AIBU to be angry that Government policy means young doctors, nurses and other HCPs cannot find jobs

[Needmoresleep]

Unbelievable but true.

Doctors, nurses and other health care professionals now have to compete for jobs and training with applicants from across the world. No priority is given to those already in the country.

Even ordinary entry level jobs can attract hundreds of applicants within a few hours. Newly qualified doctors and nurses need that first job to get the experience that overseas applicants will be able to offer.

In 2021 immigration law was changed and something called the Resident Market Labour Test was dropped for health and care workers. It means that the UK may be the only country not to prioritise those already in the country.

The previous thread:
https://www.mumsnet.com/talk/am_i_being_unreasonable/5267503-aibu-to-be-furious-that-there-are-no-jobs-for-young-doctors?page=1
included a number of stories. An entire graduating class of nurses unable to find that first job whilst administrators from the local hospital were taking recruitment trips to Asia. An experienced GP wanting to return from a career break only to discovering that she, and others in a similar position, could not find work, a consultant surprised at how well qualified locums seeking zero hours, short notice, cover work are. The number of overseas doctors applying for the limited number of specialist training positions in the UK doubled between 2023 and 2025.

A group of us, who have been on the higher education board since our DC were first applying to medical school, recently discovered that none of our DC, coming to the end of their foundation years (F1& F2) expect to get anything other than the odd shift with NHS bank. Most see moving to Australia as the only way to stay in medicine. They say the same applies to their peers.

Our young doctors have spent seven or eight years getting to where they are, and have £100,000 of student loans to repay. The taxpayer has spent £250,000 on each of them.

Unfortunately the NHS does not appear to keep data on the number of applicants per vacancy, nor on vacancies that, because of the numbers applying, close within a few hours. It also does not appear to question why such a small proportion of F2s are progressing within the NHS. Instead there seems to be an assumption that this wastage is somehow natural, and that the solution is to re-double international recruitment efforts, to increase medical school places, and to replace traditional junior doctor roles with less skilled Physician Associates. Measures that will only increase the problem.

If things are not changed, even more of our skilled and dedicated young people will find themselves without jobs. We would welcome experiences, information and ideas.

Please also spread the word, write to your MP, tell people in a position to influence who may not be aware. We have a shortage of doctors, nurses, midwives, and paramedics. Our first priority is to ensure that those already in the country are able to get jobs.

If young Doctors were asked, and the same will apply to other Health Care Professionals, they would argue that:

• Busy F2s work long shifts including nights which makes extensive job search difficult
• Posts often attract hundreds of applicants, and close within a few hours. This level of competition is in itself off-putting
• Overseas applicants are often supported by agencies who can set alerts for vacancies and ensure that multiple applications are submitted. No such support is offered to UK applicants,
• These agencies will help with the writing of applications so they score well against NHS selection criteria. Again no such careers support is offered to UK applicants.
• The Government/NHS offer incentives for overseas doctors including bringing in dependents and scope for future citizenship, as well as some exemptions from some exams and relocation packages. These may motivate overseas doctors to apply for entry level jobs even if they are overqualified. Entry level jobs which our newly qualified young people need.
• Various extensive and expensive courses are advertised on the internet designed to give participants an advantage when applying for specialist training in the UK. In contrast many UK medical schools do very little to ensure that their graduates have the additional academic super-curricular that, with current levels of competition, are effectively requirements to gain a training place. This year it is predicted that only 50% of the around 4,500 places will go to graduates from UK medical schools, even though it is recognised that for many UK training is simply a passport to well paid jobs in private hospitals in Singapore, Dubai or their home countries. This is poor workforce planning. If we are going to avoid a future shortage of consultants we need to prioritise those likely to build a future in the UK.

Many young doctors will see a couple of years in Australia as a reasonable fall-back. They accept that they will be taking jobs Australians don’t want and will be at the back of the queue when it comes to specialist training, but they will also be gaining experience in a different healthcare environment.

Others, including those with family or caring responsibilities, or those who brought their families over when offered fixed term contracts, simply face unemployment. We should not be recruiting overseas when we have good, qualified, NHS experienced, doctors, nurses and other HCPs in the UK driving Ubers or working in Tesco.

I thought this comment from an IMG was interesting:

..........The issue is also system being unfair. Trust grade jobs have dried up, GMC continued to offer massive plab positions and made money off these desperate IMGs, and now they are stuck with gmc licenses (which comes at a hefty cost) and no job. Hence, the desperation of entering into training directly. NHS workforce recruits and doesn’t give a flying fuck about what is happening on the ground either because it puts a warm body on the rota at cheap rate......

So it is not only UK graduates who need trust grade jobs to give them time to prepare for training applications, whether first time or reapplications. IMGs may need it for cultural adaptation to a new work environment. Yet these are the jobs that have been lost to PAs and to budget cuts.

I have heard one story about an IMG who turned out to be fine. It was just the first two months where they seemed to be completely frozen. Turns out that though they had good English they had no experience of regional accents, and it took them a while to actually understand what patients and some of their colleagues were saying.

Also what is the GMC making money off? Licences. PLAB?

Interesting how FY3 and junior clinical fellow is now thought of as the natural progression post fy2. New medical students are told that they go from FY2 onto further training and specialist training or for GP - not much mention of pausing careers. It does make it so good experienced people are still struggling to find ST3/4 posts when they are of an age when others would be buying their first homes and having families not having to up sticks and travel all over

I don't know why the universities don't close down the UK medical schools - can be done much cheaper in Prague and similar places and seems to be easier to get into (the students that went there are the ones who didn't get UK medical school places)

There are limited postgraduate training places in India but a rapid expansion of medical colleges churning out graduates.

2.3 million students appeared for NEET in 2024, competing for around 100,000 places in medicine in Indian medical colleges.

Clearly about 5-7 years down the line, many of these students will be considering the option of coming to the UK for postgraduate training, especially as they will be on an equal footing as UK medics.

Without legal safeguards for UK medics in the form of changes to the current points based immigration system and/or reinstatement of the RLMT, the competition for UK posts is only ever going to get more intense. There has to be a form of prioritisation for the young people already here.

Workforce planning should take into consideration that there is possibly a trend of an ever increasing number of medical graduates from abroad seeking the limited number of postgraduate training spaces here. This is due to a number of factors including the shortages of postgraduate training in their home countries. Any recruitment planning from overseas should be balanced against the need for those places by doctors that have been trained in medical schools here and existing IMGs. The sensible thing to do is to prioritise the doctors the UK has already trained ahead of newcomers to the UK by addressing issues within the current points based immigration system.

It's also madness to keep conducting PLAB exams at a time when there is a shortage of posts.

I wonder if the NHS keep stats. They need to. The absence of F3 jobs, and the huge competition for those that remain, is a major driver in causing F2s to feel they will have to look overseas. The realisation of this was what led to the thread in the first place

Some obviously do manage the transition from F2 to training. We know someone from Thailand who did just that. Real determination and dedication. But this seems rare. Quite a lot will have a go at the exam but without much optimism and it does sound as if very few of our DC's peers got through. They also need more time to prepare the super-curricular. Especially if F2 has been in, say, a rural area perhaps with big gaps in the rota, and without much research going on. All the other young doctors I know who made it through to training took at least one F3 first.

F3 or Clinical Fellow used to then be the norm. But this is where application numbers are going through the roof. Now what is more likely is bank work (which is also drying up) which gives time to apply for F3s which then opens the door to applying for a training number. And as the backlog builds, international competition grows and the number of posts shrinks, it can only get worse.

So two extra years. Before you even get started on training.

This is where the NHS really needs to do some research if they want to maximise retention. It is not unreasonable for people to feel it is a mountain to climb and to reconsider whether medicine is the right career. Is the extra time that has to be invested, before you can settle down, or before you start drawing a higher salary, worth the investment? Even more difficult for women whose biological clocks will be ticking down before they get to the end of training. And all the time you can see friends who could settle in their mid 20s and buy a house and be moving on with life. Then when you get to the end, given the investment you have made, do you stay with the NHS.....

Yes it has always been tough, but it seems tougher now, and the rewards for scaling that mountain seem less attractive.

I also wonder, judging from the comments on this thread if NHS workforce planners are really aware of the differences in loading for F1/F2s across different deaneries. Even if there is a balance across the six rotations there will have to be someone who is on nights in a busy city centre A&E or in ICU when the exams are coming up. One of our DC even struggled to book his exam slot because booking opened when he was on shift and a couple of hours later slots were almost completely gone.

@marmaladeandpeanutbutter yes presumably. The only thing I think I presumed was that the unemployed young people in question were in their twenties. If they are in their teens they are indeed remarkable, if in their thirties their mothers should be even less involved in their search for employment.

To most, intelligent reasoned individuals these statistics make v clear the issue with training. Obviously to some they are harder to understand.

And again, the more the personal attacks appear, the more confident I am we are winning the argument. Teenagers behave in a similar way. And they help keep the thread Trending.

And for anyone who thinks the University they go to matters. No one cares, or even looks for speciality training. It's points or MSRA.

Which personal attacks? Ones like calling people who have other opinions 'teenagers'?

@Annoyeddd said doctor doesn't actually know your DC - how could they ? What they know are the doctors who think they are better than everyone else. Who think because they are so 'good' they will walk into a job. And everyone else is just not trying hard enough.

V glad yours got an anaesthetics interview - top 7% of everyone who took MSRA. A stupid exam meant for GP selection. But it's good to now have a 50% chance of getting a job. Although 50%+ of those jobs are likely to go to IMGs.

Given 50% will be IMG I can't see why the UK University would matter.

Its about the exam and the CV.

Equally the sneering at 3 Bs. A lots of the entry level jobs are now staffed by Physician Associates, many of whom won't have three Bs, and are going in with only two years of medical training. As a patient I would worry about them more.

@Locutus2000 the ones claiming we are pushy mums whose children can't function on their own. There is no need to stoop to personal attacks, because that's what teenagers do. I'm a teacher so was making a comparison.

I am aware of the current and potential issues. I am a supervisor and trainer for medical students on placement and I'm a clinical and educational supervisor for FY doctors. I've been a consultant for a long time in a specialty which was traditionally unpopular and even derided by other specialties. However in recent years the applications have increased stratospherically and it's now highly competitive with a high fill rate at initial training entry stage. However in my small and less popular hospital in a highly deprived area with very high population needs, we still struggle to fill posts at both resident doctor and consultant level and there is little obvious input coming from both locally and NHS England regarding the longer-term retention of doctors.
We rely heavily on IMGs to fill the posts and participate in the rotas where I am, I'm not saying that's the correct option but until all resident doctors are willing to look outside the big cities and the teaching hospitals, certainly my specialty will continue to have vacant posts which new IMGs will fill.

@Needmoresleep and those 3Bs would get you into a medical school abroad. They require such lower standards but the doctors can come back and work here.

The only UK Uni that takes 3Bs is Newcastle for their partnership programme. Even contextual offers don't go lower than AAB (& some give that for having an EPQ).

@Transcontinentalcyclist my DD works in one of the most derived parts of the country. She's fighting hard to stay there, but limited funding for jobs.

In general the university attended matters for career progression, as one might expect. Mostly but not entirely this is due to prior attainment. For example:

Ellis R, Brennan PA, Scrimgeour DSG, et al. "Does performance at the intercollegiate Membership of the Royal Colleges of Surgeons (MRCS) examination vary according to UK medical school and course type? A retrospective cohort study." BMJ Open 2022;12:e054616. doi:10.1136/ bmjopen-2021-054616

www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=bmjopen.bmj.com/content/bmjopen/12/1/e054616.full.pdf&ved=2ahUKEwjHoLHimM2LAxUJSkEAHdG7CBcQFnoECBQQAQ&usg=AOvVaw0VPmO4xDfEPn4JROVchKCA

There will always be, and should be, winners and losers. The problem is that for many people it will be their first experience of losing.

That wasn't me.
The junior/resident doctors I talk to are those I work with although I do have a DC medic and they have friends who have been through uncertainty but now settled at ST5/6 stages. I ask them where their next rotation will be and as often as not they are going on bank or locum and working on their applications.

Someone on this thread mentioned shutting down medical schools in the UK. That's not in the interests of patients. Also see the issues of bribery and cheating in medical school entrance exams held in India last year. On a subject as important as healthcare, it's better for every country to be in control of the design and delivery of it's own medical curriculum.

www.bbc.co.uk/news/articles/cv22wl82yldo

@Transcontinentalcyclist ditto mine. She would love to stay where she is, in an area which has huge unemployment, a huge drug problem, massive wait lists for things like surgery, and big problems with retention of NHS staff.

I wonder which Deanery....

But she needs an F3 post. She had busy F1&F2 rotations and the preparation required to apply for ever more competitive training slots means she needs that extra year. F3s jobs are few and far between, and there is a backlog from those who did not get training this year. The Trust recruits a lot from overseas, all the way up to consultant level, and it is not unusual for more junior staff to need to support new arrivals. They were also using F2s to train PAs, who will then go on to take the jobs they need. Apparently all but two on DDs rotation are looking to Australia.

More would stay if there were jobs and a more straightforward path. Or perhaps if more credit were given to experience of smaller busy and challenged hospitals, rather the need to win the arms race for academic bells and whistles. Most of her peers are from the area and have ties. Many plan to work up their specialist training applications in Australia, though there must then be a risk that the NHS will not look like an attractive prospect when viewed from afar. Indeed one silver lining for DD is the prospect of experiencing a better resourced health care system.

You say that you fill resident positions from overseas. One issue seems to be that because all positions are open to those from overseas, and some are attracting huge numbers, seemingly supported by agencies, the word has got out amongst F2s that it is not worth bothering to apply. Which leads to a vicious cycle. Fewer UK applicants, the NHS assumes they are not interested, and redoubles their efforts to attract overseas applicants, leading to still more competition for entry level jobs.

Oddly the advice on the thread especially from those who claim that this generation is not proactive enough is that it is easier to find a F3 type position, and access to research and the other things needed to enhance a CV, in London. I would have thought that the best chance of consistently filling jobs in less popular regions is to ensure that proper pathways exist for current F2s. They will know about the challenges but will also have friends, perhaps play sport or engage in other local activities, and be aware of the cracking scenery or places to visit at weekends.

I am trying to think of a speciality which other doctors laugh at. How rude of them.

@Marchesman that's just surgeons. A v small part of the doctor workforce. And the Uni still doesn't matter. Some people are better at exams but does not make them a better doctor.

@Annoyeddd apologies. Meant to tag @Auchencar

Geriatric Medicine, I should think.

They stopped laughing after it became the last refuge of the general physician.

So are you saying that there is a lack of communication and disconnect within the NHS recruitment system? As I understand it, resident doctors are willing to look outside the big cities and the teaching hospitals. They just haven't been able to secure the posts no matter how hard they have tried.

@Marchesman why would looking after the elderly be a joke to anyone ? Most complicated sector health wise. Takes a very special person I'd imagine.