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.

Please could you pm me too, OP? My DD is a uni medic at the moment. I cannot believe this is where we're at. I will follow this thread too.

You're not wrong, OP.

Ironically, DH was a SHO (we are old) pre-Brexit and qualified outside the UK. The NHS, in its wisdom, interpreted the EU single market rules so that doctors who qualified outside of the EU had to be objectively better than any UK/EU candidate in order to obtain a specialist training number, otherwise it was discriminatory. No level playing field there either. It was an insanely stressful time: no job = no visa, no income, etc. DH was kept on because he's brilliant and none of the consultants wanted to lose him to Dubai or the USA. Looks as though we've gone full circle since then...

Our local hospital was recently forced to recruit a consultant from South America due to lack of interest in the vacancy. Whichever way you look at it, NHS staffing requirements have been royally ballsed up.

No, you have misunderstood the concerns here. It's not a battle against UK based IMGs. Just that new IMG recruits applying from abroad should have to wait until UK doctors (whether they are UK IMGs or UK trained doctors) are allocated positions. The current online recruitment system has introduced, possibly an unintended bias in favour of those applying from abroad and haven't yet set foot in the UK.

There's no way private hospitals can give the experience and breadth of training that the NHS can.

PP has a point about certain hospitals finding it hard to recruit, because they aren't seen as very exciting /are in rural or "unpopular" areas.

Well said OP and YA absolutely NOT BU.

I work in primary care as a social prescriber. I’m seeing physician associates coming in and replacing doctors, although that’s not what they were trained for.

I’ve nothing against PAs, the few I’ve met have been excellent but need supervision by a doctor.

I have even seen one as a patient who was lovely but had to check everything with the GP. They might just as well have employed a GP in the first place.

Having being exposed recently to a "physician associate" who made things much worse - I wonder how many people realise just how unskilled they are? It's 2 years post a non medical degree and then you are let lose on an unsuspecting public who should be (but are not always) told that they are not a doctor.

I think the government is actually trying to push doctors into physician associate and other posts like trust grade doctors that can be paid less than consultants. They think uk doctors will be willing to stay here for less money.

It is disgusting that we prioritise overseas doctors to the detriment of those trained here.

I am not 'joking' about it, I am using irony to highlight that this is a common pattern across many roles and spheres of activity.

This is about neoliberalism and globalisation, beloved by the World Bank, IMF and right-of-centre politicians everywhere. According to this school of thought, labour should be internationally mobile. Public services and professional boundaries should be disrupted and broken down. If a workforce isn't playing ball for whatever reason, bring in those who will do it cheaper or better. And yes, Boris Johnson and many other Conservatives adhere to this philosophy.

I previously worked in another profession that has been affected by exactly the process that I described. Roles that were once only legally held by graduate professionals are now 'covered' by people who don't have to hold any qualifications.

People love it when neoliberalism or globalisation brings them a cheaper product or service, but hate it when their own job or a service they value is under threat.

I don't agree with it - I believe in a large state and well-funded public services - but I think it is a tide that none of us can stop.

Eh? How can recruiting international doctors keep wages low, there's not a 2 tier wage system, a Dr of x grade will be paid y, we are paid on experience not country of origin

This is not correct.

Not true. You literally cannot be a PA if you're a Dr. We are on the list of non-acceptable undergraduate degrees (cos we would all leave for the easy life/decent salary given tbe choice)

I looked into becoming an anaesthetic associate in final year of med school as I loved Anaesthetics but deemed myself too stupid (they have the hardest of all post graduation exams along with radiology) but we are forbidden so I got stuck with the really hard exams unfortunately

It's a bit harsh to tar all PAs together I used to teach them in my gap year and some had far higher knowledge than your average f1-3 and after many years in a specialty as they're not forced to rotate like we are theyll be v knowledgeable in their field. Yeah there's some that are worrying in their knowledge (have been treated by one myself when too unwell to realise what they were doing until afterwards- feeling for a blood clot in my legs...but through my jeans and knee high leather boots!). But given correct supervision and not seeing undifferentiated patients they could easily be utilised to improve the wards with things like writing discharge documents etc

“There's no way private hospitals can give the experience and breadth of training that the NHS can.“

That is not what I meant, I did not mean exclusive use of private healthcare. I meant some rotations in private healthcare being allowed. If plenty of consultants are there 2 days a week and they are handling the backlog, then surely they can also supervise and handle some F3s? It is common sense.
With the ageing population, the more doctors we have, the better for us. The foreign doctors with experience are getting the jobs because they require less supervision on Day 1?

Physician Associates are a huge scandal and problem.

Anyone can apply for a 2 year Physician Associate degree, with any degree behind them - doesn't have to be science related. They're then told that they are the equal to doctors, know as much as doctors and should be able to treat as doctors do.

Compare this graduate entry medicine which takes applicants whose first degree wasn't medicine:
Very few schools take applicants with a non-science degee but regardless, ALL applicants must past at least 2 medical entry exams which rigorously test mathematical and scientific capability. Of these, the GAMSAT is notably a 5 hour exam and requires degree-level science knowledge (particularly chemistry & biology). Graduate medicine is still 4 years duration, compared to the paltry 2 year Physician Associate degree.

Physician Associates are increasingly employed in positions that should go to qualified doctors, and land doctor training roles which are outside their scope of skill & responsibility.

Doctors are finding either that they're prevented from applying for training roles, or that the quota has been filled, only to find that spaces are taken by Physician Associates.

Gp practices frequently are not allowed to hire new GPs. Their funding for increasing staff specifically excludes GP but permits Physican Associates so when they lack GPs, they hire Physician Associates instead. A GP practice manager was filmed undercover admitting that practices choose to hire Physician Associates instead because they're cheaper than doctors.

This increases risk to both patient, gp and gp practice: GPs must supervise PAs so they workload is increased, not lightened (the original purpose of Physician Associates was to assist doctors with the burden of non clinical work).

Physician Associates are not allowed to see undifferentiated (undiagnosed) patients because they don't have the training but frequently do. There are numerous cases of misdiagnosis, mediciness being incorrectly prescribed or long-term medications being cancelled on the whim of a Physician Associate.

There are frequent incidents of Physician Associates sharing private medical information about patients on social media, which is a serious breach of professionalism itself, even more when you realise that many of the social media posts share enough detail as to allow the patient to be identified.

It's becoming increasingly common for patients, especially those seeking to see their gp, being given an appointment with a Physician Associate instead and not being told they're not seeing a doctor. There are numerous reports of (and social media posts of) Physican Associates presenting themselves to patients as doctors.

Some gp practices will be open about the fact that they're offering an appointment with a Physician Associate, but wrongly tell the patient the Physcian Associate is trained & qualified to treat them according to the rules of Physcian Associate scope of practice, and rulings made by regulatory medical bodies.

Physican Associates are also better paid than doctors.

@Needmoresleep have sent you a PM

I’m a gp who is just trying to come back after a career break. To be clear, I am fully qualified, so I don’t need a training place, just an actual job. Firstly the return to work scheme has been absolutely ridiculous in terms of poor organisation, admin staff not returning my emails for weeks, poorly organised, and they expect me to do my retraining for a paltry ‘bursary’ rather than actually be paid a wage.

secondly, there are hardly any gp jobs available! The government is funding arss which are non doctors, which has completely fucked the job market for actual gps as many practices can’t afford to hire us now.

@Onlyhereforthebatshitneighbours exactly.

i have done 15 years of training (including medical school) and am now struggling to find a job. Nowhere is advertising for salaried gps. There’s no locum work. I know colleagues who are genuinely working for Tesco. It’s a disgrace.

Same for soon to be qualified radiographers. Hospitals are holding back on advertising posts to cut costs. Ironically, I expect employment prospects are booming in the private sector and the government will be using and paying that private sector to see more NHS patients to speed up diagnostics. It's all about where the pots of money are I assume.

I might be old fashioned but I think we should prioritise our own young people before overseas applicants. It seems odd to me that we say we have shortages of highly skilled people yet do anything we can except promote our own.

No its a mad argument, but one I have heard.

It goes along the lines of the NHS were very shocked by the doctors strike so thinks doctors from overseas will be more docile than our own and less likely to fight for further increases. .

If we have a surfeit of doctors and other medical staff, why on earth are we not building more hospitals?

The amount of new houses being built in my county is astronomical, yet no new health facilities are planned. Goodness knows how or where the new residents will be able to access a GP, dentist or hospital appointment.

No, that’s how the media portrayed the working classes to ensure the middle classes didn’t listen to their plight.

I come from a family of skilled tradies. There was a lot of genuine concern for their jobs being undercut by workers from overseas. I didn’t vote for brexit but it’s offensive to group people who were worried about their livelihoods as racist/xenophobia.

Just because some trade professionals wear clothing from sport direct to work don’t make them the stereotypes that hang out outside the job centre…

As a lay person with just a passing interest in this subject, I must say this thread is a bit of an eye-opener.

One of the issues is how to get these problems discussed more publicly in the media without sounding as though you are anti-immigrant.

So many immigrant doctors and nurses do so much fantastic work in the NHS. And are propping it up on not very good wages.

So how do you go about getting the voices of home-grown doctors heard too?

As my DS is currently F2 this is a massive worry, he really wants to stay in the UK where possible and is facing unemployment come August. I really struggle to understand why the UK appears to be the only country who does not give priority to the doctors they train up.

I was being sarcastic. I thought my follow up comments made that clear.

Although initially perceived to require less supervision because they may have more experience, lots of money is spent retraining new IMG recruits in soft skills like how to engage with patients and take patient histories correctly, how to listen emphatically instead of rushing to prescribe or rushing to do expensive NHS procedures. If the management and treatment of patients is not done correctly, it put the NHS at risk of negligence claims, cost taxpayers more money, etc.

Also lots of time spent by existing NHS staff, including staff in more junior posts, showing the new seniors who have just set foot into the country what to do. These new recruits have got in due to weaknesses in the latest online NHS recruitment system and shouldn't be prioritised.

As for the private sector being involved, that could lead to more problems due to their main objective being making money. I think the main focus should be correcting the issues within NHS recruitment.

I am an NHS consultant approaching retirement with a DD 3 weeks from her medical school finals, due to start foundation in August - we know not where due to the entirely random allocation process plus the vastly increased number of applicants
: the lack of priority for UK grads starts here and this years number of applicants far exceeds the number of U.K. medical students graduating. To say I am outraged at the whole situation is an understatement. Since I qualified in 1988 NHS workforce planning has always been bad but the current situation is unprecedented.

What would improve the situation:

1. prioritise UK graduates for NHS posts (foundation and training) as is the case in ALL other countries - those looking for work in Aus/NZ are only getting posts AFTER their own country’s grads have been placed. This is not some Reform-based xenophobia but surely sensible given the huge investment that the U.K. taxpayers have made in uk medical students training - most of who want to stay here. It is so shortsighted since many IMGs who will be trained here will return to their home countries as consultants. If many of our uk grads decide to stay abroad long term, good luck trying to find an NHS consultant in a few years time!
2. abandon the PA project which is further limiting posts for doctors (UK grads and IMGs). PAs are markedly less trained, more expensive than a resident doctor even 5 years after qualifying, cannot prescribe or order X-rays/scans and have been involved in some appalling errors (not saying doctors never make mistakes but they are far better trained and take responsibility). There is currently a review into this project to which anyone can contribute a view or experience but predictably this has been poorly publicised - please email if you want to make a point: [email protected]

Is this plan cock up or conspiracy? Many in the NHS fear the latter - nice headlines of more medical student places but no jobs for them once qualified - we are effectively training residents docs for the rest of the world. Replace many posts with non medically qualified personnel who will never become expensive consultants and GP partners. Very quickly a two tier system will develop when only those who can pay can see a doctor.

DD tells me that majority of her year of 400 students plan to work abroad or even leave medicine. At a personal level I am heartbroken but I completely understand their view that why would they work in a system that values them so little (financially , in terms of priority for training and in terms of working conditions). I can only hope that the NHS might improve enough to entice her back in future.