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Support for doctors in difficulty

This page provides information for doctors in difficulty, such as personal or health problems, difficult working relationships or problems with a certain part of their training programme or clinical practice.

If you’re experiencing problems, always contact your Clinical Director or Regional College Adviser for support and advice in the first instance.

About doctors in difficulty

What sort of difficulties do doctors find themselves in?

Doctors in training may experience problems when they ‘fail’ an assessment, such as an exam or the Annual Review of Competence Progression (ARCP), or when their trainer or Training Programme Director considers they have difficulties.

Independent practitioners may find themselves the subject of a National Clinical Assessment Service (NCAS) review or a General Medical Council (GMC) assessment, or their behaviour or performance may have come to the attention of their Medical Director.

Doctors at any stage in their career may experience issues such as work/life balance, career choices, difficult working relationships, ill health or personal crises.

What sort of behaviours do the NCAS and deaneries observe in doctors who get into difficulty?

Clinical concerns are more likely to lead to a full NCAS assessment. However, the NCAS and deaneries have identified patterns of behaviour that may underlie the reported clinical problem (see below).

Despite these problems, the NCAS describes the doctors they assess as highly motivated. They often struggle to understand what to do to improve, and are not helped by the fact that colleagues often isolate the individual. The NCAS indictaes there is need for recognition and inclusion in this group of doctors.

Leadership and team work

Inconsistent leadership behaviour can leave colleagues feeling nervous and confused. Some doctors displaying this type of behaviour are described as lacking self-awareness, not realising the impact they have on people. Others appear to be defensive and not open to self-reflection or feedback. They may interpret negative feedback as personal rejection.

Doctors who find it hard to be assertive can have difficulties influencing or negotiating. Those who seem unconventional, with a love of new ideas, can be difficult to work, and are often described as being easily distracted and lacking in self-discipline.

Decision making

Some doctors appear to have very high, uncompromising standards, and put pressure on themselves and others to achieve them. If this is accompanied by an antagonistic style, this can be reported as bullying.

Others are reported as inflexible when faced with uncertainty and have difficulties recognising when they need to cut corners. They may be cautious decision makers, who are so anxious to avoid mistakes that they over-investigate, or have difficulty prioritising.

Personal stress and organisation

Personal stress and poor personal organisation can result from difficulties in coping with a lack of structure and order in the work environment, or from being anxious to please and taking on too much. Some who are altruistic and trusting can feel let down and resentful of the system or colleagues.

RCOG support for doctors in difficulty

Always talk to your Clinical Director or Regional College Adviser for information and support in the first instance.


Some doctors in difficulty find mentoring useful. The RCOG doesn’t provide a mentorship scheme, but has produced:

Improving workplace behaviours (bullying and undermining)

Some doctors in difficulty experience problems with their working relationships, such as bullying and undermining.

Further sources of help for doctors in difficulty

Doctors in difficulty may be able to seek help from their GP, medical defence organisation, NHS Occupational Health Services, postgraduate deanery or local medical committee. Details of the GMC’s role in helping sick doctors is available on the GMC website.

The following organisations are alternative sources of support and advice for doctors in difficulty:

Elsewhere on the site

Dealing with undermining
Find out about the College’s work to address undermining (bullying) in the workplace
Support for trainees
Resources designed to support O&G trainees