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.

I'm sure a lot of places still have difficulty recruiting to be honest.

How did the average British skilled tradesman feel in the early noughties when his local area suddenly received an influx of qualified, English-speaking young Poles with low costs, plenty of enthusiasm and a strong work-ethic? That is where the seeds of Brexit were sown.

No, no you're wrong. The objections of skilled trades people were rooted in racism and xenophobia. Brexit was about British exceptionalism and a desire to return to the days of empire.

Funny how complaining about an immigration policy when it negatively affects a middle class profession isn't characterised in the same way.

I'm very sympathetic to OP's point, I'm just pointing out the double standard.

Yes, I get that the decision is in the hands of the government rather than the BMA. But would the government press ahead in the face of explicit opposition from the BMA?
BMA meeting: Doctors vote to limit number of medical students | The BMJ
I don't know the history of what happened, but it certainly creates the impression that doctors wished to restrict their own numbers - which then plays rather badly when talking about staff shortages.

It seems counterintuitive to spend 1/4 million pounds training a doctor here and then having no employment for them. Seems a total lack of planning.

I also understood they were expanding medical training places.

Australia is a big fan of our policy of spending £££ putting doctors through medical school and not deploying them. They get them fully fledged and investment-free.

This was because there weren’t enough training opportunities in 2008 and the BMA didn’t want graduates to find they had no opportunities once they finished med school. That’s what the text says.

The BMA were trying to avoid the exact problem we have now.

However the recent situation has arisen because even though the government mandated the new extra medical places that graduates are now finishing their degrees from, they also simultaneously massively increased external competition at the same time.

Waste of time for those grads. Thousands of pounds down the drain and years of their life. Unless they move.

Part of the problem is that F2s are seeing application numbers and deciding that they have no hope.

Overseas applicants are often supported by agencies, and even the UK Government which is effectively incentivising applications from India and elsewhere, providing exemptions, guaranteeing training and etc.

UK medical school graduates are found (allocated) F1/F2 positions, but it stops there.

A common app so that they could apply once stating geographic and speciality preferences post F2 would be an efficient way of matching jobs with applicants. F2s is not in a position to scatter hundreds of applications across the country. Perhaps also some advice in the way University careers offices will help graduates a a couple of years after leaving.

Better still if they had some form of priority over applicants from overseas.

@FOJN I am hugely sympathetic to the OP (and her DC) too. But I also think that medicine has been, to some extent, insulated from some of the external forces that have buffeted other jobs, industries and professions. This is not a unique situation.

Perhaps the rail unions have had it right all along, protecting jobs first and foremost?

I’m a midwife it’s a total disgrace. Midwifery students and I think nursing students in the same boat. Very limited jobs. Local hospitals say they have no money to recruit, there are shortages still

Training is nationally recruited (as there's many places people wouldn't choose to work but still need staff) - thankfully now they've segregated the 4 nations so can't get sent to NI anymore

It's still a joke it took me 9y of applications to get within an hour of my parents house. My mate applied for 4y running to stay in the area where she owned her house, and kids in school/nursery and husband worked as a teacher, still didn't get a job so had to relocate and drag them all 200miles to Yorkshire.

It's a joke we are treated as a number on a spreadsheet not a human with a life. I tried to apply for "caring needs" as my family are in such ill health frequent hospitalisation etc and was using all my time off driving 4h back and forward... was told I don't meet criteria as don't daily care for them.... Well yes I'd love to if I wasn't dumped to work 4h from their house. Can't win.

No clue why anyone would go into the job as much as I love it and am nearly done training

@Needmoresleep

What do you mean you need “a,bc” even for GP? GPs are still specialists!

It’s all very well to joke about it on MN.

I might not mind a Polish chippie or a Bulgarian electrician doing work on my house or elsewhere… you don’t need great English to know how to execute these core skills. And you’d hope it’s not life-threatening either.

But when it comes to your health, don’t you want the very best? The NHS training is very very good.

There’s a current recruitment drive to bring in 10,000 doctors from India. I’m sure they’ll all be pretty good too, but I’ll be honest and say I have more confidence in British trained doctors who know our system and speak the language innately.

It’s all just a big experiment isn’t it?

And it still doesn’t answer the question why are we funding places when the grads can’t use the degree? What’s the point? Waste of tax payers money. Again.

And in the end these people may go home. So what do we do then?

loads of Europeans have gone home. There’s a six month waiting list round my area to get any building work done - with someone reliable I might add.

A cynic might say that it is about keeping wage levels low. But it does not make sense.

We are spending a fortune on our UK medical schools, only to export our doctors. Then giving expensive and prestigious specialist training to medics from overseas, who are then like to return home or head for somewhere like Dubai or to Singapore, to work as highly paid consultants in their private medicine sectors.

Recruiting consultants with no background in the NHS can be a nightmare. They have a lot to learn, yet are expected to lead and train other staff and students.

This was definitely a problem my DH felt he had a number on his back to plug various gaps in the workforce regardless of achieving his medical degree from a top Uni and sailing through all earlier training. They have to fill positions a leafy southern suburb will have no trouble filling a post harder ti do so in the Isle of Man.

This happened when I qualified as a nurse. No band 5 positions. It was 2005, but I left the nhs, changed careers completely, lost my registration and never went back. I love my career, so all for the best, but such a waste of training nurses only to recruit from overseas.

I heard exactly this on the radio a few nights ago. Young woman trained in nursing, got debt, can’t get a job at her local hospital. She was so downhearted. She’d heard they were crying out for nurses… thought employment was guaranteed.

I think the situation is a bit more complex than you’re making out to be.

Lots of doctors left the training system after F2 because they WANTED to, not because there were no jobs. They didn’t like the rigidity of the training system, fixed rotations, poor pay etc. so they voted with their feet and went abroad, or chose to do locum work, or left the NHS to do aesthetics or media work or pharmaceuticals. This was entirely reasonable of them but the result was that the less popular hospitals struggled to recruit doctors so turned to overseas candidates instead.

Popular specialties and locations have always been super-competitive but there ARE jobs available in other areas. I’m a senior doctor in a rural hospital and we would love to have UK trained doctors applying for our jobs as it’s harder and takes a lot longer for us to recruit from abroad due to having to sort out visas, familiarise them with the NHS, register with the GMC etc. Sadly we often have no choice but to actively recruit from overseas as UK trained doctors just aren’t interested in coming here.

Also most entry-level (ST1-3/CT1-3) training posts set restrictions on the amount of experience applicants can have so people with “decades of experience” can’t apply, which is the reason there’s a far higher proportion of IMGs in non-training posts than in training - they are pretty much locked out of training due to having too much experience!

I definitely think the government should be doing more to improve the work-life balance and flexibility of training posts. And I absolutely think that PAs, paramedics and other healthcare professionals should not be used solely as a cheap alternative to doctors - this is a much bigger part of the issue but has nothing to do with overseas doctors.

However “there’s no jobs because overseas-trained doctors are taking them from us” is a very inflammatory statement to make when it’s partly a case of “there are jobs but they aren’t in the places or specialties that we want to work in”.

Get private healthcare to train them up via incentives and supervision? The foreign doctors coming is a good thing, we want and need all of them. Adjust the training and pay private sector to train them up.

They are completely inept. That’s the conclusion I’ve come to. Most find power addictive. Look at how Boris and Rishi both had to be pushed out. Starmer will be no different. If they could do it better they would but they’re just terrible at running systems and forward planning in pretty much everything.

Councils are broke, water companies bust, NHS falling apart, public transport more expensive than taking a car, roads in a terrible state, education like a battlefield. We’re just very poorly run. I think it’s called ‘managed decline’. You can see why Trump got in, whether you like him or not. The Americans said let’s try something else. I hope he can turn things around without becoming a dictator in the process.

Any off topic as this is about junior docs, but I feel this is the slide we are currently in and this issue with junior docs is just one of the many symptoms of bad governance.

Yes, the Resident Labour Market Test was replaced with the UK points based immigration system when the Tories were in government. There is no longer a need for employers to satisfy the Resident Labour Market Test which ensured that UK applicants were prioritised for jobs (not just medical) in the UK. The new points based system is less stringent and offer an easier route for foreign workers to enter employment and potentially settle permanently in the UK. This, a failure of monitoring of how disproportionate the recruitment of new IMGs has become and the ability to bring your family has led to a deluge, after Brexit, of international medical graduates (IMGs).

There needs to be a reset! I understand Labour, in their aim to reduce net migration, is reviewing the points based immigration system while in government but it needs to be done urgently. Our DCs shouldn't have to bear the brunt of poor decision making.

I agree with you.

I wonder if the people now being affected are reflecting on whether the people who previously complained about how immigration was affecting their industry actually had a point and regret shaming them to be quiet with accusations of racism and xenophobia.

Could you possibly explain what you mean by the aim being political?

What's the intention?

I can't see any benefit to anyone.

But the private consultants will also be working in the NHS. These are the same people.

Don't be so silly, why would the NHS actually hire its own staff when it can juet employ agency staff/ pointless middle managers wt 3 x the price? Throwing as much money io the private sector as possible has been the priority for yeas- do you not know that all GP surgeries for example are private businesses?