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.

Personal, petty comments help no one. This is about all young doctors who want to continue practising medicine in the country that trained them, invested in them and where they may have already put down roots. The NHS needs them and they are willing to work hard for it. But this mess needs sorting for all and I fail to understand why anyone can't see that.

@modelT the recruitment process is just starting for this year so figures will be out around April/May.

However what we do know is that over 35,000 people sat the MSRA (used for about 2/3 specialties in some way), compared to 19,000 last year (rounded figures as don't have to the person ones currently to hand). Only 13,000 of these were UK graduates.

Double the number have applied to ED. And for IMT and Paeds who don't use the exam but base on portfolios, numbers have again doubled and the scores are now so high they are almost impossible for an average F2 to achieve. Points for things like medals which are much easier to gain in other countries or publications, international conference presentations (again easier if you're international), extra degrees etc. And no one checks any of it !

None of this makes them better doctors, just better at tick boxing.

There are many wonderful IMG doctors already here who are also now not getting jobs as there are just too many people applying. Experience in the NHS counts for nothing.

For Junior Fellow/F3 jobs there are again so many applicants it's hard to apply before the job closed. And the locum market has mostly gone.

takeittakeit
Nowhere does it say if you go to university and get a degree in medicine, nursing, physio, OT, law engineering, architecture you should expect a job - life is not like that and people with architecture degrees, physio degrees etc are no less worthy than medics.

Sorry, but as a medic you should know that medicine caps the number of places specifically so all qualifying doctors have a job, not sure where 'worthy' comes into it. Any Uni can set up any course and take in as many students as they want. Not for medicine (& nursing). Legal caps as costs lots of money to train them so the supply is supposed to meet demand.

Plus doctors and nurses only have one employer while training (eg up to consultant level). No other job does.

Whilst I do think that the UK could consider prioritizing their own graduates first....this isn't just a problem in medicine, it's also a problem in academia and other sectors. In that regard medicine isn't special. The point system in theory is meant to get the best candidates i.e.those with the most points. Seeing as the UK is an English speaking country and by now that is a global language, it means Brits are essentially competing with the rest of the world for local jobs. However, why should medicine be singled out in this?

@gvhmgnr no one is saying it should. If other professions are suffering in a similar way then they too can fight their case. But this is about doctors and how we pay a fortune to train them but don't employ them. At a time the NHS is crying out for doctors.

@gvhmgnr sorry, to add, we are the ONLY country in the world who doesn't give priority to our own staff. So they have to compete against the world (and it's not a simple level playing field) at home but aren't allowed to when go abroad - they get the jobs that are left.

Your comments on these specific individual DCs who are not on this thread is unjust. Not sure what your motivation is as you seem intent on trying to stop any changes that might improve the chances for the doctors that have been affected

OneMorePiece you need to read the wording. This is very clearly, in its terminology, a non specific comment about all those young people who go to medical school and not any one individual. Quite ludicrous claims are being made for their loveliness and hard workingness and their brightness. The reality is that too many who are not particularly standout in any way go to medical school and they are not intrinsically superior to their school peers, even if a few (usually the objectively least able) think that they are.

All sorts of other nonsense is being spouted here, data is being clumsily and emotionally interpreted (see 'Ideal University for Medicine' for the calmer interpretation), and far too many posters have seemingly lost any ability to be polite to those who challenge their position, even when those challenges are made from a knowledgeable and unemotional position.

Adding bold does nothing to help a point. It's the words which matter.

@mumsneedwine yes, UK graduates compete with the world in most professions. I am an academic and the UK has invested seven years worth of training cash into me but I had to go abroad for my first post before coming back to the UK because so many academic posts go to internationals. That's sort of how the system works here. I am not sure that this is always right and I have noticed that language barriers are inevitable way in which our Eyropean counterparts tend to 'favour' the locals which is much harder in the UK. But again this isn't about medicine per se.

Points for things [such as].... international conference presentations (again easier if you're international)

Could you explain why it's 'easier' for internationals?

There is a big difference. The NHS is the sole employer of newly qualified doctors. There are lots of Universities, each of whom organise their own recruitment.

The University sector worldwide is very international. A US University funded DS's PhD. He then made applied to around 250 jobs and was shortlisted (flown out) to Universities on three continents. If now happens that he is in the UK, but he may not be for his next job. Yes being monolingual is a disadvantage, his Spanish speaking peers in the US were able to apply for jobs needing either English or Spanish. But native tongue English can be an advantage and courses are more frequently being taught in English. The problem is that the higher education sector is in crisis across the world and Universities are cutting back.. Employment prospects are not great and DS has many friends, despite great CVs, who have had to take jobs in the City or consultancy, take law conversion courses etc. .

Another difference is that academic credentials are tested. When DS was flown out, those interviewing him had read what he had published. When he was applying for PhD and Research assistant jobs, the people recruiting knew and spoke to his referees. Part of the interview process seemed to include giving a guest lecture. NHS interviewers do not appear to quality control academic credentials,. but instead take them on trust and weigh them when scoring applications.

You can argue hospitals are different employers too...in the same way as universities are.

What you are upset about is that medicine used to be perceived as one of the few middle class sectors with a guaranteed job at the end. And now it isn't. Similar to the way that other sectors aren't. Nothing you have stated makes the NHS different from other sectors.

Now am not saying that the UK shouldn't start prioritizing their own better. But it's not a medicine only problem. Now you might be able to win the argument by scare mongering that foreign doctors are somehow worse and make people fearful of them but that's not really engaging with the broader discussion as to whether or not professional jobs should be better protected for the Brits.

@gvhmgnr we are talking about doctors here. If you want to argue fit other professions then maybe start a new thread ?

@Wooleys I could but surely you can do your own research. Ask your F1 as they'll know

@Needmoresleep
What can be done?
What can Mumsnet members do to help?

@mumsneedwine yes you are talking about doctors but to win a public campaign you might need a stronger arguments. Saying why do they have to compete with other internationals when the rest of us all do....isn't very effective. The fact that as a mum you hadn't realised this to be the case isn't a strong argument either.

Hospitals do not decide who gets a training number. It is national.

I am not upset. Frustrated maybe as I enjoy having my family close. Given the amount of effort put into widening access schemes "middle class" is a poorly aimed pejorative. Those most impacted will be those from poorer, often ethnic, backgrounds.

OI can say that the DC of the mums posting here are intelligent, resilient and hard working and clearly welcomed by other countries: Australia, NZ, Canada and now the US. (Oddly not by countries who supply us with doctors, such as Malaysia or India. Yet we are accused of racism and xenophobia.) However the current approach of not prioritising British medical school graduates is both unfair and costly. Taxpayers have a right to question. Equally given that many from overseas who are accepted for training are unlikely to stay in the country once they finish, patients have a right to be concerned about the long term viability of the NHS.

Unlike in academia, there should be more than enough jobs for our own graduates, but the system is geared towards employing those from overseas. There are clearly those on this thread who believe that doctors trained in Eastern Europe or Africa will be better off than our own. Not least because they have made more effort to find employment. The concern is that academic and other achievements that give weight to their applications, and which effectively enable them to be selected above our home trained doctors, is not subject to scrutiny.

I will not get into the wider debate about capacity within the UK to take in large numbers of new arrivals whose dependents will need housing, schools, and other services. Only to say that Keir is clearly aware of voter concerns.

When I graduated in the 90s from my London medical school, it was assumed we would all get jobs. And we did. The ones that went to Australia went for positive reasons ie the weather, a new culture, excitement etc. Nobody I knew went there to escape the NHS or from fear of unemployment.

Things have changed and it is vital to look at why. I remember we used to talk about Germany I think, and how doctors there were having to work as taxi drivers. I never in a million years thought that would happen here.

In a couple of days will start a new AIBU thread asking people to write to their MPs and to also open their address books and spread the word.

The latter is important. I met a Consultant friend for lunch yesterday who was completely unaware. But ended up both shocked and not surprised. The NHS is becoming an increasingly difficult employer to work for, and who seem to have little interest in retaining the doctors who work for them, at whatever level.

I did try a draft up thread but, following useful feedback from Wooley and others, need to revise it.

I am an Asian consultant (born and trained here) with parents who are Asian immigrants, trained abroad and who were invited to work here by the British government In the 60s.

I really hate the term ‘race card’. It feels really dismissive of how awful racism feels to the recipients.

But I do not feel this discussion is about racism. In my view, the government needs to train doctors to work in the NHS here. They need to really think about workforce planning so that most doctors trained here will work here in the public sector. Ofc the numbers can’t be exact but there should not be vast swathes of competent doctors trained here out of work. That is stupid.

Many doctors here are not white. I interviewed for the medical school last month and I would say at least 80% were from ethic minorities. It’s hard to see racism at play here. Training our own doctors and then not employing them here is a poor use of funds.

I am very happy if someone else wants a go at a draft.

As Wooley suggests, my drafting skills are not the best.

True. Will try and explain as I understand it. It's being 'singled' out here because it was set up as the subject of discussion of an AIBU. The AIBU was set up to draw attention to this particular problem faced by a set of young people (not just the ones on this thread) who have been disadvantaged and are facing unemployment.

It is focusing on the current cohorts. A comparison with previous cohorts of medicine who were subject to different recruitment systems in the context of different immigration rules would have been unfair and therefore made AIBU polling difficult. Hence why points of some posters were deemed as irrelevant. This set's situation is exacerbated due to the way the current NHS online recruitment system selects. This, together with the removal of the RLMT and the current points based immigration system, has resulted in an IMG explosion (possibly an unintended oversupply) affecting the latest cohorts that is much, much larger than other sectors. This set has found themselves in a unique (you may have said special) position compared to previous batches of doctors who faced different circumstances.

With voting being part of an AIBU, it made sense to discuss this particular set of medical graduates potentially facing unemployment with a narrower focus within the current recruitment rules in the context of the current immigration rules. A comparison against all sectors would have been too wide for people to vote on the poll. How it affects other sectors is a valid point that needs important consideration too but the scope of that discussion would have been too wide for this particular AIBU poll.

It's not about research. It's that your statement is inaccurate so I wondered why you thought it correct.

You are very welcome to set up your own thread, on the wider issues around skills and the RMLT.

I set up this one because I was shocked to discover that my DD thought she had no chance of getting a job in the UK, and then that her pessimism was very widespread. I can say factually that she is both academic (first class honours in biomedical engineering from Imperial) and is a good doctor (some very strong appraisals.) As a teenager she competed in national championships and represented the country in two major sports, and was selected for a major school leadership position. I am sure that other DC will have similar accomplishments. DD is not looking for a place on a super competitive training scheme. Nor for a job at a London teaching hospital. Just a job, any job, in her current relatively unpopular deanery.

Trouble is the lure of NHS salaries and the chance of bring dependents over, as well as the support organised recruitment agents and anonymised recruiting means that DD will stand no chance to get an entry level job, because there will be hundreds of applicants and other candidates with the experience she has yet to get.

Yes you are getting an initially stronger candidate but the logical argument then is not to bother with UK medical schools at all as there is no path through to getting the experience young doctors need. And simply recruit medics from overseas.

@Needmoresleep I am not against your overall sentiment - however, my point is that by the time every other profession works on this basis - the fact that medicine as the last bastion of essentially almost guaranteed work at the end of the degree is now failing is sort of too late. No one in the UK assumes they are guaranteed work at the end of their first degree - that has been true for most people for years. The fact that it is now also the fact for medicine is sort of too late.

In fact - medicine actually suffers even more from some of these issues. Every incoming government promises to vastly increase numbers of doctors almost overnight and the public never asks how exactly is that going to happen. Well the only way that is going to happen is by importing them from abroad because it takes more than a single term in parliament to train them. So medicine is even more incentivised to get them from abroad than other industries.

However, your ignorance of facts does not make for a public campaign.

And if you are trying to save British medicine then honestly focus more on the deskilling of the profession than foreign born doctors.

So just to correct mumsneedwine: it's absolutely no easy to gather points from conferences for international applicants. No need to fret on that score.