Why don't we just train more doctors?

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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?

New medical schools have opened recently, but there is a question of capacity: the needs to be enough hospital capacity for these students.

Moreover, most importantly, work needs to be done in retention. There is no point training doctors, at cost of over £200k each, only for the poor training, pay and conditions in the UK to mean that they go abroad soon after graduation. This is the reality now.

I asked people at a party how much they thought I earnt as a 'junior doctor' several years after graduation. Most thought I earnt double what I do.

You can look up the pay scales on the bma website, it is shocking given the length of training, debt, level of responsibility and trauma of the job.

I work in a medical school which is under pressure to take on more students... however we can't magic up additional placement capacity and don't have the time/staff/space to provide alternative teaching such as ward-based teaching spaces or VR experiences. Also, huge numbers of students failed during the pandemic (they thought they could watch videos and catch up later, but didn't have the required time management skills), so we now have another bottleneck.

Mmhmm. It was basically about keeping medicine as an elite profession which offered huge pay opportunities especially for doctors working in the private sector. Keep the supply of doctors small and keep pay high.

Except conditions deteriorated for docs in the NHS (because of doc shortage) and they started bailing like rats from a sinking ship. And the ship really is sinking now.

Apologies if I take pay scales from the BMA website with a massive pinch of salt!!!

Before everyone starts frothing at the mouth regarding this, some points:

1. This was from 2008, before a significant proportion of doctors qualified today, were qualified, myself included
2. This was a vote from the BMA, a trade union. They do not represent all doctors, not do they often do a particularly good job at representing doctors. I have left them previously as they are incredibly ineffective as a trade union. Trade unions also have no power to prevent the opening of medical schools
3. It was passed by a 'narrow majority '
4. Workforce planning is key. There is no point in opening new medical schools and creating new doctors, if there are no jobs for them when they qualify. This would be a waste of public funds apart from the personal impacts to those effected.

There's also no point in spending so much time and money training them for so many to work just 1 day per week! When the trend started for part time working in the past 25 years or so, training places should have been doubled to provide the staff to replace full time retiring doctors. If the average doctor is now working, say, half time, it's common sense you need twice as many doctors as you needed in the 80s/90s when most doctors worked full time.

Here it is from the NHS website, with the exact same figures:

www.healthcareers.nhs.uk/explore-roles/doctors/pay-doctors/pay-doctors

Feel free to verify it with your local hospital. It's a national contract, with no room for variation. This is exactly what junior doctors are paid.

It' hardly the students' fault if medical schools/Unis reverted to virtual lectures instead of face to face is it? You make it sound like the students' fault!

Because during to the working conditions.

No matter how many you train they will leave for better working conditions.

If you make the job attractive it will retain the current workforce and attract more from overseas. But currently the NHS is haemorrhaging staff.

Again, factually incorrect. In training, the minimum training percentage is 50%, but in practise it is 60%. The majority of doctors who work less than full time work 80%, which together with the out of hours commitments that most specialities have, generally works out at 35-40 hours a week, which is full time for a normal person. This isn't counting the unpaid overtime which is inevitable, or the locum shifts which are often expected.

Seems like only 23% of doctors work 37.5 hours or more per week

Retention is also a problem. Quite honestly I don’t blame them. There is so much negativity about doctors, the NHS that I would avoid. DD mentioned going into medicine and I asked her to seriously think about it because it’s brutal at the moment. Nothing is good enough, no one is happy and the abuse they get is awful. I don’t want that for her. Her dad has already had a breakdown because of his job in the NHS and never thinking he’s good enough. I don’t want that for her .

I want to retrain as a doctor but can't afford to.

I don't have dependents, I'm as free and unencumbered as I'm ever likely to be, but it's impossible to train without money to live on and my savings would support me for a year, no more.

Where does this statistic come from? I have never heard it before. Perhaps it refers to GPs? It is definitely not true of hospital specialities.

The problem is that doctors "work" time is often defined as time spent seeing patients or "sessions". However each session will have additional paperwork time resulting from it which is still work but not allocated to a session.

Also, time spent training juniors, lecturing medical school students is not sessional work and is obviously essential.

Classic issue is you need more doctors to train more doctors and doctors firefighting doing 2 or 3 jobs are not in a position to train others effectively

BMA NHS payscales and NHS doctor payscales to be the same. I have found consultant payscale information to be more concise (other than private work/locum work etc). The difference at more junior levels were the out of hours / antisocial hours pay awards. At junior doctor levels these could be (if I recall correctly an additional 42% on top of basic). For consultant work it has been 8% on top of basic. With consultant work you frequently get extra sessions (each worth 10% but each taking at least an extra 10% of your time and you have to justify this to HR) you also get discretionary or clinical excellence awards. Clinical Excellence and Discretionary Award values are all noted correctly. So I think there is leeway with payscales but websites try to be open and honest.

With the new contract (that everyone in England is now on) the pay uplift for out of hours work is minimal. It was far more on the old contract, hence the motivation to change it.

BMA is one of the weakest unions in terms of fighting for the rights of its members but it has an undeservedly fierce reputation as being a strong union.

The reasons doctors voted to not increase medical schools and medical school places were complex and boiled down to obvious lack of funding and totally inadequate planning. The proposals at the time we're to increase medical school places in existing medical schools but without a corresponding increase in funding, facilities, lecturers, or clinical tutors. Essentially cramming more people into the same class with no extra resources. Unfortunately, medical training is extremely resource intensive. You simply can't have 20 medical students filing past a sick patient, all of them examining the same person being supervised by the same person. You need more people teaching, and teaching students takes time away from other clinical activities so hospitals don't like doctors doing much teaching unless there are enough resources.

Proposals for the new medical schools were put forward to lower the teaching, assessment, examination and exit standards for the newer medical schools and would create a 2-tier medical graduate system.

There were also no plans to increase junior doctor posts for these doctors to be employed after graduation, no increase in training posts so that they could receive the necessary post graduate training they need to become GPs or specialists (a GP still needs 5-6 years of post grad training after 5-6 years at medical school, some hospital specialties need 6-7, others need 8-12 years additional training), no plans to increase consultant posts so that any newly trained specialist could be employed, and no funding for increasing GP numbers.

These were just some of the more easily understood issues with the proposals at the time, there were many others including changes to the training scheme application system, qualifications awarded, specialist examinations, loads more. The 2008 vote wasn't just about medical school places or new medical schools, but entire medical careers, specialist medical training, working patterns and hours and other linked issues. Many of those proposals were implemented anyway and wrecked tens of thousands of careers with huge numbers of UK doctors emigrating to Australia and Canada, which meant we had to rely even more heavily on doctors from abroad.

It's far too easy to say just train more doctors, or condemn a vote from 14 years ago for opposing proposals to increase numbers without understanding the underlying issues. It takes a huge amount of long term planning and investment that's way beyond the horizon of any government - 12 to 18 years at a minimum - to be able to get us out of the hole successive governments of all hues have dug into.

DOI: I'm a doctor and had many friends affected by the "medical career reforms" around 2008, the MMC/MTAS fiasco, which devastated the training and careers of a generation of doctors.

I'm not a GP, but it's not true of GPs either. In fact, it simply isn't true at all. It's far too easy to lie, and then spread the lie as truth, on the internet.

This is true. My comment wasn't intended as derogatory to GPs, I was more wondering, as others have pointed out, that it is falsely low, if only patient contact time is counted.

@BelleMarionette you're correct 23% part time relates to GPs.

Ooops that should be 23% full time

Source was the Royal College of GPs

Would you train to be a doctor? I wouldn’t.