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?

Published pay scales are pointless unless they include the average/required overtime. You can't compare the basic wage of a person who is required to do regular paid overtime against the basic wage of a person who has to work unpaid "overtime". You're comparing apples against bananas. The only valid comparison the actual hourly pay, taking into account the total wages earned against the total number of hours worked. Anything else is meaningless.

100% agree with badbadbunny

Paid out of hours work will vary from post to post and this can also vary every 6-months for any individual doctor as they rotate through specialities and trusts.
The average out of hours commitment and, therefore, supplement can be wildly different within a given speciality let alone between different specialties and so quoting an average is pretty meaningless and not as transparent as you think it may be.

And, again, they also do unpaid overtime, as do most patient-facing staff. Hours of it every week.

Same applies with other professions though. Even within a profession, say, accountancy, different firms will have different policies/practices as regards out of hours working, and again, same applies with different departments within a firm, the out of hours working requirements of a tax dept within PWC will be different to the out of hours working requirements of their audit dept.

This is a good point but due to our shit voting system, most governments are elected by a minority of those voting - i.e. most people voted for something else.

Then you will understand that publishing an average is meaningless unless you break it down for each subspecialty and each trust or, in the case of accountancy, each department within each form.
The caveat being that the salary for an individual junior doctor will potentially change every 6 months depending on the intensity of out of hours work.

@Coffeewinecake most F1s and F2s will earn a very similar amount over a one year period working probably in more than one different specialty over the year. There may be a few outliers at the top end of the earnings range, but NOBODY earns the base salary.

We don't need any separate analyses by hospital or specialty within hospital. We just need an average with a statement to say actual pay depends on actual rota. There simply is not a wide variation in gross pay over a year period for the vast majority of F1s and F2s.

In addition there is a London weighting which I don't see mentioned very clearly.

This is a useful comparison of average pay by jobs, both in total and also average hourly rates.

www.unionlearn.org.uk/compare-average-pay-job

Wait! Junior doctors get time at work for training? I must tell my F2 son who has been spending loads of his time off travelling to different hospitals for mandatory training courses and completing his portfolio work. I'll message him in a minute but I doubt he will be back from his overnight 8 till 8 shift yet. He rarely leaves before 11am and has to get back to his lovely HMO room .

Actually many do earn the base salary. There are specialities with no out of hours commitments. There are also doctors who are not able to work night shifts for health reasons.

The supplement is for working additional hours, weekends and nights. It's not 'free' extra money, as you are trying to portray it.

The London weighting is a pittance, and no where near reflects the additional cost of living in London. This is why all my fellow junior doctors live in HMOs, unless they have a wealthy partner. We have food banks advertised in our toilets, and I have known foundation doctors do need help from charities to meet basic living expenses, following unexpected events.

I do wonder what your purpose is here?

In other jobs where there is a lack of workers (for example HGV drivers) consideration is given to why (pay and conditions).

The leaky bucket analysis is a good one. There is no point creating extra medical school places, at great expense, if the graduates will leave the UK. We need to work on retention. Recruiting from abroad is problematic ethically as we recruit from less developed countries generally. Our graduates go to mainly Australia and New Zealand, so it is in no way an exchange.

The comparison with accountancy is like comparing oranges and apples.

The advantage though with accountancy is that professional exams and study are paid for, as are revision courses and study materials, and professional registration fees. We have none of that in medicine, and the costs are quite considerable. We have to pay for GMC, royal college membership and medical defence union membership. Plus a union is highly advisable as we are usually underpaid as HR cannot understand/willfully misunderstands the contract.

The nature of the work is also completely different, so I am not sure why it is even raised.

@BelleMarionette

The advantage though with accountancy is that professional exams and study are paid for, as are revision courses and study materials, and professional registration fees.

That depends on the employer. Most of the big firms provide a good support package, but lots of medium/smaller firms provide very limited support, certainly unlikely to provide paid study time, often limited support re study materials, registration fees maybe/maybe not, but yes, often paid exam entry costs. Then of course, lots of people are completely self funded if they don't have a "training contract" job, i.e. lots of book-keepers and accounts assistants pay entirely for their own self-study to put themselves through accountancy qualifications where their employer makes no contribution at all.

Apologies fnrtt, but has one mentioned the part-time working? It costs the same in time/money to train a part-time doctor as a full-time one. Many, many GPs are part-time, some very part-time, and not just women.

I read a statistic somewhere that women predominantly choose GP work, rather than surgery, as they want family-friendly conditions. If over 50% of trainees are going to ultimately work 50% of the time, then that needs to be addressed - how I do not know! If you double the trainees you may end up with too many doctors (not to mention the added cost) and also we surely want a high bar to entry? The young people I know who have gone to study medicine are top notch.

Apologies then, everyone I know socially doing accountancy has everything paid for, with rather generous packages. It may not be the case for everyone, but for many.

For doctors none of us ever have any of it paid. There is even controversy over whether we can claim the tax back on the money spent on exams.

@BelleMarionette no, over a one year period almost nobody earns the base salary

1. they don't work nights due to their health condition - presumably hardly anyone falls into this category
2. they don't work in London - ok, many don't but a huge number do
3. none of the specialties that they work in during the year require unsocial hours working or on calls
4. there is never a need for them to work any overtime??????

C8H10N4O2

no this is not true, you are incorrect.
It’s very specific to how the NHS pension is calculated and differs from other public sector related pensions.

As i told you earlier, pay hours worked isn't relevant to the question of why the UK hasn't enough Doc's.

We don't train enough and we don't retain the ones we do.

On waiting lists, you nor your friends would be told that your on a waiting list for a waiting list & no such thing exists.

Why am i so sure? because a very good friend of mine works within the NHS on managerial side (non medical) and has complete over sight on waiting lists in her trust, plus neither the Kings fund or the Nuffield trust have mentioned this in their in depth analysis into NHS wait times.

But again, its not relevant to why the UK hasn't enough Dr's.

Focus on the thread title please.

They may be training in a speciality without out of hours commitments. The London weighting is pitiful, and contrary to what you think, the majority of doctors in the UK don't work in London.

Health reasons are not unusual either, particularly considering the health effect of working in medicine.

I'm not sure why you seem so sure, given you quite clearly do not work in healthcare.

That's horrific.

I think there may well be a case to pay doctors more, or maybe not, I'm not sure if pay is the best way to help increase the number of doctors or not. It certainly doesn't stop enough highly intelligent people wanting to become doctors. It is probably a factor in retention of doctors but I suspect it's just one of many factors, some of which eg working hours and workload, work/life balance, working conditions etc are probably more key than pay rises in my opinion.

What I am sure of is that we need to understand what doctors are paid at the moment and the base salary does not inform this.

@BelleMarionette are you really telling me that there is a significant number of F1 & F2 doctors who work zero hours of overtime over a 12 month period?

There has been a long term failure by successive Governments of workforce planning in the NHS.

It shouldn't come as a surprise. Hunt was talking about this a couple of years ago

committees.parliament.uk/committee/81/health-and-social-care-committee/news/136782/committee-chair-jeremy-hunt-criticises-failures-that-make-a-mockery-of-nhs-workforce-planning/

It's pay and conditions. When graduates can go abroad, be paid twice as much, and have much better working conditions and training, of course many will leave. I have stayed due to family ties, but for many the pull is stronger.

As a foundation doctor my salary didn't even cover childcare. I was on the old contract so my base was even less than it is now.

The pay is dismal, truly.

There have also been years in recent times when medical schools have had to go to clearing, so it is also effecting medical school applicants.