Changes in alcohol-related perceptions and behaviour among Vietnamese early career doctors after graduation

Abstract

BACKGROUND:

Vietnamese medical students believe becoming “strong” drinkers is important for their future career working as doctor. However, it is unclear if this is a temporary behaviour associated with life as a student, or a phenomenon associated with the transition to working as a medical practitioner.

OBJECTIVE:

This study explored changes in alcohol-related perceptions and behaviour among Vietnamese early career doctors working after graduation.

METHODS:

In-depth interviews were conducted with 15 Vietnamese early career doctors in Hanoi city. Thematic analysis was used to analyse the qualitative data.

RESULTS:

Vietnamese early career doctors perceived binge drinking as common among doctors, especially male doctors, surgeons, and preventive medicine doctors. This perception was different from when they were medical students because, at that time, they believed doctors would not drink alcohol at hazardous levels. Additionally, Vietnamese early career doctors’ drinking behaviour changed in the frequency and quantity of alcohol consumption after graduation due to peer pressure, job stress, working collaborations, and working environment.

CONCLUSIONS:

Vietnamese early career doctors changed their alcohol-related perceptions and behaviour after graduation. Gender, mental health (stress), factors related to the working environment, and the role of professional relationships should be considered in strategies to reduce risky alcohol consumption among Vietnamese early career doctors.

Keywords

Binge drinking early career doctors qualitative Vietnam

1 Introduction

Globally, harmful use of alcohol is an increasing public health problem. Excessive alcohol consumption can cause complex physical, mental, and social problems for individuals, communities, and populations [1]. Early detection and counselling about harmful alcohol use is an effective strategy to reduce harm [2]. Doctors play an important role in conducting alcohol-related primary care interventions. However, doctors’ drinking habits and attitudes towards alcohol could influence their approach to screening, counselling, and treating patients with alcohol problems, and influence patients’ attitudes and motivations to change their drinking behaviour [3].

Previous research found high levels of alcohol consumption and increased risk of alcohol-related harm among doctors [4 –8]. The nature of the medical profession, work overload, stress, and burnout are reported as risk factors for heavy alcohol use among doctors [6 , 10]. Harmful alcohol use can negatively influence doctors’ own health and well-being and the quality of care they provide to their patients [11]. However, doctors who are risky drinkers rarely seek help. Colleagues hesitate to report doctors with alcohol problems because they do not realize how serious the problem is and fear reporting will affect doctors’ careers [12, 13].

Most studies about alcohol use among doctors have been conducted in Western countries using quantitative methods [7 , 14]. These studies concentrate on prevalence, factors underlying drinking behaviours, and the impact of alcohol use in doctors’ lives. Some recent qualitative studies explore health professionals’ experiences regarding alcohol consumption and its influence on patients’ care [15], the challenges that physicians with substance-use disorders (including alcohol use) face in the workplace [16], and the barriers and facilitators experienced when doctors seek help for substance use disorders [17].

In Vietnam, research about alcohol use among doctors is limited. Most studies about alcohol use in the Vietnamese medical profession focus on medical students. Previous studies show many Vietnamese medical students drink excessively [18, 19]. A recent study found Vietnamese medical students believe alcohol use is necessary for their future careers as doctors [20]. A previous quantitative study found the role identity of future doctors (that is, the set of expectations prescribing behaviour others consider appropriate [21]) was the most important predictor of intention to binge drink among Vietnamese medical students [22]. Also, Vietnamese male medical students consumed more alcohol, engaged in more binge drinking occasions, and suffered from more alcohol-related problems than female medical students [20, 22]. It is not clear whether harmful alcohol use among medical students, especially among males, is a temporary behaviour associated with student life or a transitional phenomenon associated with becoming a medical practitioner. It is important to understand this issue because doctors, who are seen as role models in promoting healthy lifestyles, may influence community attitudes towards alcohol consumption.

The findings from previous studies indicate that Vietnamese medical students believed alcohol use played an important role in their careers as future doctors, with role identity as the strongest predictor of medical students’ intention to binge drink, and male medical students showing more binge drinking engagement and alcohol-related disorders [20, 22]. No research to date examines alcohol use among early career doctors or considers changes in their perceptions of alcohol use after graduation from medical universities. A more in-depth examination of this issue is warranted.

This paper described a qualitative study that aimed to understand changes in the perception of alcohol use and alcohol-related behaviours among Vietnamese early career doctors after graduation. The findings of this study provided a preliminary exploration of alcohol consumption and factors underlying drinking behaviours among Vietnamese early career doctors to add to the understanding of alcohol use within this group. Further, it may assist in developing effective interventions targeted at reducing the risk of alcohol misuse in doctors as well as medical students, hence lowering the likelihood of compromising medical professionalism and patient safety.

2 Methods

2.1 Participants

This study was conducted in Hanoi, Vietnam, and included in-depth interviews with early career doctors. Purposive sampling was used. The first author contacted 30 doctors (by phone, email, or in person) from lists provided by the Personal Affairs Offices of a medical university, a hospital of a medical university, and a health prevention and research institute. The first author emailed a recruitment flyer and an information sheet about the study to early career doctors who had graduated from a medical university 3–5 years previously. The information sheet described the purpose, participation requirements, risks, benefits, privacy, and confidentiality of the study, and included a consent form. If early career doctors agreed to participate in the study, the first author arranged a convenient time and suitable location for the interview. The study achieved data saturation with 15 interviews of early career doctors.

2.2 Data collection

Interviews took place in the participants’ private rooms at work or another suitable location such as work meeting rooms or coffee shops. Each interview lasted 45–60 minutes. Before the interviews were conducted, participants completed a brief survey about basic demographics and drinking behaviour. The survey included 9 demographic questions including age, gender, marital status, graduating year, and place of employment. Questions related to alcohol use were based on the Alcohol Use Disorder Identification Test (AUDIT), a well-validated measure to identify people with hazardous and harmful patterns of alcohol consumption [23], which was reviewed by two experts working in the healthcare environment in Viet Nam for at least 5 years (see Appendix 1).

The first author conducted audio-recorded interviews with the early career doctors, using an interview guide. Questions addressed participants’ perceptions about alcohol use and harmful drinking among Vietnamese doctors, their experience of alcohol use as a medical student, and any difference between their experiences with alcohol consumption as a medical student and as a doctor (see Appendix 2).

A demographic description of the doctors who participated in the study is presented in Table 1. The results of the AUDIT questionnaire showed that male doctors consumed more alcohol and engaged in binge drinking more frequently than female doctors (p < 0.05).

Table 1
Demographic information about early career doctors who participated in the study

Male (n = 10) Female (n = 5) p-value

Mean age (SD) 29.1 (2.47) 28.2 (1.64) 0.560

Mean length duration of work by year (SD) 4.3 (1.33) 4 (1.41) 0.143

Marital status (Yes/No) 5/5 3/2 0.573

Working areas

•Diagnosis and treatment 4 1 0.434

•Health prevention 6 4

Past alcohol consumption (Yes/No) 10/0 5/0 N/A

Ever having consumed more than 5 drinks per occasion (Yes/No) 10/0 2/3 0.022*

Numbers of drinks in a drinking occasion if ever having consumed more than 5 drinks per occasion

•5 drinks or less 0 3

•6 – 10 drinks 4 2 0.122

•11 – 15 drinks 3 0

•16 – 20 drinks 2 0

•More than 20 drinks 1 0

Consuming more than 5 drinks per occasion during the last 2 weeks

•Daily 0 0 0.014*

•Weekly 2 0

•Occasionally (e.g. once per month) 6 0

•Rarely (e.g. only in special events) 2 5

	Male (n = 10)	Female (n = 5)	p-value
Mean age (SD)	29.1 (2.47)	28.2 (1.64)	0.560
Mean length duration of work by year (SD)	4.3 (1.33)	4 (1.41)	0.143
Marital status (Yes/No)	5/5	3/2	0.573
Working areas
•Diagnosis and treatment	4	1	0.434
•Health prevention	6	4
Past alcohol consumption (Yes/No)	10/0	5/0	N/A
Ever having consumed more than 5 drinks per occasion (Yes/No)	10/0	2/3	0.022*
Numbers of drinks in a drinking occasion if ever having consumed more than 5 drinks per occasion
•5 drinks or less	0	3
•6 – 10 drinks	4	2	0.122
•11 – 15 drinks	3	0
•16 – 20 drinks	2	0
•More than 20 drinks	1	0
Consuming more than 5 drinks per occasion during the last 2 weeks
•Daily	0	0	0.014*
•Weekly	2	0
•Occasionally (e.g. once per month)	6	0
•Rarely (e.g. only in special events)	2	5

* Significant factors (p < 0.05).

This study, along with all associated documents was approved by the University Human Research Ethics Committee at the Queensland University of Technology, Australia, and the Ethics Research Committee at the Hanoi Medical University, Vietnam.

2.3 Data analysis

The interviews were transcribed verbatim and the transcripts were analysed in Vietnamese by the first author. A subset of transcripts was translated into English by the first author and checked for soundness and trustworthiness by the co-authors. Thematic analysis was undertaken in several steps [24]. The process of data analysis is presented in Fig. 1. Throughout this process, each interview was identified by a unique code constructed using an abbreviation based on the gender of participants (M-male, F-female) and order of the interview.

Fig. 1

Data analysis process and themes.

2.3.1 Coding

The first author coded the transcripts inductively to categorize and organize the data. The first author read the transcribed text several times to understand it as a whole and to identify essential themes. Reading and re-reading the text line-by-line and open coding were conducted independently to identify and label concepts revealed in the data. Meaningful units referring to the same content were identified and sorted into ideas relevant to interview questions and the aim of the study. The first author identified and assigned a participant code to significant statements throughout each transcript. Then, these significant statements were copied into a Microsoft Word document and printed for manual grouping.

2.3.2 Grouping

Codes were grouped and regrouped by constantly comparing and contrasting pieces of data. Similar significant statements were grouped into sub-categories and later merged into main categories. Some significant statements were moved into a more relevant category. All categories were unified around a “core” category, which represented the main theme of the study, to identify emerging themes. Emerging themes were analysed to identify recurring themes, their relationships to each other, and overt and latent meanings.

2.3.3 Co-judge concordance

A subset of codes was translated into English and checked for reliability by a co-author.

2.3.4 Labelling

The first author named each emerging theme with a label that encapsulated its essence. All authors engaged in critical discussions to finalize the themes.

Data collection and analysis occurred concurrently. Recruitment occurred until the process of analysis did not identify any new themes and data saturation had been reached.

3 Results

This study revealed four themes which represented how Vietnamese early career doctors in Hanoi changed their perceptions of alcohol use and alcohol-related behaviours during the transition from medical school to professional practice (see Fig. 1).

3.1 From expectation to reality: “When we were medical students, we did not expect doctors would consume a lot of alcohol but now we think it is a misperception.”

This theme described changes in perception among Vietnamese early career doctors about doctors’ alcohol use compared to when they were medical students. Participants considered alcohol use as a normal behaviour in Vietnamese society and said alcohol plays a central role in Vietnamese culture. However, participants reflected that, as medical students, they did not think this behaviour was appropriate for doctors because of their professional responsibility to promote health. During their time as medical students, some participants suspected that, for some types of doctors, such as preventive medicine doctors and surgeons, heavy alcohol consumption may be associated with success. After graduating to become doctors and experiencing or witnessing alcohol consumption among other doctors, participants realized the use of alcohol by doctors was similar to alcohol consumption more generally in Vietnamese society. The change in perceptions of alcohol use is described in the following participant’s quote:

“When I was a medical student, some older students said to me that I should drink alcohol because in the future, although being a doctor, I would still drink a lot of alcohol. I felt very confused when hearing about the drinking behaviour of doctors because I often worked with them when I practised at hospitals and I rarely witnessed doctors drinking alcohol. Now I am a doctor I have experienced many drinking sessions among doctors and I have to agree that doctors also drink a lot of alcohol. I, myself, have consumed a lot of alcohol since I graduated from medical university.” (M-09)

Participants reported they participated in regular drinking sessions and frequently drank more than 5 drinks during a session. They believed binge drinking often occured among doctors, especially male doctors, and alcohol consumption played an important role in their professional collaborations. A participant described his participation in drinking sessions with other doctors:

“I believe binge drinking is common among doctors. Generally, when participating in a drinking session, we often consume more than 5 drinks. It’s rare to drink fewer than 5 drinks per occasion.” (M-10)

Participants suggested harmful alcohol use, such as alcohol misuse and alcohol abuse, occured among specific groups of doctors, especially the older generation of doctors. Participants believed these doctors understood the disadvantages of harmful alcohol use but still drank excessively. For example, one participant revealed the following:

“Only a few doctors, who may be dissatisfied with their jobs, or old doctors may drink a lot of alcohol. These doctors have consumed alcohol frequently for a long time leading to addiction and they cannot stop drinking. I do not see alcohol abuse among young doctors.” (M-11)

In summary, Vietnamese early career doctors’ perception of alcohol consumption changed when they experienced or witnessed repeated drinking sessions among doctors. Participants suggested that, as medical students, they believed doctors would not consume alcohol excessively but acknowledged this was a misperception. Binge drinking was perceived as a common occurrence among Vietnamese early career doctors, especially specific cohorts such as among males and older doctors.

3.2 From study to work: “When I was a student, I drank alcohol just for fun; but now, as a doctor, I often have a drink to improve working relationships and release stress.”

This theme described how the drinking behaviours of Vietnamese early career doctors changed compared to when they were studying at university. As medical students, participants acknowledged they often drank alcohol for social reasons. Some participants indicated they drank once or twice per week during their time at university. Most participants remembered their alcohol consumption increased from the third to fourth years of their medical degrees. This increase was because they had more friends and closer relationships, and because they participated in more drinking sessions. Their alcohol consumption typically reduced during their fifth and sixth years, as they were busy with study and working in the hospital. A doctor shared how he consumed alcohol when he was a medical student:

“We might not have money to buy food, but we would spend money to buy alcohol. We drank a lot of alcohol during drinking sessions. We were medical students at this time and, because we were students, we would drink alcohol as much as we could and drink until we were drunk.” (M-07)

The drinking behaviour of participants changed when they became doctors. Participants reported their alcohol consumption increased in frequency and quantity after they graduated from university and started work. For example, preventive medicine doctors in this study typically reported their alcohol use increased after they started their jobs. Participants perceived this change was because they communicated with staff at different levels and sectors, and consumed alcohol to improve working relationships. A doctor shared:

“My alcohol use obviously has increased both in frequency and amount... Certainly, I shouldn’t drink a lot of alcohol, but sometimes I can’t avoid it because of our work. Besides, some social events also require us to drink a lot of alcohol such as at weddings or birthday parties. I need these drinking sessions to communicate and create relationships with others.” (M-01)

Participants shared many reasons which they considered explained their increased alcohol consumption after graduating from university. When they were medical students, participants consumed alcohol for fun and as a way to talk openly with friends. As early career doctors, they used alcohol to reduce job stress and create or improve working relationships for a successful career. Participants believed that, if they did not consume alcohol with their colleagues, their working relationships would be limited. A doctor shared:

“When we were medical students, we felt comfortable when drinking alcohol with friends. We consumed alcohol just for fun and we could consume it until we were drunk. Now, we are doctors and we use alcohol for some other reasons. We drink to improve old friendships because after graduating from the medical university, we started to worry about earning money and didn’t have much time to consume alcohol freely with friends as in the period of medical study. Additionally, we drink to communicate and create new relationships with others.” (M-07)

Excessive workload was the main reason for increasing alcohol consumption among doctors who were working in hospitals. However, creating and enhancing professional collaborations was a reason for increased alcohol use among some doctors, such as preventive medicine doctors working in the community. These reasons explained the difference in drinking behaviour between these types of doctors. Participants believed doctors in health prevention areas, especially government departments, were more likely to consume alcohol excessively. A doctor compared alcohol consumption between doctors who worked in hospitals with those who worked in the community and stated the following:

“Doctors working in the hospital rarely consume alcohol. They are too busy and don’t have time and opportunities to drink alcohol. Also, alcohol may influence their medical practice and communication with patients. Preventive medicine doctors and epidemiologists, however, often drink a lot of alcohol. They often go to the field where they meet and work with other staff and the community and have to drink to communicate and create relationships which are helpful for their work.” (F-06)

Among doctors working in hospitals, surgeons were perceived as drinking more alcohol than other doctors because “they always work in high pressure environments with high amounts of concentration for a long time. I think their work is more stressful than others. Alcohol use may help them to reduce stress. So, they may often drink more alcohol and more frequently than other doctors.” (M-13)

There was a noticeable change in alcohol consumption among female Vietnamese early career doctors. Female doctors in this study stated they rarely consumed alcohol when they were medical students. Once working as doctors, however, they started consuming alcohol and often accepted unwanted drinks from their colleagues as a way to show respect. A female doctor said:

“I often receive unwanted drinks in drinking occasions with colleagues, especially those in the community, and I often have to accept these drinks. I think I have drunk more alcohol since I started working.” (F-06)

Overall, the reasons for Vietnamese early career doctors’ drinking behaviour changed after graduating from medical universities. When they were medical students, they drank for social enjoyment. After graduation, doctors working in the hospitals, especially surgeons, drank to relieve job stress, while preventive medicine doctors drank to create and improve working relationships.

3.3 From classmates to colleagues: “When we were students, we drank alcohol to socialize with friends, but now we often drink due to peer pressure.”

As medical students, participants typically drank alcohol to socialize and have fun with friends at parties, celebrations, and social events. At this time, participants shared a dormitory and lived with other students, and it was easy to meet each other and have a drink together. A doctor shared information about his drinking behaviour with his classmates when he was a medical student:

“When we were students we had many reasons to drink together and it was very fun. We lived in a dormitory together. We drank alcohol together when we were happy, like for someone’s birthday or if one of us had received a scholarship or subsidy from our family and even when we were sad like breaking up with someone. We drank a lot of alcohol without thinking.” (M-07)

Once working as doctors, participants commonly drank because of peer pressure from colleagues rather than socially and for fun. Participants identified peer pressure as one of the main reasons for increasing alcohol consumption among Vietnamese early career doctors. Peer pressure occurred more frequently and forcefully in drinking occasions after becoming doctors. Participants experienced peer pressure on most drinking occasions and in circumstances related to their work, including parties with colleagues and gatherings with staff from different levels and clinical areas. Most participants were aware of the pressure to drink. In most circumstances, participants acknowledged they accepted unwanted drinks because they wanted to create or improve relationships and show respect to other colleagues who invited them to drink.

“Preventive medicine doctors like me often go to the field and work with staff at different levels and areas and I often have to drink alcohol at parties after or before work. I could not avoid drinking alcohol in most drinking situations. If I refused to drink alcohol it would be difficult for me to work with them. As a new doctor, I need to create good relationships with other staff so I often accepted unwanted drinks .” (M-01)

Peer pressure was a specific reason for increasing alcohol consumption among female doctors. Female doctors indicated they found it easy to refuse drinking invitations when they were medical students. This was because most invitations were from classmates and they could refuse the invitation without affecting their friendship. However, when they started working as medical practitioners, they received drinking invitations from colleagues and managers and accepted these invitations as a mark of respect. Some female doctors felt they received less pressure than males in drinking occasions. However, in some circumstances, especially when working with colleagues from different workplaces, female doctors believed it would be difficult for them to work with these staff members in the future if they refused drinking invitations.

“When I was a medical student, I did not consume alcohol. Sometimes, my friends asked me to drink with them at some parties but I directly refused. Now, my work requires me to meet and collaborate with many people. When at parties with them I often have to consume alcohol out of politeness to show my respect to my collaborators. Certainly, as a woman, I do not receive a lot of pressure to drink like men but I still have to consume alcohol although just a little bit.” (F-08)

In summary, when Vietnamese early career doctors were medical students, they perceived binge drinking was for fun. After graduation, they perceived peer pressure was the main reason for their increase in alcohol consumption. This increase in alcohol consumption was evident among male and female doctors, although it was more pronounced for males.

3.4 From carefree to concerned: “We could drink freely and be drunk when we were medical students but now we have to avoid intoxication as we think about our work and patients.”

While Vietnamese early career doctors might binge drink alcohol, they typically reported being motivated to avoid intoxication. This was because losing control might influence their image as a doctor and hurt relationships with their colleagues. Lower levels of intoxication may also reflect increased tolerance to alcohol. Conversely, when participants were students, they could drink until intoxicated without worrying about study or work.

“Drinking alcohol among medical students was very comfortable. We could drink a lot of alcohol and it would be fine if we were drunk because we were students, we were friends and we consumed alcohol just for fun or sometimes to make friends. Now, we also consume a lot of alcohol when drinking with our colleagues but we cannot get drunk. It is not good if I am drunk and say something stupid to others. No one will ignore my mistake because I am a doctor ... One of my friends lost his job because he could not control his words during a drinking occasion with his colleagues.” (M-07)

After graduation, participants became more worried about their responsibilities for disease prevention and treatment, and reduced their number of drinking occasions. However, they did not necessarily reduce the amount of alcohol they consumed in a drinking session. A doctor shared his change in drinking behaviour after graduating to become a doctor:

“In the past, I frequently drank a lot of alcohol. Now, I can drink more alcohol but the frequency of drinking occasions has reduced because my work requires me to meet many patients per day and I don’t have much time to go for a drink. Now, I only drink alcohol at some special events. I don’t want my alcohol consumption influencing my work.” (M-14)

Doctors working in hospitals avoid drinking occasions because they frequently consulted and treated patients. However, because of stress and work overload, they often drank alcohol after work, typically drinking more alcohol overall than when they were medical students.

“I know some doctors who are working in hospitals. They even drink more alcohol than I. They said that their work is really stressful, so after finishing their shift they go to have a drink and often consume a lot of alcohol as a way to reduce stress.” (M-07)

A minority of participants reported they drank less alcohol compared to when they were at university because of the demands of their work and the change in their situation, such as getting married and having children. When working as doctors, participants had to frequently communicate with their patients. Consequently, they might limit their drinking sessions to avoid drunkenness and the impact this could have on their work – such as concerns of misdiagnosing health conditions, shift absence, and an inability to focus. Additionally, after participants had their own family, they often spent more time taking care of their family and reduced their drinking with friends. A doctor stated:

“In the past, I could drink a lot of alcohol and participate in drinking sessions quite frequently. Now, I could drink more alcohol but I rarely go drinking. My alcohol consumption has increased but the frequency of drinking sessions has reduced. I have to communicate with patients every day so I have to limit my drinking. In some special circumstances I still drink a lot of alcohol but generally, my alcohol use has reduced.” (M-14)

In summary, Vietnamese early career doctors’ experience of alcohol consumption and risky drinking behaviour changed from when they were medical students. Alcohol consumption among Vietnamese early career doctors was a complex interplay of peer pressure, stress avoidance, and not wanting to be intoxicated. However, in most cases, Vietnamese early career doctors reported their alcohol consumption increased after graduation. In some instances, it decreased because of work or family commitments.

4 Discussion

This study explored how the drinking behaviour of Vietnamese early career doctors in Hanoi changed during their transition from medical students to medical practitioners. The findings revealed Vietnamese early career doctors experienced risky drinking behaviour when they were medical students, consistent with a recent study which found Vietnamese medical students experienced or witnessed regular binge drinking sessions when they were at university [20]. Other studies found 18.4% of Vietnamese medical students in Hai Phong province experienced alcohol misuse and 12.8% of medical students in Hanoi and Thai Nguyen provinces reported alcohol problems [18, 19]. Despite their experience and knowledge that alcohol use is popular among Vietnamese people, Vietnamese early career doctors, as medical students, perceived doctors did not drink substantial amounts of alcohol because they were responsible for health promotion and preventative health strategies. However, this perception changed when they became medical practitioners because they experienced and witnessed drinking among doctors. Participants in this study realized doctors’ use of alcohol reflects the general population’s high levels of alcohol consumption. Harmful alcohol use among doctors had been found in many international studies [8 , 26] but prevalence data among Vietnamese doctors were not well established. Future research should adopt a quantitative approach to examine drinking patterns among Vietnamese doctors.

The findings of this study suggested binge drinking occurred frequently among Vietnamese male early career doctors. This drinking pattern was different for female Vietnamese early career doctors; however, female participants also indicated they consumed more alcohol after they started working as medical practitioners. Binge drinking was common among male physicians in many countries [27 –29]. International studies supported the female doctors consumed less alcohol, less frequently than male doctors [8, 29], but a significant proportion of female doctors (15%) engaged in high levels of hazardous drinking [27]. A study among undergraduate and postgraduate medical students in Italy found the proportion of participants engaging in hazardous alcohol consumption was higher among female resident physicians than female medical students [30]. Further research should be conducted to clarify the difference in drinking behaviour between male and female doctors in Vietnam.

This study showed alcohol abuse/misuse was perceived to be a problem among older, specialist doctors. These findings are consistent with results from international studies, which find hazardous alcohol use was predominately an issue for male doctors, especially those aged over 40 years [8, 27]. In particular, Vietnamese early career doctors believed surgeons and preventive medicine doctors drank more alcohol than doctors in other specialities. Previous studies in Western countries showed significant differences between medical specialities; doctors in surgical departments and health care centres consumed more alcohol, more frequently than other medical specialities [31]. More research needs to be undertaken to better understand drinking patterns among different specialities of doctors in Vietnam to inform interventions to address harmful drinking behaviour.

Vietnamese early career doctors changed their drinking behaviour after they graduated from medical university. This study found some Vietnamese early career doctors drank more alcohol after beginning their careers, with others drinking less alcohol because of work or family commitments. There are no studies investigating changes in alcohol consumption over time among doctors in Vietnam. Internationally, a longitudinal study among Norwegian medical students found the prevalence of hazardous drinking significantly declined from the final year of medical training to 4-year follow up, but not from the 4- to 10-year follow up [32]. Additionally, male gender and hazardous drinking in the final year of medical training were found to be predictors of hazardous drinking at 4-year and 10-year follow up.

Vietnamese early career doctors’ reasons for increased alcohol consumption changed after graduation. When Vietnamese early career doctors were medical students, they drank alcohol for social reasons. After beginning their career, Vietnamese early career doctors increased their alcohol consumption for work-related reasons. Peer pressure from colleagues was reported as the main reason for increased alcohol consumption among Vietnamese early career doctors, especially among female doctors. Previous studies found peer pressure was a significant factor in drinking among Vietnamese medical students [20, 33] and in the general population [34, 35]. Job stress and enhancing professional collaborations were other reasons for changes in alcohol consumption among Vietnamese early career doctors. Vietnamese doctors in this study reported they drank alcohol to reduce stress after work. This result was consistent with findings from previous studies in which adverse working conditions and work overload were the main causes of high levels of hazardous alcohol consumption by doctors in Western countries [14, 36] and reflected expectations alcohol would reduce tension [37]. A recent study among doctors in the United Kingdom found occupational distress and job factors increased the odds of doctors using substances including alcohol [7]. Another reason for alcohol consumption among Vietnamese doctors was to improve professional relationships or to be accepted by groups of people, such as preventive medicine doctors. In Vietnam, alcohol use was considered to facilitate business dealings and everyday socializing. Drinking behaviour was reinforced by engaging in group activities because collective social functions were encouraged and expected [35, 38]. Peer pressure, job stress, and work-related factors should be explored in future research and interventions relating to alcohol consumption among Vietnamese doctors.

Overall, this study indicated that the role alcohol played in the professional lives of doctors in Hanoi, Vietnam, was not anticipated by medical students. The symbolic nature of drinking to build professional networks and relieve stress was reinforced upon graduation and driven by the social norms of the medical community. However, the added responsibility of medical practice was also recognized in terms of potential alcohol-related impairment; the meeting of professional standards represented a restraining influence for many young doctors. This study revealed conflict between having to balance the use of alcohol for professional network building and not drinking alcohol so excessively that drinking related problems occurred.

When interpreting the findings of this present study, it should be noted that participants were recruited from one province only, so they may not represent doctors in other provinces where different regional cultures exist. However, this limitation was minimized because the participants originally came from different provinces across the country. Selection bias, a quantitative concept, may have occurred due to the purposive sampling. However, this sampling strategy, whereby participants are purposively and carefully selected for their nuanced, contextualized, lived, real-world, and near experience of phenomena under investigation, is methodologically sound in qualitative enquiry. The quantitative data were analysed from a small sample size of doctors and, thus, could not be used to comprehensively assess alcohol consumption. Future mixed methods research conducted with a larger sample would help to identify more detailed drinking patterns.

5 Conclusion

This study explores the difference in perceptions and behaviour of Vietnamese early career doctors in Hanoi about alcohol consumption among doctors before and after graduating from medical universities. As students, Vietnamese early career doctors thought alcohol consumption was common among doctors but did not believe doctors would drink alcohol at hazardous levels. However, once working, Vietnamese early career doctors experienced changes in the frequency and amount of alcohol consumed and the reasons for drinking alcohol compared to when they were students. Binge drinking was viewed as occurring frequently among young male doctors. Surgeons and preventive medicine doctors were believed to drink more alcohol than other doctors. Alcohol consumption among female early career doctors was perceived as increasing, especially in circumstances relating to work collaboration. Peer pressure, job stress, work collaboration, and the working environment are reasons for increasing alcohol consumption among doctors. Future research should adopt a quantitative approach with a large sample size to clarify drinking patterns, especially differences between male and female doctors, and examine how widespread the factors underlying drinking behaviours are for this population, including specialities. In the context of Vietnam, gender, mental health (stress), the working environment, and the role of professional relationships should be considered in strategies addressing risky drinking behaviours among early career doctors.

Ethical Approval

This study received ethical approval from Queensland University of Technology (1700000810) and Hanoi Medical University (IRB00003121).

Informed consent

All participants signed an informed consent form before the study was conducted.

Conflict of interest

None of the authors report any conflicts of interest relevant to this manuscript.

Footnotes

Acknowledgments

The authors thank all participants for their valuable time and opinions.

Funding

No funding was received for this study.

The Appendix part are available in the electronic version of this article: .

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