Why don't we just train more doctors?

[Blip]

The UK has had a shortage of doctors for decades now and we have relied a lot on using doctors trained overseas.

I understand that it's expensive to train doctors but it's clearly a lot more expensive to not have enough doctors and have to pay locums at locum rates.

It's also a lot more expensive when people are unable to work due to waiting sometimes a year or more for medical treatment that will let them get back to work.

Lots of people make the grades for medical school and there is no shortage of applicants, nor has there ever been.

What has been the blocker to training more doctors, I just don't get it?

Apparently it's lack of hospital places for trainee/junior doctors. They need extensive work experience and to get that they need close supervision over long periods of time. There's a limit to how much mentoring/training existing doctors can do alongside their "day job". Hence there's a limit to how many trainee/junior doctors can be put through the real-life on the job training/experience.

It's basically where the bottle neck is. As you say, there's no shortage of applicants to medical schools/Uni, and there's clearly massive demand for qualified/experienced doctors. It's the bit in the middle, i.e. between education and experience that causes the bottleneck. No point in increasing medical school/uni places and enrolling more students onto the medical courses if there aren't any placements in hospitals for them to move into.

The same reason why they don’t invest in nurse training anymore. They can’t be arsed to fund it and just rely on foreign doctors/nurses.

@Badbadbunny I have heard this argument but how do other countries deal with this I wonder?

@DarkKarmaIlama there is certainly truth that it seems easier and cheaper to recruit doctors from other countries but this no longer seems enough to fill the gap and surely is leaving other countries short of doctors themselves.

The doctors votes for it… this is from 2008!!!!!

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

@Blip

Same for nursing. Not enough to fill the gap now. They’ve relied on that too heavily over the past few years.

*voted

Also - Notoriously difficult to plan medical workforce because of 1.) how long it takes and 2.) changes in medical technology and it’s impact on need. Classic example is the advent of interventional cardiology - putting in stents instead of open heart surgery - to a large extent killed off the need for cardiothoracic surgeons and increased need for cardiologists. AI may have similar impact on diagnostic specialties.

@ChiefPearlClutcher that is mind blowing

Text from the BMJ article
"Delegates at the annual BMA conference voted by a narrow majority to restrict the number of places at medical schools to avoid “overproduction of doctors with limited career opportunities.” They also agreed on a complete ban on opening new medical schools.
David Sochart, from Manchester and Salford, warned that in the current job climate allowing too many new doctors into the market would risk devaluing the profession and make newly qualified doctors prey to “unscrupulous profiteers.” A glut of doctors would undermine competition and would therefore lower standards and ensure mediocrity, he claimed.
He said, “Patients and health care should not be treated as mere commodities, and neither should medical students. We must not allow another lost tribe of doctors to be consigned to the wilderness.”
Grant Ingrams, representing GPs, said that doctors should not be trained if there was no job at the end. He warned that this could spark another “brain drain,” adding: “It is wrong and immoral and a waste of taxpayers’ and students’ money.”

"The same reason why they don’t invest in nurse training anymore. They can’t be arsed to fund it and just rely on foreign doctors/nurses."

This is only half of the story. The UK electorate keeps voting for parties (note the plural) that do not prioritise healthcare funding to the same extent that many other countries do. The "They" in the statement is the people that the voters have elected - and if "they" don't do what is expected of them, then voters should vote for someone else.

In other countries, having 10% of the population waiting months for hospital treatment, people waiting days to see an GP and waiting hours for an ambulance would result in the Health Minister being kicked out on his or her arse. In England, the man who is the longest-serving Health Secretary, who held this position from 2012 until 2018 and whose plans for stabilising and improving the NHS should therefore by now be coming to fruition has just become Chancellor.

They (actually most medical professionals) take forever to train and to keep up to date. You need a pipeline. Decisions made then are really affecting us now.

That is from 14 years ago, however… things have changed substantially since then - one of them, Gordon Brown was PM!

I doubt doctors haven’t voted on anything similar since.

does anyone have newer resources to cite? 2008 is a long time ago

cross post, and good poinT

See my comment about a pipeline of new doctors. Of course it is affecting us now!

I don't think this is it. In my experience in the acute sector Hospitals are regularly struggle to fill their spaces because there are not enough training places at uni.

The fall out rate means that numbers get more challenging as you try to fill spaces for more experienced junior doctors too

My dr colleagues (I’m a lawyer in a large public sector org) tell me it’s the BMA blocking it. Sorry don’t have source. The BMA is an incredibly powerful union and govt officials terrified of them!

working and pay conditions since then also mean many that were at some point during their training have now left the profession or the country.
I know doctors who have quit the specialist training route, that could lead to a consultant role/expertise, to work as locum as they cannot afford to stay on the ST route

Time scales may play a part. It costs a lot to train a doctor ( I think medical school alone is over 250, 000 - many years ago). You do not see benefit of increased numbers for many years (5 year medical school- 4 year if postgraduate fast track , 6 years if intercalated degree etc) . Then there are junior doctor years. This takes more than a parliamentary term. The government will not see the benefits of its investment in the term.

Not surprised at BMA . Very powerful and does not surprise me at all that vote mentioned by previous posters.

Honestly you need to come from a stable background with good finances to do medicine. Most of the UK population are languishing in abject squalor presently which is why we rely on the children of decent foreign homes to diagnose us

Pay and conditions my arse.

The pay is not bad at all. Their main complaints come from overtime/pension contributions/how they are taxed.

The conditions are totally of their own making, they should take their own union to task on that one.

Nurses are criminally underpaid for their workload and the legal and moral responsibility they bear.

Graduation from 5 yrs in medical school is only the very basic qualification . The medical training takes up to a further nine years ; while working full time and studying for very demanding professional exams. The post-grad hospital training is done by more senior doctors who are also working fulltime at their medical job with patients.

Capacity to train and supervise plays a late role in this. There are not enough staff to do this to increase the pool basically. First hand experience.

This. They can deny it all they want but the BMA are a significant chunk at blame here.

6 years to train a Doctor with an intercalated degree, + 2 foundation years of general hospital training before specialist training. E.G. Paediatrics was a further 8 years, now shortened to 5, however those doctors who started training under the original 8 years are still training now and therefore count as Junior Doctors almost 10 years later.
Anyone who has relatives or offspring going through training can see the toll taken on the NHS workforce, and please disregard the media quotes regarding salary, they always use G.P salaries, never the shift working Junior Doctors at the hospital rockface…