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.

Current contract they still try to refuse leave for major events.

I was refused leave for a funeral. I eventually did get it after a lot of to and fro and quite literal begging, but this shouldn't be the case. The circumstances of the funeral were particularly tragic (unexpected death of a young person) which they knew about.

Cock up or conspiracy, you ask?

What do you think of this? Maybe out of step with UK DCs who want to stay's needs?
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Isn't this disadvantaging UK trained medics that can't get a job at the moment? Does anyone know whether and how much NHS money, time and resources is allocated to upskilling these new IMG recruits? I think India is hoping they will return at the end but they may not. India is hundreds of medical colleges churning out graduates with no places for postgraduate training so here we are....

Without prioritising the doctors that want to stay, a UK based lobby influential in NHS recruitment and central to decision making in the NHS Long-term Workforce Plan is in arrangements with India, perhaps at the expense of our young people to provide fast tracking of new IMGs.

This GMC backed pathway exists and allows international medical graduates from India to obtain UK medical registration 'without PLAB or Royal College exams (MRCP, MRCS, etc.).' This fast track pathway allows 'specialisations into
Medicine (MRCP)
Surgery (MRCS)
Emergency Medicine (MRCEM)
Pediatrics (MRCPCH)
Obstetrics & Gynecology (MRCOG)

Eligibility
MBBS and internship completion.
State Medical Council registration'

I did not realise PLAB had been dropped.

Surely international doctors not having to do membership exams unlike the UK medical school graduates is completely unfair.

Totally unfair! What a joke!! PLAB exemption appears to be only for this Indian lot who are in a special arrangement and who get parachuted in. Who knows what other arrangements are in place for IMGs from other countries?

A collaboration between India and UK organisation made in 2024 while the Tories were in power!! I hope the current government reviews this. This is not investing in our young people!!!

Is there any scrutiny into this arrangement? How is it affecting UK medics already in the UK?

This organisation which is heavily involved in NHS recruitment in the UK and very influential in what happens here is promoting India saying and I quote

"This training initiative is designed specially to help International doctors gain experience at core and higher levels in UK hospitals.”

"This unique and innovative programme is a great example of living bridge between U.K. and India and benefits all with India getting trained workforce to help with Ayushman Bharat"

Wow! Upskilling the Indian workforce at what expense and cost to the UK though? Growth in the UK by an investment in UK medics' education and training should be prioritised.

It may be well intended but I really don't know exactly what impact it's having on the situation here. Just trying to understand and posting all this hoping someone can explain? Maybe it needs readjusment as it might be out of step with what's required in the UK now given the fact there are unemployed doctors here.

And that's why skilled migrant visas without prioritizing the local force - deskills the population. That's also why people who sat they don't want unfettered low skills migration but favour high skilled one are so wrong. Obviously without prioritizing the UK doctors will result on fewer UK doctors. It's actually the same in other professions. No idea why no one is concerned. I am also not a reform voter. But other countries such as Singapore or Switzerland have moved to restrict high skilled workers moving in precisely to support their own professionals.

I don’t know why either.

I wonder if there are links with the post-Brexit UK-India trade negotiations, that started in 2021 and were relaunched by Keir Starmer in the autumn. I have a vague memory of seeing something about the scope to ease our doctor shortage. Without going into a deep dive I picked up this 2021 warning shot from the GMC.

https://www.gmc-uk.org/-/media/documents/gmc-response-to-consultation-on-trade-negotiations-with-india-july-2021-86917702.pdf

Access to the UK job market for Indian doctors was clearly on the table. If doctors in India (and elsewhere?) are possibly getting exemptions to key exams and therefore ahead of own graduates when it comes to a limited number of training places, things are awry. It suggests that our bright young people may have been discarded in pursuit of a trade deal.

It may explain why Wes Streeting is apparently unwilling to answer questions.

My casual knowledge of the Malaysian situation is not great but better. Having a child who is a doctor is many Malaysian mother’s dream. Private medical schools pump out huge numbers of graduates, The state medical system is limited and can really only absorb graduates from the University medical schools. Hence a bottle neck effectively before the start of the foundation years.Chatting to Malaysian medic friends about 15 months ago they claimed that that when questioned about unemployed medical school grads and what they should do, the health minister suggested they become bricklayers. True or not, one planned for their own DC to do their foundation years and training in the UK. The mum will have given lots of support in terms of knowledge of how the system worked, ability to access research opportunities, and so on. The private Universities similarly will have ensured that their students had the prizes etc that will add points to their CVs. Once qualified there was lots of scope for very well paid private consultancy work in Malaysia or Singapore. My friend showed me her very flash consulting rooms. It would be hard to think of reasons to hang around and work as a consultant in the NHS.

I had not realised that IMGs also had equal treatment on F1 allocations. This is very wrong. UK graduates are allowed five preferences and after that are allocated randomly. Two DC known by my friends ended in Northern Ireland and were initially very upset. For young people from the south of England it is a long way from friends, family and in one case fiancé. They have accepted that in any system there are winners and losers, and got on with it. But wrong if those coming to the UK so without local ties got posts in the deaneries they had wanted.

Then, unless things improve, or unless they absolutely knuckle down and ensure their own CVs are littered with the same research and prizes, they won’t be able to compete for specialist training. Even an F3 12 month contract will be an achievement.

Yeah it's a joke they even needed to add it as a clause in the contract to encourage us to vote for it (I mean the bma did us all over by accepting it)

Yup one of my mates (old contract) got a job in Devon (Anaesthetics), wife (surgeon) got Scotland. They asked if one could be allocated to the same area as they had a toddler etc and wasnt really commutable. The only reply was you're welcome to decline if you don't want the job

None in my family are interested in medicine as a career. Hardly anyone wants to pursue it as a career that I know.

Only one girl in DS (S6) cohort at school is leaving to study medicine. That's it! One.

I feel sorry for the state of the NHS tbh. Yes, we are short staffed. Need paediatricians in Scotland! Come here please!

Just checked NHS Scotland...confirmed anecdotally what I already know...

There are loads of vacancies!!

Yes but how are you advertising staff jobs?

On line, with overseas applicants winning the "fastest finger first"?

I am pretty sure that amongst our F2s, there will be someone who would seize the opportunity as a way of getting the experience they need to successfully apply for training. .

DC know a young doctor who is currently training in one of the specialist children's hospitals in London. From SE Asia, and will return.

I know someone who is in the process of setting up a medical tourism business to Malaysia. Link a lovely holiday to a complete health check, probably given by UK trained doctors. (Actually I am genuinely tempted. My GP practice is homeless, and is having to perch in odd rooms in other practices.) Perhaps one day our shortage of specialists will be so acute that we will have to ship Scottish babies there, in the same way that a generation ago, affluent parents from the Middle East or Asia used to fly to Great Ormond Street.

Is there an example letter I can send to my MP, mentioning some of the key issues? I will tailor it to my own circumstances but it would be good to get the basic facts in order about the schemes that have been set up to recruit limited training places from abroad without prioritising our own British trainees.

Are these for training posts for junior doctors?

Anyway I have no problem at all with qualified doctors being employed from overseas as long as the job has been advertised to British citizens / residents/ trainees first and no suitable candidates have applied.

Though I will add to that if we don't train our own doctors then they won't be able to apply will they?

How will they apply for a job as a GP if they weren't able to get into GP training?

I think many people are relying on private healthcare to see them through the next decade or so. What they don’t realise is that unless we train UK young doctors, we will end up with no UK-trained consultants. So no private doctors either.

Private medicine is a minefield. We had to let a locum staff grade go, due to his questionable clinical skills and the number of patient complaints about his manner. I was recently sent a link by a colleague to this doctor’s new private practice in Harley st, charging £750 for an assessment.

As an NHS consultant I can usually sift through private doctors and find someone decent if needed. But many people can’t, and will end up seeing shit doctors like the one I worked with. What a mess.

Yes, we should all be concerned. Hopefully shining a light on the plight of UK trained medical graduates will open up a dialogue about other professions and what kind of chance our talented young graduates have of making a good career in the UK.

We've taken caps off university places whilst failing to grow graduate jobs (unlike countries that did not opt for austerity after the financial crash), failed to invest in training our young people or to incentivise companies to train young people, added the skilled migrants visa, (and all other manner of visas which make it easier for companies to get ready made employees rather than invest in training our young people)which makes it easy for overseas graduates to come and work in the UK. Plus along came AI making it so much easier for anyone to write an application and flood job vacancies.What a time to be young and what a mess! I've a DD graduating in a STEM subject and have no idea how she is going to compete. Decent STEM masters degrees are ££££ and now can't go to the EU and do a cheap masters. And now looks like she could be competing with medical grads who can't get jobs and want to stay in the UK.

Of course, the healthcare visa and skilled.migrant visa probably helped plug some gaps when we lost EU staff back to Europe and there was a bit of an exodus of UK doctors to Australia and NZ due to various reasons but this should have been reviewed annually.

There is a first draft hidden away on another thread, the thread where a group of F2 mums realised that the impossibility of obtaining an F3 post for our individual DC was a systemic problem.

I was going to look at it today, though need to do some work first.

Some way back in my past I worked in policy in Whitehall, so have answered my share of MPs letters. The draft needs to be something that an MP can just forward to the Health Secretary so needs some thought. The more MPs who write, ie the more people who send in slightly personalised letters, the greater the understanding will be that the current approach is something that the public are concerned about.

I was then planning to work with others - please PM - starting with ideas to consider who to write to. This is so very cruel and short-sighted that we need someone to run with it. The policy needs to be changed and fast.

Does anyone know of a current campaign organisation that might support us?

My guess is that the BMA will be wary. Too many conflicting priorities. We also don't really know why the NHS has ended up in this odd situation, so we don't know what we would be lobbying against. Someone, somewhere must have argued to open up NHS career development opportunities (F3/CTF/Specialist training) on an equal basis to applicants currently overseas.

I should thank contributors to this thread. I accepted DDs decision not to enter the fray and to simply apply for Australian jobs, but questioned it. She had not seemed very interested before, and indeed had bought a house as an F1 intending to continue her career in the same deanery. (The deanery is relatively unpopular so in normal times it would be reasonable to expect a well regarded former F2 to be able to find suitable or semi suitable work.) Last week I started to realise that there was a systemic issue and that indeed, as she claimed, many other F2s were in the same position. Now it is clear that the problem is much bigger than this. Midwives, paramedics, nurses, F1s, doctors returning from maternity leave or coming to the end of a short term contract are all affected.

Situations like this take a whole to turn around. It will get worse before it gets better. Keir has started muttering about a White paper on immigration and skilled workers, but that is not enough. Normal processes will take too long. Awareness, amongst our politicians and with the general public, needs to happen quickly.

@Needmoresleep I have already contacted a campaigning group for doctors. I know the founder.
Also I think that once we have a letter we should be emailing LBC and Newsnight etc.

An online petition may be appropriate too.

Also there is a bottleneck at ST3 for specialties that are not run through.

All great. Just give me a day or two.

I have a few personal contacts that might help.

If people want to contribute feel free to PM.

Thanks. Happy to help with anything that needs to be done. Thanks so much for highlighting this. A lot of great information on this thread already.

Thank you. Is that campaigning group different from the one ( with heavy influence on NHS recruitment setting up academies promoting new IMG recruitment) fasttracking Indian doctors without PLAB into UK positions? If so, that would help get DCs' voices heard.

Just want some transparency and scrutiny of what's going on!

Do you think the campaigning group you know can also have it investigated? As taxpayers and NHS users, it is vital that we know if this is the most efficient way of allocating NHS money, time and resources in the drive to recruit new staff. Having exemptions from aspects of recruitment which are compulsory for DCs here is unfair no matter how well intended a scheme might be.

Have there been sufficient safeguards for UK medical graduates who naturally may have thought, perhaps naively, that their country might have prioritised them (instead of new IMGs) for NHS positions?

Years ago a friend who was a medical graduate from China had to do PLAB and get a very high grade in a series of written and spoken English exams.

I have forwarded the thread to a campaigning group for doctors. I have previously highlighted the issue to them.

Re PLAB, I noticed there was a plan initially to abandon it when the plans to introduce the MLA were announced.

Strangely, the idea to make all doctors, IMG or UK trained, do the same MLA exam was abandoned? Possibly due to some resistance?

Possibly due to potential benefits of keeping the 2 exam cohorts separate?

The new PLAB is now just MLA compliant. Not sure that's fair or as rigorous as the MLA that the UK trained grads are subjected to.
Some earlier posters did mention that these new IMGs were getting through on merit. How can merit be measured fairly with everyone sitting different exams or IMGs having exam exemptions or CREST forms signed off overseas?

I keep mentioning these issues because if we are going to make our young people sit tougher exams with more barriers for entry than new IMGs, it's unfair that they're unemployed at the end.