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?

These are my ideas to improve retention-

Have a working IT system that lets me quickly do what I need to do without the computer repeatedly crashing or spending 5 minutes staring at the spinning blue circle.

Make mandatory training easy to access- run it for the convenience of the staff, not the trainers.

Have reception staff for the wards so I'm not "first on" for answering the phone.

Have more phlebotomy staff so that we don't start the day spending half an hour taking blood.

Have enough chairs that everyone in the office can sit down at once, and a system that doesn't make us feel like we're being entitled for asking for this.

Some kind of clerical help so that I'm not one managing appointments to see relatives.

I'd like to spend more time seeing patients and less time dealing with keeping the creaking support system going.

There is a lack of suitable placements and mentors.

The biggest problem is retention. Junior medics are often treated very badly, in my experience.

@HistoricMoment - So, if you tie doctors into working for a certain amount of time in the NHS - or, paying back a percentage of their tuition costs if not - that isn’t really “forced labour” is it?

I’ve been offered expensive training paid for by employers in the past, where part of the contract was that if I left within a year then I had to pay the cost of the qualification back, with a sliding scale reduction after that.. that is because companies don’t want pay out huge amounts tor qualifications for staff who then leave. That seems fair enough really and it isn’t forced labour it’s a contractual agreement.

There are also too few graduate entry places. I might be talking out of my arse here but standard entry (5 year course, mostly 18/19yos with no prior degree) is about 8 applicants per place, whereas graduate entry (accelerated 4-year course, mid-20s and older with a previous degree) is about 100 applicants per place.
I really, really wanted to do medicine. But having just finished my first degree as a mature student I can't spend years of my life trying to get into another, 4-year, degree, in order to graduate into dreadful working conditions on shit pay, or possibly even no job at all.
Another issue with medicine is that no matter how much of a hard worker you are, you can't really work alongside a medical degree. It's not advisable. But the loans and bursaries are not enough. So medicine is very difficult to access for those without financial support from parents/spouses.

I'm shocked by the level of obstacles needed to fix this. It just seems insurmountable for any government.

I think I agree with looking at who is picked for med school in the first place - at Ds school it seems to be something that people aspire to rather than a vocational choice. I also think they're too young to cope with the pressures (and obviously from this thread, not very well supported for all sorts of reasons). Hence the high drop out rates and poor retention.

Perhaps training should start later, at 21 say, and trainees should be required to have had some kind of health care role beforehand so they know what they're letting themselves in for. I also think there should be some stipulation or incentives for newly trained workers to commit to a few years in nhs practice.

It's not just as as simple as train more doctors

To train more doctors you need facilities, you need experienced doctors to train them. You need FY1 places. You need to make sure that the people you are training a)want to go in the right specialities where there are gaps and b) live in the right areas

You need the facilities for those doctors to practice, the rooms to see patients, the theatres to operate (alongside the additional theatre staff to run the theatres), the extra beds for your post operative patients and extra nursing staff this comes with. The extra admin staff to facilitate extra doctors. Extra office space for the extra doctors to carry out their admi

You need to improve working conditions for doctors, which admittedly would improve if there were more doctors, pay to improve to retain doctors. Better computer systems so that more time can be spent on clinical work

You then need more CT scanners, MRI machines, pathology facilities and staff to run these. All of these also result in delays to patient care.

The training is long. It's not as simple as pass a medicine degree get more doctors. The NHS is well over capacity in all areas

The grad PA route because although a PA isn't a doctor there are similarities will help a bit but it also causes many of its own issues..

I also think in my experience being a junior doctor isn't always very rewarding. I've seen very poor treatment towards me and colleagues from nursing staff, ED staff, other specialities, seniors within my own speciality and management. Some hospitals are really toxic places for junior staff and its no wonder that many say fuck this. You can often get poor treatment from all angles.

Doctors don't want to be GPs. Even if we trained more, they would leave.

We need to change the whole system and get rid of GPs altogether.

We need to look at what works in other countries as our system does not work anymore.

OP, delaying starting training until 21 would hugely disadvantage female medical students, who would then be 3 years older before qualifying, ie at 26, then facing their FY years and a further seven years of specialist training - they would be heading for their late 30’s before having a fixed home or being able to even contemplate children.
When I was a medical student, in the 1970s in Dundee, they took applicants at 16, straight from school, who qualified as doctors at 21. I was a little surprised to be dissecting human cadavers as a teenager, but we all got on with it, and only 3% of my year failed to complete the course and qualify. Being young and resilient was a big help in coping with the 100 hour weeks on duty.

Health education England have increased the number of medical school places so they are trying.

Im sure I read somewhere that last year not all graduates got a job, there were too many qualifying 🤷🏻‍♀️ Seems a bit bonkers if true.

@PenguinWings a really interesting view from the inside…

IT and organisation problems seem to crop up again and again don’t they? The NHS needs ‘Undercover Boss’ - so when the junior doc gets treated like shit, for ex, someone at the top finally ‘gets’ it…

to target medical and dental school places they upped requirements to all A's at A level and stopped interviewing in 1980's you need 3 B's to do medicine and BCC to do dentistry, just getting 4 A's does not make you temperantly suited to being a doctor, there are loads of good doctors in their 50's that never got A grades maybe grade inflation means and 1980's B is a current A I don't know,
lack of training is one thing mountains of paperwork is another
I worked in NHS dentistry for year mostly in rural scotland then 4 years in a deprived area near Glasgow before I left dentistry for good
reasons earning deflation earning the same in 2014 as I was in 1998 costs increased expontentially fees did not ,
pressure and stress, form filling undervalued I left before Covid but dentists are leaving NHS in droves, it is not just money but work life balance time with patients etc aggressive patients it is not my fault you have holes in your teeth when you drink 2 litres of irn bru a day, any more than it's GP's fault your blood sugar is through the roof for the same reason, then they complain to the health board you were rude because you advised cutting down on sugary drinks it is no longer worth the aggro, left before I was shattered by burnout and stress have told my DD 13 not to consider health care as a profession or teaching for similar reasons

It’s pointless training more doctors when the job is so unrewarding that nobody wants to do it.

When I qualified 16 years ago three quarters of my class wanted to go into GP. It was seen as rewarding but also family friendly. These days none of our juniors want to be GPs: the workload is overwhelming, the abuse from patients and social/mainstream media is constant and the pay isn’t that great, considering how stressful it is.

I wouldn’t do it in a million years.

The BMA voted against increasing the number of medical school placements. They want the supply restricted. Ok when you can import docs but not now.

One of my best friends is a GP and I've known her since school.

Issues are, it's hugely expensive to train doctors, the training is very hard work (my friend was always very bright and academic, she has about 6 As at A level, and even she found it very difficult). Places in med school are hugely competitive because of staffing issues, universities often struggle to retain good staff.

After graduating, there are better paid careers for those qualifying in medicine than becoming a doctor. After finishing med school lots of people choose to pick a specialism in a hospital rather than go into GP training. Trained doctors might find that living in certain areas too expensive so because of demand they can choose to go live in cheaper areas.

Then there's all the issues that come with being a GP itself

All doctors need clinical supervision, so this is another barrier.

However we do need to increase the pipeline being trained as Drs are retiring at a faster rate than entering the workforce. We are now recruiting more Drs from abroad than inside the U.K.

All trusts have vacancies- but they might not be the jobs individuals want to do. So there will be a mismatch there. The areas which require large numbers of Drs (GPs, A&E, elderly medicine) not necessarily the areas people find attractive to work in.

We need more (some!) and better forward planning. Although I think the NHS is in danger of being too big to fix. We throw more and more money at it, yet the impact seems to be minute. Paying staff more, while seemingly a good idea, isn't the answer either. The problem is that a vast amount of money is going towards supporting an increasingly complex and byzantine system that no one completely understands. This is pretty typical of any very large organisation.

Maybe we need to break it up into smaller independent units, where the emphasis is on people facing care?

So GP's specifically and locally. My practice used to have 5 full time GP's. They now have many (I loose count) part time GP's. Great, work/life balance, most of the part timers are women. However, many of those women also have private clinics going. Fantastic if you can afford it. I have switched from seeing my one day a week menopause NHS GP, to her private practice. Same lady, same knowledge and prescriptions, just more available. I don't blame her, but it does highlight issues at practices. NHS consultants, same. All the local ones fulfill their NHS roles, and then have private practices as well.

It's a question of retaining the doctors the NHS already has.

The job is incredibly stressful, with long hours, sometimes little sleep and being on call during the night.

If these issues were fixed then maybe fewer doctors would leave and more young people would be keen to train.

Without those opportunities though many would go abroad to practice. No countries are utopias for doctors, but many pay much much better and with better working conditions. Of course many don't go in just for the money, but it is a job on the other hand like any other and so of course money plays a part. If the NHS sorted out its issues I'm sure many more would be inclined to not subsidise their NHS careers with private work. You'd also lose some if there weren't part time opportunities. The issue is its just not an appealing route for many, can't blame them. The public are getting more and more entitled as well which isn't pleasant to have to deal with.I

Why would you choose medicine with its long hours and poor pay when you can choose dentistry and earn more working 9-5?

Theres better careers out there than medicine.

This.

During an operation, you could have 2 medical students in there, along with 2 student ODPs, and possibly a student nurse too. If X-rays are needed, then a student radiographer could also be tagging along too.
All need supervising and mentoring.

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.

I hear this figure a lot, but have no idea where it comes from. I am a doctor and I teach at the medical school. I lead one weeks teaching a year and help out for the odd lecture on other peoples weeks, as they help out on mine. For this, I get £10k a year. There are around 80 students on my course. £250k to train a doctor would be £50k a year, so £4 million per year for the 80 on my course. The teaching at £10k a week would be roughly £400k a year. The students are paying £720k per year in tuition fees between them. Obviously there are staff expenses other than teaching, as well as exam entry/costs, and other costs, but I doubt these amount to £4.3 million pounds a year. The clinical placements are all provided by hospital consultants, and we don't get paid any money for providing these. We also don't miss any clinical time as the students basically tag along to whatever we're doing and learn as they go.

I genuinely cannot see how training 80 students costs £4.72 million pounds a year?! If anyone knows I'd be very interested