All the doctors I know are leaving. Are we going to be screwed for healthcare in 5 years time ?

[Gigihadr]

Our NHS now has some of the worst health outcomes out of 19 wealthy nations compared in an international study.
But in 2010 the NHS regularly ranked 1st or 2nd in most international studies.

The UK is under-doctored, we have a 3rd fewer doctors per 1000 people than Germany or Spain

Our government response to the doctors we have left has been to erode working conditions and pay, ensure they have record levels of inflation and rocketing student debt

They are moving to better paid, better resourced systems/employers (they are a competitive international commodity) and I can’t blame them for that.

AIBU to think we are utterly screwed? why are we just sitting back and watching this slow motion car crash ?

Of course we’re not going to be screwed in 5 years time - don’t be so silly

We’re screwed NOW

Probably, unless there’s a change of Government next year.

Sadly this is common.

ANPs used to be highly experienced ward nurses who'd specialised in a particular area and could advise about e.g. diabetes management for inpatients.

Now people specifically study nursing to become ANPs because it's good money and they can pretend to be a doctor. So they don't even benefit from the extensive (decade+) nursing experience that used to be their selling point.

At this point the ward domestic may as well be given a stethoscope and a copy of the BNF to "streamline patient care".

Anything but pay doctors what they're worth.

Well no surprise I guess. We already have nurse and midwife apprentices. Not long after the govt withdrew nursing and midwifery diplomas and said they were graduate professions. I get that they still do a degree as apprentices so not sure why it’s needed? Probably to do with the student not paying so widens participation and potentially increases numbers. But surely that’s not needed for medicine where demand for the course exceeds spaces.

med school places were reduced last year mainly due to there not been sufficient training places for students on qualification. This was a couple of years after opening 5 new medical schools! 🤷🏻‍♀️

Yes. Managed to see the GP last week whos confirmed my diagnosis of an unusual medical condition. Which potentially has cardiac involvement which could result in me dropping down dead any second. Year wait for the specialist. GP cheerily asked me if there’s a family history of sudden death.

Nursing and midwifery courses are also very hands-on.

Medical degrees are highly academic, as being a doctor relies on having in-depth understanding of the science behind physiology and pathology. Which is why most medical degrees still follow the 2 years pre-clinical hard sciences, 3 years clinical placements model.

It just wouldn't work as an apprenticeship, shoving 18 year olds onto the wards to work from day 1.

And in the same breath as fantasising about “apprenticeships” they now announce they will increase medical school places in the new “workforce plan”. But will there be any senior Doctors to supervise them? It all seems very confused and panicky to me. Too bloody little too late.

Nursing and midwifery courses are 50% theory. 2300 of academic teaching over 3 years. We should be producing registrants who have the academic rigour as well as the practical skills.

Meanwhile ignoring the totally artificial bottlenecks they've created in postgraduate training.

Every year so many excellent candidates fail to get into core or specialty training and languish at SHO level or are forced to emigrate.

They would immediately have more trainees and consultants if they stopped limiting training posts.

Don’t worry the physician associates can look after them.

years ago as a band 6 midwife I used to teach the med students weekly when on their obs and gynae rotation. They were meant to have clinical teaching from a consultant but they were too busy so they subcontracted it to me. And paid me! Can only imagine it’s worse now.

We either have a free at the point of use NHS and doctors earn what they earn now, or we have an NHS partly funded elsewhere (perhaps via employers contributions such as in Germany) and doctors get the remuneration they want.

Currently doctors proclaim to love the ethos of the NHS but piss off aboard because they don’t like the associated pay. Seems a bit hypocritical to me, and the UK public are suffering.

Let’s learn from systems other counties use, get other funding streams on board and get a better NHS.

Christ 🤦🏼‍♀️ some of the doctors we get through now are half clueless and terrifying to work with!

Yes that's right. I age by at least 3 years every time I try to book an appointment to see my Dr.

The pay is not rubbish. It's low at the start but there's good career progression. Why wouldn't they be paying for housing? We all do.

Also diversifying the medical field with different career routes is a good idea. Shorter career paths to get people into the workforce and specialising earlier in their career - no rotating round specialties they've no interest in.

That’s right blame the people who have paid tax all their lives for the screw up now happening!
l

Stating that they are issues with our changing demographics doesn't mean older people haven't paid tax.

Honestly I despair at the stupidity.

There's money to pay PAs £40k as new grads but mysteriously doctors aren't worth that amount.

You are not wrong, all public services are crumbling to be honest, they have been held up by goodwill for a fair few years but post covid that's (rightfully) crumbling. The government's plan, instead of addressing retaining doctors, is to just introduce lesser qualified and lesser experienced 'associates' and hope the public doesn't notice that patient care is being compromised. They're also not listening to doctors when they say it's not just money but things like a lack of training places, anaesthetics for example is highly oversubscribed so many doctors don't get to enter the programme; the government's plan to address a shortage of anaesthetists? Introduce a lesser role instead of investing in doctors. Outrageous and downright dangerous. More will leave, be interesting to see the results of the consultant strike which are due this week.

What exactly can physicians associates do? They can't prescribe and they can't order x-rays. I live abroad now so I've missed the introduction of them - heard them talked about but what is the actual point of them?
Is it like 20 years ago when teaching assistants were being made to teach whole class lessons (planned by teachers) basically to save money on salaries and yet so many of the TAs I worked with felt really uncomfortable with the whole thing because whole class teaching was not what they signed up for and not what they had trained for and they were being taken away from the very valuable roles they originally had.

The pay is not rubbish. It's low at the start but there's good career progression. Why wouldn't they be paying for housing? We all do.

pay is rubbish for many people particularly younger ones because of wage stagnation. 35k in the early 00s is equivalent to 63k now...

Of course they should pay for housing but again housing takes up a much higher % of a younger persons income then it used too.

My point was of course talented people will look abroad if they can get a better deal.

Well why can't junior doctors opt out of rotating then? Most hate it and find it adversely affects their lives yet they're forced to. Why can't they specialise sooner? Filling these gaps with less knowledgeable and less qualified people is dangerous and reckless. PAs for example were introduced to support doctors, now they've started to branch out into all sorts of areas.

It’s perfectly possible to have an excellent NHS and fairly paid well motivated Doctors. Why do you assume that isn’t possible? It’s all about political choices, and the public need to accept that healthcare staff aren’t working for a charity!
When my dh became a consultant in 2004, the NHS was doing well, there had been a big investment from the Government of the time, Dh felt well paid, he was able to keep on top of his workload, and was proud of what he was achieving. Waiting lists were at an all time low, he was instrumental in the rolling out of the National Bowel Cancer Screening Programme.
Then in 2010 came a new Government and austerity, very quickly the effects began to be felt, and now here we are……
Oh and he hates his job now, he’s totally burnt out, and despairs at what has become of the NHS that he used to love.

Regarding housing they're forced to move around if they want a job, military are too but they get cheap digs, why not JDs whilst they're forced to rotate? A JD also has huge responsibility and is a qualified doctor from the day they start F1, I don't see why well they progress and eventually get more is a decent reason to not pay them fairly.

They can't do anything.

They were originally called Physician Assistants. The point of them was to do cannulas, take blood, scribe on the ward round and write discharge summaries so that junior doctors could actually attend clinics, gain theatre experience, receive training from consultants and be trained to perform procedures essential to their role (chest drains, LPs etc).

But PAs have pushed to diagnose and assess patients like doctors do. Yet they can't prescribe or order scans. They are trained to examine patients and read test results but only have 2 years of education and their courses don't require significant academic achievement.

Essentially you've got pseudo-doctors practicing medicine without a license, and only doing half the job as well.

(For over £10k more a year).

@Afishcalledwand well we were paid 35% more in 2008. I’m a junior doctor (new registrar) and it’s only in the past 20 years that our pay has massively dropped.

Everyone’s pay has dropped in real terms but none more so than doctors. When I become a consultant my pay will be HALF of what I would have been paid in 1999/2000 in real terms.

I got top A levels, I have a 6 year medical school degree, I have passed royal college post grad membership exams (paid for myself as all doctors do) and multiple other compulsory assessments. I’ve been a doctor for 5 years.

As of August at night I will be the most senior medical doctor overnight in the hospital. I will be the first called to lead cardiac arrests and other emergencies. Alongside my colleagues in ED and critical care I will be called to see the very sickest patients in the hospital.

For some reason my hourly rate is far below the advanced nurse practitioners that I work with who (whilst being fantastically skilled) do not have the training or level of responsibility that I have. I will earn less per hour than other professions that I supervise.

Physician associates who do not go through the rigours and demands of junior doctor rotational training and only have a 2 years masters and are not allowed to even prescribe paracetamol are paid more than many junior doctors.

We have made huge professional and personal sacrifices. We work longer hours than anyone else in the NHS (before overtime our “full time” contracted hours are usually 45-48 per week (unlike rest of nhs on 37.5/40).

We feel so undervalued and demoralised. With the cost of commuting to hospitals we get sent to at little notice, finding childcare to cover shifts, professional fees and paying for our own exams if you’re now two registrars in acute specialties you literally cannot afford children and a house.

I wish I’d been an ANP. Better money, less responsibility, more autonomy over where you work and consultants treat you better as you don’t keep rotating.

Im striking again in July. Because our pay and conditions are intolerable and I’m terrified that so many of my colleagues are leaving, I’m really scared that no one will stay and become a consultant in the UK. If I need surgery I want the best and the brightest operating on me, but they’re leaving for Aus/NZ/canada/pharmaceuticals/law.

@Chocolateship As long as the training is solid then why shouldn't PAs branch out? Are they not allowed to build their careers too? I think juniors should specialise earlier.

I think doctors have enjoyed the prestige of the career for a long time - they will have been top in their school, top a uni, move into a prestigious career and now hate the idea of some of that prestige being taken away.