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?

Purely from an academic point of view, a lot of med candidates drop out during the course - the first dissection class is too much them and they realise the reality is much tougher than they believed, or they discover that they're squeamish, etc.

I agree with Lunar270 that junior doctors should not have to work 60 hour weeks to achieve their competencies. We either find a way to train them more effectively or the training needs to take longer.

I don't think working over 60 hours is good for doctors - or patients - and I think it's wrong to create a system where this is required. Having doctors on duty who are over tired from over work is detrimental to the quality of their work and to their own health/quality of life. As a practice it also excludes many people from being doctors.

Is there a published list of salaries for accountants? Are these negotiable? How many hours extra are they expected to work as standard? No it’s not transparent

You do realise that a lot of patient-facing staff work many hours per week unpaid on top of their contracted FT and out-of-hours commitment?

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.

It’s definitely a big issue. Both volume and quality.

In fact, in my (somewhat related) field there’s a big quality issue even in people with a few years of experience after university. It’s a real struggle to find people who can actually think things through, adapt and problem solve rather than just following process and spitting out mediocre (or worse) outputs. At all levels really.

The result is that the UK public sector spends ludicrous amounts on consultancy, where they get lots of mediocre (or worse) outcomes because they cannot recruit or retain skilled people. And the commissioning model means that it’s almost impossible to get better than mediocre outcomes from the work they outsource.

It doesn’t make the papers like NHS problems do. But it’s a pretty widespread issue.

No I understand how tax and pensions work - the sheer size of the pot in public sector pensions is huge because its final salary/career average based. That is what attracts the tax bill. The same tax implications fall on anyone who builds up a pension pot substantially above the tax limits, whatever their profession.

It’s not about working 60hours - a lot of training happens during the normal working hours - clinics, elective surgery, endoscopy, MDMs etc.
If they do a standar 40h/wk then who will be covering the night shifts and weekends?

We come back to having more doctors so each does fewer out of hours shifts. Will salaries drop as a result? Probably.
Will people still be interested in doing medicine if salaries fall even though the work is becoming much more complex and litigious? Add to that the suggestion of a 5-year commitment to working in the NHS? Probably not.

@walkingonsunshinekat we will have to differ on our opinions. Many of my friends and family are accountants and don't get paid extra for extra hours or weekend working.

Bonuses do of course exist but most do not get these especially ones at the start of their careers which is what I am talking about.

It's not just accountants either. Most professional people I know work additional unpaid hours every week, I think this is widely known and accepted.

I don't have a point of view about doctors salaries I just think they should be discussed openly and honestly and I don't feel that this is the current situation. You seem touchy about this information becoming public but smoke and mirrors isn't a good way to address the problems of the healthcare service.

@walkingonsunshinekat it's worth saying that although I don't have an opinion on whether pay is right for junior doctors I do think they are working too many hours.

Of course doctors benefit from social status, however unhappy people may be with the state of healthcare in any one time. Overall its profession with high social status.

One of the changes over the decades in medicine is the extent to which it has become an A* applicant profession rather than one which would accept a slip in grades for someone who can demonstrate other skills or capabilities commensurate with making a good doctor. An acquaintance who used to teach at one of the London med schools found it an increasing struggle as students coming in with great A level grades had less interest in any form of public medicine - they were there to build a career which would enable them to work in private medicine.

Other countries where more of the costs are borne by the student have no lack of applicants to courses. I wouldn't actually like to see this in the UK but lets not pretend there isn't a big investment by the state into medical training.

@Blip When comparing salaries, we should only look at base salary.
Shift allowances and OT are never guaranteed and aren't inc in employer/employee pension contributions.

I also doubt very much that Doc's dont work a lot of unpaid hours as well.

But as with Nurses, healthcare professionals are voting with their feet and leaving the NHS, often to go abroad, so whatever we all might think on salary etc, they prefer to work elsewhere.

My ex used to get David Lloyd membership, BUPA and a very nice car, he wasn't a partner either.

@walkingonsunshinekat no, it's quite wrong to compare "base salaries" when ALL junior doctors work significant levels of antisocial hours and on calls and extra hours too and most work similar amounts of these with a few outliers.

Unless you always say the base salary for an F1 doctor is £28k, with additional pay of on average £7k depending on actual rotas worked.

I'm saying 60 hours as an example, because it's mentioned often. Naturally it's about doing over 40 because you're talking about covering out of hours etc. For arguments sake let's just call it anything above 40.

Doing a standard 40 hours is what's best for everyone. The employee, the organisation and the recipient of care. The EU directives for hours isn't just something plucked from thin air.

As I mentioned in another pp. Once you have x doctors working well over 40 hours, repeatedly, it's important that more staff are recruited to maintain an average of 40h by all staff.

I think you're lacking in imagination if you honestly can't work out how people can cover nights/weekends on 40h and still gain experience during critical times.

Salaries are already set for a 40h week so they're not going to drop. You're just getting someone else to do the extra 20h being done by x number of existing staff. Obviously there's pensions etc but is why I said you'd need 3-4 existing staff doing 20h to justify another doctor.

Are new doctors going to be discouraged? What, by working 40h like most people? If so it says more about them than a revised system that would be better for their (and everyone's) wellbeing.

@Blip No because that extra money is earned by working extra hours, shifts, on-call and always feeling tired.. & less time with family friends etc i.e life.

Few non medical professions require shift work over nights and bank holidays, certainly accountancy doesn't!

@walkingonsunshinekat perhaps you are misunderstanding me here.
I do not think it is wrong for doctors to be paid extra for antisocial hours or extra hours worked.

I think it is wrong that when the public is considering doctors pay they are considering the wrong figures.
What would be wrong with publishing the figure for an F1 as I suggested?

ie base salary for an F1 doctor is £28k, with additional pay of on average £7k depending on actual rotas worked.

No, because accountancy is an open/free market. Small firms tend to pay minimum wage or just above for their trainees. Top 10 firms pay a lot more, maybe £25k or so for trainees. Then wages rise as the trainees gain experience and qualifications. Specialisms tend to pay more, i.e. mergers/acquisitions, insolvency, tax specialisms etc. But it's all down to what the clients will pay. Businesses pay more for a Top 10 firm or a specialist than they'll pay a small town general practice. Newly qualified accountants can be on as little as £30/£40k, even experienced qualified accountants can be on as little as £40-£50k in smaller firms in the regions. Plenty of job advertisements on recruitment/job websites if you want to look at open market rates for different levels of skills/experience, etc. It's impossible for all accountants to reach the heights of being a partner in Top 10 firms earning half a million - probably only a fraction of a percentage of qualified accountants earn anywhere near that.

@Blip

I just think that the only salary figure relevant is that which the employee is contracted to do, OT and shifts are not guaranteed and depending on the setting, may not be available to the same extent - i.e. a Doc based in a major teaching hospital will be working more than a Doc in a stroke rehab unit in Plymouth.

Its also a red herring, as i said earlier, the Govt has the means and ways to increase medical training places, they have consistently failed to do so, which to me shows they have no desire to do so.

The real question is why?

Well, trainee accountants usually have to study in their own time outside full time working hours unpaid. When I was studying for 4 years to get my chartered accountancy qualification, I'd typically work an average 15-20 hours per week studying, (more as exam season approached), in evenings and weekends. Certainly in my year of studying/taking the final exams, I had virtually no "life" outside work! Basically, the working day was for work, and evenings/weekends were for study. We also got very little "support" from our employers, i.e. they'd pay for study manuals and exam fees, and time off for exams, but we had to use our holiday entitlement if we wanted a couple of weeks off pre exams for revision or to attend residential revision schools, etc.

It's pretty basic expectation of anyone who had to do studying/exams for a profession.

As for out of hours working, yes, we did that too. Unpaid, but we got time off in lieu/flexitime. Weekend/evening working was required at busy times of the year, i.e. the few weeks ahead of tax return filing deadlines, year end stocktake attendance (31 Dec and 31 Mar). Also attending client board meetings and AGMs which were usually evenings, or sometimes daytime weekend. Obviously, none of that is a matter of life or death, but accountancy certainly isn't always a 9-5 M-F job with no working requirement out of hours.

Numbers of accountants or training places for accountants are not managed by the Government.
Neither are their salaries dictated by the Government.

Governments (yes successive ones) have failed in the NHS workforce planning.

Agree with previous posters that the electoral cycle isn't helpful and there needs to be an independent commission to review.

As I posted earlier an independent commission (to report on numbers of medics and the project numbers for long term workforce planning) was removed from legislation earlier this year.

@walkingonsunshinekat
"I just think that the only salary figure relevant is that which the employee is contracted to do, OT and shifts are not guaranteed and depending on the setting, may not be available to the same extent - i.e. a Doc based in a major teaching hospital will be working more than a Doc in a stroke rehab unit in Plymouth."

I'm sorry, we are talking about junior doctors here. All of them work overtime, all of them work unsocial hours. Month to month their pay will vary but over a year they will all earn a similar amount over the base pay and it will be in the order of 25% more. It's disingenuous to try to deny this and also to describe it as a red herring. If you wish to submerge facts I'm sure there is a reason for this.

As to your other question the addition of training places is indeed in the hands of the government.
Maybe the problem is lack of public engagement and lack of facts in the public domain.
Maybe the problem is the short term nature of government
Maybe the problem is powerful vested interests that do not want the NHS to improve
Maybe the problem is that some doctors want to limit entry into the profession to safeguard their own status and salaries
Maybe the problem is incompetence of one or many parts of the system
Maybe the problem is the NHS, social care, DWP, education and/or government policy makers are not working together effectively.
Maybe all sorts of things.

We need the FACTS for the public to see and we need wider discussions on the future of healthcare provision as it is currently failing most of our society badly. Most families now have someone on a waiting list for an operation.
Even the waiting list figures are smoke and mirrors. They don't include people who need operations but haven't even had their first consultant appointment as there is a huge wait time there. There are effectively waiting lists to even get onto a waiting list.

Sorry, I am not sure whether your point is for or against but pretty much all of what you describe is the same for junior doctors, expect the time off in lieu/flexitime for unpaid overtime.

For the umpteenth time, it is there for anyone to see - just type in doctors salary scale UK. You analogy of accountants is pointless, because their salary is not transparent.

Here:
www.bmj.com/careers/article/the-complete-guide-to-nhs-pay-for-doctors

@Blip

Nope, i just think its irrelevant, the relevant point is the Govt has deliberately chosen a course of action to reduce the number of Doctors trained in the UK, based on demographics and demand.

After all, you called the thread "why don't we just train more doctors" NOT "I want greater transparency on junior Doctor pay"

You ve come up with a long list of "maybe's.." but the one you ve missed out is the "Maybe they want to reduce the NHS to an emergency service only?" with routine care done via insurance and charities - i.e pre NHS.

The lack of new real estate, medics, nurses/AHP's and no change to social care, shows this is the true aim of Govt policy, these simply isn't any other explanation - what possible other reason would you go and introduce tuition fees for Nurses/AHPs when you know there is a shortage of 40k of nurses, let alone OT's physio's radiographers paramedics ?

You are wrong about waiting lists, another diversion.

The point about accountants is that they don't need to have transparency over their pay unless they work for the public sector. There does however need to be transparency for NHS doctors as they are paid from the public purse.

The point is, a previous poster (maybe you) was suggesting that accountancy didn't have "out of hours" work, whereas in reality it does, albeit not a matter of life & death like some doctors, and there was a clear inferrence that accountancy trainees had a much easier time of it. But in reality it's comparing apples and bananas - accountants aren't making life/death decisions, but aren't getting paid for their training time and not usually for the extra/out of hours work. Trainee doctors are at least being paid for their training time as it's packaged as part of their working time.

As for the other argument about what salaries to use, I agree with the other poster in that if "overtime" is common and standard, then the wage, for comparison purposes, should include the average amount of overtime. It's disingenuous to just use "base" salary, when virtually no one would ever be paid as little as that due to the requirement/nature of the job to do x number of paid overtime hours as part of the job.

@walkingonsunshinekat
I'm not wrong about the waiting lists, there are huge wait times to even get onto them, several family members of mine have or are experiencing this.

I'm quite uncomfortable about the level to which you seem to want to suppress facts about the NHS by either denying them or dismissing them as "irrelevant" or "red herrings".