AIBU to be furious that there are no jobs for young doctors

[Needmoresleep]

Yes, you read it right!

At the end of their two foundation years (F1 & F2), young UK trained doctors are struggling to find work. They don’t want to go to Australia or NZ but for many this will be the only option. Seven or eight years study and work down the drain.
The UK supposedly has a shortage of doctors, so immigration rules have been amended to encourage overseas applicants. They then complete equally with those who are working in, or studied in the UK for both general entry level jobs (known informally as F3s) and for speciality training positions.

The average hard-working doctor does not stand much of a chance. Anecdotally even quite ordinary vacancies will attract hundreds if not thousands of on-line applications. The NHS does not keep statistics, but it appears that to keep numbers manageable many NHS Trusts will shut applications within a few hours. Tough for the junior doctor who is at work or sleeping off a night shift. The best from overseas will be very qualified with perhaps a decade of experience, and lots of additional bells and whistles, so it probably does not matter. They will score better so the chance of an interview for a young doctor who needs to build their own experience will be vanishingly low.

The expansion of medical school places, and allocation of some of these traditional entry level roles to Physician Associates is only exacerbating the problem.

Training positions are even more competitive. The Government has introduced a number of incentives to encourage applicants from overseas: exemptions from exams, guarantees on training and promises for British citizenship. Medical school places have been expanding without a parallel increase in training opportunities so bottlenecks would have happened anyway. In 2021 36% of new trainees were from medical schools outside the UK. In 2023 it was 41.5%. This trend is expected to be continuing, even accelerating.

A group of us have been on the higher education board since our DC were applying for medical school. They are now F2s spread across the country, working long hours for relatively little pay but enjoying the contribution they are making. None of them expect to get either a short term contract or a training position, so are applying to Australia or accepting that they will be reliant on zero hours NHS bank work covering staff absences.
As taxpayers we should be concerned that we are paying for medical schools, yet the NHS is not supporting their graduates into employment. We might also question why we are not giving priority to those already working in the NHS for the limited training slots. Doctors from elsewhere may be very good, but a significant proportion are then likely to leave to return home or to take up well paid private consultancy posts in either their home countries or in medical hubs like Dubai or Singapore.

Keir Starmer has said he will review sectors seeking labour from abroad to ensure that applications for the relevant visa routes, whether it’s the skilled worker route or the shortage occupation list will be balanced with expectations on training people here in our country. Wes Streeting seems to be refusing to answer questions on the topic. Whilst last week the BMA finally issued the following statement, albeit limited to training:
https://www.bma.org.uk/news-and-opinion/bma-statement-on-speciality-training-application-bottlenecks

Any action will be too late for our DC. When they applied for medicine they did not realise that it would mean having to leave the country. The hope has to be that a way is found to retain those that follow and to allow our impressive young people to be able to return.

Thank you for highlighting this shocking issue. To ensure the future of the NHS, I hope the government gives it the attention it deserves.

It's strange as it's so fiercely competitive to get into medical school but then the terms and conditions are appalling at the end of it. I think whilst there are so many people applying and desperate to become Drs the government won't do anything to address the issues. Hopefully I'm wrong.

The Government seems to have gone overboard to recruit doctors from overseas, offering incentives and guaranteeing training, but seems not to have realised that they need to do similar for doctors already in the country. The young doctors I know want to be "retained". They want jobs and training. But competition levels, both for jobs but especially for training, are now bonkers. The sort of CV needed to be interviewed for specialist training, even as a GP, is extraordinary. Prizes, published papers, conferences. Some manage, but for many coming off a 13 hour busy night shift, hitting the books is not the priority. Yet these dedicated, resilient work-hard play hard doctors, who prioritise a work-life balance, should be forming the future backbone of the NHS. We need more than just academic doctors.

Why are we reaching out across Eastern Europe, Africa and Asia, but not offering the same opportunities and support to those who are here. Those, the tax payer has spent so much on training.

No research seems to have been done into why F2s are not applying for jobs and training. All but two of DDs last placement were planning to look for work abroad. Not just because the climate is better, but also because they don't have the time to apply for hundreds on short term F3 positions across the country in the hope that they can beat worldwide competition and land just one. It's sort of unbelievable.

I can appreciate that this creates larger issues and the problems in the NHS are well known, but surely most professions are highly competitive at entry level? For example, getting a training contract in law is highly competitive and is likely to become more so now that the new SQE process is being embedded.

The imbalance surely happened years ago when the BMA decided to restrict the number of students and training places?

To add, it is awful for the individual but it is very similar to the action of market forces on all kinds of jobs. Fundamentally, we have an imbalance between the number of highly educated people and the number of jobs that are available for them to do.

I don’t like it either, but I’m not sure what the answer is.

The situation described is the opposite of natural market forces. The NHS is the only employer and has complete control over whether a young doctor progresses or not if they are to reside in the UK.

This has been a problem for decades certain specialities will mean travel to all over the country. My DH spent 6 months attachments in the north for one and then the midlands and then the south east etc...it was a nightmare tbh. He had to change to an unpopular speciality in the end so he could stay in one location.

Thank you for highlighting this issue. It's one thing having to move to areas of the UK to continue training, but quite another to have to move to another country, on the other side of the world.
These young people don't have the luxury of more than one employer - it's NHS or leave the country to continue.

Thank you for highlighting this scandalous issue. Everything you have said is true. Something needs to be done about it.

I know several doctors who moved to AUS shortly after qualifying in the UK but they didn’t do it because there were no positions available here, they did it for the hugely increased salary.

It's completely ridiculous and shortsighted to import doctors whilst denying training to those we have qualified at home. It will create a long term problem. It's also unethical. There is a school of thought that the aim of this is political.

Prizes, published papers, conferences. Some manage, but for many coming off a 13 hour busy night shift, hitting the books is not the priority. Yet these dedicated, resilient work-hard play hard doctors, who prioritise a work-life balance, should be forming the future backbone of the NHS. We need more than just academic doctors.

Yes this has always been the case. My DH was doing 100hr weeks in the early 2000s revising for his surgical college membership on top of doing courses etc...and applying for his next 6 month rotation which might be in the Isle of Man if he was lucky.

Or nurses or midwives. Despite a national shortage, due to funding there's a recruitment freeze so hundreds of newly qualified and band 5 nurses and midwives are struggling to secure jobs which is wild.

@BadSkiingMum Surely law applications are mainly from the UK. Also in medicine there should be enough jobs (though not specialist training) to go around.

The new (2021) issue is a government decision to offer jobs and valuable training opportunities to applicants world wide, without giving any form of priority to doctors already in the UK. Indeed they have committed to exemptions, incentives, training guarantees and support to applications from overseas.

The result is that even short term locum contracts will receive hundreds if not thousands of on-line applications with a few hours.

In contrast F2s within the NHS work long and often anti-social hours, so job search is tricky, and get no support or protection.

The government seem to have decided there is a shortage of doctors without delving into why, so is looking for gaps to be filled from overseas. The failure to lend support to doctors already in the UK means they have little option but to look for work elsewhere. Therefore exacerbating the perceived shortage. I

There may be an argument to opening up the UK professional job market completely to worldwide competition in that it would allow us to recruit the best. Salaries in the UK are a lot higher than, say, in some parts of Africa, so a successful applicant is likely to have a lot more experience and a stronger CV than a UK F2, indeed more than is needed for an entry level job. However if this is the case, why is the government increasing the number of medical school places. It would save taxpayer money if they just closed all but a few elite schools. It would save a lot of heartbreak eight years down the road.

I think a market analogy is fine? Yes, there is a single purchaser of medical services (the NHS), but a huge and highly varied number of suppliers (young doctors). The market is imperfect (a lot of suppliers cannot sell what they are offering), but it is still a market.

How did the average British skilled tradesman feel in the early noughties when his local area suddenly received an influx of qualified, English-speaking young Poles with low costs, plenty of enthusiasm and a strong work-ethic? That is where the seeds of Brexit were sown.

A lot of professions that were previously considered guarantees of employment will now become vulnerable to external forces in the next few years.

This is just so wrong. Healthcare in this country from top to the bottom needs a complete overhaul.

British medical graduates should be prioritised for British jobs like it used to be, before the government changed things for in 2019 and allowed any doctor in the world to apply with zero restrictions.

i understand there may be a shortage of qualified doctors to carry out procedures but how can it be fair to pump up medical school places and then ramp up competition from abroad so much that U.K. grads can’t get jobs?

I’ve heard of thousands of people applying for one post and the application shuts early but a U.K. grad can’t apply because they’re actually working in one of our hospitals!!

Such poor poor planning on the part of government yet again.

Indeed the Australians certainly seem to value and reward their doctors much more than we do in the UK. Some will be motivated to move by that. However, there are many more young doctors who genuinely want to stay in the UK and work for the NHS that they chose to be part of when they started medical school. Stockholm syndrome perhaps but they should get the opportunity to stay in the UK and work here as a doctor. It costs so much to train them. Why don't we want to keep them?

I agree not everyone is motivated for money. This doctor on Reddit is advising others to move because they just can’t get the work here.

https://www.reddit.com/r/doctorsUK/comments/17m0gy7/f3_is_dead/

I think a lot are going because they have to, not because they want to.

I accept it was always tough to get into competitive specialities. With unprotected worldwide competition for scarce training places, the prizes and whistles arms race is a lot worse now. Even for GP training which, for good UK applicants, used to be reasonably straightforward .

However the bigger problem is that it is now near impossible to find any job post F2 where a doctor already in the UK can gain experience and put together the CV needed to apply for training.

In the past overseas doctors coming to train in the UK would probably stay within the NHS until retirement. The proportion of International Medical School graduates taking up training places is now creeping up towards 50% and it is now much more likely that once qualified they will leave for lucrative private practice in either their home country or in international medical hubs like Singapore or Dubai.

Yet these dedicated, resilient work-hard play hard doctors, who prioritise a work-life balance, should be forming the future backbone of the NHS. We need more than just academic doctors

The key phrase there could be 'who prioritise a work-life balance'.

Is it that the young doctors who aren't securing training posts are the ones who don't push quite hard enough in the first two years? Prioritising work-life balance isn't something that a lot of clever young graduates can afford to do. That's true of so many graduate jobs.

Work-life balance is a dream for some, during that early phase. Being successful as a doctor has always been notoriously hard. Playing hard as well as working hard is the ideal for sanity but at some point these young doctors do need to do the things which which secure training and promotion, and that, unfortunately, requires re-allocating time that they may well prefer doing pleasanter stuff. The rewards are for later.

Expect Reform to get in then next time around…

Why should we allow this?

“A lot of professions that were previously considered guarantees of employment will now become vulnerable to external forces in the next few years.”

Do you mean unfettered immigration?

Why should the NHS be a offering opportunities to a global population and not prioritising British grads?

No OP is talking about some doctors who are prepared to have no annual leave for years. This is what is talked of on forums. You’ll see some people come here who are prepared to sacrifice everything to make it. But is this healthy?

Would you like no holiday for several years?

I don’t think some people understand just how challenging this industry is.

Much worse now. Those attachments even in hard to recruit hospitals and in unpopular specialities will be attracting hundreds of applicants. No chance for the F2 who misses the very short application window because they have come off a 13 hour night shift and need some sleep.

Where as our Trust I work for is really struggling to get Doctors - but psychiatric and community work, not acute hospital.

They are not scared of hard work or moving. They just want a job. Twas ever the case that training is hard. The issue is them not getting the training opportunities they need to develop as doctors.