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.

Interesting.

The difference that showed up in our small, but random, sample of MNetters DC is that Australia is a Plan B. Something they will have to do because the competition for jobs and training in the UK is so intense.

Several are having a go at exams and applications, but so far with no success. DDs plan which was to focus on a busy but rewarding F1 & F2 and then use an F3 to get applications in, also looks unlikely. (Less than a year ago she bought a house in the Deanery thinking it would be a good place to pursue her career.)

Hopefully she will get the opportunity to apply next year from Australia. My understanding is that Australian jobs will be those that Australian don't want and that training there for UK citizens is far from automatic.

It will be interesting to see what the next survey says. Perhaps a bigger concern is whether Australia will have enough jobs.

I assume the F1/F2s who made these observations are now busy climbing the ladder on the way to becoming consultants, with little regard for the fact that their successors are effectively blocked for a large number of jobs which previously they would have been able to apply for. And for many of them, de facto prevented from pursuing medical careers in the UK.

But OK let's say it is their fault.

From what you say, consultants are very content with people with lower academic qualifications and much shorter training. Why on earth are we still admitting enthusiastic and intelligent people to medical schools when the government offers more support to those in India and consultants prefer PAs.

Only 1 in 6 of them could be called enthusiastic at the prospect of working in the NHS, even before they get to the end of medical school.

One is obliged to question the fitness for purpose of the selection process.

One is obliged to question the degree to which the NHS is broken that this is the sad reality for students who probably mostly started out with high hopes of working for the NHS for the duration of their medical career. If you are suggesting that the harsh reality of just how awful things are be laid bare more clearly as part of the selection process, I suspect it could result in more of the top candidates, who have their options wide open, high tailing it on to other prestigious non-medical courses instead. In this scenario, it could be a dumbing down path, which seems to be an area of specific concern to some.

DD and her friends were. She had great ambitions and seems to enjoy the practical side of medicine, which is why she deliberately chose a less popular deanery. Feedback from earlier years was that London hospitals were overwhelmed and so there was little time for support and training. Her deanery is also overwhelmed but there seems to be an old fashioned espirit de corps. She was lucky as well because her first placement group got on really well.

Which is why the sudden change of heart seemed so odd. From what I hear the same is true of the others. This thread has helped me understand what is going on. She had originally wanted to go into a seriously competitive speciality but more recently enjoyed a placement in an area which will probably suit her. Busy and challenging. She has enjoyed her day clinic placement less.

Are people not wanting to work for the NHS because it is clear that the NHS, both in practical terms and from posts on this thread, is only interested in the top 15%. If there were more opportunities might there be more enthusiasm?

I actually have some doubts about how many of that 15% will stay in the NHS long term, either because they burn out or because the rewards are not sufficient. The competition for training is such that the hurdles are high. And as I have said before, once they have jumped these hurdles I really doubt that this group are going to be interested in less popular jobs in less popular places. The way things are going I would foresee increasing numbers of vacancies for more senior posts and hospitals where the majority of staff are not UK trained. Do the most academic doctors make the best doctors.

One is obliged to question the fitness for purpose of the selection process More than that, why are we wasting so much money training doctors when there is no career path for them. Why are we destroying their dreams. These are bright kids, who could have spent the last eight years pursuing something else.

I also wonder why we have "de-scienced" so much medical educaiton. PBL, lots of training in communication skills, examination by OSCI. . Yet those that do better in the exams are those who went to more old fashioned medical schools where a lot of core science was taught. Yes soft skills are supposed to be important for doctors. But progress to the next stage seems to prefer more academic research orientated doctors.

The academic part works until they get to interview stage. And then those soft skills win out.

I'm not sure if everyone understands the weird MSRA 'scoring system'. I didn't.There can be only approx 20 points between top and bottom scorers but that would equate to v different final scores. The middle score is given 250 and then it extrapolates out either side. So has nothing to do actual score, just how it compares to everyone else.
And you all get different questions.
The other half of the score is the well loved SJT. Ask 5 senior doctors and you'll get 5 different answers.

So that top 15% of scorers might have got 2 marks more than the median score on the academic part.

Weird that some people would prefer an academic treating them than a well rounded doctor. All doctors are clever. They wouldn't have got A+ at A level, passed 5 years of exams and managed to pass the UMLE from this year. Strange to think they are not all bright and capable ! But I'm thinking some people here just don't like doctors very much.

But in case stats have got lost, hereare some v clear reasons why change is needed.

Is anyone 'enthusiastic' about working in the current NHS ? Our young doctors trained during a pandemic, many working as HCAs on Covid wards. All they know is under staffing, under resourced hospitals. They often have to fill shifts as lack of staff, stay late and training is often cancelled.

Doesn't mean they don't want to stay and improve the NHS. Abroad is plan B for all of them I'd imagine. As family and friends are here. But seems 85% of them are not wanted by some people anyway.

Although, as RCP showed yesterday, exams are a bit of a farce. The exam mentioned was sat in 2023, and they told them yesterday the results were wrong. So I assume people would now change their opinions of the doctors who were prompted because they were told they passed, but now told they failed ?

Let's hope he means it ! Peter Prinsley understands. A doctor with integrity.

I also wonder why we have "de-scienced" so much medical education. PBL, lots of training in communication skills, examination by OSCI. . Yet those that do better in the exams are those who went to more old fashioned medical schools where a lot of core science was taught. Yes soft skills are supposed to be important for doctors. But progress to the next stage seems to prefer more academic research orientated doctors

Needmoresleep soft skills may be a good attribute for registrars and consultants but the science is essential (and even more essential in some specialties than others). But the medical schools wouldn't have been able to puts bums on all the many seats created if they hadn't offered newer, softer, courses in response to demand. Part of making sure that doctors can communicate effectively and not be dismissive of patient concerns is of course simply progress in the modern world.

The academic part works until they get to interview stage. And then those soft skills win out and

Weird that some people would prefer an academic treating them than a well rounded doctor. All doctors are clever

Oh mumsneedwine.... Wild. Again. Rather like international conferences having to happen in India, which was quite the read 😆 I'll keep it very basic: a person can be perfectly pleasant without being academic but there is no reason whatsoever why a highly academic person can't also be highly personable too. I could add that a very clever person may well be more likely to have the sort of sense of humour which keeps them and their colleagues afloat in challenging times and when under pressure but that's a bonus.

On the second quote, all those who get into medical school will be clever enough.... to get into medical school, but unfortunately that bar is now fairly low. I would say that not all those getting into medical school are clever enough to progress much beyond foundation years - and that's what I expect we'll see, even if more training posts are reserved for UK graduates. After all, it's what happened when (you claim) it was easy peasy to wander into training just a couple of years back. There has to be wastage for the safety of patients and the sanity of colleagues.

Needmoresleep you say a good deal about London training without showing a good deal of knowledge. No reason why you should be knowledgeable, that's absolutely fair. But it's not right to mislead inadvertently. I think what you're doing is generalising from a small number of comments that you've heard socially. London is in fact an outstanding training ground for the foundation and the training years. I absolutely don't recognise this thing about consultants not giving responsibility or time to their juniors. There are appallingly large areas of deprivation and the population is incredibly diverse. Add on the generally high quality of those teaching and you have a strong cocktail for progression. That doesn't mean that all the regions are necessarily less good but there's a reason why London has been so competitive to get into for so long. Once ranked after interview, I would expect it still to be the toughest to join. I don't see the quasi random allocation for the foundation years making much of a dent. The lower your ranking, the fewer your choices geographically. So I suspect a lot won't change but hopefully the sheer narrowness of the bottleneck will.

@mumsneedwine the MSRA exam isn't a professional qualification, it doesn't need to have precise grade boundaries. It is a selection tool, merely to measure basic competency. Sadly, as @Auchencar has pointed out it sometimes isn't rigorous enough. Obviously everyone applying for jobs has passed.
The fact that the skilled clinicians got A and A* at A level is also admirable, but hardly unique, I think about 1 in 6 A level candidates achieved that.
It's very odd that you think that a doctor with a very academic background can't be 'well rounded ' , and that you would rather be treated by someone with less knowledge and fewer skills as long as they were nice!
Thank goodness, as @Needmoresleep has worked out, successful doctors still come from traditional academic backgrounds.

Sorry, cross posted with @Auchencar .

Well I disagree, and that is allowed. I don't think people who pass exams with higher marks make better doctors. I think they are just good at exams Johnathan Van Tam got BBB at A level and he seems to be pretty good at his job.

The MRSA is the gateway to training for many specialities. It used to be that if you got in top 50% you'd get an interview. Now it's you 8% for some. That can be a difference if 10 marks.

And as can be seen from the MRCP fiasco, exams are not important to be a good doctor. 19.5% got the wrong result but they've gone in to be great doctors.

@Auchencar again, when losing an argument you get personal. Nice to know I'm wild though, not been that for 30 odd years.

This smacks of privilege so hard I'm surprised you've not got a black eye. What is a 'traditional academic background' ?

Thank goodness, as @Needmoresleep has worked out, successful doctors still come from traditional academic backgrounds

Again, people trying to derail the issue, wonder why ?

But well done for keeping the thread trending. It's working - not us, but doctors fighting for what they know is right.

Was chatting to a member of one Unis medicine team yesterday and sent them a link to this thread. They take BBB and allow any A levels. They were amused that many on here wouldn't like to be treated by their alumni.

Maybe Newcastle don't offer that 'traditional academic background'. They do fantastic WP though (as do Oxbridge !).

Ooh must not get off the point. Trolls like that ! For anyone reading and interested, this is the problem.

There is literally nothing personal in the MN not-allowed rules about that. You claim personal for full stops. You have to read the post and its content. Not personal at all, just refuting your point.

Also, can I just ask, what on earth argument am I losing? I'm way ahead! About twice round the M25 ahead! (assuming an 'argument', which I can't flatter myself we're having).

Johnathan Van Tam got BBB at A level and he seems to be pretty good at his job

He took A levels in around 1982. You would need to index link the BBB.

My eyes are fine thanks. Ask the O.P what a traditional academic background is she's worked it out. Why on earth is it 'privileged ' to want not just bright people but the brightest and best to be in charge of life and death situations? I don't however think that someone with 3 B's at A level could be seen as any sort of bright.
Could you tell us which university this academic that you were conveniently talking to was from? I would probably like to avoid their alumni.

I am just pointing out the disconnect between medical school focus and that of the specialist exam system.

I have previously suggested that during my daughter’s intercalation in the engineering department at Imperial, her soft skills gave her advantage when it came to the extensive group working elements. Many from the sorts of medical schools you may approve of, took a very individual approach. And that despite the obvious snobbishness displayed, a talent, for say, maths took you a lot further than the medical school you went to.

Usefull to know, give your and Auchincar’s claimed expertise,what your background is. It would be ironic if it turned out that you were both “mummies”

I make no comment on London. Choices were made based on reports handed down to the medical students themselves. It was quite soon after lockdown so a surprising number of DDs friends, chose to go to the Celtic fringe. More outdoors, after a lot of indoors. All strong students. It should not matter.

Posts too are quite circular. Do you have any opinion on what appears to be the offshoring of some of our medical education. Given you approve of the very academic hurdles that need to be jumped in order to achieve selection, and given that those from overseas seem to be better than graduates from our own Universities. Is this the way to go?

Again, people trying to derail the issue, wonder why?

In what world is commenting on direct quotes from OP and yourself a derail. The subsequent comments by oddandelsewhere and myself are about training bottlenecks and who gets through them. Again, bang on the money. Big bang.

If you want a discussion as opposed to telling others what they have to think, you need to stop panicking with baseless shouts of 'personal' and 'derail'. The substance of the latest posts are neither, on any stretch.