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?

In his F1 year, my DS only had 1 rotation with any kind of unsociable hours/weekends in it - not overtime though he works at least 20% of every day for free. So 2/3rds of his F1 year was at base rate. This year, he has 2 rotations with weekends etc so he will get paid for those hours. However, he hates working a 14 hour shift in a hospital where he is usually the only one available surgical cases for his hospital and also one in the neighbouring town, no food available and the Doctors Mess is 10 minutes walk away and he doesn't have time for that. He spends the extra money he will have made that night on a full English breakfast on the way home. He doesn't think the extra money is worth it.

There is never any shortage of people who want to become doctors and who have the intellectual abilities necessary.

This is the case in the UK even given current pay and conditions. There is no issue finding people who want to train to be doctors, that's very clearly not where the problem lies.

Absolutely, the night and weekend allowance is only for time worked. It's not 'free' money as purported by the OP. It can also involve a lot of extra expenses, including childcare (which is prohibitively expensive out of hours).

That's because a significant proportion will take their degree and go abroad.

If there is such a glut, then why do medical schools need to go to clearing?

@BelleMarionette once again, I have never said, or even suggested that doctors receive any "free money", your repeated accusations are completely without basis in reality and are frankly ridiculous.

@BelleMarionette
"If there is such a glut, then why do medical schools need to go to clearing?"

I don't know, could be any number of reasons eg they didn't allocate enough places originally.

And going to clearing is no real problem if there are loads of suitable A grade students ready and waiting to take up places which is the current situation.

But retention is a huge issue.
To say there is no need to improve pay and T&C s because there are lots of intelligent youngsters applying to medical school is wildly short sighted.

there is a huge shortage of actual doctors. So what if there is no shortage of school leavers applying for medical school.

the pay erosion and conditions need addressing to improve retention

Your insinuation that the quoted base salary is not realistic is frankly rediculous. I have said this many times, this is what many earn. Those who work more, get a little more.

Retention is the biggest issue, and needs tackling. Retention is down to pay and conditions.

Medical schools going to clearing indicates reduced demand for medical school places. This is an issue if it means choosing candidates who are not suited for the profession. Contrary to popular belief it's not all about academic ability.

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@BelleMarionette the base salary isn't what most earn and the majority earn around 25% more than this.

I absolutely don't think it's true that we don't have enough people of the right calibre in the UK who want to train to be doctors. Your opinion may differ.

Retention clearly is part of the problem, I agree with this.

And raising my head above the parapet here, I am a speciality registrar, nearly 10 years post qualification from medical school. I work an on call rota. My current salary, including London weighting, is 44k. I can send a screenshot to prove this. I am working over 35 hours a week.

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.

To be fair, the reason for medical schools going into Clearing isn't a lack of high-quality applicants. It's the uncertainty about how many will accept offers (given that they might have multiple offers) and how many of those will achieve the required grades. Medical schools were more or less told by government last year to go into Clearing rather than risk over-recruiting. Because of the instability of A-Level grades in the previous 2 years (and, to be honest, since Gove's "reform" of A-Levels a couple of years previously) it became very difficult to predict how many students we would end up with for a certain number of offers. We have ways of dealing with under-recruitment (e.g. Clearing); dealing with over-recruitment is very difficult and ruinously expensive, so we do whatever we can to avoid it.

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consultants definitely don’t get much above the base published rate.
As explained earlier, £16.50 for 24 hours on call on a Saturday or Sunday. I’m definitely worth more than £1.45 per hour, thanks

Sorry that’s after tax.
I should say £2 or so per hour, gross
Erm still disgraceful

For at least 50 years, probably more. I understand there was a massive recruitment drive to encourage foreign doctors to come to the UK as far back as the 1960s.

It seems that successive governments for decades havn't grasped the nettle on this problem. Though I do seem to remember that Blair's new GP contract in the early noughties was supposed to "solve" the GP recruitment/retention problem. Well that worked well didn't it?

I am a junior doctor. There is a massive problem with retention so there may be lots of people wanting to train as a doctor but if you can’t retain them. I am 7 years post medical school and know of at least 12 doctors in my graduating class of 150ish that either have left medicine altogether or work abroad. I am not in touch with my whole class so the figure is likely to be more.

Whilst you could increase the number of places at medical school in theory there isn’t the capacity for training places once these people graduate. I am a GP trainee and they are struggling to find enough practices to take on registrars as there are certain criteria to be met and my supervisor has to complete supervisor training etc. In theory you can offer the funding for more, there aren’t the actual posts for us to go into.

Now I’ll probably be shouted down for this but I am one of these trainees who work part time. This is for many reasons. I work 60% so in theory 24 hours a week. In reality if I take patient care activity alone I work about 30 hours a week. However on top of that I have to complete my training portfolio that has mandatory requirements- that is at least an 3 hours a week of my time. I also have to study for my exams- which I pay for at between nearly £500 and £1100 an exam. Part of life is generally working more hours than is contracted but the pay is poor for the level of responsibility and experience I have. Now I will get flamed for this but I looked at increasing my percentage but by the time I have paid additional tax, membership fees to the college, my indemnity insurance, my pension and student loan contributions I will be no better off. Why add to my stress levels when I won’t be financially any better off

Could you create specific training roles? A burnt out doctor might consider moving into a training/mentoring role rather than quitting altogether. It would keep them in the field plus support new students coming through. A hospital would presumably need a variety of these for different specialties, but they would pay for themselves if they increased student numbers and retention.

I'm a hospital doctor. I used to be a trainee (a qualified doctor, training to be a consultant in a particular specialty), paid according to the payscales referenced already. The comments about payscales etc seem to be implying that there is deliberate secrecy about what doctors earn. I don't think that's true.

There are 2 types of work over and above the "standard 9-5", as I see it:

1. Unpaid overtime - all professional jobs have this I imagine. My husband is an accountant and he has this, as do I as a doctor. Coming in early to prep for the ward round. Routinely leaving at 7pm instead of 5 because of the volume of work. Skipping lunch, studying for (essential) postgtad exams. Doctors don't get paid for this.

1. Paid antisocial hours, which attract a supplement on top of the basic salary in the salary scale. These vary so widely from post to post that, as a previous poster has said, to reference an average is meaningless. The supplement is calculated according to the percentage of rota-ed hours that occur "out of hours" and their frequency and timing. (Of note, "core hours" are defined as 7am - 7pm.)

A junior doctor may be on a training programme with 4 month rotations. Each rotation may have different scheduled hours, due to the specialty, hospital and level of other staffing. So you could absolutely have one post with no on call/out of hours commitment followed by one with lots of night shifts, etc. Junior doctors have little control over which exact posts they will be allocated to early in their training, so their take-home pay can be difficult to accurately anticipate.

Here is the BMA page about out of hours supplement, with specifics: www.bma.org.uk/pay-and-contracts/pay/pay-banding/how-pay-banding-works

Most jobs I worked as a trainee were technically 2B, for context. The important thing to note as well is that in order to be a 2B rota (for example), the average working hours over a period of weeks need to fall within the hour listed. The actual week's work would vary hugely from week to week depending on whether I was on nights/days etc. HR seemed to employ some creative tactics to ensure rotas were compliant whilst working me like a dog! (Often the medical staff would dispute that they WERE compliant - this is a whole other thread.) However, I would say this was a huge underestimate of my actual working hours. As with any professional-type job, I was working hours and hours of unpaid overtime per week.

I would also say that as a trainee, I had huge responsibility and pressure. As a 3rd year Doctor, I was the most senior person in a large DGH overnight and was genuinely making life and death decisions.

I was also absolutely rushed off my feet, chronically underslept, and spending every free minute studying for my postgrad exams. Don't even get me started on being allocated to a peripheral hospital (not my choice) an hour away from my house, and having the joys of working e.g. 9am to 10pm at the weekends, and sets of four consecutive 12 hour nightshifts, without hospital accommodation. It's a wonder I didn't kill anyone on the motorway on the way home.

Your joking - no wonder Docs are going abroad - £44k is very low.

The UK needs to pay properly and avoid penalising people with higher rate tax. And Scotland is worse for that than England is.

@Lapland123 surely you get £1.45 an hour if you are not called in but get your hourly rate on top of you are called in for hours worked? Is that correct?

I'm really talking about junior doctors salaries rather than consultants here though.

The thing with a lot of high powered,high pressure, high pay jobs is that they seem like a great idea in your teens and 20s. I was fixated on the idea of city law, got the silver circle training contract but started looking at the life my bosses and people ahead of me on the career path had and realised it wasn't going to be worth it.

As a young 25 year old doctor with colleagues you like plus your parents in their 50s/early 60s work taking over your life is kind of ok. Fast forward to marrying a fellow doctor, your rotas seemingly deliberately set so you never see each other, having to scrabble around to swap shifts so you can attend family and friends' weddings (or even your own) booked as holiday on the rota system a year in advance, parents getting a bit older and you wanting kids, you start needing more balance in your life...

Probably one of the biggest cheap solutions to retention would be rotas being set with some consideration for long time booked things like weddings, possibly even predictable days of the week off to facilitate hobbies, childcare and having a life and trying not to be shitty about it rather than seemingly deliberately putting shifts in to be as inconvenient as possible.

What was most peoples experience of getting a GP appointment in the 2000's and onwards?

I don't know what other peoples experiences were but even as a child in the 70s, it was very easy to get GP appointments.

In 1997, it was an approx 2 year wait for heart surgery, 10 years later that was down to 3 months.

But what i just don't understand is how people cannot grasp that Austerity, Brexit then finally Covid has had on this country generally, let alone in Healthcare where we also have vastly increased demand, which spending and training just hasn't kept up with.

Retention clearly is part of the problem, I agree with this.

Retention is the biggest problem imo. If you cannot retain your doctors, then not are you losing their skill in treating patients and the money wasted in training them, their leaving also means a shortage of people able to train the next generation of doctors.

The problem, of course, is that the damage to the profession has been done over the last 10+ years and will take at least that length of time to fix. No government is going to be okay with that because it is more than 2 election cycles. So they go for the headlines "training more doctors than ever" and missing off the crucial "but not enough to replace those leaving". Or "paying doctors more that ever" missing off "but not enough to keep up with UK average wage inflation". They do exactly the same with teachers, nurses, police officers, railway workers etc. Headlines over substance every time.

Sorry, that’s just nonsensical. I teach at three different (private) schools where there are vast amounts of ferociously clever, well supported students who make the grades but from whom there are no
medical school places. So they go abroad to study and stay there. Not denying there’s a problem with the poverty gap but universities are taking more state students than ever. What you are asserting isn’t the problem.

But they are already giving return of service and have to di so to progress to independent practice. They also have to pay an amount for the privithrough MDU GMC and Royal college fees and exam fees. Those are paid by the doctor after Foundation stage.