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.

It's the same for paramedics and nurses - lots of those who graduated last year are struggling to find jobs as trusts have recruited abroad.

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

This is the full quote from OP's post. It is specifically talking about work for applications not being the priority and work-life balance being the priority instead.

This paragraph is not about annual leave, or lack of it.

@Needmoresleep
Applicants for legal training contracts were mainly from the UK, true. But since way back in the nineties there had been a huge problem with universities churning out law graduates like there was no tomorrow, then also offering the postgraduate LPC or Bar Vocational Course to anyone with a law degree (at significant fee expense). Not to mention legal conversion courses, LLMs and other postgraduate degrees. It was a huge educational pyramid with absolutely no guarantee of a job, unless you got a training contract with a law firm before you embarked upon the postgraduate training. The system has changed now, but I suspect there were a lot of sorely disappointed young people who had spent a lot of money on fees, spent 4-5 years in higher education (depending on their route) and yet never practised as either a solicitor or barrister.

But when you say 'there should be enough jobs to go around' is that realistic? I can't really think of another profession that works like that, where the supply of people exiting training is exactly matched to the availability of jobs - apart from perhaps the armed forces? There will always be some oversupply, some competition, otherwise there would end up being shortages due to people dropping out.

As before, I am not disagreeing with you that this is very hard on the young people in question, but I think it is not unique to medicine and also reflects wider social and economic problems.

As pps have said its not just Doctors, it's speech therapists, occupational therapists, nurses, midwives etc.. Trusts only have so much money allocated to staffing, even if a ward or department is desperate they have to put a "business case" together to increase the staffing. That business case then goes through layers of managers (most of whom have no idea where that ward/department even is!) And then it gets rej, or if your lucky it gets accepted six months later - but 3 more members of staff have left by then 🤦‍♀️

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 .

The most popular speciality training after most surgical specialities in the early 2000s was General Practice so I can understand that this would be even harder to access now.

This is a scandal. The UK is the only country in the world that does not prioritise its own graduates for training positions. It spends £100ks to train a medical student with extremely high entry standards and then they are discarded in favour of international graduates from countries with much lower entry standards.

Why expand places if the NHS imports staff instead? Is this part of the reason why NHS productivity has plummeted as the number of staff has rocketed?

It seems crazy to me that there aren't enough training slots when so many headlines say the NHS is understaffed.

My old GP surgery had a nightmare finding GPs. They went from 5 doctors to 2 before one of the old GPs came back part time from retirement.

It's a national scandal . The government are not fit for purpose , posturing about increasing med school places when there is no training available post qualification.

First they came for the Unskilled jobs
And I did not speak out
Because I was not unskilled
Then they came for the trades jobs
And I did not speak out
Because I was not a Tradesman.......

Funny how the chattering classes didnt seem to care when blue collared workers were being displaced pre-Brexit!

The issue with medicine is there is one employer. And actually there are jobs to go around, however, they are hiring internationally instead.

Before Boris Johnson you could only hire internationally if there were no suitable UK candidates. Boris Johnson tore that up AND launched programmes to bring in international trainees in preference to UK ones. Hence expensively trained UK medical students are unemployed while the NHS is instead giving training posts to Indian and African medical graduates.

No other country does this.

Don't forget the F2 "work" bit of the work hard play hard is 60+ hours a week in very busy jobs, with plenty of 13 hour shifts, perhaps 10 days in a row, and nights thrown in. Often far away from friends and family. (F1/F2 allocation is no longer points based, so you can come within the 10% of your cohort at Oxbridge and be sent to Enniskillen. A perfectly nice place but tough if you don't know anyone and your shift schedule prevents you from developing a social life..

Some are impressively dedicated and will come home to study and work on research papers. However who can blame others who decide to focus first on their job, then plan for a year in a Clinical Teaching Fellow job or a locum in order to gain experience, study for exams and polish a CV.

The problem now is that those entry level jobs are attracting huge numbers of applicants from overseas. Then there has been no real increase in the number of training places. Competition levels are rocketing so the arms race in terms of exam scores and CV bells and whistles is rising equally fast. The level of dedication required is tough possibly verging on the unhealthy.

There is a basic question. Will that very bright young doctor in Enniskillen make a better senior doctor if they opt, when they have a week off, to sit in their hospital accommodation and study, or whether they meet up with friends and go skiing. I think, and anecdotally I hear, that the very bright and focussed doctors who make it through will often wonder whether being a senior registrar in the NHS is worth it, and instead head off for something far better paid the City. Or feel they have earned their rewards and be unwilling to apply for jobs in less attractive parts of the country.

The tortoise might win, or at least apply for the senior registrar job in Blackpool, if they were given a chance.

It's outrageous!! It's only fair that medical graduates trained in the UK should be given first refusal for UK postgraduate training posts. International Medical Graduates (IMGs) have a choice whether to come here, to train in their home countries or go anywhere else in the world. Being forced out overseas due to current NHS recruitment procedures and poor workforce planning that is out of step with the needs of our latest batch of UK trained doctors should be sending alarm bells to our politicians! It's clear that just expanding medical school places without fixing the bottleneck higher up is a sign of poor forward planning and mismanagement of NHS resources and money. This issue needs addressing urgently.

At a time when the net migration figures are rising, the fact that this is happening is just preposterous!!! Fix the issues within the current points based immigration system, that was introduced after Brexit, that allows this! Reinstate the Resident Labour Market Test to prioritise UK applicants temporarily or something!! The recruitment of IMGs in other countries is kept in check, monitored and is limited according to need.

It's not a battle between UK IMGs and UK medical grads but I think recruiting extra IMGs is disproportionate given the current availability and unemployment of UK trained medical graduates. Not doing anything about this problem is a risk to social cohesion if the issue becomes divisive.

A moral duty is owed to our young people who have taken on a huge financial burden. They should be prioritised ahead of IMGs who haven't stepped into the UK or spent time in the NHS before taking postgraduate posts here.

Not only is it having a devastating impact on the morale of UK based medics, having to train newcomer IMGs in the NHS way of doing things is taking up valuable time and resources which the NHS should be using to treat its patients and bring down waiting lists. It's unacceptable that DCs, after 7 years of medical training in the UK are having to handhold new IMGs fast tracked into senior positions. The uncertainty that UK based young doctors are having to face and the potential impact on their mental health and wellbeing while having to put in 12 hour shifts is a betrayal of our young people. We ask of our doctors to be resilient but demanding this sort of sacrifice is on another level!!

l call for a correction! I want the powers that be to redress the balance!! I don't want these doctors to go to Australia or NZ and split them up from their families. Give them a chance to stay in the UK and treat us patients the way it was intended when they set out as young 18 year olds on their dreams of a medical career after years of working hard at school in the UK.

Every other country prioritises its own medical graduates. Countries do this because investing in their own young people is investment in their countries' economic growth and future. This is how it should be!

The biggest threat to the medical profession is AI. Many medics will be replaced by someone who can take a good case history and use a keyboard.

Same with gp. So many of my mates have finished training and can't get a job, the government is giving practices PAs at a hugely subsidised rate so they're preferences (even if it's not what patients want

This is awful and really needs to be addressed.

I have no doubt this is the case. And the problem is escalating. First because a backlog is building up. But also because Agencies and Trainers overseas, see profit in helping overseas applicants prepare their applications and are promoting the opportunities in the UK. So overseas applications can go in to every vacancy when it comes up, with the help of computer alerts, whilst our DC have to juggle job search and individual applications with a busy work schedule. .
It is so mad, and heart-breaking for our dedicated young people.

I plan to write to as many people involved in the decision making process as possible. I will mention that young doctors are not the only HCP affected.

It would be really useful if people could also write to MPs. There is a lack of awareness of the problem. When people realise the implications for both the tax payer and the future of the NHS they are shocked.

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

I truly am sick of seeing this trotted out. Numbers of medical students and training places are nothing whatsoever to do with the BMA. The BMA did not "decide" to restrict numbers: it's not their decision to make. The BMA passing motions against them is the same as my students' union in the nineteen-eighties passing a motion to make our college a nuclear-free zone.

Would an online petition help to get it discussed by parliament? Please DM me if you would like to do that. I have two DC in this situation and would love to work with you.

Yes, exactly. This has been happening for years but it is now creeping closer to traditional middle class professions that have always been a 'safe bet'.

The playbook is:

Loosen regulations under the guise of 'getting rid of red tape'.

Introduce an alternative, cheaper role that is there to 'help out' the stressed Professionals of a public service. Look how helpful these people are, perhaps even more helpful than those 'stuck-in-the-mud' professionals with their tiresome rules and restrictions....Let's call them 'Professional Assistants'.

Bring in some new technology. Gosh, how whizzy and fab this makes things for most of the service users. Not all of them mind, but that's a problem for another day. Keep up everyone!

Loosen regulations still further so that now 'Professional Assistants' can take on the roles previously held by Professionals. What a good job they are doing! And look, the new technology is there to help them out. But the Professionals must keep an eye on the Professional Assistants to make sure that standards are upheld, as after all, it will be their fault if things slide and service-users suffer. And do we need to pay those Professionals quite as much, now that the Professional Assistants are doing all the work?

It's a brave new world for everyone, enjoy!

It’s dreadful. And it’s the same story with nurses and teachers. All these cries we don’t have enough are bullshit - we do. But we don’t have the right budgets so it’s a race to the bottom - hire supply, bring in overseas workers who’ll work for pittance on fixed term contracts etc. Plenty of senior teachers can’t find permanent posts if they move or made redundant and replaced by NQTs. The country is broken but no one has the guts to do full scale reform of public services - just throwing salary increases at incumbent workers is solving nothing. We need to reform public pensions, NHS, immigration, etc. But it won’t get done so the situation will gradually get worse until the country goes bankrupt and services collapse. As they are already actually…

Thank you. That is a really good idea.

It is a really bad policy that needs addressing quickly before more money is wasted, more hearts are broken and more careers destroyed.

We (a group of mums who met virtually years ago on an apply to medical school thread) now have F2 DC, all working hard in challenging parts of the country. Whatever thoughts we had that our own DC might be exaggerating have been washed away. They are all saying the same thing. Job prospects are awful. Training prospects even worse.

We are exploring some other ideas, so I will PM you in a few days. It is important that policy makers are aware.

You need to go to your MP. This is a ridiculous state of affairs. We. Need to be training and employing British citizens first.

Perhaps somebody who works for NHS (HR) could explain how they can employ a non-British citizen to a job when there is a suitably qualified British citizen available for appointment.

Boris Johnson's whole immigration policy needs to be reformed.

Before Johnson, firms could only hire abroad if there were no UK (or EU) workers with the right skills. Now all jobs are open to anyone from around the globally, which is why net migration is 700k and many young people cannot find jobs.

Why do people still assume that this sort of thing is just bungling or the government doesn’t know about it. Of course they know that there are no jobs for UK trained doctors, and that it’s nigh on impossible for most of the population to get to see a doctor. And yet they do nothing to improve the situation and keep poaching doctors from other countries instead.
Why are they doing this is the question? And when I say government i don’t just mean the current one, this situation has been going on for a very long time. They obviously want it.

I think there are jobs but maybe not in the places or specialities they want