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.

This is a great post and my DH's experience. It was brutal and as I said he switched from Surgery to EM after going through all the training to reg rotation. He has 16 letters after his name.

This was a different system that was before formal training posts.

So what do you think the solution is? To decide the current crop are cosseted and to recruit overseas, or work out why they feel that they don't stand a chance getting a job in the current system.

@takeittakeit I think the issue is that back in the day, as a doctor, you would have been guaranteed a job. Not where you want, not in field you want and not a training rotation. However, you could always find work.

This landscape has changed.

Experienced doctors are actually being made redundant. This was unheard of when I was in medical school.

And I have heard of young doctors who cannot make ends meet in their enployed role, they have had to do additional work (if they can find it). When I was a young doctor, any additional work was purely for additional income for luxuries and not a necessity.

I am also sure that previously, local graduates were hired ahead of IMG. If this is changed, it will change the competition significantly as the IMG for the same role will be more experienced as they are likely to be older than local graduates and would have had more opportunities to develop their skills and have publications, research etc

Are you saying medical graduates of today face the same future as graduates 25 years ago?

25 years ago you could build your own training by doing SHO jobs. That does not exist anymore as training posts have replaced it.

@Needmoresleep in the GP world the issue is lack of funding or poor allocation of resources. GP practices simply don't have the money to employ the staff they want and may need to hire cheaper staff. I am sorry to say that IMGs are more likely to accept poorer working conditions and lower pay amd not kick up a fuss.

However, I feel in your DDs case, perhaps she should try actually applying for F3 roles to see how far she gets?

Amd also I am surprised if F1/2 doctors are working 72 odd hours every week as the rotas and shifts changed when EWTD came into play. They should have time to make applications.

@CherubEarrings training posts also existed 25 years ago and CESR route still exists today

However, the issue is 25 years ago, if you were prepared to travel across the country, you could get enough stand alone posts and fill a logbook.

I don't know but in the early days it felt like my DH was in the Army. He took a Fellowship post on low pay, 4 days after I had given birth to our second DC, 2.5 hrs away so I saw him at weekends but not always. I can imagine it is tough for JDs now but it was tough in other ways 20 years ago.

Training posts are the norm now. There are very few SHO posts compared to 25 years ago when it was the norm to create your own Training pathway via a series of SHO posts.

@Truetoself

I am not saying she is working 72 hours every week, though she has had some very tough ones. This (her fifth) placement is the first without nights, and though the patients have serious illness there is not the being called from one emergency to another. As a mother phoning her the difference is marked. It was common for her to be too tired to speak. During this placement she has time to chat, plan things, be off over Christmas. She is making the most of it as the next placement is a fantastic learning opportunity but will be demanding.

The word, including from people on this thread, that with the opening up of F3 posts to international competition the odds are too long. DD know that many will have bags more experience and papers than her. Their applications will be more polished, so will score better.

If she could get to interview she would be fine. But to do so she would need to have everything in place. Observation suggests that those getting F3s within the last couple of years have been doctors' children with better networks. And even some of them have had to opt for NHS bank first.

And then there is the next step. She can see the level of focus that those wanting to get a training number need, in order to compete against international peers. And the increasing sucess rates of IMGs over UK grads.

One, British born to refugee parents, I previously mentioned chose not to take any vacation from the age of 18-28 in order to ace exams and enter competitions everywhere from Bangkok to Buenos Aires. He lived at home so was fully supported. I love how the dad is bursting with pride but am unsure how my daughter can be motivated to do the same. DD also came across some who were ruthless in prioritising their own needs over group work or placements. The week before her first year exams she and a friend ended completing compulsory group work that 8 were down to do. It is quite possible that by prioritising individual benefit, one of the others picked up an academic prize the first step to burnishing an impressive CV. (Imperial, where she took her intercalation was smarter. On their major project they had a certain number of marks which the students themselves could award to the peers who contributed most. Whilst another piece of group work required individual vivas.)

If there were a relatively easy step from F2 to F3 I think DD would get her head down and start earning those supercurricular points. (Her brother is an academic economist specialising in labour markets and a whiz at crunching data, so perhaps they could produce something together about health care labour markets under a monopolistic employer in a free trade environment!) One big advantage of her current deanery is that is unpopular so if selection criteria could be tweaked away from the out and out academic arm race, to give more of a look in to those prepared to roll up their sleeves get on with the job, she would be better able to see a way through. With the benefit that a decade or two down the line the deanery would have one more person they could appoint as consultant without having to recruit overseas.

I also suspect the despair is catching. The NHS does not seem to be doing anything to retain the current crop of F2s. Just redoubling their efforts to replace them. Even the BMA, whilst acknowledging current F2s are leaving in droves, simply advocate increasing the numbers of medical school places. I had thought it was just DD and her peers. This thread icame about because other posters then confirmed that the despair is widespread. As taxpayers and patients this needs investigating and sorting.

I do wonder why people who trained under a different system don't seem to realise things have changed. Because you or your husband had a different experience it does not mean that the issues we are highlighting are not true. I am not negating your experience but you constantly want to do just that to the many parents and doctors on here telling you otherwise.

35,000 people took MSRA this year. 2 years ago it was 17,000. So double the number of people applying for the same number of posts. Majority of these extra applicants have never worked in the NHS and won't stay in it long term.

Even 2 years ago it was possible to have a v lucrative F3 doing locums. That's stopped. And Fellow jobs were a plenty. Now you have to see the job before 4pm or it's closed.

Keep calling me names and being rude to me if it makes you feel better. I'm a teacher so used to abuse from parents. People saying I'm not listening, maybe talk to this years F2s. Not ones who were there more than 2 years ago.

It's sad that a few of the senior doctors on here don't seem to want to help, but then that's also how we ended up with PAs doing surgery in babies.

Support our resident doctors so they can be employed in a job, any job as a doctor will do, that's all they ask. I'm surprised this is controversial 🤷‍♀️

If you'd like to hear from the F2s. Contains some v helpful statistics.

https://www.reddit.com/r/doctorsUK/comments/1ikmh2k/ukgraduateeprioritisationcalllfor_action/

You are obsessed with an F3 job as if it is more prestigious than a Trust grade junior clinical fellow post - they are one and the same thing.
Overseas applicants may have 2-3 yrs more experience but many are prepared to take a Trust grade job to get UK experience and work there way through the system.
I do firmly believe we should train our own that are competent first before training the rest of the world -sometimes that means our own need to get a yrs more experience to be ready that in the context of a job where you learn from experience is not a bad thing.
Insight into your own lack of experience or readiness is a big part of being ready for the next step

@takeittakeit possibly I have been using wrong terminology.

I thought F3 was just an informal term for a non training post straight after F2. So Clinical Teaching Fellow or locum or somewhere where you work whilst preparing to apply for a training number.

The big issue seems to be that the increase in international competition is causing both jobs and training that F2s would normally move in to are becoming much more competitive.

Those already in the UK have NHS experience, will have a better understanding of patients, often have better soft skills,and are more likely to stay for a full career. Taxpayers have invested a lot in them.

They put caps on the number of overseas students in medical schools. Why not similar caps on entry level jobs and on training places?

Headline figures from the report. There is a problem. It needs looking into so a solution can be made, or else we are going to spend money on training doctors we never employ.

@takeittakeit may I ask why you think the current F2s need more years experience to get training when your cohort didn't ? Or did the majority of your year group take several years before joining a speciality ? Forced or otherwise ? Did they manage to get a job as a doctor in the NHS or were they working in coffee shops (some F3s this year are). Be interested to know how many years of unemployment were common in the past, as you say things haven't changed.

Also, how much debt did you have on leaving University. This matters as the investment these days is not just time.

DrEilidhMaria on Twitter has also just been rejected from speciality training this week.

@Lovecatsanddogs and she didn't get a training post - was rooting for her (complete stranger to me). And has endless extra experience, degrees, publishing stuff and being in leadership roles and seems an amazing young woman, but no job. Made me sad.

@Needmoresleep I know and apparently some of her PA followers have been celebrating.

@Lovecatsanddogs 🤬tells you all you need to know about those PAs.

What a disgusting thing to do.

On a similar note

https://www.reddit.com/r/doctorsUK/comments/1ikk2it/gpregistrarssdelayinggppqualification_because/

Wonder why you can't see a GP ? Because they are driving an UBER

Ahh. Something an earlier generation of doctors did not face. Being asked as F2s to help train PAs, knowing that the same PAs would be taking up positions they previously could aspire to. (And that the PAs would be paid more for doing the job.)

It seems that NHS want anyone but their own medical school graduates.

75% of F2 in 2023 didn't get into speciality training. Was 48% in 2022. In 2012 it was 5%. For those who claim 'nothing has changed'.

www.rcp.ac.uk/news-and-media/news-and-opinion/rcp-responds-to-gmc-2024-workforce-report-and-calls-for-a-review-of-postgraduate-medical-training/?utm_source=chatgpt.com