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?

Interesting, this lag is an issue

I assume it’s been upped but will take time

As a degree it does strike me as competitive

These are great ideas, but the result of implementing is the tabloids stirring up fury about how much the NHS pays on 'administrators' and 'managers' not 'frontline medical staff'. The problem with cutting the administrators is that other people end up having to do the administration.

(If they had a working IT system their administrators could actually do more than just stare at spinning wheel of death as well - much more efficient.)

It is also a job that very few people are capable of doing

I also don't believe this. It's a job that very few people are capable of getting on to the training course for. The majority of the consultants I work with are excellent^^ and have been in the job 30 or 40-odd years. They got a mixture of A-Level results, but most were in the BBC, BCC, CCC range. They freely admit they'd never get in to do medicine these days.

The retention crisis is partly because we're now choosing the wrong people for the course. Academically brilliant, but little in the way of life experience or (often) common sense. They have no 'street smarts' because they're often from very privileged backgrounds, and have been spoon fed at private schools from an early age. Often they come from wealthy backgrounds and this gives them choices. If they qualify and find that they hate it or can't cope with the pressure, their backgrounds mean they can just up sticks and leave, and retrain as something else. I don't blame them. A fair few do this now, Many more so than when I trained.

I came from a working class background. I happen to love my job, but if I'd have hated it, I'd still have stuck it out as I'd got so much debt I'd have had no choice!

We need to be selecting Med students differently these days. We need to forget attracting triple A* students, and focus more on those with the right personal characteristics and a heavy dose of resilience. Having worked in A&E, I would argue that a black belt in Karate and a job working behind a bar in a rough part of town are far more useful attributes than Grade 8 piano, but we still insist on choosing students with the latter 🤦🏻

Doctors have essentially had around a 30% pay cut over the last decade.

Our government also spends some of the smallest percentage on healthcare compared to those in Europe.

Coupled with the constant exams (which you have to pay for), horrific shift work, competition for placements, media smear campaigns, being treated by the NHS as nothing more than a number, dealing with anti-social behaviour from patients and their families... it just isn't as appealing a career as it used to be.

Doctors have been banging on about the decline of the profession for years. The public might only just be waking up a bit to these issues now that trying to see a doctor can be a challenge. But they deserve to be paid better, as do all NHS clinical staff, so no wonder they're leaving in droves.

We have a friend who is on their third training programme now - failed one, changed and then quit the second one. They are now back doing the first (or similar to the first) one. Post foundation years she has also worked abroad to supplement the income for all the funded here training - it seem completely insane given how much money is being wasted.

Doctors always mention the "horrific" shift work - but it isn't the only profession that has shift work - it also isn't the only profession where you pay for your own exams, professional registration, external training, CPD in your own time etc.

Yes - AndSoFinally - your second paragraph sums up the person we know so well.

It wasn't so long ago that the BMA voted to restrict places because they didn't want an oversupply of doctors!

They didn't want a large surplus of medical graduates competing for a restricted number of foundation training posts. This is fair enough. It is unethical to expect students to undertake 5 or 6 years of degree-level education/training and then say some of them aren't allowed to become doctors despite having completed their degrees successfully, meaning they only have the same to show for 5 years of study as others have for 3 years.

There are numerous pinch-points - including lack of capacity for clinical placements - in addition to the lack of political will to fund more undergraduate or postgraduate training posts. To its credit, Health Education England (the part of the NHS that funds training of healthcare professionals) is currently trying to force medical schools and their partner hospital trusts make more efficient use of placements. However, there is always the issue that a doctor who is teaching students will take longer to get through a list of patients than one without students. (Added to which, some patients refuse to have students in the room with them: this is one of the reasons why it has so far proved impossible to place students in private hospitals.)

There are some efforts going on to develop alternative pathways for training doctors. Some of these, such as the part-time programme run by the University of Edinburgh, might provide a quicker route, but this programme is for other healthcare professionals, so this approach just replaces a shortage of doctors with a shortage of nurses and allied health professionals.

It is fairly obvious that just increasing the supply of medical graduates would not achieve much unless the loss of early-career doctors to other countries or other careers can be controlled. This is already urgent, as this morning's news story shows: www.theguardian.com/society/2022/jun/08/nhs-hiring-more-doctors-from-outside-uk-and-eea-than-inside-for-first-time

There are many female GPs now who want to bring up there families and opt for shorter working hours. However it still takes the same amount of time to train them and much of their work time involved keeping up with Continuous Professional Development. The number of hours worked means they often lack experience. Just one of those changes that we haven't managed to accommodate.

Again, lots of professions have women in them who want to work LTFT due to raising children - they have managed to overcome this issue (mostly!)

Having worked in A&E, I would argue that a black belt in Karate and a job working behind a bar in a rough part of town are far more useful attributes than Grade 8 piano, but we still insist on choosing students with the latter 🤦🏻

Who are "we"? I have been a medicine admissions tutor for a very long time and we have always favoured the former over the latter. I am only aware of one UK medical school where grade 8 piano will contribute to your chances of getting a place. (I know that's one too many.)

I am 47 and a very experienced GP ... I am burnt out beyond belief and am not sure how to make it through the next 3 months let alone the next 13 -18 years. Yesterday i got in to work and started my admin at 7.15. I spoke to my first patient at 8.30 , I had so many extra patients added on to my morning surgery that I was still going when my afternoon surgery started and I had to slot them in alternately. I finished speaking with patients about 7.30 pm and started on my admin again. I left work at 9 45 pm having left my desk for 2 wees and to microwave my lunch to eat at my desk. Today I have a day off and I am doing the rest of yesterday's admin. I cant do this anymore..every single one of the patients yesterday deserved more time, thought and head space than I had to give. I'm scared of what might happen and I can no longer just work harder and longer to make it all OK as there is no more to give.... and everyone hates us and thinks we are lazy and work shy.... why the HELL would ANYONE go into the job it is now ?????

The government won't pay for the it system required for the stress levels put on it by the nhs. That's why your system is shit, mediocre supplies. It would cost them millions, if not billions, to upgrade it properly, and take about a decade probably to be done right.

You can heavily subsidise training for those who do work in the NHS for a number of years, though.

I believe that GP training is particularly unpopular though.

And of course being a doctor has to be somewhat family friendly for people to stay (ditto other HCPs). A&E nurse friend retrained as a HV when she had DCs; so she's still a nurse but that's an A&E nurse down. GP mum at school works part time but still needs a babysitter to pick up her DC from after school club because her shift (at the nearest surgery to school) ends after the club finishes. So many therapists that have seen my DS, and adoption social workers, go off on maternity leave, and he needs consistency, I don't think we've ever had any kind of overlap or transition. For school-based therapy (e.g. SALT, OT, assessments) you are almost always looking at private so the HCPs train, work in the NHS for a very short time and then find they are not allowed to do what they think is best for the child so they set up in private practice instead.

That's true. Remember about 7 or8 years ago the fuss about young British doctors not being able to get posts here and then discovered Australia wanted them. They raved about their modern, fully equipped hospitals, their pay, lighter workload...
The NHS has fallen so far, or should I say, been let fall so far.

This.

My job is in GP training. It's not the recruiting into training that's the issue. We recruit to capacity twice a year, but you can't control the outcome of if they pass training/change specialty/get a permanent job outside the NHS at the end etc. There's also lots of other factors that impact the number of trainees we can actually recruit onto the training programmes. The work that goes into it is absolutely mind blowing and the entire team work flat out behind the scenes to get as many as possible through training and into post.

Adam Kay being a case in point!

We have plenty of talent in the UK - we just don’t want to pay for the expensive training. There are new med schools opening but it’s a drop in the ocean. Too used to importing doctors who now don’t want to come. Can’t blame them. Or the doctors leaving the NHS.

The BMA voted to restrict the number of medical students and voted for an outright ban on new medical schools.

www.bmj.com/content/337/bmj.a748

"to avoid “overproduction of doctors with limited career opportunities.”"

That was in 2008. If they'd allowed growth in medical schools and numbers of students, we'd have a much bigger "pool" of qualified doctors etc now, given that it typically takes 10 years or so to train a doctor up to a self-sufficient/unsupervised standard.

But no, the BMA wanted to keep numbers low to keep demand (and pay) high!

GPS are private businesses that provide services to the NHS.To be a go, you train for 7 years at a cost of £25k per year average.
Then you work for a gp practice for a year or two, then you can either buy yourself into a partnership (huge cost) or you can set up with another gp but you have to provide your own premises, muses, pharmacy, etc etc. All very high cost. The hours are very long, the govt wants gps to offer weekend & evening appointments.

It's hugely hard work, long hours, big investment, ungrateful British patients. Or go work in Aus for more money, fewer hours, less stress etc etc.

Nurses, not muses

The tuition fees to train as a doctor are only a fraction of the cost of the training and yet there is no obligation on new doctors to work in the NHS.
Many complete their training and go straight into working for pharmaceutical or med tech firms, or go part time.
There should be a period of 5 years at least in the NHS or pay back the full cost of training.

If you did that, they'd do something else and not even bother to train as Dr's.. so a bit of an own goal.

Even if they did, Pharma would pay the costs back for the brightest.

When are people going to realise that unless the NHS improves pay, conditions benefits etc, it will never train enough staff as so many leave, not least to work abroad.

The government refuses to address the long term issues in the NHS , including providing enough training positions. They would prefer to poach already trained Doctors from overseas www.theguardian.com/society/2022/jun/08/nhs-hiring-more-doctors-from-outside-uk-and-eea-than-inside-for-first-time

Working in the NHS is shit - the pay and conditions are miserable given the hours required (LOTS of unpaid overtime) and huge number of years spent studying (and then coming out with £100k of debt).

I know quite a few ppl who studied medicine here, worked in the NHS for a few years and then left for New Zealand or Canada. Fewer hours, MUCH better pay.

If you did that, they'd do something else and not even bother to train as Dr's.. so a bit of an own goal
There are way more applicants than places.

This Tory government is running the system into the ground in a whole host of ways.

Saw a nurse who got a £100 parking ticket from their hospital because they had stayed late at the end of their shift due to too few staff to care safely. I mean really - how is that sensible?

You have to make being a doctor or nurse a rewarding job. These days it is stress, overwork and political bullying.