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.

Well exactly. Your DS must have had a good amount of energy to cope with a day or work ontop of his studies. Not everyone is going to be able to sustain that intensity. But it doesn’t mean to say they wouldn’t make a good doctor.

I felt extremely guilty PlopSofa. DC did it to make ends meet at the time. It wasn't an exercise in proving resilience.

Old contract they could

One of DDs friends got caught up in an inquest. She only had a small role in the patient’s care and even if blame could be attached to anyone, it was not going to be her. It was still a huge pain in the butt, delayed her F1 approval and hung over her for a while.

Similar could happen to any of them at any time.

Five out of six of DDs placements have involved patients who die. Elderly patients who come in from care homes, drug addicts who have overdosed, day surgery patients who are too unstable to discharge, those admitted after pub fights. Both placement hospitals have been in very deprived areas. She has had plenty of nights where she has had to make on the spot decisions about which very sick patient to see first. The other placement was a quite a specialist day clinic, albeit with patients suffering, effectively, terminal illness. She has been given a lot of responsibility.

There are 46 medical schools in the UK now. 16% of school leavers achieve AAA or better. The historic medical school where I was involved asks for AAA but contextualises that down to ABB and explicitly prioritises non-academic criteria over academic.

When I went to medical school only 8% of school leavers went to university and medical schools had the highest entry requirements. Afterwards, instead of having shifts limited to 13 hours, juniors worked continuous on-call shifts of 32-80 hours. Part time jobs had not been invented and it was more usual than not to move to different parts of the country for work. A very large but undocumented number of perfectly able doctors ended up in specialities that were not what they wanted.

Since 2023 there has been no reserve list for foundation year training. (Contrast this with Law where in 2022 there were 34,000 admissions to law schools but only 5500 training posts.) The situation at CT1 is nearly as good, and stable, in 2023 for Internal Medicine there were 2.64 applicants per post as opposed to 2.55 in 2013.

I therefore don't recognise much of what you say. Junior doctors have been disgruntled ever since the EWTD was implemented (when they lost the right to be called resident). The Marxist element in the junior's section of the BMA capitalises on this now, feeding into a vicious cycle of anxiety that extends to the helicopter parents of graduates, a significant number whom were not selected for academic ability or resilience. It goes without saying that they do not all lack these qualities and those that have them will undoubtedly succeed.

On F1/2 the doctors rotate through various specialties. So will definitely be involved in life or death decisions.

Thank you. As it stands her hourly wage is much less than the minimum rate due to the huge amount of hours she works (they have to commit to open ended, unpaid overtime). Annual leave is generous but can only be taken within very strict, prescribed timelines e.g. she cannot take any leave between start of January through to the start of April. No exceptions.

She can access a very generous Wellbeing Fund though which pays for her fancy gym membership and private medical & dental care. Something that junior doctors certainly don't get.

They are worked like dogs but that is the price they are willing to pay in order to be earning £100K+ by the time they're 30 (assuming they can last the pace).

Yes, obviously. The idea of rotations is exactly to expose medical students to a variety of specialties and situations.

However there are a good number of hospital departments where almost any death would raise concerns. On any common sense basis it's manifestly not the case that every patient every doctor sees is a high risk patient.

Ouch.

Obviously. However F1/F2s are used to cover nights. So lots of scope to have a crisis.

Well again, not on certain wards without the random intervention of God or some spectacular feat of medical negligence.

.I don't think they are getting visas in the basis of shortage occupations. They are applying for a Skilled Worker Visa and the list of eligible occupations appears to be all of them.
See gov. list here

Eligibility is simply a minimum wage - set around £38000 I think. But under 26 year olds can apply and be paid £30000, even if the job would normally pay more. And those with a STEM PhD can be paid less than the usual going rate.

Placements apparently vary a lot from deanery to deanery. Some F1/F2s are not expected to work any nights. DD had a lot. F1/F2 rotations are now allocated, not chosen. It is much easier to make time for job search or study if you are working close to standard hours.

@Needmoresleep

My DC will go into F1 next year, and confirms this to be the situation. Has always believed in the NHS and wanted to work for it.

I have only read your posts, OP, so may have missed much. Have you contacted any reporters yet?

There is a regional BBC reporter in the next village, so I gather. I could ask her if she would be interested in this issue (but I don’t know her). I realise it’s not primarily a local issue, but I guess the NHS affects all regions, and she’s the only reporter I have contact details for. Let me know if you think that’s worth a shot, or if you have other plans at this stage.

There are plenty of decent doctors around who would not walk out like this. Because of loyalty to colleagues and patients. Because they know it’s a shit system that they are in and management can be harsh.

It’s a disgusting thing to call them ‘wet’ , and you saying its a ‘test of mettle’ all but condones the stupidity of the system. You remind me of the doctors I used to work with who used the line, ‘back in my day we worked 150 hours etc so current doctors have it easy’ . I did 56 hour oncall shifts in the 90s, but I am pleased that residents no longer have to do that. None of this tests strength and none of this is a mark of being a good doctor.

Leaving colleagues in the lurch does not a good doctor make.

I feel sorry for any doctor being refused leave and having to change their wedding day. I would never consider them wet. Quite the opposite actually.

squashbuckled

It is extraordinary. There are jobs, there are lots of good doctors already in the UK. We should not be bringing in more unless we genuinely have posts we cannot fill.

We are hoping people will raise the issue with their MP, and any other useful contacts they may have. Someone has suggested a petition.

We, ie a group of F2 mums who discovered that almost all our DC are reluctantly having to go abroad. The next step is a draft letter that people can personalise or amend. Then to get as many people as possible to send it to as many influential people as possible.

Which bit are you not relating to?

Certainly in the late eighties, the standard offer for many medical schools was three Bs. UCL was three Cs.

The shifts were long and brutal as a house officer. I hated it. But there was a feeling of belonging to a ‘firm’ and having a consistent team and being able to follow up your own patients. There was less litigation. Less documentation. Less micromanagement. Some parts were shit. But I am not deluding myself that this current cohort have it easy.

The amount they need to have achieved to apply for the next step of training bears little resemblance to what it was like in my day.

I am so relieved my kids chose other courses.

I said 'perhaps' it's a test of mettle. The clear implication being that that would be nuts.

I'm sorry but to try to claim that giving nine months notice to the rota co-ordinator for agreed annual leave and then to wrangle for seven months of stress and finally to give an ultimatum of two months notice to organise a locum is hardly leaving your colleagues 'in the lurch'. It is not 'walking out' on any remotely sensible interpretation of the English language.

Unlike the colleagues who conveniently go sick every Friday before one of their weekends off, at no notice.

Your own wedding day clearly takes priority over some batshit power wielding of a crazed rota co-ordinator and in my view it would indeed be wet not to tell the crazy rota co-ordinator where to get off.

No comparison to pulling sickies to facilitate a long weekend.

We can agree to disagree. You call it ‘wet’ not to take unauthorised leave. I call it ‘professional’.

Well it wasn't unauthorized because batshit rota co-ordinator had no choice but to authorize it. With two months notice.

Yes I see they had no choice. There are of course all different types of residents around, with different attitudes. As in any workplace.

She's now a consultant, two years on and happily married. I'm not sure her extremely reasonable stance did her that much harm.

I am sure it didn’t.

The whole MTAS/MMC thing was such a nightmare. Sad to see another potential exodus on the cards. My husband had to switch specialties too - we decided living together was more important. Luckily, he enjoys his current one.

Our Best Man missed our wedding as he wasn’t allowed leave. I was late to my wedding rehearsal as the ward was too busy to leave. A lovely colleague stepped in in the end and let me away. We were lucky enough to get a honeymoon straight after the wedding - several colleagues were refused their requests.

Like a previous poster said, some aspects of Medicine when we were juniors made it feel better. Less paperwork for a start, and you really did feel like part of a team. We also lived in hospital accommodation for at least the first year. If you’d had a rubbish shift, there was usually someone around you could chat to.

I disagree that Medicine is more competitive or academically demanding now. However, that is not to say that I think that juniors have it easy, far from it.

On paper things look better for juniors: much shorter hours, better "supervision", formal and much shorter training, less need for further academic qualifications. But as we both know, in addition to the dismemberment of the medical team (which alone was pretty catastrophic) the job has been thoroughly deprofessionalised for doctors at all levels. Now, unlike in the past, juniors can see that things will not get better when they complete their training. Without light at the end of the tunnel it is not surprising that they are unhappy.

I haven't known any hospital consultants with children at or planning to go to medical school for probably twenty years. Mine went into accountancy and law where they earn two or three times as much and were treated like grownups from the start.