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.

That's just so wrong. What is going on?

In my bit of London, yes.

A decade or so of underfunding will do it by government

its too late to undo

It is obvious that bright British born people are gradually being replaced by people from overseas. It’s entirely political.

Same for my hubby who qualified in the early 2000’s. He has published many many papers, received prizes etc and also done a fellowship. It isn’t easy being a doctor and getting a training number is such hard work! Not sure work life balance is actually possible in the initial years! It is a very gruelling high pressure job and the competition is fierce. Those who excel will get the good roles and the average students will get left behind as is the case in all fields.

@Truetoself i am based in Leicestershire. But not inner city.

@PlopSofa honest answer is no, they don’t get paid more for being with an agency. And they don’t get the NHS pension when they work for an agency. At one time, locums used to get paid a lot more, but they saturated the market so the price of them has gone down.

But there are a lot of issues.
Junior doctors have had a real term cut. For the hours they do, they are on a stupidly low salary.
The expectations for GPs is overwhelming. They are expected to see patients, go to multiple meetings, run like a private business but get paid by NHS standards, all whilst dealing with a lot of push back from hospitals. Most people don’t realise that GP practices are businesses but they have limited control over how they do their business.
There is a push for practices to move from a partnership model to a salaried GP model (I support both types of practice and there are pros and cons to each). It is said that a partnership model GP will do 1/3 more work than a salaried GP.
The press have a lot to answer for. Practices are delivering more appointments now than pre covid, but nobody believes that but the figures prove it. But then people complain to the GP about how hard it is to get an appointment.
General practice gets about 8% of the whole NHS budget, but are the ones that have to deal with all letters that come back from the hospital etc.
And then space. Unless you have had a newly built practice (and some practices fight for years to get funding), your practice is likely to now have enough space for all the clinicians they need. And if they do get funding, the partners will still have to take out a hefty mortgage to pay for the building.

Honestly, I love my job but staffing General Practice is hard. Whilst this is about doctors in general, we are walking into a staffing crisis for GP’s (I think the last thing I read is that we are 800 FTE GP’s fewer than 2019), advance nurse practitioners and nurses.

We are having to have more staff for social issues (loneliness, isolation, debt, addiction etc), which is exactly what patients need but there is no space for these people to work from.

Overall I think that each and every person that trains to become a doctor, does it because they want to help people. But the reality is that they are worn down by the years of study and negativity that is around the NHS, and once qualified, they want to see the financial reward. And they should. But whilst general practice is underfunded, we can’t offer loads of salaried positions. We just can’t afford it.

Honestly there is lots wrong with the NHS that a politician doesn’t see it. We have over 100k vacancies across the board. And we are losing good clinicians because we don’t have the support in place for them to reach their true potential!

It’s totally unethical for us to actively recruit doctors from other poorer nations. They end up with no doctors.

But it’s no different from what Australia is doing to get our qualified doctors.
And in general, they get paid more to work here than in their home country.
Im not saying it’s right, but I also think some people train to be a doctor to give them and their family a better life and the UK can support that.

@Clucket87 this is a sad read. The system is so dysfunctional. My DF is an 80 something retired general surgeon and he described the kind of service now available to the public was like medicine in a war. You do the bare minimum because you’ve got the next patient to see, and the next and then the next. He said it was impossible to do a good job because the budgets have been cut so much, the staff aren’t there, nor the resources. And this was quite some time ago. He described the NHS as the worst employer in the U.K. and he advised me and my siblings not to go into medicine.

As you say he was demoralised because he went into it to help people. He retired early because he couldn’t take anymore of the management and being told to cut budgets further. He said it would be better if they attracted more pragmatic people who care maybe less and don’t get so worked up at having to often do a sub par job.

It’s really sad to hear things are even worse now. I didn’t know how things were for GPs so thank you for explaining. I’m not close to DF so I only ever hear bits and pieces about his work.

In fact the stress of the exams to become a surgeon and then finally a consultant broke him. My parents divorced through the stress of it all. He chose his career over family, something he regrets I think but he can’t change the past.

Thanks for posting this OP

My cousin is a salaried GP in London and she has doctor friends/ex colleagues who are struggling with finding work/training roles

Public perception is often that doctors are somehow rolling in money and living some lavish lifestyle

The truth couldn't be further from this

This is about the global agenda.

Unfortunately this year Australia has to be given credit for allowing our young doctors their only chance to practice medicine. The NHS isn't.

The hope has to be that the NHS wakes up and realises that they trained bright enthusiastic medics, often with family ties in or willing to work in hard to recruit areas. And make some effort to bring back those who had no alternative but to leave.

I was wondering if there was any way someone finishing F2 could be given a locum F3 job in your practice and effectively be trained on the job.

But probably not. You would have to advertise on line and there would be hundreds of applicants on line , many from overseas. The competent F2 with family roots in the area, and who would be willing to commit to career in the practice might be on shift and unable to apply before you are forced to close applications. Or will be put off applying by the number of applications.

You would also need a training/qualifying route similar to the ones used by, say, central London private schools, when they need to recruit maths teachers. (Hides from mumsneedwine - what else were they supposed to do. The state school down the road could not find STEM teachers either and often went without. Better to link a suitable graduate with a job and provide support than fail to run a service or recruit from overseas. Especially if access to GP training is defacto closed both because of the high levels of competition and because the lack of F3 posts means the potential GP is headed for Australia.)

This thread is another astonishingly bad read about the plight of young doctors and the absolute mess of a system that’s crying out for specialists but won’t open up any more training to train the extra hands we need. Nuts!!

https://www.mumsnet.com/talk/am_i_being_unreasonable/5107793-why-are-newly-trained-doctors-not-getting-jobs-and-leaving-the-uk-when-were-so-short-of-doctors

All of this has well and truly put me off advising my DD to consider medicine. The potential for failure is too high and the level of competition gruelling and unrewarding and we haven’t even talked about pay yet.

Very sad for the U.K. because ultimately we are all losers when we are so very poorly run by successive governments. Our healthcare has been going downhill for so long and I can’t see a reversal of fortune in the near or far future. We’re fucked, to put it bluntly.

@PlopSofa I completed my GP training 20 years ago but even back then the competition for training posts were stiff and i therefore relocated to pursue training in another UK region.

However the issue now is not only the competition for training posts but there is no funding for jobs at the end of the long, hard slog.

I don't believe we were in a situation before where doctors were unemployed. If you don't get a training post there was always stand alone posts.

In addition the quality of life of doctors has deteriorated significantly due to pay stagnation. I recall the life my GP trainer lived, which us very different to the one I would have if I was working as a GP partner today.

The UK taxpayer partially funds the training of doctors through medical school and the NHS (I guess therefore the tax payer) mostly funds the training. So it is absurb that the country wouldn't want to retain these doctors after investing so much money in them.

Actually the whole nation should be really angry at the misuse of their hard earned money.

You can't give 'many months' notice though (in F1/2) Leave cannot be booked until the shift pattern is allocated, which is only done shortly before the rotation starts

This doctor was not an F1 or an F2.

To be fair, not many F1s or F2s will be needing to plan a wedding so this is slightly theoretical.

@Wooleys this doctor was an ST4. Although DD has several friends who have got married during F1&2. Not everyone does medicine straight from school.

Why on earth not? And even if they're not getting married themselves, they may have siblings who are and having to miss a close relative's wedding because you're not allowed to book a day off is pretty crap. I can't understand why you seem to be so determined that young doctors aren't having a hard time

I am not sure if nit picking over F1/F2 detail is useful. DD was able to book leave some months in advance to attend her brother's PhD graduation in the US by writing to the person who administered F1 rotas for her third placement. It helped that her third placement was in the same place as the first, that she got in first before they had allocated leave, and perhaps, because it may have been the same person she had fought (and won) over whether it was safe (forget legal) to do a day shift straight after a night one. Or the admin person may simply have chosen to be reasonsonable.

I think you may be wrong about F1s and F2s not getting married. Even the youngest are in their mid 20s. Deanery placements were a real issue for some of the more devout Muslim girls, and others who culturally expect to live at home until they are married. One of DDs medical school cohort who wound up in an initially tbc role, started out trying to commute over 100 miles to each shift. She had always anticipated she would have an arranged marriage. It was then no great surprise that a wedding happened quickly, presumably to enable her to live closer to her work. I think giving more F1s the chance to get one of their top choices was the reason behind moving away from the points system, as jobs in London and nearby had become super-competitive. There are plenty of others who meet their partner is medical school. Bringing forward a wedding so granny can attend etc, must be reasonably common.

I do wonder what is happening to those who, for various reasons including those above, might not be able to look overseas for work.

Yes it really was not uncommon to move around for certain jobs possibly worse before the current specialty training and MTAS which all started when I graduated in 2009. Expecting to stay in the same place throughout your junior career is unrealistic. Expecting there to be a fair opportunity of getting a job post F2 is acceptable.

Agree. It's less usual these days though and the more pressurized the career the less usual it is. That's just what the statistics say.

When I was an FY2 I was told I was not able to attend my grandmothers funeral due to staffing issues
missed my sisters graduation due to staffing issues
have had to work countless christmases and summer holidays due to being the ‘childfree one’
have had to miss weddings

partner is the same
its always been happening

This used to be the way before mmc came in

the hospitals and gps could ‘grow their own’
it was originally said to get rid of the old boys network but really it has made training places harder to come by

my sister who applied for subspecialty training had to go through several years of this moving around the country

I'm completely sure that young doctors are under pressure on all sorts of fronts and I'm not clear where you can construe that I don't.

I'm less clear that young doctors have it uniquely hard in high pressure graduate jobs though. Many careers have appallingly anti social hours and incredibly tough demands especially in the early years when adjusting to the life of work as opposed to university can come as a shock. That's quite different from thinking F1 and F2 are easy going.

If an F1 or F2 has an important family event to attend then they can't generally have that leave confirmed more than a few weeks ahead of the start of the new rotation but what any of them with any sense will do is to flag the date up even if that means sussing out who to send an email to in a new hospital, assuming they'll have transferred by that date. A normal rota co-ordinator won't act like a tit. Occasionally you'll get one who will. But in this case many months notice were indeed given and the rota co-ordinator seemed to want to deliberately try to put obstacles in the way - very, very unfair.