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?

Perhaps because we don’t insist those with ancient history degrees to work as museum curators or those with engineering degrees to serve in the Navy? You can’t single out one profession for return of service unless there was an option to give a bursary and pay off tuition fees.

All doctors qualifying in U.K. already give return of service as part of their training pathway.

Two years horrendous rotas, very limited choice of where they live in the country, frequently moved, as Foundation Programme doctors, paid at an hourly rate that often ends up being less than minimum wage. That’s not optional.

A couple of years doing core medicine or core surgery. Again, little choice of where they go, horrendous rota, nights, days, not in their own area of interest etc. Has to be done before they can move to speciality training. The alternative is a three year GP pathway with eighteen months treading the wards around the clock.

Minimum five years ‘pay back’. More usually at least seven.

A proposed amendment to the Health and Care Bill – which would have made it compulsory for the Government to publish regular, independent assessments of how many doctors and nurses the NHS needs – has been defeated.

The amendment would have helped inform long-term decisions about workforce planning in the NHS – something that has been missing for many years.
We are disappointed that Government has removed this amendment, and it is now unclear how ambitious targets laid out in the Elective Recovery Plan and other NHS delivery plans can be met. 

Without a long-term workforce plan, heart patients will likely experience further delays, further cancellations and poorer outcomes.

www.bhf.org.uk/what-we-do/news-from-the-bhf/news-archive/2022/march/government-rejects-health-bill-workforce-amendment

Jeremy Hunt, chair of the Health and Social Care Committee, said the government has missed an opportunity to address the “cycle of crises”.
He said: “It is disappointing the government has again rejected our call for transparent and independent projections of the number of doctors and nurses we need to meet future demand.
“Unless we have future-proof workforce planning, it will not be possible to address the NHS backlog and the cycle of crises putting dangerous pressure on staff will continue.
“We hope the government will be persuaded by the case for independent workforce planning as the health and care bill progresses through parliament. Without it, we see little hope that the workforce crisis will be alleviated.”
Last week, NHS Providers chief executive Chris Hopson told Sky News he was “incredibly frustrated” that health secretary Sajid Javid had refused to support a long-term workforce plan for NHS staff,

www.civilserviceworld.com/professions/article/government-rejects-mps-plea-to-overhaul-nhs-workforce-planning-despite-crisis-warning

At consultant level it’s up to 8% extra so on the very top scale it’s approx £10k year on top but that’s after 20y at consultant level and for the most demanding out of hours commitment.
Junior doctors have a greater percentage supplement, again, depending on how frequent and unsociable the hours are.

The “extra” pay is for hours worked above your contacted 40h (full time) or part time hours.

However, it doesn’t make sense to compare salaries this way. Need to look at what pay is for a standard 40h week across comparable professional for the training and the level of training and responsibility required.
Also at pay progression and the timescale.
Post graduate qualifications.
Need for out of hours commitment etc

Just to be clear. The BMJ doesn’t vote. It’s a magazine.

This is such misinformed cobblers.

Yes and no. A great many responsible jobs in industry require a certain amount of effort. I've been places where 10% is expected. But a continuous 20% is unreasonable and should be compensated accordingly.

But this is where trusts etc are a bit short sighted IMO (dare I say a bit thick). If you have three or four doctors doing 20 hours a week extra, long term. That is about the tipping point and justification for taking on another doctor surely.

Quality suffers past about 50 hours/week so should be obvious and whilst doctors may feel they're letting the public down by not working more, are probably doing the opposite by perpetually working 60+ hours.

You mean give doctors additional tax perks over and above those they already enjoy as higher tax payers in pensions?

The fact that doctors hit the max tax free limit in their pension schemes relatively early is a reflection of the generosity of the scheme and the high levels of pay.

Yes apologies, but am sure you know what I was referring to back on page one.

If you are putting in stents you need a theatre and personnel on call.

You still need surgeons to perform bypasses.

You also need them to do things like transplants which are much more common.

Yes stents are more successful than angioplasty alone but there are cases where you can't use them.

This show a lack of understanding, which I understand if you are not working in the system or know someone who is.
You need doctors to do night and weekend shifts.
If a standard full time week is 40h week includes the out of hours work then the doctor will be doing fewer day-time hours. This equates to less training time and, so they won’t be able to meet their competencies and reach consultant level for a very long time.

Then we need to buy some experienced ones in from other countries. We need more hospitals, doctors and nurses. People aren’t getting treated and it’s causing lifelong consequences and further cost for the NHS.

Any professional whose job involves life long learning and who aspires to move up the ladder will do long hours beyond those contracted. This is not unique to medicine. The return for most is a interesting career path leading to higher earnings and depending on the path - a degree of social status such as in medicine. You don't have to look far to find grads on elite graduate programmes turning in hours which translate the salaries to minimum wage.

The actual cost of training doctors is substantially higher than most other professions where the post graduate or post doctoral costs are born by the company/individual.

I'm not generally a fan of indenturing or requirement for X FTE years "pay back" but to minimise the investment of the state in medical training for doctors is to downplay that investment quite significantly.

Funding is the biggest one.

It is transparent- it’s all available for anyone to look up.
The out of hours supplements they earn for doing approx extra 50% work I’m addition to their 40h FT week and these extra hours are done overnight and weekends.
Of course they should be paid more for this!

Just to add as consultant on 1:10 out of hours rota I was paid 1% extra of annual salary, so that’s £1000 per year before tax, so £600 per year after tax.
For 1:10 rota which was quiet - that’s why it was paid 1%- but nonetheless disruptive and limiting to your life and plans.

thats £50 per month after tax, for 3 nights or weekend days each month.
That’s £16.50 for a Saturday on call? 24 hours available by telephone
yes I am worth significantly more than that. Everyone is worth significantly more than that.

I think what most posters are missing is the Govt doesn't want more Doctors or for that matter more nurses.

This nonsense about the BMA ? this is the Govt that faced down junior doctors, will face down the RCN, has never given into a union.

The Tories want a poor service, more go private, less money spent on the NHS, so look at the way below inflation increases for the NHS & nothing on social care, introduced tuition fees for nurses and other AHPs, froze pay for years during austerity & most importantly have had 12.5 years to sort out staffing in the health service.

The public don't care either, so good luck coming up with solutions for the shortages of Doc's and 7m waiting for treatment.

Good luck with recruitment.

C8H10N4O2

You are misinformed about the pension situation. The problem is getting a HMRC bill for 6 months of your take home pay due to theoretical rise on your pension - not actual rise. It is confounded by how it is calculated. It was fixed for judges. But think government would like NHS collapse so presume that’s why they don’t fix for senior doctors.
No I can’t afford to pay this so had to step away from NHS though would never have done so otherwise.
no doctors won’t pay to go to work, no one would.

Surely the state must invest - the stakes are high!
The investment is not for the benefit of the doctors - we will train you but for that you owe us 5 years of your life - it is for society.

Social status?! It’s not the 1950s anymore

Try to compare salary for doctors just out of med school and accountants in their first job post degree though - accountants will be working extra hours and some evenings and weekends for no extra pay, so the advertised salary is what you get.

If I were an accountant looking at the published salaries for new doctors I'd assume that's what they get.

I'm making no judgement on what doctors salaries should be what I am saying is that it's really not transparent and it should be.

Alongside all the other issues mentioned, it’s also not a quick fix. First year medical student to competent doctor able to function effectively without significant supervision and support is a long road.

Especially if an increase in student numbers also requires a significant increase in training capacity and infrastructure - both in hospitals and in universities. Medical training doesn’t scale up and down quickly or easily to respond to demand (it cannot be a ‘just in time’ type of system!).

it’s a much, much longer road than can be achieved within any electoral cycle. That makes it spending where the results cannot possibly be realised within the timescale a political party requires to show the brilliant improvements they’ve made to the NHS for the money spent.

@Coffeewinecake are you suggesting that social status no longer exists?

I'm not a medical doctor (but a Comp Sc Phd) and have no knowledge of how our NHS works. But the topic raised by the OP is exactly the same issue we have in my field "why don't we train more developers/software engineers". There's a certain supply from Uni's now, but just not at the volume and quality level required. The companies I've worked for also end up hiring a lot from abroad, to fill the gap. We're competing for those foreign workers against the US, Canada and EU countries.

There are probably a whole range of disciplines where there are more jobs available than trained people, medical field just being one. Conceptually the need for "levelling up" in the science areas is something we need to do. There seems to be a huge gap between having that as a goal, and actually executing it in the real world.

No, I know doctors, nurses and physios that work for the NHS.

It's an excuse to say that anyone needs to work 60+ hours in order to achieve certain competences. It's not 'a very long time' but obviously just a proportion of the differential. It's not beyond the wit of humans to come up with a working schedule that achieves the goals required.

Anyone in any industry will gain experience faster if they work more hours. But flogging people to death and seeing them leave out of exhaustion etc. shows a distinct lack of comprehension of anything at all.

Ultimately what does it really matter if a doctor takes 40/60 less time? If the entire industry made a shift then what does it matter in the long term? Eventually we'd have the same thing but with staff that weren't broken in the process. Complete short termism.

I think you very much are with your constant references to salary.

I was married to an accountant, they most definitely get paid extra for extra work, often in the form of bonuses, they also don't perform live saving surgeries and treatments.