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.

*no easier, sorry.

This is the trouble with a lot of info on these two threads. It's written as fact but so much just can't stand up to any level of challenge.

Here's my story. About 10 years ago I was a medical SHO (in a training job). It was (then) a 2 year training programme, involving working a 48 hour week with nights/weekends, the need to complete 3 exams (a 6 hour written, a 9 hour written and a practical that had to be taken in an unknown area of the country while unknown consultants watch you examine and diagnose patients), and a portfolio full of reflections, audits and evidence of both attending and giving teaching. For a UK grad this is the MINIMUM requirement for getting into higher training for hospital medicine. You get extra points on top of that for publishing or presenting at conference, or doing something extra like running a full teaching programme for students/juniors at your hospital.

At the end of my 2 years I was exhausted. I was also TTC and just could not get pregnant (we ended up needing IVF). I did not apply for higher level training because I could not face doing the extras, knew my application wouldn't be competitive enough, and knew I couldn't handle another 5 years of it. I jumped ship to a different training programme that allowed me more space to focus on my own quality of life, though I've never had the same passion for my work since then.

An IMG came to shadow me for 2 months during those 2 years. She had 4 years experience in her home country. She shadowed me 9-5 for those 2 months. No out of hours work, not registered with the GMC so not actually able to manage her own patients. She had a lovely time. Off the back of that she managed to get a research fellowship, which she did for a year and managed to get some publications and presentations. Then she applied for higher training.

At that time she still had no UK clinical experience, no postgrad exams, no portfolio. But she did have her research fellowship and her clinical experience in her own country, and she ended up with an enormously competitive job as a result. As a UK grad, if I had put in an application with a similar background, I would have been rejected before interview.

She could not cope with the job. She ended up taking several breaks from her training job and has now returned to her home country for good without completing the training programme.

This is now happening en masse. Not only are we failing our own medical graduates, we are absolutely up shit creek for future medical workforce staffing.

sheepish this is your own account of a single IMG but it has no bearing on the (incorrect) assertion by mumsneedwine that in general it's easier for IMGs to attend and present at international conferences.

It's far easier to do research and go to conferences if you aren't spending all your time doing clinical work and meeting the basic requirements for training programmes, and IMGs have been given a free pass to avoid the clinical work.

Only on the specific model you cite. It's not a general thing.

Of course it is. All medical recruitment gives higher scores for research and conferences than for clinical work, so if you're applying without having to do the preceeding training programme, you prioritise gaining the research and the presentations. That's just logical.

I have been watching this thread silently, since there seems to be some reluctance to accept views of outsiders. But I do feel compelled to point out a few misconceptions that have cropped up over the last few pages.

Firstly, it is not necessarily easier to attend conferences or publish in academic journals abroad. While there are certainly more conferences and publications internationally, many will accept peer-reviewed, high-quality research from professionals across the globe, including UK FY2 doctors. And since the applications process is quite specific (for instance, requiring PubMed ID for publications), any research published in ‘dodgy journals’ is not likely to be competitive enough to count towards the UK scoring.
And in regard to scoring, it appears that conference attendances do not count for CST applications in 2025, and fetch reduced points for the top category in IMT applications. So it does look like issues are being addressed.

Secondly, India does accept UK doctors. They are not even required to take the Foreign Medical Graduate Exam that some other international graduates are expected to take (this is mostly to do with the regulation of medical education in various countries). I am not quite sure about Malaysia, but a quick search seems to show that UK graduates are eligible to register with the Malaysian Medical Council too. Whether a UK FY2 is willing to consider India or Malaysia for a couple of years of experience, instead of the US, Australia, or New Zealand, is totally up to them.
And, before I am called out on this, the reason that such immense number of IMGs are suddenly applying to the UK is largely the NHS’s own recruitment drive in these countries. A graduate in India/Malaysia would think, 'The UK seems to want us,' just like UK FY2s think, 'Australia/US seems to want us’.

Again, I would reiterate that I DO agree with the intent of this thread. The UK system must provide priority for their own graduates. It is also not fair to pit relatively inexperienced FY2s against experienced international applicants, without some attempt at levelling the field. Someone on the reddit pages had suggested adding extra points for UK graduates/ NHS experience, which seems a good starting point.
I do understand the difficulties faced by the graduates and their parents, and wish them the best. But the misconceptions really need to be addressed fairly (and not emotionally).

In specific instances a UK graduate might be in a preferential position too. This is not something you can generalise about.

Cross post with Forgotmyunagain. Thanks.

But obviously very open to hear mumsneedwine's justification for her assertion.

Please do share these instances. I'm not aware of them.

I have one point of view which some may find controversial.

I actually think we have gone too far in what we ask of all applicants.

You have to be clever to be a doctor. You have to have a good memory and be able juggle lots of information in your head at the same time. But in my humble view, you do not need to be an academic genius. A baseline of academic excellence is needed yes, but there is no need to do as much as is now expected.

It is great if those are interested, want to do research and publish papers. But I would suggest that for the vast majority, the ability to critically appraise journals is as much as is needed.

There are so many qualities you need to be a good doctor. You cannot underestimate the importance of organisational skills. It is all very well having a bright resident doctor, but if they are not organised and on top of admin, the system falls apart.

And of course communications skills. To this day, I am appalled at the poor skills in this area from doctors of every grade. Having a brilliant CV does not always equate to a good doctor. Empathy and sensitive communication help patients keep follow-up appointments, understand their treatment and take prescribed medication etc. These qualities should be valued more.

We need flexible and accommodating colleagues. We need people who are calm in a crisis. Doctors with an innate sense of responsibility who are reliable.

We do not need mini-Einsteins applying for all training posts. I am fed up of the growing demands and expectations on resident doctors when applying. The fact some play hockey at international level or have a PhD should not be as important as other skills.

Of course some amazing applicants have it all! The soft skills as well as academic excellence. Fabulous!

But as a consultant of almost 30y, I can say with confidence that there is no direct correlation between academic success, conferences and published papers, with the ability to become an excellent doctor. So we need to think about how we select doctors, without making them jump through higher and higher hoops. Many may disagree!

@Forgotmyunagain UK doctors can work anywhere in the world. But will get the jobs local staff don't want.

And publishing and conferences count for points. It comes down to 1-2 points between getting an interview and not when there are so many applicants.

I wish it was nice and easy to get a job, but this year it isn't. Unless you are an F2 trying to do it not sure how you'd know, which is why this thread was started.

Any medical graduate can apply for positions at Indian hospitals. In fact, they might even find it easier, since most aspects of UK medical education are very well documented, making the applications process easier.
I think we are running in circles here, with this insistence that anyone apart from FY2s/parents of FY2s/people impacted by the application process can’t possibly understand! You’re quite right in assuming that others do not experience the mental uncertainty and agony, but rather mistaken in assuming that all of us lack empathy. I do very much sympathize with you all, as I have mentioned in every post of mine on this thread. But it is essential to clear misconceptions, especially in regard to processes in other countries. I think I will bow out again at this point!
Again, I wish you all the best - and I wish things get sorted soon, in time for the current cohort.

@gvhmgnr my argument is not as a mum so please don't make it personal. Too late for my F2 to make changes this year.

My argument is very simple. We pay a lot of money to train our own doctors, at great expense, and then we don't employ them. This is silly and wasteful to the NHS. We are the ONLY country in the world who do not give priority to our own staff (of whatever nationality), so the NHS trains them and then replaces them with new staff who then need training ? Bit senseless.

And it's really not hard to understand that if you live in India it's easier to present at a conference in India, which is then counted as international for points in the NHS.

I still fail to understand how anyone does not perceive the problem. Unemployed doctors is not going to be a good look for the government come August.

Forgotmy that's great! Indian doctors come here to work and UK graduates go to Indian😂

They certainly could work in India, if they would like to consider the option! As I'd said, a huge reason for this sudden influx of IMGs is the NHS's targetted recruitment drive. I had posted the details upthread. Perhaps the Indian Medical Association could do a counter drive, instead of refusing to support the NHS drive, citing brain drain!

Again, I do understand the problem, and I do see the impact on the graduates and young doctors. I fully sympathize with them, and support their demand. All I am trying to do, on this particular thread, is to clear the many misconceptions that are frequently mentioned in regard to medical training in other countries

Any UK graduate can take time off after FY2 if they wish. That's all you're talking about tbh, in this particular arrangement. Tbf the doctor's research fellowship was overwhelmingly likely to have been awarded on the back of her four years of training prior to the shadowing, not the shadowing itself.

I'm really not clear why presenting a short piece at a conference held in say Edinburgh is easier for IMGs than it is for UK graduates. Unless mumsneedswine explains otherwise, I can only assume that she made this unthinking error. That's on the basis of her saying previously that international conferences were out of the reach of a lot of UK graduates on the grounds of cost. Obviously happy to have an alternative explanation. Edinburgh conference = Skegness conference = Hawaii in terms of points. I genuinely think mumsneedwine and several other posters don't realise this.

I think you’re 100% correct. I really don’t care if my doctor plays international hockey.

I just want to know that I’m in good hands. I’d find the hockey a worrying distraction to be honest!

No points any more for leadership so no need to worry PlopSofa.

And it's really not hard to understand that if you live in India it's easier to present at a conference in India, which is then counted as international for points in the NHS

Oh 😂I was actually correct about mumsneedwine's reasoning 😂

That's very funny.

I hadn't read this when I posted the post immediately prior to this one. Although my hunch has proved absolutely spot on, the rookieness of the misunderstanding is breathtaking - seriously.

@Forgotmyunagain

Please stay. You made some fair points.

I am glad about the conference attendance. We live in Central London so some of the more ambitious of DDs peers were very organised about paying for conferences ....and staying with us. More shocking was the not that well off girl who stayed with us to attend a paid for elective at Great Ormond Street, partly because she was interested, but presumably also to help find a way into her chosen speciality. Having money would clearly help.

I am happy to admit I don't know that much about the process because DD isn't there yet. Her plan was to give 100% to her F1/F2, and then find some sort of F3 position that would give her the time to prepare for the next step.

My reaction to her saying that there was no point even trying to find a job in the NHS and that her F2 colleagues had come to the same conclusion, was one of disbelief. My friends, especially those that know her, have the same reaction. But it seems from our MN sample that this view is widespread.

Wooley and takeittakeit have very different experiences. Wooley's DS, only slightly older than our DCs is a consultant, whilst takeittakeit has a group of F2s two of whom have landed training posts. The message there is that it is possible to get a job as long as you have near total dedication. The blame lies with our DC who lack that dedication. The UK benefits from recruiting the best candidates it can.

If they are right the obvious approach then is to reduce medical school places and to only accept those who can demonstrate that level of demonstration. The tax payer saves £250,000 per UK educated junior doctor and, benefits from what they would consider a more skilled workforce.

The system seems to agree with them. sheepissheep's example is one. Another, long-term MNetter is another. An IMG herself with a medical student DD, she herself was so shocked by the way weight was given for (paper and unverified) academic achievements which gave priority for some relatively mediocre interviewees that she has refused to take part in interviews since. And even yesterday, chatting to a Malaysian consultant friend working in a London teaching hospital. She first confirmed that some of the super driven and academic types don't make good doctors and indeed a proportion will burn themselves out. Even if they don't they won't be applying for posts in Doncaster or Enniskillen.

We have a mutual friend in Malaysia who is a high flyer, UK trained consultant, actively involved in some prestigious international research projects. We love her dearly but those who know her recognise that she is super-ambitious for her children and we watch with amusement as she plots their way through the system. UK training was always on the cards, and she is in a position to ensure that they have strong applications. The end aim will be consultancy jobs in the rapidly expanding health care sector in SE Asia. But it is not just individual parents who will want to game the system. It does not take much googling to find Asian based private providers of the sort of qualifications that put you ahead when applying to the UK (MBAs and some sort of medical Masters qualification: £33,000 for three years.) Interesting, to pick up SpicyAlways point, one Indian provider I looked at suggested that Indian graduates can often be short of the "soft skills" required to practice successfully in the UK and that they, for a fee will also address this.

When you talk about working overseas, you should note that both Australia and New Zealand give priority to their own applicants. As Wooley has said several times, UK doctors are welcome as long as they take jobs the Australians don't want. Locals enjoy similar priority when it comes to training positions. The issue for Malaysia, and presumably India, is that private medical schools are pumping our medical school graduates in numbers well beyond the capacity of their own state health care systems to absorb them. No problem at Consultant level, as the private health care system is expanding fast, but private patients want to see consultants so no jobs for those needing experience. They are not going to take our F2s. They have enough problems of their own with unemployed doctors.

The large number of IMGs may be partly NHS recruitment drives, but there is a huge push fact as well. In the same way that Australia may temp our doctors in with incentives, but most will be going because they can't find work here.

I completely recognise that we are not expert. Mumsnet is an interesting place to start a campaign. What we have is anecdote. What then needs to happen is that this anecdote is tested. It appears that the NHS do not keep stats on the number of applicants per (F3) job, nor the length of time applications are open. They also seem to assume that F2s leave for Australia because they like beaches and aussie rules. In short the NHS is focused on overseas recruitment but does not seem to have devoted much effort to retention. Indeed the response to retention problems seems to be to redouble overseas efforts.

I understand (takeittakeit?) that the NHS does already give weighting to NHS experience. What I think is needed is some sort of employment agency arrangement, like those available to overseas applicants. What could happen:

1. Single application that allows an F2 to list geographical areas and specialities they are interested in. Fully aware that it they limit their interest to brain surgery in London they probably wont have sufficient irons in the fire. They load their CV and the computer matches. There is a similar process for would be academics. In the final year of his PhD, DS loaded his CV onto a worldwide common application system and ticked boxes for the jobs he wanted to be considered for. Universities sift through and long list a number who they interview on line. The short list is "flown out" and go through an intensive interview process.
2. F2s are given careers advice. How to present the experience to date, who to use as references, what to do to strengthen weaker areas, what sort of roles to aim for.
3. F2s are given help with interview technique.
4. Perhaps if necessary relocation support is offered in the same way that it might be offered to overseas recruits. Staff accommodation in Enniskillen or London, or a relocation person to help show the ropes around renting in the local market.
5. And most important, reimpose the RLMT, so our good doctors are retained within the system. Like with Australia there will still be jobs for others, but paying for medical students and then not prioritising them for jobs is mad. .

(Please note that F2 is shorthand for doctors undertaking job search, and indeed other HCPs.)

Efforts made to retain will help the NHS understand why they are losing staff, so they don't need to be told by Mumsnet that they have a problem. I would add that applying for Australia seems far easier. Find an agency, tell them where you want to work, and bobs your uncle. DD plans to apply this week, but other DC already have offers.

Also thank you for your post. Most of us think there is a problem which the NHS needs to consider. If there is, we need to find a solution the NHS does. Perhaps the combined brains and diverse experience of Mumsnet may be useful. It is not an argument to win, but a chance to dig down to find out where the problems lie.

I agree, @mumsneedwine. Also, I think it's easy when you're a consultant who came up on previous promotion and financial regimes (in terms of pay, training and cost of education) to be blase about what's required.

Your consultant son is clearly an example for young doctors to follow. What did super-curricular was he able to demonstrate. Did he enter competitions overseas like other successful medics I have known or was he good enough that he was able to focus on the UK.

And does he intent to spend his whole career in the NHS or is private practice part of the ambition.

It is fine for people to argue that our DC should be doing more. But if those who do all the extras that get them onto and up the first rungs of the ladder don't stick around, what does the NHS do. Our dedicated bright and resilient DC will be long gone and the NHS will end up with no one, relying on recruitment drives for consultants in WHO red list countries.

(Actually sport is a great way of learning time-management, team work and resilience. I would say better than some of the academic stuff that the NHS demands.)

I think if I listed my elder DC's achievements it would compromise his privacy too much. I've already said he's been in London since F1. These worlds are small. So I'm afraid that I can't say much more than I have done. He's not a consultant though, just on the specialty registrar train.

He's always been emphatic that he has no wish to work privately and isn't currently intending to move abroad. He would if he had to though, I suppose.

One stand out feature is that he's always been immensely popular with colleagues and he seems to have received a lot of encouragement from all the consultants that he's worked with since F1, including interview support and advice with applications. He now helps those below him in seniority.

He's incredibly bright, has presented twice at conferences, has plenty of extra curriculars to his name (not relevant for points now though). He also has a reputation for being extraordinarily kind with patients (an experienced Matron in his last hospital wrote that he was the kindest doctor that she'd ever come across in her long career). He does far more than his fair share of stepping in for colleagues, indeed his current supervisor has just commended him for it but also said he should say no more than he does.

So I guess if one had to drill down to the essence: high intelligence coupled with an unusual lack of self interest and real kindness, all of which seem to be recognised by his supervisors and the wider teams and in consequence they support his next steps.

The F1 is not too different. Time will tell how things play out there - early days.