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?

Yes because they aren't being forced to work in the NHS for 5 years.... introduce your idea and see what happens?

I don't want to be treated by a doctor who is there under duress, thanks. They will be shit at their jobs.

Why not improve things so they want to stay instead of setting up a bonded labour system?

Stop treating doctors like shit, that would be a start. I remember Jeremy Hunt actually saying ‘Doctors want war!’ Re: the junior doctor strike. Yes, according to the government and media, that’s what we wanted… WAR. 🤦🏽‍♀️

I am a female nurse in my 30s with two toddlers and I work full time, many other women do also, so not sure what the point of your input is.

I know many doctors in their mid 20s who are currently working as locum whilst trying to get accepted to GP training so I'm not sure where your statement comes from?

GP training is still attractive, more reasonable hours at a consultant grade. Unfortunately the training places are very limited and this has led to a massive shortage of Gp's

The treatment at work is a huge issue.

My brother is a registrar who was working over Christmas. He applied for a temporary staff parking permit because the buses wouldn't be running and was told that applications for permits were reviewed in strict order of receipt and his would be looked at in turn, but not to expect a response until February. The trust said they would pay for taxis on Christmas eve but the taxis had to be booked 24 hours in advance... his taxi had left by the time he was able to leave his shift 3 hours late because there was a medical emergency.

He was the last doctor to see a patient who discharged himself and killed himself (36 hours after DB had seen him). He had to give evidence at the inquest and was put through a disciplinary procedure. he was cleared but it was 18 months of waiting, during covid, with no support, no recognition that this was stressful, and very much the hospital looking for people to blame.

A system like the air travel system where all near misses are reported without blame would go a very long way to make the job better. As it is, the pay is not enough for the level of responsibility, the doctor's career is on the line every day, and any bits of bureaucracy which can make life more difficult for the staff seems to be put in place.

But surely the BMA is a trade union. They might have an opinion, but they can't make these decisions.

But their members, i.e. the doctors themselves, can decide not to offer themselves up for training, offering training places, working in the medical schools, mentoring etc., i.e. a kind of "work to rule" or "strike" to support their trade union should the government of the day go ahead and increase medical schools/places against the BMA's wishes!

But their members, i.e. the doctors themselves, can decide not to offer themselves up for training, offering training places, working in the medical schools, mentoring etc., i.e. a kind of "work to rule" or "strike" to support their trade union should the government of the day go ahead and increase medical schools/places against the BMA's wishes!

Is there any evidence whatsoever, they actually did this?

My understanding is that as there wasn't enough funding in primary care to pay for extra GPs, so the BMA said what it said on places.... it was also 14 years ago.

700 EU GPs have left the NHS, many of these were working in the areas, traditionally hard to recruit into.

I work in professional services. We hire a lot of associates who finished medical school and maybe worked 1-2 years and then came to us. I was actually surprised and asked why so many were transferring, because I think of my industry as less prestigious/top-tier etc than medicine, and these kids are all obviously brilliant...

Every single one said it was the pay. We pay ~£50k to new grads which rises to ~£100-120k after 3 years or so. Shit but predictable hours and no weekend work. Who wouldn't?? These kids can sleepwalk through our interviews, it's a no-brainer!

Its not just doctors

The whole if the nhs is in crisis.

And yet going by a recent thread on nurses lots of people seem to think its an over paid easy job.

Weird how we cant recruit or retain staff then isn't it?

But they didn't.

Any restriction on numbers cannot be put at the door of the BMA.

The BMA can't restrict the offer of training places either, the Deaneries (or whatever they might be called now) do that. Nothing to do with the BMA.

@missingmiddle what industry do you work in? Asking for a friend.... 😁

Is that the cap that the BMA themselves voted for?

Is that the cap that the BMA themselves voted for?

No.

Govt imposed the cap not the BMA, they don't run the NHS, could have been lifted and funded at any time over the last few years.
www.gponline.com/9000-medical-school-places-available-2021-cap-lifted/article/1724173#:~:text=A%20record%209%2C000%20English%20medical,Department%20for%20Education%20has%20announced.

I've been a hospital consultant for nearly 15 years. UK medical school, all UK training. I wouldn't want my kids to go into medicine.

The problems as I see it are:

It's a long university course with no special financial support. Yet, it's an intense university course with no real down time and it's difficult to have a part-time job on the side. Graduates are often burnt out before they've even begun. Supporting struggling doctors in Year 1 is common...

It's a highly competitive course that takes the top 5% of academic achievers from school but the salary doesn't compete with other professions taken up by that group. This has been the case for a long time, but there used to be more in the way of non-monetary rewards. Now we have a devalued job that feels less of a profession, and the hourly rate looks bad...

After 5/6 years of medical school, Doctors in training still have a ~10-15 year route to becoming a consultant, longer if they take any maternity leave or work part-time. Those years are really tough, and work out at ridiculously low hourly rates of pay. The system for training doctors, residency, was designed by someone who barely slept and abused cocaine. Google Halsted Cocaine Residency, if you are interested. Yet this remains usual practice in western medicine. A lot is dictated to these "juniors" for those years (actually adults usually 25-35 years old); where they work, where they live, they get rotas with leave that is fixed and dictated, they will be under constant pressure to cover ever present rota gaps, and be expected to undertake the post graduate study required for their chosen specialty while working a variety of antisocial shift patterns. Throughout my time training, seeing people in tears over rota issues was common, people who just wanted to attend a grandparents funeral, their own wedding, see a loved one who was dying, have a honeymoon, take paternity leave when their wife when into labour etc...throughout the NHS there is a computer says no attitude to these normal life events accompanied by the outdated and erroneous idea that the rewards of being a doctor outweigh these losses. Retention, as you can imagine, is poor. Better conditions are to be found elsewhere, people burn out and take time out, many will be put off becoming consultants after this experience, many go part-time even before kids and family life might call for this.

The NHS is a really challenging work environment -most consultants are working at their absolute capacity and more. Training junior staff is ill thought out and relies on the goodwill of each consultant to do "extra". Personally I find that very hard to do -like anyone else I have kids to be home for or to collect by a certain time. There is always a conflict between finishing the pressing work of the day, ignoring the trainee in the room, getting out somewhere close to finishing time and actually doing some training/teaching. I'm sure most people can guess what happens to training in that environment. Trainees will vote with their feet and disappear to NZ/Aus. As an individual I can't change that. I would need another 0.5 of me for the same workload to actually have any meaningful time to train someone. Imagine that number for every consultant working in the NHS right now.

Complaints are really tough. Looking at complaints when they come in, its really rare that a complaint is really about the doctor as an individual. They are almost always about the system. You think the doctor had a bad attitude? Every time I've been tasked with investigating this, I've found a doctor who was over-worked or under-trained/under supported in some way. They got something wrong? Same. You had to wait too long? The whole system, not the doctor. The doctor cancelled your appointment? Lack of flexibility/cover in the system. Apart from rare cases, like Shipman, it's always the system. But when you make a complaint, the individual is made to sweat, not the system. The GMC focuses too much on individuals rather than the corporate and governmental failings...and the real underlying problems are not addressed; the system just loses another doctor.

Overall, I think there is a huge amount of work to be done on retention before simply thinking about expanding the workforce. Or at least alongside.

In lreland we train lots of doctors. Very high points to get in so very bright students. There are no fees for college here so all free. Then they head off to Australia. Recently my ds's friend went and 80 doctors were on the same flight out. Its heartbreaking to see them go as we are relying on other countries and we are not even sure what their training is like. Some come back but most don't. I find it very worrying going forward

I wonder whether this will make it to the Daily Mail with all the considered responses. Or whether they will just pick up on wedding and MIL problems again.

My daughter has a conditional offer for medicine. I'm shitting twinkies reading this.

So what was the point in the BMA balloting their members if they (and their members) have no control in the number of training places/medical schools???

I have definitely seen doctor colleagues be refused leave for their own wedding. Normally for something so important another doctor will cover for them, for the actual wedding, not for a honeymoon!

and forget being able to go to relatives weddings, funerals, festivals, etc unless you happen to be off on that date.

Can't remember if I've said this in this thread but I was refused leave for my own wedding.

Each medical school has a limited capacity for places and can't expand easily

Mmmm... I'm not sure that's true. The impression I get (Med School where I work), we could physically find a way to double the current intake. If we were paid to do it. Lecturers need to be paid. There's equipment costs, too. Pay us & we could figure out a way to squeeze 'em in.

selecting Med students differently these days. ... 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

I don't, or didn't, anyway. I'm not aware of any point in our recruitment process where those exC things would carry much weight. The karate is good for conflict resolution skills & the bar work is obvious customer service, fair enough if those things came up in interview. I wouldn't know what relevance is musical talent. Maybe there are clinics with piano playing to soothe patients so those hospital trusts recruit accordingly.