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.

Needmoresleep I'm replying to a post which was directed specifically to me. It's a little presumptuous of you to tell me that I can't reply to it.

And cheers, but I can emphatically see the bigger picture. Not agreeing with a few MNers doesn't evidence any lack of empathy whatsoever although it might irritate the more vocal ones.

What is your interest? Your son is doing fine. What are you doing here?

On another thread a poster with a very similar posting style claimed an interest in data and argued with just about every figure presented, but then denied they had a data background. You now say that you don't have a medical background. So why the disruptions. Are you naturally oppositional? Or is it something else?

Could it be that you are involved in some way with the recruitment of overseas doctors?

One might suppose Wooleys has a specific agenda to derail the thread given it's the only thread they have posted on with this username.

I am still trying to think of who else might want to disrupt the thread. A young Labour apparatchik. A misogynist who has issues with women meeting on line to discuss what appears to be a problem of potentially wide ranging significance.

I will get the draft for MPs and others up within the next day or two and post it here for comment along with ideas of who people might write to. I have already been in contact with potentially useful people in my address book and will explore other avenues.

Someone suggested an on-line petition, which is a good idea but we need to get the wording bang on.

This thread has been useful not just for hearing other stories and other areas that have been affected by international recruitment, but by learning what people do not understand. The "my husband had it tough 30 years ago, working 100 hours a week whilst writing research papers and studying for exams (and presumably doing his share of the housework) so I don't understand why this snowflake generation are complaining." I think things have changed post 2021. And unless problems are recognised, and appropriate statistics are collected, they will only get worse.

It means that the drafts are taking longer, but should be better. This is a steep learning curve

Early feedback suggests that the international recruitment question is a difficult one for organisations representing doctors and they are unwilling to touch it. organisations (glad to be proved wrong - I can be reached by PM) So I am thinking of other efficient lobby groups. The TaxPayers Alliance might run with it given the extraordinary waste of training doctors, nurses and other HCPs who then can't find jobs. Or giving scarce specialist training to doctors from overseas who have no intention of staying in the UK afterwards.

Patient groups too might be interested, though I don't know much about them. Suggestions are welcome. By failing to provide career paths for our very competent young doctors, and instead giving them to doctors from overseas who may well return home at the end of their training we are denying the NHS of a supply of future consultants. Buying doctors in at consultants level from poorer countries is both immoral and, at best, a makeshift solution. It will spell the end of the NHS and probably, the end of Britain's international reputation in medicine.

Other thoughts are also welcome.

I didn’t reply more throughly as I’d just done 12.5 hours as the medical registrar on call. I was tired.

Because the point scoring isn’t fair! You might fork out for a masters for your reg application and work your arse off and then the next year they remove that scoring domain and it doesn’t get you any points anymore. Someone can have a nice prof at med school stick their name on a scientific paper and that is worth more points than a masters of PhD anyway! Even if they didn’t help with the paper. You can build a cv abroad that is of nowhere near the same standard/rigour but the arbitrary points system treats it as equal to a UK CV even if the papers are published in dodgy journals.

You're a medic mum right? I assume you’re disagreeing with the rest of us as you are worried and don’t want to accept the reality that your kids are going into a very difficult job market. My friends and I are registrars and since we did core training competition ratios for training numbers have quite literally exploded. We all feel very lucky we applied when we did, we don’t feel that we worked harder but we were luckier.

Yes but instead of learning from us who actually are doing these sort of job applications you are just maintaining and holding onto your own entrenched views.

All medical students got top grades, more extra curriculars than peers, went through competitive selection and a long and demanding degree. It’s not the same as those who got BBB and did law at a lower ranked uni and can’t get a training contract. Medics were the high flyers of their school years, these are not people that you want to pay to train with taxpayer money and then have leave for Australia. These are not people who just coasted and can’t get the next job like in non medical fields.

Agree 100%. I stopped some time ago.

Everybody who works in medicine or knows F2s - it's hard to now get a job after F2

People who don't know any F2s - no it isn't

I think we have a 🧌. These need to live in a hole.

I have now written to Wes twice, last email had some very well researched facts (from a v senior doctor not me). I will share his response when/if it arrives...

I am really struggling to believe this.

I work in psychiatry. Traditionally, it was undersubscribed. Now it is exceptionally popular and excellent foundation doctors are fighting for CT training schemes in London. They are having to do locums. We don’t have any unfilled posts. We are struggling instead because posts have been taken away from us to other parts of the country because London is thought to have too many. Young doctors are desperate to work in London. There is no way there are no applicants for surgical training schemes here!

Anyway when I was a house officer in the 90s every single student from my medical school had a job. Unemployment didn’t even cross our minds.

The difference between the NHS and law firms is that it is public sector. We need doctors in this country. Workforce planning needs to be much better than it is. There should not be such a significant number of doctors who can’t find jobs in this country. It is simply not the same as the open private market employing young lawyers.

international recruitment question is a difficult one for organisations representing doctors and they are unwilling to touch it.

Yes, I wonder if it's possible to get scrutiny though, especially if the organisations involved have highly influential voices and are central in decision making in the long term future of the NHS.

Also it's a question of a conflict of interests. If incentivising foreign recruitment has provided personal gain to the individuals involved, the general public will want to know how long this has been going on.

What effect has it had on the current issue of failure to secure NHS posts? What effect will this have on those still in medical school in the UK? Can it be stopped or paused by say reinstatement of the RLMT or similar?

Also at what expense is it educating doctors overseas instead of our young people? Is this the right direction for the UK? Neglecting the investment and growth of young people here in the UK while fuelling the economic boom of another country is wrong!!!

The recruitment drives overseas have been promoted as opportunities for foreign nationals to get highly coveted UK qualifications through training and experience in NHS hospitals which they can use to secure jobs in the global market if they wish not to return to their home country.

Even if it's well-meaning, that kind of prioritisation is unfair as the standards required of UK trained doctors to work here are different to that of overseas based IMGs , some who seem to have qualified for exemption. At the moment there's fasttracking going on which is disadvantaging young doctors here. What is the true scale of this ?

I would also be questioning the design of the current online recruitment system to see the measure of bias in favour of overseas based applicants.

We as taxpayers keep hearing the NHS needs more money every year. How much of this message is coming from the people who are running the overseas schemes? If so exactly how much of that NHS budget is earmarked for foreign recruitment, especially at a time when doctors here are unemployed?

I am surprised that such powerful decision makers at the heart of NHS recruitment have been tone deaf to the numerous increasing number of reports that young doctors are being made unemployed.

The TaxPayers Alliance might run with it given the extraordinary waste of training doctors, nurses and other HCPs who then can't find jobs.

Sounds good.

Patient groups

That should be useful. It would be interesting to hear more accounts of anyone who may have received poor care at the hands of inexperienced overseas IMGs who hadn't been vetted adequately, especially given reports of PLAB exemptions, the use of CREST forms and other documents signed off overseas, etc.

For whatever reason, it appears that resistance has been there all along. It's time to get to the root of the problem not only for the sake of our young people who want to stay and work here without being split up from their families by being forced abroad to continue a medical career. But also in the interests of the general public, who as users of the NHS and taxpayers, want a proper functioning NHS where the NHS budget is used effectively.

It's wrong to turn a blind eye to this issue while debating statistics. It is unfair on UK IMGs and UK medical graduates who need to be prioritised ahead of overseas based IMGs who haven't set foot in the country. As the current points based immigration system has led to an IMG explosion and with the net legal migration figures being so high, we need to redress the balance urgently or else it will be picked up by people who might politicize it for the wrong reasons and divide society further!

The comparison with young lawyers or accountants is false. If Slaughter and May or Ernst and Young were to lose 50% of promising trainees after eight years (degree + training) someone might be asking why. Even though they recognise there are other employers in the UK.

The NHS is the ONLY employer of young doctors in the UK yet is not asking any questions. Criminal.

Some absolutely amazing posts on this thread.

I think general public may be interested in the safety aspect of non-UK applicants not having to do PLAB or membership exams to secure a training post.

Personally I would want my surgeon to have passed MRCS part A and B.

@SpicyAlways it's a v easy search. NHS jobs does not currently have any jobs in anaesthetics for F3. Let alone 22 at one hospital.

Very good points. Surely there are concerns about CREST forms being signed abroad?

Also does anyone know about the English tests? Have these been dropped too?

A friend trained in China and she had to work as an HCA for a couple of years in order to get her English to a high enough standard to practice as a doctor here. Think it was level 7 needed. She took the exams in the UK.

This is nothing to do with law and lawyers. Young doctors are lionised because we need them, society needs them (rather more than we "need" lawyers).

The idea that after 5 years of university training plus two years paid "training" the young doctors who are facing unemployment shopuld suck it up and go elsewhere is shocking.

The UK has invested so much in these doctors already, they are supposed to be the workforce of tomorrow, the consultants of the 2030s.

There should also be a guaranteed place for the average young doctor who is competent but not wildly ambitious. Perhaps they have family commitments, or a spouse with a career that ties them. It doesn't matter really because the NHS needs workhorses as well as high flyers.

In the current state of the NHS it is criminal that doctors can be unemployed.

Yes, there should be concerns when people overseas signing off documentation outside the UK have no clue about the expectations within the NHS. It's possibly open to misuse too.

It appears that the language requirement is not as stringent as before. I have read that the IELTs is very difficult so there seems to be other ways of satisfying the language requirement depending on one's situation. The PLAB exemption or keeping PLAB after the introduction of MLA is questionable, especially when there seemed to have been an initial plan to get rid of PLAB and make everyone sit the MLA. To judge applicants on merit, all applicants should be subjected to the same exam requirements and marks moderated within a single cohort.

In any case some new IMGs are a risk to patient safety if they can't understand what exactly patients mean. Experience of having IMGs struggling with answers when asked questions relating to the condition, having to rephrase questions several times for IMGs only to get a poor answer or worse still IMG not able to explain in clear terms or depth the diagnosis or management!

When you have only approx 10 min in an NHS appointment but have waited, say, a year for an appointment worrying about your condition, imagine the disappointment, anger and the feeling of being let down by the NHS when you are seen by a new IMG that struggles to give you an answer. That's not fair on patients using the NHS, some whose appointments have been cancelled several times.

Even if there are only a few of these IMGs, this adds to potential negligence claims which the NHS has to pay for if they have failed to diagnose correctly and deliver treatment as required.

This thread has been an eye opener. When working as a doctor I had absolutely no idea of these changes. Do these politicians know what they will do when international graduates return home as consultants after training? Surely unemployed UK graduate doctors would be too much for general public when NHS is flat on its face? Yet again politicians not planning for the future of the NHS.

First I heard was from F2 DC who mentioned ridiculos ratios for training places.

NRTFT but it just sounds typical of this country.

Train our own people at high cost then send them to work abroad. Then spend more money attracting doctors from other countries to work here. Complain of a recruitment crisis.

It sometimes feels like our politicians hate us ordinary people, no wonder people are voting for parties that say they'll tear the system down and start again.

Best to pressure the current government for changes as they are best placed to make these and have expressed an interest to prioritise the domestic workforce even before coming into power.

Labour mentioned in 2022 before they got into power, of a plan to reinstate the RLMT that would help reduce a reliance on overseas workers and reduce legal migration numbers.

Now that they are in government, Labour appears to be in the process of bringing in legislation to prioritise the domestic workforce. This they plan to do by addressing the issues within the current points based immigration system which was brought in after Brexit. Hopefully, imposing a legal requirement on employers (eg NHS) to prioritise the UK based workforce would help the DCs mentioned in this thread plus all young people that didn't vote for Brexit with whatever career they are pursuing.

It's astounding that there has been a repeated failure of investing in the education, skills and career opportunities of the young people in the UK who ultimately are the foundation of a country's growth.

It should be of no surprise then that the continued investment and reliance on foreign workers, in whatever sector, has boosted the economic growth of the countries they come from and has led to divisions in society here.

Are they better doctors? Not better as such, trained differently? I've heard that EU nurses do an additional year training and they come out with more clinical skills than their British counterparts and this is favourable in the workplace even where they cannot perform those skills as a nurse here.

Did you hear from this poster? Are there jobs available or not? What was the outcome? It’s this sort of post that threatens to derail what’s being said, when you have someone come in and say they’ve got 35 unfilled vacancies.

@takeittakeit what level are they at?

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.

I’d posted about this earlier – the NHS has presented a case for hiring Indian doctors to address the shortage of workforce in the UK. But the Indian Medical Association has since refused to support the UK’s recruitment drive citing brain drain and the hiring of skilled doctors who end up being overqualified for their posts in the UK (I’ve posted the links upthread). Yet there are recruitment agencies still advertising recruitments. There are several such agencies both in the UK and abroad, so it is not just the case of overseas agencies trying to find loopholes to weasel in their clients.
Again, I wanted to present the alternate perspective: IMGs are not likely to be ‘less trained’ as mentioned frequently on the thread. If anything at all, they are likely to be overtrained. They do not come with papers presented in ‘dodgy journals’ – most academic journals maintain rigour, not just the western ones! Their language skills might need improvement, but given the diverse population in British city hospitals, this sometimes acts in their favours.

These IMGs might be a good addition to the workforce, BUT only after all potential British trained graduates have been hired.

If there’s a petition going up, I would suggest it presents both sides of the case - insisting that local graduate jobs need to be ringfenced before opening up the field for others, as is the case in the USA, Australia, India and just about everywhere else. A focus on the alleged ineptitude of foreign doctors (as mentioned in the anecdotal evidence presented here), will most likely be countered with research supporting the alternate view by the powers-that-be backing the recruitment drive.

@PlopSofa no. They mysteriously disappeared ......