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.

@HermioneHerman I think she's a PA 😂

I'm here because I'm in an incredibly cosy kitchen waiting for the supper to cook in the oven after a long day and tbh quite enjoy the high drama and emotions and all the ! The dodgy spelling is less than ideal but I'll roll with it. That time of evening I guess.

I'm not the only name which has featured since the early stages of the thread.

Bu yes, I do think this is being massively distorted but then MN parents do have a rep for that sort of thing if it negatively impacts their DC. Why would I change my view with less than compelling posts and arguments and evidence? If I'm shown anything of substance I'll listen. Otherwise not.

On the cosseted, it is worth noting that different regions have different pay and conditions. DDs F1 placement group was down 15% in a month. No supernumaries and issues with some of the locums. (They begged F1s to take on extra shifts if they had a few days off.) Five out of six rotations have involved nights, often with very sick patients. Deprived area. Big drink and drug problems and a lack of community mental health support. Early in F1 it was 10 days in a row including 13 hour longs. Three of them, with less than 2 years experience between them, having to hold the fort over night because a Registrar did not show up.

Curious how senior doctors are determined that current F1/F2s have it easy. No complaints. They are learning lots and given more responsibility than they might get in London. However none of this counts. No jobs. The NHS prioritises people yet to get their hands dirty in the chaos that is the modern NHS but have collected points from research, papers etc.

MN parents do have a rep for that sort of thing

Then bugger off to Netmums.

Needmoresleep with the greatest respect and seriously, how on earth do you know that your DD is given more responsibility than F2s in London? I was horrified at the level of responsibility my DC was given initially but of course didn't say that to DC at the time. I really think you might need a rain check about what F2s nationwide have to take on, and maybe think that even if you're alarmed by your own DD having a significant burden to bear, those in her deanery aren't in any way unique.

I suspect that you may have done for years 😂I remember the applicant threads well.

It's all so short sighted and ridiculous. Foreign doctors go home. A PA cannot progress in training the same way as a consultant and make those decisions. Older doctors will retire, who will fill these roles and provide the required expertise??....I worry for the future of the nhs

I've never ever been moved to post on the applicant threads HighStars. I've skimmed them on occasion but only as a lurker. Once I get to 'roller coaster of emotion' I'm out for the duration😂

Because the London consultant you are so keen to quote says F1s/F2s are cosseted. I assume her observation is of London F1s/F2s.

I doubt it is the same poster.

The one you are thinking of would argue, but argue intelligently.

Needmoresleep I quoted the post once. The consultant that I find extremely persuasive is on the thread you were content to derail in Higher Ed. But she might not want her username repeated here and so I won't repeat it. mumsneedwine has accused the poster that you refer to on this thread as a troll and I don't want to get sucked into that at all, not least because I've no view.

I trained in London it waa brutal. No cossetting. Sink or swim just like all my colleagues around the country.

Mumsneedwine - your arrogance is beyond belief.
Yes I am a doctor and the reality for most hospitals is we struggle to recruit into trust grade level jobs - F3, CT1/CT2 level - so you can understand the level we are talking about.
Your reality is not the reality that I see in a hospital short of resident doctors. There are very few jobs where people do 72 hrs per week every week on a rolling cycle and on a week of nights usually 1:8 then there may be that many hours. Exception reporting is there to stop excessive hours and has made most hosptatls develop rotas that quite rightly limit hours

You seem to think after 4-6 yrs of med school and 2 years of foundation training that the rest of the path should be smooth and easy - but life is not like that in any profession and medicine is exactly the same. If you understood the ebb and flow of interviews and jobs in the NHS you would know that higher surgical job interviews are in the next few weeks. Those appointed on the next step, will then resign their jobs for August and those jobs will become free. Yes not knowing what you are doing in August is worrying when you have had 6 years of medschool and 2 years of guaranteed employment planned for you but there are jobs out there.

Every single one of the FY2s we have had in the department in the past 3 years have gone onto the next level of training they wanted to - either directly, with a year in Oz/NZ/Canada, industry/ research/F3/locuming and some have left medicine altogether as realised it was not for them.

But as you know I am not a doctor, not got a clue, never worked on a ward and never studied medicine!

Yes, these concerns were never meant to cause a conflict between UK IMGs and UK trained medical graduates.

We are just talking about the influx of new IMGs leading to UK based cohorts (UK IMG and UK trained grads ) not securing posts.

IMGs have made a significant contribution to the NHS which is appreciated. Moving to a foreign country where everything is unfamiliar is an enormous sacrifice especially if you have to work in stressful conditions in busy hospitals. I have friends who are IMGs here who miss their parents. Their parents miss them and the grandchildren.

I understand how tough it would be to be thousands of miles away which is another reason why I am supporting these DCs who don't want to leave the UK.

Just like the IMGs, these DCs work really hard in hospitals but have found that the current points based immigration system (which has been in place post Brexit) has disadvantaged them. Many of us are of course upset this has happened and worried that, if not addressed urgently given the way the world is, this issue will be picked up and politicised for the wrong reasons. Hence the urgent call to redress the balance. There is also the issue of whether the lack of robustness of the online recruitment system has perhaps unintentionally introduced a bias in favour of new IMGs applying from overseas who are yet to start working in the NHS.

Just like you said too, I don't want the situation to be toxic for IMGs living here. Of course there are IMGs that might not deliver at the level expected by patients and the NHS due to inexperience or incompetence but the vast number do provide excellent care for patients. They have and will also be a vital part of the NHS. The demonisation of any health care worker is wrong because I think that the NHS has one of the toughest working environments and everyone providing excellent care to patients deserve a job within the NHS if they want to stay and continue working for it.

That includes the DCs who are the subject of this thread!

@takeittakeit if you are a doctor how can you call foundation cossetted ? That's arrogant and insulting to the doctors working 78 hour weeks and brutal understaffed night shifts. If you are a doctor I hope you talk to your F2s and try and understand how it feels to not 'have a smooth path' but be facing unemployment in 6 months. Not just have to take a year or two to get into training, but no job at all, no locums, no nothing. This has not been the case in the past. Do you think all the doctors chatting about this are wrong ? I hope you have more understanding of than you show here.

If there are all these jobs going spare why are they not advertised on NHS jobs ? Why are most jobs closing after 24 hours due to too many applicants ? If you can say here what hospital or trust I am pretty sure you'll be inundated with applicants.

I am not arrogant, I am angry. I've spent years helping disadvantaged youngsters become doctors and this is what they now face. £000,000 of debt and limited jobs.

It will be interesting to see if they have sorted out the number of F1 jobs this year. Last year they hadn't got enough for all the medical students - they'd had 5 years to plan it,

Again, how are these numbers sustainable ? How are they fair ?

@HighStars I'm still on the applicant threads. Still helping prospective medics. Because it should be a fantastic career. But it's hard this year when I see what's coming for them later on.

I'm still unclear why a very few people think this is all made up (especially anyone who is a doctor). It's never been like this. You've never needed so many portfolio points to get paediatric interview. Not a job, just an interview.

Hi,

Only just spotted this.

We are trying to work out what is going on.

Our DC are struggling to get jobs after F2. There seems to have been an explosion of applicants for the next (non training step) F3. It appears that legislation introduced in 2021/22 has opened up health sector jobs (nurses, midwives etc) to overseas competition. It seems that our DC, from different backgrounds, working in different parts of the country are reluctantly deciding that the only way to stay in medicine is to move to Australia. They report that their peers feel the same.

They need these jobs, first because they need jobs but also because they need time to study and prepare for their specialist training applications. Applications for these have also exploded, perhaps alongside the explosion of private medical schools in places like India and Malaysia, but undoubtably encouraged our own Government's incentives which seem to include exemptions. UK specialist training then opens the door to fantastic opportunities in Dubai or Singapore.

This opening up our jobs to open international competition seems to be causing a raft of other problems. Bottle necks further along the training path, people spamming every vacancy then not showing up for interview, perhaps applying for UK training numbers as a fall back then not applying for jobs here leading to vacancies.

The NHS and BMA seem not to be keeping important statistics and not carrying out deeper research into, say, why our young people are leaving, so instead seem to think the solution is more medical school places and more opening up to international competition. Our aim is to get decision makers to take a step back put aside current assumptions and dig a bit deeper. Then work to ensure that UK based F2s have the support they need to have a fair crack at UK jobs and training.

Actually no need to argue. For some reason our F2s, working in all parts of the country seem to have decided independently that getting an F3 job is close to impossible, and report that their peers are thinking the same.

Anecdata at best, though this thread contains other posts (GP trying to return after a career break. Nurses. A rapidly rising quality of bank locums.) that tend to support our concerns.

You and Wooley have a different experience to us. It appears that you are facing a crisis of unfilled vacancies at F3 level and on the first step of the training ladder.

The recent opening up of our job market to international competition will have had an impact: a mix of desired and undesired consequences.

As I said in the post above need to get decision makers to take a step back put aside current assumptions and dig a bit deeper. It is extraordinary that the BMA think the way to reduce overseas recruitment is to provide more medical school places.

They need to start by talking to current F2s, and find our what is causing them to leave. They don't want to go.

Retention should be a lot cheaper and more efficient than recruitment.

@mumsneedwine where do you get the graphs from? Think we need some on our letters to MPs etc

mumsneedswines - you really do not listen. The UK job market has always been open to international medical graduates and this is nothing knew. You only have to see the PLAB courses being run and have done for the past 30 yrs to realise this. There was a down turn in International applicants as the foundation set up bedded in but it has never gone away - but sorry my lived reality means I am a troll!!
My CT equivalent programme - in 4 jobs I was the only GB graduate out of minimum 6 jobs
My senior training - 8 : 4 UK, 2EU, 2International

I do think Foundation years are much more protected than they used to be and agree with it to a certain extent. Cossetted in respect that knowing you employment for 2 years - placements and rough pay is within healthcare cossetted. It used to be find a job every 6 months, rotations developed giving people a respite from the relentless round of applications - it is a good improvement. However it delays the crash of employment reality and the need to start owning and progressing your own career - it is your career no one elses. The criteria for short listing are now fr more transparent than they used to be for numbered posts - if you know that is the target then you and only you can make sure you start ticking those boxes. Some might do it in1 year some might take longer - Darwinism exists in every profession.

F3 jobs are also called trust grade clinical fellow - they deliver the same training experience and pay.

As to pay - yes foundation job pay varies depending on hours are you advocating the F2 in public health in a 9-5 office job should be paid the same as the F2 on a 12 hr shift pattern working a 4:3 night cycle once every 10 weeks?

If you give up in February trying to get a job for August then you really do not understand the NHS ebb and flow of jobs.
To give you an idea of my smooth path to being a consultant on a 2 site job one teaching hospital and one DGH!
Every job bar higher training was applied for individually -
6 month house job
6 months house job
6 months locumming
18 months Oz/NZ
6months SHO
1 yr SHO ( got this job 2 days before the end of the previosu one!)
6 months locum/ overseas research unpaid
1 yr SHO
6 months SHO
6 months SHO ( got this job 2 weeks before previous one ended)
1 year research / RMO
LAT post 1 yr
Training rotation 5 yrs ( glorious bliss of no applications for 5 yrs!)
1 yr Fellowship over seas
1 yr Fellowship in the UK
Locum consultant
Permanent - 5 yrs ago I made it!

The majority of my colleagues have had something along those lines but then we are all trolls!

It was the Tories in the previous government that decided on expansion of medical school places. See comment from Steve Barclay ( then Health and Social Care Secretary) and Gillian Keegan (Education Secretary)

https://www.gov.uk/government/news/expansion-of-medical-school-places-to-be-accelerated-to-next-year#:~:text=Government%20will%20expand%20medical%20school,and%20Edge%20Hill%20medical%20schools.

Clearly poor planning in the NHS Long Term Workforce Plan introduced in 2023

Ali Mirage on LBC has just mentioned Wes Streeting saying we rely on too many foreign doctors.

Is anyone thinking of phoning in?

This builds on expansions the government has already funded. Between 2018 and 2020, the government increased the number of medical school places in England from 6,000 to 7,500 – a 25% increase – and as part of this process opened 5 new medical schools across the country.

The difference now seems to be the agressive overseas recruitment efforts, recent changes to skilled worker visas, on-line recruitment, on line interview and the massive expansion of private medical schools in places like Malaysia and India, far more than their job markets can absorb. Also the arms race in terms of research and prizes.

Maybe our DCs are wrong. However a large number of them seem to believe they cannot compete against overseas applicants, who have been supported through their applications, have the (at least on paper) additional experience, prizes and research that puts them to the front of the queue.

DD is aware that two F3 jobs will be coming up in her Deanery in preferred (large and normally not that competitive) area. But she also knows there will be extensive competition from her peers, others in the UK and especially from overseas. And this is arguable the least popular deanery in the country.

What do you see as the solution? Decide are own graduates are too coseted so continue to make no effort to retain them. Perhaps by explaining the ebb and flow and by helping them write competive applications and ensuring jobs are advertised long enough for them to apply. Or to redouble efforts to attract overseas applicants by offering incentives and exemptions.

Is anyone on twitter? DrEilidhMaria has been suggested. 30K followers.

Am close to completing my letter to my MP which I will share. If we get anyone's attention it is important that the problem, possible causes, and possible solutions are clear.