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.

As soon as MN allows pictures again I'll post the graphs of competition ratios. Quite horrific, and going to get worse.

I think people who know what they're talking about are out since this is AIBU - and are a bit wearied of the misconstrued statistics and the endless drama.

AIBU is here for robust opinion. I'm not putting my little toe even near the wrong side of the MN guidelines, whereas others are crossing the line. Easy to ignore however. But honestly: so much is over the top!

Pedant?

If you want change, ignore the forces of resistance!

Their lack of acknowledgement of the current issues and refusal to believe that there are unemployed doctors disadvantaged by the current system in place is perhaps one reason why the NHS never improves! As a user of the NHS and taxpayer, I support the OP!

The point is that the explosion of new IMG numbers is due to the removal of the Resident Labour Market Test in January 2021. For anyone going on about law, STEM, etc, it's affecting those applicants too, only not as evidently, as it's not in the news! Perhaps those denying haven't been affected.

The people being disadvantaged now by the current points based immigration system never had a say in Brexit!! I don't see why they should suffer because of it! For that reason, I support the OP's DD and others in the same situation! Ignore the disrupters trying to derail any efforts to make changes. Call for change!

Time for a virtual mute.

This thread has been a valuable way of hearing stories from across the medical profession. I would like to keep it that way.

Disagreement is useful. However the repeated contributions from a specific poster who hen says she does not know much about medicine are very odd.

I am very happy to be corrected by @takeittakeit if I have in fact written "many wrong things". When you say "resident posts" what do you mean? And unnumbered posts? Are you talking about what are referred to as F3 posts. Ie for people who have finished F2 not sat/passed the exams that would make them eligible for training jobs, or are you asking about those who have got through and are eligible for a training post. My understanding is there are plenty applying for the first. (Which is mainly what the thread is about.) However as the competition to become accepted for specialist training is tough it is quite possible that there is a mismatch resulting in a shortage of applicants.

I have knowledge of the system from when I was a doctor and have two DC that are junior doctors. You have not written anything that is incorrect.

If that poster mentioned residents then surely they are talking about a system outside of UK? The term resident in the UK is used for descriptions of type on on call. Resident oncall or non-resident oncall.

Unfortunately, IMGs from overseas are in fact being fasttracked here after all, even with exam exemptions. This is to the detriment of the young people in the UK who are working hard in medical school, etc.

The UK based side of the deal says

“We are excited about partnering with .... to deliver an accelerated training scheme for doctors in India to be placed in U.K. The NHS is able to offer opportunities for higher training and India has the depth and quality of talent to capitalise on this. I have been hugely impressed by the work ethics and speed at which ..... can source and place senior medical professionals into suitable roles, 4x faster than we have seen elsewhere. Their blend of innovative technology and deep partnerships in India with the government and leading associations makes them uniquely placed to deliver.'

This deal was made 2024 while the Tories were in power.

It could only have been made possible because the RLMT was abolished and because there were no safeguards to protect UK applicants in the current points based immigration system. There is no longer an onus on the NHS or any employer to prioritise a UK applicant so this affects not just medicine but those PPs that mentioned law, STEM, etc

It opened the floodgates for academies to open overseas that now parachute overseas IMGs into posts at the expense of applicants within the UK. Perhaps someone on here can explain whether, and if so how, the NHS budget is used in these deals being made with India, etc. As a taxpayer, I would like to know.

Disagreement is useful. However the repeated contributions from a specific poster who hen says she does not know much about medicine are very odd

Needmoresleep the poster is merely parrying the accusations of other posters who have made snarky comment along the lines of 'Oh, but I thought you were an expert'. Obviously very immature but AIBU does tend to prompt that sort of thing. The poster (me!) has just responded er no, never made that claim. As the mother of medics I probably know as much or as little as you and all the other non medic mothers on this thread. With the caveat that I don't do the helicopter thing, so I'm a bit vaguer about the actual content of the various exams and the alleged deficiencies etc. Which is why I ask the questions about those sorts of thing.

But the bottom line is the statistics, which are being wildly misconstrued.

But the bottom line is the statistics, which are being wildly misconstrued.

Statistics aside, the issues within the current points based immigration system need to be fixed urgently to right the wrongs done to people who never had a say in Brexit!

OP the reality is if you go onto NHS jobs right now and search CT, trust grade jobs in surgery there 30+ adverts - there are jobs. as of 15 mins ago

It is February, jobs will come up and are up, people can apply. Welcome to the big wide employment world after 2 years of cosseted foundation training. You now need to take the next leap into the next stage some will make it in one go, others will need to be a bit more creative - but please stop telling us there are no jobs - there are loads. Not everyone is fit for the purpose they think they should have -quality control and quite rightly so

I wanted to do neurology but could not get a training job, took a job in an allied speciality and changed my path ( def for the better) I would have been a phenomenally crap neurologist. It is scary, you worry, look around, re think your ideal plan and make it work. You are describing nothing different for the last 30 years in medicine. Just because you want to be something, does not mean you will or it is the best thing for you and people change their plans. Welcome to the world of employment in any profession.
Your background has nothing to do with this - infact the trainees who are the most motivated, switched on and determined are those from the non trad backgrounds as a general rule.

We do not call junior doctors juniors anymore they are residents and that trust grade jobs are generally filled with people striaght out of FY2 to a few years of experience at CT1 level.

There always has been and always will be a mis match in higher training jobs- attrition, competence and popularity being the issues

Surely it's draining the overseas countries of trained medical staff

Yes we definitely need to prioritise our own trained students

I don't understand it

Yes, it is.

The right thing to do is invest in the young people in the UK!

I'm not the parent of a medical student/grad, but.... really? You think young people should get to the end of 7 years of study, exams, placements and foundation years and still have their career path hanging in uncertainty? If they have passed all those stages in a different career they'd expect there to be a very good chance of continued employment at the end of it.

I understand there are many talented people chasing high flying careers that take perseverance and sideways moves to get there but medicine is a very specific career path. If they aren't up to the job, there are many points where they could fail before they get to the end of those 7 years. But you'd expect a national health service to be able to plan their training and employment needs so there's not too much surplus and not to then create surplus by allowing the whole world in to take on the roles available.

Also we have a housing crisis so why keep bringing in more people when we have qualified people here already, just a nonsense and their language skills would be better surely

Please read up about the selection process. It’s publically available info. It isn’t just exams. You’re also scored for your portfolio for most specialties.

Have you actually read the thread? These doctors ARE trying to take a sideways step e.g. get a job at SHO level and they aren’t available anymore. They get hundreds of online applications from abroad. I recognise my privilege as a registrar that my time as an SHO was not like this, this is a new issue. Everyone on this thread is disagreeing with you, are you a doctor? Please don’t invalidate the experiences of many of my colleagues.

@Wooleys why when you’re not a doctor are you disagreeing with multiple actual doctors on this thread? Do you really think that you’re better informed than us?

Also:
It is February, jobs will come up and are up, people can apply. Welcome to the big wide employment world after 2 years of cosseted foundation training. You now need to take the next leap into the next stage some will make it in one go, others will need to be a bit more creative - but please stop telling us there are no jobs - there are loads. Not everyone is fit for the purpose they think they should have -quality control and quite rightly so

I am still struggling to understand but would like to. Putting aside the idea that foundation training is cosseted, you talk about “the next stage”. Do you mean the first rung on specialist training? Ie the sort of jobs that some F2s will be able to access in one go, and where others will others will need to be a bit creative. (You refer to “trust grade” jobs.)

My understanding is that in order to become eligible for those first rung on specialist training job, you need to have gone through “quality control”. This is competitive and only a fixed number will be accepted each year.

DDs F1 and F2 rotations have been busy. Comparing notes with medical school friends Trusts vary a lot in what they expect F1/F2s to do. She sees this as a positive, Indeed chose the Deanery and rotations because she would get good general experience. (Feedback from friends in London teaching hospitals was that senior doctors were often too busy to “teach”.) So rather than apply for specialist training during F2, she planned to “be creative” and look for something like a Clinical Teaching Fellow, or locum role. (You previously referred to “unnumbered jobs”.) Something less hectic than F1/F2 where should would have the time to study and prepare her specialist training application.

Am I right that DD would not be eligible for the jobs you are talking about?

If so we may not be in disagreement. Opening up both jobs and training to international competition three of four years ago seems to have changed the picture considerably. The explosion in the number of private medical schools across Asia means there are an awful lot of medical school graduates looking for jobs and training. Those unemployed medical school graduates are now able to apply for jobs in the UK on an equal footing to doctors already in the UK.

The issue with the “be creative” jobs is that there are loads of graduates world wide looking for the same thing. Somewhere to work whilst they prepare for the next step. These posts for people without a training number are being inundated with applications. And our F2s are struggling because on paper they may not look as good so don’t get shortlisted. (Overseas applicants probably get help with their applications. Ours, unless they pick up some informal mentoring, probably don’t.)

Hence the realisation that if they want jobs, being creative probably means applying to Australia or New Zealand. These posts for thread started because a groups of us realised that all our DC had reluctantly come to the same conclusion, bar one who will stay and see what work NHS bank can offer.

The process that leads to getting a training number is also open to worldwide competition, and my understanding is that now graduates of overseas medical school now take up over 50% of the places, a proportion that is increasing by about 5% each year. The number of places has not increased to match the increase in medical school places in the UK, let alone world wide.

The levels of competition means that more and more in terms of super curricular, research papers, conferences etc is required of successful candidates. “Quality” is rising fast. (Depending on what you see as quality. Lots of prizes and papers from a range of institutions in various countries or solid heads down NHS experience as an F1/F2.) Time, and a degree of single mindedness needs to be dedicated to preparing that application.

Working conditions and pay in their home countries for consultants from overseas but trained in Britain have increased significantly in places like India and Malaysia and particularly Singapore and Dubai, as the private health sectors in those countries has grown. Unlike a generation ago, many accessing training in the UK will be planning to leave as soon as they are qualified. Leaving the NHS to have to scrabble around to recruit consultants from Africa and elsewhere (Africa does not have the same developed private health care system as much of Asia, and the NHS does not always offer great working conditions.)

If I understand you correctly, there are lots of entry level jobs for those with training numbers which have become hard to fill, there may be a further problem. That some of those who have applied for a UK training number have only done so as a fall back. They are very strong candidates in their own countries, but not sure they will get a training place there. So they apply at home and to the UK and are successful in both. So no need to apply for jobs in the UK. Jobs which without a training number, those completing F2 cannot be considered for.

In short the recent opening up of UK health sector jobs and training to worldwide competition is throwing up all sorts of issues, but not solving the NHS’ Labour shortage.

Perhaps we can agree. There are plenty of jobs but the level of international competition make it hard for doctors here to access unnumbered jobs, or to get a training number. Therefore Trusts are struggling to recruit for numbered jobs.

Sorry if I got any terminology wrong.

You implied it was a farce and was deeply flawed. I asked in what way the selection process was flawed, which you haven't explained.

Of course I know enough to know that you're scored as well - and a lot of complaints from the non medic mothers (well certainly OP) hinge on this. I personally think the point scoring element seems fine but I'm interested in what flaws in the overall process you see as throwing up major issues.

I know a reasonable amount. Enough to have gleaned a chunky amount of anecdote relating to the success or otherwise of medical job applications and easily enough to interpret statistics and to ask relevant questions and to then triangulate the info. I'm not sure that each and every doctor who pops up on MN is better informed than their rl peers. Some will be, some won't.

I don't understand your post and so cannot agree.

You appear to be the master of whataboutery. You pick on a small point of detail and argue it to the n'th degree. Do you find your inability to see the bigger picture and the inability to listen to, understand or empathise with others impacts on your dad-to-day life.

We are discussing the futures of some lovely talented and dedicated young people. It is very upsetting and very serious. Then you along determined to score points.

Time to read the room.

It's absolutely not the case that 'everybody' is disagreeing with everything I say. It's more accurate to say that some people are disagreeing with the general idea that things are impossible for the current F2s. It's also the case that some people are taking a lead on dispelling the idea that things are impossible and several people currently more senior to you are illustrating the point that these applications do generally have to be done against a backdrop of the full time job.

If you read the thread you'll see that these things are so.

Example ST2 in surgical training has to apply to continue surgical training from ST3 onwards.

UK graduates have to do two exams to continue surgical training but non-UK graduates do not have to do these exams. These exams are difficult and expensive.

Fair? Not a level playing field. Good idea? Also this could be an issue with safety as knowledge is untested.

*that things are not utterly impossible for etc.