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.

@Wooleys because they are not working in the NHS, doing 72 hour weeks, nights and weird shifts, while also trying to study for the exam. Lots are doing 9-5 jobs in their countries. Indus even gives free coaching for the exam, the UK doesn't even give study leave.

India not Indus

All our doctors want is a fair chance at getting a job. For Paediatric training this year you virtually needed another degree, several published papers and to have presented at international conferences. Most of which are not easy to do while also being a foundation doctor in the NHS.

DD applied for an F3 trust job last week. It was posted at 9am and she applied when she came off shift at 6pm. Her application was rejected because they'd already had 600+ applications. There are bots that spam every job that comes up, majority of applicants won't even be qualified to work in the NHS. But the recruitment people can't sift through 00000s so they close the job.

For another post they had 1,000 applicants. 5 were eligible. But took days for the staff to sift through the forms.

The sort of CV needed to be interviewed for specialist training, even as a GP, is extraordinary. Prizes, published papers, conferences. Some manage, but for many coming off a 13 hour busy night shift, hitting the books is not the priority. Yet these dedicated, resilient work-hard play hard doctors, who prioritise a work-life balance, should be forming the future backbone of the NHS. We need more than just academic doctors

Hmmm, presumably it is the doctors who are prepared to 'hit the books' after coming off a 13 hour shift, who win the jobs and better placements? Twas ever thus.

For these elite professional jobs there is no work life balance for the first few years. DD is doing her placement year with one of the Big Four and once she finishes university she will be accepted onto their graduate program. She beat hundreds (thousands?) of other applicants and the selection process was brutal. She's still only 20 but typically works a 14 hour day, works many weekends, and has had to miss so many family/friends events. And after a 14 hour day she is studying for exams. This is just the beginning, it will only get harder on the graduate program.

She is by no means unique in this.

Hmmm, presumably it is the doctors who are prepared to 'hit the books' after coming off a 13 hour shift, who win the jobs and better placements?

This is a fundamentally unfair & privileged attitude. It fails to take into account anyone with any health conditions or responsibilities outside of work which make it harder for them to put in the additional hours after a 13 hour shift.

@Arraminta no, the people who get the jobs are the ones with time, who are often IMGs. See these charts (to follow as won't let me send them at moment)

Bet your DD won't have to compete with every single person from around the world to be employed in her own country.

And working 14 hours in an office is not really the same as 14 hours in A&E.

And does it really matter who works hardest ? Even if our F2s did work 24 hours a day they could still not compete.

Big difference with doctors and other professions is there is only one choice of employer. You can only train within the NHS. Which has cut funding for doctors and employed less qualified staff (who need to be supervised by doctors).

DD has toyed with the idea of signing up for locum NHS bank work. Last year or the year before it might have been fine. Locums they were using were of variable quality, and hospital colleagues would have been very happy to see her turn up.

However it is an option that several of her friends are thinking of, as an alternative to moving across the world. Indeed on the the F2 mums in our chat last week is planning to do this. Unfortunately it seems, from that reliable source known as Reddit, that this sort of work is also suffering from too much supply and not enough jobs. My impression is that some of the earlier locum workforce comes from doctors recruited from overseas, whose initial contract has either come to an end or who have been let go.

Given it is so difficult to find a F3 12 month contracts, their ranks will be bolstered by those finishing F2 or other short term contracts. It does not seem to be as bad in London where the cost of living deters people from taking on zero hours jobs. The Reddit thread suggests that elsewhere it is part time doctoring, part time Deliveroo.

A doctor friend whose DC is a year ahead of me (Oxbridge) proudly announced that the DC had landed an F3 position in London. In the past the same pride would have attached to getting on a training scheme. Now, after a year of zero hours employment taking NHS Bank shifts in A&E he has a "proper" albeit 12 month contract. Doctors children, from observation, seem to do better because their parents know the ropes and have wider networks. DC from London have a huge advantage if that they can move home and pick up locum slots, in your department or elsewhere.

So much for all that improving access, increasing diversity stuff. Nah. Go into medicine if you are middle class, have informed parents who can mentor you so you start ticking boxes early, have the resources to cope with periods of low employment, and can retreat to your childhood bedroom in a high cost area.

Not sure. Found this from an online article from March 2024 quoting a UK based doctors and healthcare organisation that lobbies for IMG recruitment within the NHS:

“We are entering skill building in India. Our three-year programme will enable MBBS graduates to gain UK qualifications and open the doors to the world," he said over a phone call.
Singhal clarified that the NHS also recruits from numerous other countries, not just India. “We are running similar programmes in the Middle East, Pakistan, and European Union for hiring consultants. Soon, we will be opening centres for junior-level hiring in the Middle East and Central Asia." While labelling Indian doctors as “brilliant" and “outstanding", Singhal said those at the junior level – who have recently finished MBBS – require understanding to execute whatever they have learnt so far.
Mid-level doctors need more soft skills. “The curriculum in India does not teach the way doctors should communicate with the patient, patient’s family, compassion and teamwork. Knowledge is not a problem with Indian doctors. We only need to polish them."
Singhal believes that gaining work experience in the UK equips doctors to excel in various global settings, including the US and Europe. “Moreover, if doctors choose to return to India, their experience will also benefit the country."

I can see they're expanding but is anyone monitoring whether UK based medics, whether UK IMGs or UK medical grads, are being disadvantaged.

Ten days in a row: check

Thirteen hour shifts: check

Nights one week, days the next: ??

The sort of concentration you need when working with very sick patients: ?? (DD's hospital is in an area with a huge drug problem. As well as ordinary sick patients they have a lot of overdoses.)

Six patients dying on one night shift alone: ??? (don't worry all expected deaths, though including one where DD, coming on duty, had to get a senior about to leave to agree that a very sick patient was not going to make it and to reclassify them as "expected". Just as well as otherwise she would have had to explain why she lost that patient. As it was she had to face some very unhappy relatives who did not understand what had happened.)

Job at the end ???
.

Oh, don't even get me started on ARRS!

I'm a GP myself. I'm hoping that my son doesn't want to be a doctor. He is 7 now. When he was 5 he wanted to be a doctor like me but now he is insistent that he is going to be a professional footballer breathes a sigh of relief 😆

It is ridiculous. It should only be possible to recruit a medical professional from overseas if it hasn't been possible to recruit from the UK. And there should be guaranteed training places for UK medical students and newly qualified nurses and midwives etc.

Before we left the EU at least we could go to other EU countries to work and study. Now it seems as though we have the worst of both worlds. Anyone can come here but we have no right to go anywhere else.

The majority of doctors I know who left (mostly for Australia) was because they wanted out of the NHS. Overworked, underpaid, the risk stakes being too high. Good friends of mine (both GPs) said it was either leave the NHS or leave medicine. They recently got their citizenship and said they will never return, the work life balance is so much better, the DC have a much more physically active life and of course the weather is better.

Yes, only it's not great if you miss your parents in later life. It's a huge sacrifice! Not great if you don't want DPs to miss DCs' milestones. It's not somewhere you could pop over from for a weekend. Travelling to the other side of the world takes a day and is extortionate over the school holidays. Australia is an expensive place to live and if you're not Australian, you're not prioritised. Might have to live in a rural location as cities can be too expensive.

Leaving family and friends behind mean missing parents when they are too old, being helpless to leave dependents behind to help parents navigate their old age when they're ill. Also it risks not seeing them one last time if say a pandemic forces a shutdown.

These DCs want to stay. They don't want to split up from their families. They should be prioritised.

I am a GP and I totally agree with the OP,it makes no sense at all .

I never said it was fair. It's often wildly unfair. But for every candidate struggling to meet their course requirements or cram in extra study (for whatever the reason) there will be dozens who can, somehow, pull it off.

This is what comes of living in a capitalist society. It is inherently unfair.

This is just the beginning, it will only get harder on the graduate program.

Unless the issues within the points based immigration system are addressed, it's going to get much harder for your DC too. She won't be immune no matter how hard she works. The Big Four are known to be ruthless with retention etc. They value global talent and right now as it stands, the points based immigration system is not in her favour.
BTW it's not about who has it harder or who deserves the positions on offer in the UK, it's just about a defective points based system that is affecting recruitment in all sectors and also adding to the problems of net migration. Addressing these issues urgently before they completely break our young people should be a priority since they always seem to suffer from the effects of poor political decisions.

I don't understand.

A limited number of training places. More graduating from UK medical schools, with a relaxation on restrictions for overseas applicants. This means that an applicant will need better and better exam scores and more and more super-curricular on their CV even to get to interview.

Yes some are very dedicated and willing to give up a lot of their 20s collecting "points". Others can be rather focussed and selfish. Group work at medical school could be a nightmare as there were always some who would decide whether their contribution to a group assignment would have any impact on their individual goals before deciding to pull their weight. A friend, now a rather starry radiologist working in a US cancer research hospital, probably preferred studying to social interaction. At the end of the day some of the super high achievers will make great doctors, others not so. And given the effort required it is hard to see them applying for general surgery posts in Blackpool. Dubai or a mixed NHS/private/research practice in a London teaching hospital will be more likely.

The point is we are supposed to have a NATIONAL Health Service. Training needs to be pitched to those who are willing to commit to an NHS career, including some who want to work in less popular areas outside London.

And working 14 hours in an office is not really the same as 14 hours in A&E

It's not the same qualitatively but it's hard to argue that either is inherently harder. Arraminta's DC clearly has a disrupted family and social life and will have enormously stressful deadlines etc. 14 hours as standard is certainly in excess of a doctor's regular hours. Also, in the first two years no doctor works all the time in A&E. An A&E placement will be four months no more. in addition, nurses are the ones who do the heavy lifting. Sometimes doctors (and their mothers!) do give the impression that they think they're a special case in terms of being hard done by. I'm not sure that argument can be sustained. There are all sorts of young people out there who work every bit as hard and face just as much competition in terms of career but don't have a ready made job to transfer seamlessly into abroad. I'm not clear why young doctors can't work for the exams etc on their days off, just like so many other young people have to. They don't need to work straight after a thirteen hour shift; they need to factor the work into their rostered days off. Plenty clearly do manage to do this because plenty of the training posts do seem to go to UK graduates.

I do think in medicine there is a stronger argument to retain your own graduates than in eg accounting or banking. Patients are at their most vulnerable and connecting with a patient on a cultural level can be important as they need to open up and trust a doctor. Which can be facilitated if there are shared cultural norms.
Nobody is recruiting overseas for MI5 extensively much either so there are jobs where you must aim to keep your own, over and above just the cost of university training.
This whole thing sounds like another NHS quirk. I don’t particularly like the top heavy policy nature of the NHS. It’s where a lot of its inefficiencies lie as well. It’s red tape and contrary to logic. And needs to be sorted asap by the sounds of it.

Thank you for highlighting OP.
As a former nurse, wife of a hospital consultant and mother to a current medical student, I am appalled to hear this.

To think that the UK general public think there is a national shortage of doctors and yet those who can help out, can’t get a job is unbelievable and totally back to front. I totally agree that if there is a gap it needs to be plugged but not at the expense of taxpayers money and ambition of newly qualified doctors, surely? I wouldn’t want my dc to live on the other side of the world for the same reasons as others have stated. It used to be a guaranteed job in the NHS but not anymore it seems. And whilst I feel for those who have dc in law, (as a pp mentioned) is it on the Occupation Shortage List?

I hear that by 2031 the NHS Longterm Workforce Plan aims to double medical school places to 15,000!! That will make great headline news! I do wonder if anyone will still want to apply by then given the potential scarcity of training posts though. Very sad and disheartening.

Also we spend a lot if money on medical school places. Unlike perhaps a subject like law the fees paid by the students are only a fraction of what the course costs to run. Why do this if we don't intend to employ these doctors? Makes no sense.

@Wooleys you speak as if you have knowledge of the changes in doctor recruitment in that 18 months ? Unfortunately NN has stopped posting pictures but in 2023 49% of all training posts went to IMGs. Last year will have been much higher, so no, not more UK graduates. This year more IMGs will get jobs over UK trained graduates. Doctors who have never worked in the NHS and have no intention of staying more than a few years, because they can then go home and earn lots more money

And I'm sure being a banker or lawyer is hard work, but come back to me when you've tried to console your own child after a 13 hour shift where they've had to see things that most people would not want to even know about. Oh and after that they were supposed to do some studying.