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?

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!

This is nonsense.

The BMA is concerned with ensuring that there are jobs for doctors. It opposes moves to promote competition by increasing the number of medical graduates without increasing the number of training posts for them. It is entirely unfair to put someone through 5-6 years of medical school if a proportion of them are then unable to get jobs as doctors and would have been better off doing a 3-year degree. In any case, the BMA doesn't make policy; it expresses opinions on behalf of doctors. It doesn't have any power to "block" anything. And the stuff about government officials being "terrified" of the BMA is utter horseshit.

(Disclaimer: I am not a doctor. I do work in a medical school.)

The main obstacles to training more doctors are: (a) the cost to the NHS (approx £200,000 per graduate); (b) the sclerotic approach of medical schools & teaching hospitals to clinical placements, which are inefficient and put tighter limits on placement capacity than are necessary; (c) the GMC's outcomes for graduates, which require too many specific skills to have been demonstrated at undergraduate level, when opportunities to practise them are often scarce, while not setting a high enough bar for generic skills; (d) the BMA's issue of bottlenecks in postgraduate training programmes (these are currently being addressed, although it remains to be seen whether anything genuinely changes); (e) the "leaky bucket" of junior doctors' emigrating, taking career breaks and not returning, and working part-time (especially in general practice) because of the unreasonable workload.

Some of the measures put in place to try to support the over-stretched medical workforce have made the situation worse to some extent. For example, training physician associates to take on part of the role of doctors places increased pressure on clinical placement capacity as these students also require extensive placements in the same settings. The proposed apprenticeship route to train more doctors risks causing shortages in other healthcare professions.

It seems to me there needs to be an increased number of places on accelerated (e.g. graduate-entry) medical education/training programmes with sponsorship schemes that remove financial obstacles to students but impose some requirement on them to work for the NHS for a minimum number of years in return. But to do it will still require the use of placements to be much more efficient, which, in turn, requires the doctors who teach medical students to become more immersed in education (understand what students have already learned, tailor placement activity to specific learning points, etc.), which many will be reluctant to do.

The above is my opinion. I am not aware of any organisation that shares my opinion.

BMA and the doctors are often the biggest restrictors of medical places
www.bmj.com/content/337/bmj.a748#:~:text=Delegates%20at%20the%20annual%20BMA,on%20opening%20new%20medical%20schools.

No source quoted, so I cannot verify.

A google search did not find this statistic, but this instead, from the same purported source, which contradicts:

www.rcgp.org.uk/News/GP-working-hours-more-complex

"GPs and our teams are working incredibly hard right now, under intense workload and workforce pressures. More than 28 million consultations we made in general practice in England in September alone - over two million more than the same month in 2019.

"When GPs work 'less than full time', the reality is they are often working more than the 37.5 hours a week that are generally considered full time. A GP working a three-day week in clinic will on average work 40 hours, with reams of paperwork to complete when they're not seeing patients. A quarter of GPs are working 50 hours a week or more. To put this into context, a pilot is restricted to flying 32 hours over seven days, because doing more would be considered unsafe.

“The size of the qualified GP workforce fell by almost 6% between September 2015 and August 2021, while the number of patients has continued to grow meaning that the ratio of patients to GPs has increased by more than 10%. Put simply, workload is escalating in general practice, whilst GP numbers are falling.

“This is unsustainable, which is why the Government needs to make good on its manifesto promise of 6,000 more full time equivalent (FTE) GPs by 2024. We are also calling for a system-wide programme to eradicate bureaucratic burdens and unnecessary workload, to prevent GP burnout and allow GPs more time to care for patients.”

That's said current medical school caps are i think because of lack of available funding and taking doctors away from front line to train might not be the immediate vote winner for the government.

Why are we so rubbish compared to other countries?😫
Why is it so easy for our government to pull the wool over the eyes of the electorate?🙁

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.

This is untrue.

My OH's haematology consultant only works 2 days per week as she has a young family.

A consultant is not a doctor in training, therefore it is possible to work less days, though still uncommon. The vast majority of consultants I know work full time. In fact, in my last hospital, in my speciality, there was no one who didn't work full time.

I'm not doubting that a minority do work less than full time for personal or health reasons, but it is a fallacy to claim that the majority of doctors work 'very part time' as has been claimed upthread.

Because the British public keeps putting people in power who have vested interests in privatising the NHS.

The more broken the NHS looks the more likely privatisation becomes.

Criticising doctors for working less than full time (though this is often more than full time hours for other professions) is massively missing the point, as is overlooking the retention issues (moving abroad and leaving the profession). If we want to keep a sufficient medical work force here then we need to examine what is causing the heamorrhaging of medical professionals and fix this.

This thread has highlighted that a significant proportion of the public have no interest in this and would rather simply criticise, with prejudices based on misconceptions and misinformation.

No wonder the NHS is sleep walking into a death spiral.

Depends on the specialty- some are more conducive to part time than others and so the majority could be PT or FT.
Secondly, some consultants maybe doing compressed hours, e.g 3 long days, which could equate to FT hours but they may appear to be PT as they are not at work 2 days/wk

I work within the School of Medicine at a UK University - NHS placements are limited to 'X' amount per year. We are always over-subscribed, students want to come to us but we just do not have sufficient placements available.

@Soothsayer1 makes a great point - why is the UK so unable to train enough new doctors whilst other countries manage to do this?

Presumably other countries also need clinical placements for their trainee doctors so how come they can provide enough of these but the UK cannot?

And presumably, "immigrant" doctors who come into the NHS also need supervision/training within the NHS to satisfy regulators that they're competent and to train them in the NHS ways of doing things. So that's also a "drain" on NHS resources. Unless they come straight in and into hospitals/GP surgeries without any kind of "conversion" and supervision based on an overseas qualification?

OP, the reliance on locums is not directly a result of lack of medical school places. Many locum doctors are UK trained doctors who have quit working for the NHS due to the lack of flexibility, poor training opportunities, unpaid overtime etc. We lose many junior doctors overseas or to other professions for the same reason.

It’s pointless throwing money at extra medical school places if you don’t fix the issues that are causing many UK trained doctors to leave the NHS. The first step is to retain the doctors we’ve already trained. It’s a lot cheaper than training replacements.

That is not true at all.

Within the OECD countries the UK is firmly in the bottom half for doctors per capita.

If by that you mean full time...I work half time and do 34 hours/ week... my DH works full time and works 60 + hours/ week... both GPs

I am currently chucking it in after 20 years to work in a minimum wage job as I cannot get far enough away from it .. its utterly utterly shit....

I don't think the cost of training lots of new medical students is prohibitive at all. Just think of how much is paid out in benefits and lost in tax paid for all the people who cannot work due to lack of or delayed healthcare provision. There are hundreds of thousands of people in this category.

And if we trained lots of new doctors some would leave to work overseas yes. And that seems fair considering how many doctors we have recruited from overseas.

And with the ones who stay this will help workload for our existing doctors which is one reason why many leave or reduce their hours. It would get us back into a positive spiral instead of a negative one.

One third of UK doctors were recruited from overseas. I find that ridiculous.

On another thread it was explained that basically the exusting doctors do the training - i know its through a university with lots of books learning, but much of it is on the ward. So you cant train more doctors than the existing level of doctors can train.

i actually thought that we should approach some other countries that did have more capacity to train and put some extra cohorts through - paying there fees etc, rather than poaching other countries trained doctors.

@AntlerRose that's an interesting idea.
I don't understand though why is there countries seem to have more capacity to provide clinical training than the UK has. Are they approaching the training differently and more efficiently?

All anecdotal.. i accept but on my DD course AHP, half the students were overseas and had no intention of working in UK, her friend is on a nursing course... very similar.

I was treated at a dental school... many students also paid full fees and would leave uk once trained.

Does this happen with medical students too?

We have independent world leading uni system, anyone can come here and train, subject to the fees, as far as i know, places are not reserved for UK only students.

It's expensive, takes a lot of time to train, increasingly media graduate go into the city, medics emigrate etc etc etc. A lot and I mean a lot of European countries import from elsewhere e.g. Switzerland from Germany, Germany from Romania - that pipeline for the UK ended with Brexit, a lot of European medics left and couldnt be bothered. The UK is now trying to import from elsewhere. If you are only looking at the individual country - the most efficient system is to import from abroad rather than train locally. It's cheaper and much more responsive to current needs. But for all of it, you need money - the British electorate dont want to spend that money.