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?

It would be good to see a lot more transparency about this issue and a lot more facts and figures.

I have been very frustrated by our system. My understanding was that it was the lack of training places. Recently I have seen people blaming doctors leaving NHS. Perhaps if we deliberately aimed for an over-supply of doctors, and allowed many of them to work part-time they would find a work-life balance that suited them and stay. There would be extra cost from training a surplus, but not in actually employing them, assuming part-time pay is pro-rata.

I was encouraged to read recently that some British students are going abroad to study medicine, so the constraints that our our half-baked system impose on doctor supply are not an absolute blocker. I think people were going to Eastern Europe, or possibly one of the ex-Soviet republics, where apparently there are plenty of places in medical schools and local hospitals for trainee doctors. (I don't remember the details of how this was funded, presumably it is self-funded, but not expensive.)

The number of training places in medecine (and vertinary medecine) is strictly controlled, and it takes many years to train doctors properly.
(I do not know who exactly is responsible for this. I don't think it's just the money)
Others have stated the lack of suitable training posts at hospitals.
I hate the fact we rely on overseas doctors and nurses, but there are also many who train here and then go abroad.

It's also a retention problem not just a training problem.

Same as nurses. There are plenty enough nurses being trained, certainly more than the NHS actually has capacity to train. But then they get disillusioned with the job and burn out so quickly, they leave the NHS for better paid and more flexible work.

It's the working conditions in the NHS that need to change. Not the training.

There's also a problem with doctors choosing to work part time - increasing pay, especially for gp's partly is the cause, only one gp at our practice is full time, the ones I've spoken to openly admit they are fortunate to be able to work 25-30 hours a week on a good salary. I'm not suggesting that we pay doctors less but more there is an incentive to work full time, not necessarily money perhaps annual leave

Does this happen with medical students too?

No. Some medical schools (the most recent wave of new ones: Sunderland, Anglia Ruskin, Kent & Medway, Lincoln) aren't allowed to recruit international fee-paying students. For most others, the number of international fee-paying students is capped at 7.5% of their 2017 intake. (Their total intake numbers might have increased since then but the number of international students they're allowed to accept has not increased.)

This is complicated, though, by the recent emergence of some private medical schools that either only recruit international students at no cost to the central NHS (e.g. Brunel) or recruit any suitably qualified student who can pay the fees but, again, don't receive NHS funding in the same way as mainstream medical schools (e.g. Buckingham). However, these medical schools are accredited in the same way as all other UK schools and are in a position to take standard-funded home students whenever numbers are expanded.

I was encouraged to read recently that some British students are going abroad to study medicine, so the constraints that our our half-baked system impose on doctor supply are not an absolute blocker. I think people were going to Eastern Europe, or possibly one of the ex-Soviet republics, where apparently there are plenty of places in medical schools and local hospitals for trainee doctors. (I don't remember the details of how this was funded, presumably it is self-funded, but not expensive.)

But, of course, many of these were displaced by the war in Ukraine and have been unable to complete their training. Students who train in other countries have to go through an additional assessment before they can practise in the UK. From 2024 this will become the medical licensing assessment (MLA), which anyone who wants to practise medicine in the UK will have to pass, regardless of where they have trained (UK, Europe, rest of world). While this might - or might not - increase the number of medical graduates wanting to work in the UK, it doesn't do anything about the bottleneck of foundation training. At present, graduates have to complete a foundation training year before they are fully licensed and a second foundation year before they can enter specialist training programmes. Unless the number of foundation places expands (or the postgraduate training pathway is completely changed), it makes no difference how many medical graduates we have: they won't be able to work as doctors.

(I do not know who exactly is responsible for this. I don't think it's just the money)

Numbers are capped by the Office for Students on the instructions of the Department of Health & Social Care. DHSC attempts to match the number of medical & dental graduates to the number of jobs available to new graduates. Medical & dental schools that exceed the cap are subject to severe financial penalties.

Keeping the numbers down keeps their wages up.

@Blip @ChiefPearlClutcher

Yes, I totally believe this. Doctors are earning megabucks through the NHS due to being in high demand. Those same doctors are taking on private work on the side. They don’t want more doctors. The BMA holds a lot of power and I don’t think change will be coming anytime soon.

There should me more university places, and subsequently more doctors. Also, I don’t agree an NHS doctor should be able to do private work. There seems to be a conflict of interest here, ie; longer NHS waiting list are, the more people go private… more money in their pocket.

Don't know about UK but where I'm from the doctors unions are against it cause their salaries would go down if there was enough doctors. Also doctors work in public sector for a short time and then move on to private practises for better pay. Also small town that really need doctors are undesirable for younger doctors to move to.

Op I've asked the same thing.
Recruiting from other countries seems cheap but how are other countries managing to train their own people?

Why are we landing Doctors and Nurses with student debt, why not refund it / write it off after say 15 years working for the NHS?

I knew a boy who was thinking about becoming a Doctor, reviewed the training and salaries and decided that Dentistry was less training and more money. 8 years down the line he's a qualified dentist in a flash merc.

Depends what you mean by megabucks - their salary scale is clearly available on the internet.

Also, it’s not possible to keep lists artificially long - there are targets and layers up layers of manages that monitor them

It’s usually the doctors pleading for more colleagues so they can run extra clinics and lists, rather than having two patients booked into one appointment slot - unsurprisingly, by the end of a clinic everyone is stressed and frazzled, hardly conducive to good patient care or experience.

The doctors leave nhs to be locums as more money - less stress , better hours, holidays when want and making it an even worse place for permanent staff to be - make all doctors locums or regulate the industry

www.politico.eu/article/france-doctors-europe-too-far-too-old-too-few/ I read this article today which suggests this is not just a UK problem, and that some of the problems here are found elsewhere too

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

It’s a complex issue, but here are some answers to your simplistic question:

• Lack of capacity in UK universities due to chronic under-investment over the last decade.
• The £9k tuition fee doesn’t cover anywhere near the actual cost of a medical degree. Have a look at what international students are charged: that’s nearer to the real cost.
• Lack of training posts and current capacity because of deliberate underinvestment in the NHS over the last decade. (as a side note, most people don’t realise that the NHS is an educational organisation as much as a medical treatment service).

@Badbadbunny "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!"

Students were directed to take part in online classes which were synchronous. The classes were recorded, so many students chose not to attend and then couldn't cram everything at the end so they failed. That wasn't the fault of the Unis. Students who attended the online sessions did well.

the Department I work in has just accepted medical students for training. The load on us is huge (and which we are deeply unhappy about). Even having a student in the room slows things down and when clinics are overbooked that is a big impact.

also just having more doctors doesn’t help. Our clinic is fully booked - there’s no space to see more people. Same with theatres - you can have all the surgeons you like but you need the ODPs, scrub staff, recovery, HSDU, porters never mind the beds to put people in.

out of my department, one consultant has dropped his hours to protect his mental health and another has done a retire and return on less hours. Everyone else is either 40 hrs or more. Part of the problem at junior level is the working time directive - they have to have multiple zero hour days which scuppers medical training, continuity and staffing levels.

It's kind of cheaper to avoid doctors retiring in their 50s. Sort pension tax Mr Sunak!

As many others have pointed out it is retention that is the problem. At the senior end stupid tax and pension rules mean the most senior Dr's have to effectively pay to work extra. So they don't work extra. Or they retire because the stress is ridiculous.
In the middle- consultant's and GPs in their late 30s/40s the stress of working in a completely broken system, juggling childcare with very long shifts, getting treated for ptsd following covid, getting abused by patients. The knowledge that they would be paid a lot more for less hours and less demanding pts if they moved abroad.
The junior doctors being forced to move hospital every 6 months, often having fixed annual leave do missing weddings, birthdays etc. Not getting your new rota until 2 weeks before your 6 month placement starts (imagine trying to plan you childcare). Having nowhere to rest on a nightshift. Having your colleague die driving a ridiculous distance after a set of nights because they were too tired and had been sent far from home. Again knowing you would get paid a lot more for a lot less abroad.
We are hemorrhaging staff at every level. You have to make the working conditions better otherwise there is no point training anyone.

What we need is a root and branch reform of the NHS to look at what we can and can't fund from taxes. The work the NHS did nearly 80 years ago when it was founded has changed out of all recognition. Do we need the same professions as we did then? Why do we have to pay through the nose for dental care and not for other medical care when lack of treatment for dental issues can be really serious? (Just as one example.)

Governments are abysmally bad at long-term planning and we all pay the price. Nobody has grasped the nettle of how to fund social care for the elderly and people with disabilities and chronic health issues. It's long overdue that the political parties put their differences aside and set up a Royal Commission or similar, but not one that takes a decade to hear all the evidence and another few years writing up. We need some rapid action on this.

One thing nobody has really got to grips with is the effect of medicine moving from being an almost all male profession to being about 50 50 male female. Inevitably most of the female doctors take time out for maternity leave and don't want to work 70+ hours a week when their children are young. Increasingly male doctors don't want to live like that either, especially as they are now very unlikely to have a wife at home holding everything together, answering the phone to patients and putting her own career on hold or more likely abandoning it altogether, as was often the case 50 years ago.

We need to find a way for doctors to get the experience and training they need without destroying their physical and mental health in the process.

Places at medical school are capped by the govt at 7,500 per year. This may include vets as well, not sure. There are plenty of A* students that want to study medicine but the acceptance rate is something like 7%. Add to this difficulty in getting a place, a medical degree is incredibly hard, much longer hours studying than other degrees, 5 or 6 years plus then the junior doctor years. They come out of this to horrific working conditions, not great pay and £100k student debt. I am working 7 days a week to get the money together for DD who is applying for medicine. There is no way she could pursue that option if I dont fund her. I wont be able to retire until she is through to the other side. I figure it is going to be stressful enough for her without having to get a job on the side. When we went to open days I really did get the feeling that most of the families there were pretty rich. Easier to get the high grades etc if you go to private school and have tutors, and doing a long degree is easier if mummy and daddy can pay for everything. BTW the last year of the degree, they dont get a normal student loan, they get an NHS bursary of about £2000 for the year - that has to do them for food/rent etc, regardless of the students income. It is going to be a push to cover the costs etc, even with her getting the max student loan, if she does get a place.

I have a niece that did medicine. There was a significant number of medical students in her year that passed their degree but there were no places for them to do their foundation training. So you lose those ... then the ones that get the places get overworked and burnt out and leave ... so you lose them. Its a long long training period to get fully qualified doctors and the NHS does not have the capacity to train enough or the retain the ones that get through.

I’m a sociologist who studies these things. There’s something called the ‘professional project’ where professionals restrict access to generate an artificial scarcity which raises the values of their skills. Lawyers and doctors have been especially good at this historically - lawyers struggled as higher Ed expanded but they found other ways to restrict entry other than credentials. The BMA is implicated in this in medicine. (It is also true that there are more lawyers doing degrees than training places).

Just seem a few comments on BMA. The BMA have absolutely no power in restricting medical student places. Nor are any doctors wanting to restrict places for spurious reasons such as keeping demand for their skills high.

the training needs and various bottlenecks have been described well above. So hopefully OP you are now clear on the problem. It’s what to do about a solution ….