presence actually helps a doctor’s private practice. Many private hospitals view NHS consultant status as a marker of credibility, and being well-known in NHS circles increases private referrals. Patients themselves often feel reassured knowing their private doctor also works within the NHS, as it signals expertise and up-to-date practice.

So, why don’t more doctors go full-time private? Because, despite its flaws, the NHS remains the backbone of medicine in the UK. It offers professional development, career security, and the chance to make a real impact. Private work can be a great supplement, but for most doctors, the NHS is home.

The Rise of the Part-Time Consultant

Over the last decade, an IFS report shows that NHS consultants have been quietly stepping back. In 2012, just 15.6% worked less than full-time in acute care. By 2021, that number hit 21.6%. But are they really working less—or just working elsewhere?

Specialty matters. Obstetricians and gynaecologists are 9.6 percentage points less likely to work part-time than peers in other fields, while ophthalmologists are 5.4 percentage points more likely to do so. With burnout rising and private sector opportunities growing, many aren’t reducing hours—they’re just shifting them.

Flexible working or a silent exodus? You decide.

​​More Hands, Less Sense? The Workforce Paradox in Healthcare

It’s not just about numbers, experience matters.

What does a proficient workforce look like? If you ask the powers that be, the answer seems to be "as many hands as possible for the least amount of money." The idea is that throwing more people at a problem will solve it. More hands, more productivity, right?

Well, not quite. While a larger workforce might mean more tasks completed, it doesn’t necessarily mean they’re done efficiently or correctly. There’s a small detail being overlooked: experience matters.

Instead of prioritising a well-balanced workforce that combines knowledge, expertise, and the ability to manage risk, healthcare often frontloads its system with novices. These fresh recruits, eager but green, are expected to navigate a profession where mistakes carry serious consequences.

The reality is, experience is the result of countless mistakes—ones you’ve learned from (hopefully). Novices need space to fail safely, and some specialities understand this better than others. Radiology and anaesthetics, for example, are two fields that embrace this principle. Radiology trainees spend their first year essentially in study lockdown, preparing for the dreaded FRCR exam while being fully supernumerary. Anaesthetists? Their seniors stay close by, making sure the phrase "you learn best from your mistakes" doesn’t become a literal wake-up call.

Few professions demand as many real-time trade-offs as medicine. This ability to weigh competing priorities only comes with experience, and it’s why retaining seasoned professionals should be a priority.

Professor Alison Leary, an expert in healthcare workforce modelling, has highlighted that if we want productivity, we need to stop haemorrhaging experienced staff. Retention should be the real buzzword, not just recruitment. Because at the end of the day, a well-trained workforce isn’t just about having more hands—it’s about having the right ones.

“Individual specialities deciding when you can receive your MSRA score is another level of insanity I cannot comprehend”

“There are many words that have lost their original associations in our minds. Is clubbing something you do on a weekend or something that makes you think ILD? Stool is no longer a great place to sit either.”

“Made a huge career transition today - I ditched the re-useable scrub hat life and got my own fabric scrub hat”

“Spent the first 30 minutes of the day sorting medical specialities into Hogwarts houses—right before the on-call consultant arrived. So far we think Paeds, ED and Gen med fall under Gryffindor. Micro, radiology and anaesthetics can stay in Ravenclaw. Psych is my certain Hufflepuff bet. Gynae, Orthopaedics, and Cardiology are born to be Slytherins. You don’t want to know who we put as Death eaters.”

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Some things to review when you’re off the ward…

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Find out about the relationship between the UK’s biggest private health provider, Spire and the NHS. 8,650 consultants practice privately at Spire, 90% of which work within the NHS.

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…whilst you’re here, can we take a quick history from you?

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 The Great British Doctor Drain

A new report shows that every year, thousands of doctors (mainly consultants) are leaving the NHS before retirement, costing taxpayers an estimated £2.4 billion. If things continue as they are, that figure could balloon to £5 billion annually. Of the doctors who relinquished their license to practice in 2022, nearly a quarter (24%) cited retirement as their reason for leaving, while around one in three (33%) wanted to practice or live abroad.

If, as the BMA reports, six in ten consultants plan to retire from the NHS before turning 60, the healthcare system—already under immense strain—could be heading toward a major crisis.