To ask why we can't train more doctors?

[Turmerictolly]

The NHS is desperately short of GP's and other doctors and the system is at breaking point. I look on the regular threads on here about not being able to physically see a GP any longer and my own experience of having cancelled hospital appts which are leading to worsening health. I then look at the Medicine threads where there seem to be so many bright and promising young people willing to train but not enough spaces on the courses.

It seems like some sort of dystopian catch 22. How on earth is this going to be fixed?

You need the staff to train them. Also you need it to be a bit competitive as not everyone who wants to be a doctor is cut out for it.

You need the lecturers, doctors, space in the hospitals for placements etc. You can't suddenly have thousands of extra students with no one to teach them, assess them, monitor them etc.

I know someone who is a doctor and lectures at a med school once/twice a week
essentially the issue they have is the pay for the talent/academic success that medical students offer doesn’t match up. LOADS end up getting poached by banks/pharmaceutical companies who offer better pay, better conditions…
Im in my early 30s and everyone I went to school with who went to med school (ten or so?) one is practicing in the U.K., several abroad, and the leftovers now all work in tax?!

You can throw money and resources at training all types of medical staff ( though obviously looking at 10 plus years lag on doctors being qualified) but the NHS has a massive, massive retention issue and has done since I started in the 80s and probably before that too.

Much more complicated than training new staff when senior and experienced staff are needed.

Find out what puts people off training and fix those issues. A solution that isn't popular is to fund migrants/refugees coming from other countries to convert their qualifications. I read that there's a good number of doctors from Syria who need around £20k each to convert, but being refugees it's an impossible amount for them to find. There will be similar from other countries. I can remember a woman who worked as a volunteer with the homeless and she had two foreign doctors attending the food kitchen.

The biggest issue is retention, not training enough.

A friend who's a doctor is part of a group looking at this. The issues are cost (he reckons it costs about £250,000 to train a doctor in the UK, mostly funded by the government) and a lack of training places - you need people, hospitals etc. to train that many doctors.

He doesn't have a solution.

I agree that we've also got to make the NHS a decent place to work. Doctors should be able to speak out when our government fucks them over and squanders the budget.

For decades we have got away with importing highly trained doctors from overseas. now with complex immigration rules and the crappy economy, they don't want to come.

Training doctors here is very labour intensive teaching & needs a LOT Of resources. Each medical school has a limited capacity for places and can't expand easily - lack of physical space and staff. It would be great to create new bigger medical schools but that requires a long-term (10 year +) investment and this government doesn't think beyond the next week's headlines.

That’s only part of the problem. NHS Drs are leaving the UK to work elsewhere as the work conditions are so bad here. Pay is also much better (like 2 or 3 times more!) in some places like Canada, and Drs are actually respected and listened to there.
We work in awful conditions, constantly attacked by the media and some of the public and are told we are lazy, hiding away etc.
Other more senior Drs are retiring early due to stress or due to punitive taxes related to pensions. Bear in mind we have to pay in a huge amount into pension each month (?14.5% I think depending on salary) so to then face being taxed heavily or having to give up part of our pension to pay this tax is an absolute joke.
The pension issue also disincentivises Drs from working extra as you would end up working for nothing effectively.
Fixing the pension problem would help a bit but the whole narrative of ‘lazy GPs’ has to change or the whole NHS is doomed. It’s possibly doomed anyway. GPs do more than 90% of all NHS contacts for around 8% of the budget, so if GP fails the rest of the NHS will also fail

The exams, training, working hours are all extremely grueling. It's not just the university time it's the residential years on top. Most of my friends work in medicine, from GPs to surgeons through to pathologists, pro rated for hours, the salary just isn't worth it.
I do see the physician's assistant route taking off which offers a middle ground but I don't know how much it is promoted over medicine.

Why would anyone want to work for the NHS given the state it's in?

The whole planning process is a mess and just getting more medical students to graduate won't solve it. This year there were medical graduates with no F1 posts to go into.

Years ago (John Reid was health sec so a very long time ago), a colleague and I went to a meeting with the BMA and the DH. My colleague, who was a consultant with a particular interest in workforce planning in Medicine, spoke about the complete lack of planning for service demand. He suggested a top down process, calculating how many GPs, consultants, service grades etc would be needed, then calculate backwards to work out the number of medical students needed. Obviously things like drop out rates would need to be included.

The so called experts said it was too difficult to do workforce planning in Medicine and actually shrugged their shoulders...

Nothing appears to have happened to solve it since. Planning needs to have started for late 2030s service needs bearing in mind how long it takes to put someone through medical school and onto the relevant register when they complete training.

There's also got to be a cost element for study. I wanted to retrain as a nurse a few years ago, but couldn't afford to.

£10k/year study fees, plus at the time, limited bursaries etc. How was I supposed to pay my rent, bills, run a car to get to placements etc?

I've already done one degree and that took me years to pay back. Doing it again in my 30s was a very intimidating idea.

Add that to the extra years of study for a Dr, and I dread to think the amount of debt people end up in.

Going into medicine is becoming the privilege of the wealthy. Again.

We train plenty of doctors every year. A lot of them decide not to practice medicine. Some go abroad. Some practice medicine for a few years then pack it in. Working for the NHS is not as popular as it used to be.

It's not just that there aren't enough doctors! We need more social care, more physios, OTs, nurses, admin staff, paramedics, pharmacists, support staff, decent clinical accommodation, better IT and data systems.

Find out what puts people off and fix those issues.

Main thing is lack of experienced staff who can train. There’s not the capacity to work/train/oversee with current experienced staff. Trainee’s need oversight and this takes time and when everything is already short staffed it’s not feasible. It’s also not a case where there is no difference in overseeing one or ten. So limited training places match existing experienced staff availability.

Also, the fact is not all medical degrees are equal. Qualifications in some countries are more than adequate and it’s just fine tuning to local systems that is required and easily achieved, but qualifications from some other countries are not worth the paper they are written on and I wouldn’t let them loose on a paper cut-out let alone a patient.

My parents both recently retired early from the NHS.

When they started, they said it was an incredible place to work and they both felt very privileged.

When they retired, they both said that if they were just starting their careers now c they'd never work for the NHS.

It's been ruined and it's such a shame.

There isn’t a drop in people applying for medicine though. Yes, I’m sure there’s an issue with people from poorer backgrounds considering it as a career but a shortage of suitable applicants isn’t the problem.

What really needs to happen is investment in supporting early career doctors so they don’t emigrate or leave while the greater number of trainees works through. Having loads of very junior staff who haven’t really got a clue what they’re doing isn’t very helpful. You need to keep more of the ones with experience.

My son is a doctor. It is a long hard career path with a massive amount of responsibility. It is also a job that very few people are capable of doing. The NHS does and always has relied heavily on overseas doctors and nurses to keep itself going. Similarly most UK trained doctors are in demand in the US, Australia and elsewhere. Even three to four years into training a doctor can move to the US work less hours, enjoy much better conditions and double their pay. Given stress levels and working conditions a large number of more experienced doctors are exiting the profession in their mid to late 50s. Once a doctor reaches the pensions cap, there is limited incentive to remain at work. Little has been done to address this trend to date.

Not enough placements available, not enough mentors and people trained to assess them. It's as simple as supply and demand.

I've wondered about this, as it annoys me when people claim we "have to" import doctors. (It may be a short-term solution, but there should not be a shortage in the first place.) Given how competitive medical school entry is, I doubt there's a shortage of UK people both able and willing to be doctors.

What I've read is that the main bottleneck is hospital training places. Hospitals apparently can't accommodate more on-the-job-training. I don't know if this is absolutely true, or if it is only true because it's assumed various other elements of the status quo can't be changed. (In the same way that people saying we "have to" import doctors are assuming training places and/or retention can't be improved.)

It wasn't so long ago that the BMA voted to restrict places because they didn't want an oversupply of doctors! Since then and only recently, have places increased, but the time it takes to train a doctor means we are still suffering from the limit places on students 10 or so years ago.

We have a cap on the number of students that can study medicine. A number of universities have called for this cap to be lifted. The government have increased the cap but not enough to have a significant impact in coming years. They also need to increase the funding for universities and the nhs to support additional placements.

There's also a limited political will to fix it as it takes 8 years to train a doctor and we have elections every 4 years. Not many politicians, especially the campaigning type we've got at the moment, will take the pain of the significant upfront cost knowing their opposition are likely to get the credit by the time the doctors are actually trained and making an impact.