Why are newly trained doctors not getting jobs and leaving the UK when we’re so short of doctors?

[Waterm3]

Just read a worrying thread in education re newly trained doctors being treated really badly and unable to get posts after training. Leaving for Australia/ New Zealand seems to be quite popular.

From my recent dealings with the NHS it seems to be a shortage of doctors that is a huge issue. So what is going on and why isn’t this being focused on more in the election?

What is the point of us as a country training doctors only to not give them work leaving them to emigrate whilst we then recruit from abroad? It’s not cost effective.

There is also a nonsensical cap on how many placements are allocated to training doctors, I think that was put in by the BMA. So that also needs removal/reversal. I guess the BMA doesn't like/want competition. I wouldn't want Starmer near anything, to be perfectly honest 😄 I'm trying hard to not involve myself in politics, but it's not easy.

Not a doctor but other health care professional who leaving to go to Australia. She wants to travel, see the world and has the skills to get a visa ... the UK is seen to be dreary. But, has every intention of coming home once she has experience under her belt ...and if the price is right.

Young educated, skilled adults have so many moreoptions these days.

A third of medical students are from overseas anyway and never had any intention of living and working here for long. But they pay over £30K a year in tuition fees, so cash-strapped universities need them, even though it reduces places for homegrown students.

Junior doctors are very badly paid for their level of expertise. They used to get paid overtime. When the European Working Hours Directive came into force in the NHS that stopped. The overtime didn’t stop. You can’t go home if you are in a busy A&E dealing with patients and there is no one to replace you. But the overtime is not recorded and the pay stopped.

Australia, with its hybrid NHS-insurance system, has far smarter, better equipped hospitals paying medical professionals enough for them to get a mortgage to buy a house. 30 years ago in the U.K. a junior doctor would earn earn enough to have a good lifestyle, but that is no longer the case. Some of them work in war zone like conditions and their take home pay barely covers their rent and utility bills.

It’s the fact they can’t even get jobs that I find worrying.

All of this. Medical workforce planning has been a disgrace for decades.

When John Reid was health secretary, a colleague raised the lack of planning with the DH and the BMA at a meeting I also attended. He pointed out that unless you plan from the top down, so know what service you want to deliver in x years, and by what grade of Dr and how many Drs that would take, then work backwards all the way to the number of medical students you'd need to deliver that service in x years' time, then you don't have a hope in hell of ever getting things right. The DH leaders shrugged their shoulders and said it was too difficult.

There have always been specialties that are oversubscribed, and conversely specialties where it's impossible to appoint to consultant posts because there aren't enough trainees on the specialist register to go round. Those specialties lacking enough trainees run their junior rotas with gaps/agency cover. That makes for a worse experience for those juniors in the specially, so the next cohort won't want to work in it. It's a vicious circle.

My friends son fifth year in medicine is part of the strike this week. It's not just about money btw, they're fighting for their career. He's accepted that he'll probably have to go abroad, his fiancée is in the same boat. He actually wants to be a GP she a consultant.

You just insist your appt is with a doctor. I’ve done it many times after a PA misdiagnosed my elderly mum.

Junior doctors are very badly paid for their level of expertise. They used to get paid overtime. When the European Working Hours Directive came into force in the NHS that stopped. The overtime didn’t stop. You can’t go home if you are in a busy A&E dealing with patients and there is no one to replace you. But the overtime is not recorded and the pay stopped.

That's not quite correct. With the introduction of the 2002 junior doctors contract, a banding supplement was introduced which was a percentage of basic pay. This was dependent on the amount of hours worked and how antisocial they were, but in broad bands (40 -48 hrs, 48 - 56 hrs), so not 'overtime' . Overtime ceased in 2002 when UMTs were abolished. EWTD wasn't fully implemented for junior doctors until 2009.

This. You find out who the GPs are in your practice and you refuse to be seen by anybody but one of them. I appreciate it’s more difficult in hospitals but the problem is mainly focused in surgeries anyway.

One gave my dad some medication for a minor alignment that he wasn’t allowed to take under any circumstances with his long term complaint. Thankfully, we have a real doctor in the family who stopped him taking them pretty quickly.

It really is a disaster waiting to happen if this practice of using cheaper unqualified labour continues.

It’s due to non-sensical medical workforce planning. One of the NHS seems completely unable to communicate to the other part. There’s oversupply of medical students and foundation doctors, but not enough speciality training jobs.

It’s also partly due to increased overseas recruitment. The UK unlike the US/Australia doesn’t prioritise UK graduates for training positions. If you look at GP training this year and large amount are going to overseas graduates. If they will remain in the UK once they finish GP training remains to be seen.

Crap conditions, compromising their registration, bullying, harassment, chronic understaffing, having leave cancelled at the drop of a hat, having to pay insane exam fees, salaries that would be far higher than they are if successive governments hadn't shafted them since 2010 in particular...

Don't believe me? Take a trip to any A and E, especially in the north west of England, and just observe the conditions for ten minutes. Try not to get in the way. If you want the full NHS tourism experience, do it on a Thursday or Friday night before a bank holiday.

You'll mostly (with the exception of a couple of A and Es in Greater Manchester which are generally akin to field hospitals but nowhere near as well organised) see stressed people doing their best with, metaphorically, elastic bands and tissue paper. That level of stress, day in, day out, is not sustainable for anyone. Add that to the lousy weather and rubbish general standard of living and it's amazing we've got any doctors left.

In other parts of the country it's almost as bad but there may be other factors that keep people going - beautiful landscapes or low costs of housing.

Oh, and Health Education England no longer exists as a separate entity, it's been absorbed into NHS England for a while now. Growing our own is a great idea but at some Trusts what exactly happens to at least some of the training money given by HEE has always been something of a mystery, as it certainly doesn't appear to reach medical or nursing or AHP education in any form. Under whoever forms a new government it would be helpful if NHSE could maybe start auditing where that funding actually goes and examining the financial evidence rather more carefully than they currently appear to...

In general for a bit of context around how recent governments have funded the NHS, try this link

https://www.health.org.uk/publications/long-reads/health-care-funding

For those blaming PAs anecdotally quite a few who would like to work in hospital settings can't get jobs as there aren't even any to apply for. There's a handful of GP based roles. At this rate they'll be emigrating too and we'll continue to charge insane visa amounts for overseas trained doctors to come and work here. That's assuming their qualifications are deemed acceptable of course, at least a couple of our friends from the Commonwealth with fantastic experience and qualifications had to redo their entire medical training. And this was an ex colony if you'll pardon the expression with English as the main language...

Your BIL should take up a substantive GP post (salaried or partner). Locums cost a lot but the NHS has been forced to pay ridiculous sums to locums for a long time. PAs are not a good Development for many reasons - the main one being they don't have the prerequisite base line knowledge to practice medicine and can therefore not safely 'play doctor'. However, GPs (and doctors in general) have milked the locums system too long and that needs to change too

And the number of medical
student places and training doctor places is designated by NHS England, nothing to do with the BMA!

Not fair that someone in need of help (so vulnerable) should have to be assertive. The onus should be on Trust leadership to ensure every single healthcare staff a patient comes in contact with introduces themselves clearly and their role in a way the public understands. And really, a PA should not be the first contact for undifferentiated patients (patients that have not been seen by a doctor or advanced practice nurse). That established the relationship and once a care plan is made, actions or aspects of care can be delegated to assistants - which is what PAs are

Yup - PA training will not be recognised abroad in its current form. That is also poor leadership by those that forced and expanded the roles as a form of cheap labour, laced with false promises.

To increase productivity, we need 'Physician Assistants'. Similar to how health care assistants support nurses. Physician assistants can of course go on to medical school and become doctors

To quote previous posters:

“Medical workforce planning has been a disgrace for decades.”

“It’s due to non-sensical medical workforce planning. One of the NHS seems completely unable to communicate to the other part.”

Physician associates were piloted to assist with gaps in the medical workforce as a result of years of poor-planning and terrible management.

They have now become THE problem child
scapegoat for the entire shit-show circus, with the social media warriors conveniently forgetting the issues that led to the role being brought about in the first place. There has clearly been role creep, where in many cases the job has outgrown the original spec. The key question is WHY this is - what are the driving factors?

PA’s are not planning a militant coup to replace doctors. Those I work with just want to work quietly alongside them. We’re missing the bigger picture in a big way here.

The BMA is a union and has nothing to do with training numbers.

I dont think you understand how medical recruitment, or visas, work.

Check out the Additional Roles Reimbursement Scheme for GP Practices. This may shed some light on how clinical roles are recruited.

It isn't true that a third of medical students are international students. The intake of international students onto medicine courses is capped, I think at 7.5%.

But totally agree that pay and working conditions for junior doctors are disgraceful.

From my ds's POV, he doesn't really want to go to Australia but if he can't get a post foundation place here, and he can more easily get a job in Oz that is better paid, with better working conditions, a better lifestyle and where the training he does is recognised in the UK then he will really have no option.
Every political party talks about increasing the number of places at medical school but none have mentioned sorting out the reasons for this brain drain. The junior doctor s' strikes and their dissatisfaction are much more about these issues than money but it's easier to argue about pay rises than overseas recruitment and workforce planning.

I agree, OP, that this issue needs more focus. My dd is about to embark on her medicine degree and at the moment, she absolutely wants to stay and work in the NHS, but who knows whether she will still feel like that in the future when she has seen first hand how bad the working conditions are, and who's to say that she will even get a job at the end of it all. I will be lobbying my new MP to ensure that they start looking at this issue!

Apologies. You are right. I thought the cap had been lifted, but this was hasn’t happened. Universities have asked for it though. It doesn’t change the fact that we don’t have enough places for talented British students to successfully apply for and then we don’t seem to have enough trainee places after graduating, despite a massive shortage of doctors.

@Willmafrockfit
I don't know . If I didn't know her so well I wouldn't have believed my ears ! She was saying how fed up all the nurses are . They feel cheated of the future they were trained for

This is a complex issue and please be wary of sensationalist headlines / SM discussion. You won't get the full picture.

Going to AU/NZ on completion of foundation training has been popular for a while. The majority return home after a year or two to commence specialty training.

Workforce planning requires multiple stakeholders working together. Well resourced teams and effective systems certainly help but are not there in practice. I believe HEE had to reduce their staff complement by 50%? It's easy to scapegoat admin/management staff but they have v little control in this situation.

The task has become so much more difficult due to LTFT, extensions to training, stat leave, EWTD etc.It is also v region + specialty dependent. There are specialities that do have training bottlenecks + high competion ratios. Others, such as GP might not fill all posts available. London is popular while other regions will be seen as undesirable to many. This will be reflected in competition rates. It isnt as simple as just create more posts.

Concerningly, in GP there are more trainees with multiple exam failures and issues around professionalism. There is also a small group who are clinically v poor and require a huge amount of senior support. You won't see this mentioned in debate but is a growing problem. It certainly contributes to the complexity of workforce planning and is v much a patient safety issue.

The current discussion has focused on GP recruitment. In terms of context, practices have been struggling to recruit for salaried roles/partnerships. Locum market boomed with premium rates that practices could barely afford. Not sustainable. Using PAs to provide cover is obviously inappropriate.It is an unscrupulous minority doing it.

As a patient, I can only express my concern about the toxicity of this debate. So much misinformation and pointless baiting. There are multiple issues at play here. We need to be mindful to keep context in mind: an underfunded healthcare system with ever increasing demand.

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