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.

@Auchencar your thinking is wrong. Not actually mentioned her at all except she has a job down under. Leave the personal out please.

@Auchencar hysterical, a comedian from the 1980s used offensive stereotypes and you think it's appropriate to use that ?

I don't think repeating what a poster has already said is personal is it? Apologies if it is, but you have put this in the MN domain on the original thread so I assumed ok. It's not revealing anything not said by you, which is obviously something I wouldn't do - far too scrupulous.

Oh dear god. Really ? That's because they had SEN and were treated like crap. You say you work with students ? Please don't.

Yes dimwits. It wasn't that many decades ago that nepotism helped open the doors in various professions. But dimwits tended not to get much beyond the downstairs hall

@Auchencar I've never said anything like what you posted ! So don't make things up. It makes you look like a dimwit.

I don't find Harry Enfield funny at all myself but the Guardian explains why Tim-Nice-But-Dim has become a shorthand.

Maybe complain to the Guardian if you're outraged.

Let's leave it but you absolutely did mention that your DD had taken the exam and that the Australian job was a fall back (but a good one with training opportunity six months down the line). Maybe check back your own posts because I'm 100% or I wouldn't have mentioned it (or known it!).

I think oddandelsewhere is probably muddling up posters. I also thought we were trying to keep the thread away from the personal. If we are going the route of poster circumstances and perspectives, could oddandelsewhere please clarify how long ago their close relative qualified as their posts suggest being stuck in the distant past.

In Auchencar's defence, I think all professionals of a certain age have come across TNBD. Thankfully it's a dying breed in the professions and I am a firm believer that in my own non-medical professional field, the parameters for both selection and progression have without a shadow of a doubt become more robust.
Why would medicine be any different?

No absolutely not SEN. These are the not bright DC of well off parents referred to in the first paragraph of the Guardian article I linked to. It's very clearly set out.

Madness. Why make life harder for British students

By 1998 things had already gone seriously pear shaped. The Lancet, vol 350, 1997, on Calmanisation:

"Experiential training (particularly under pressure) has been reduced, an effect exacerbated by the introduction of protected teaching time during core hours. At the middle grade, trainees enter a programme, complete with curriculum and log book, but shortened to 5 years, and with restrictions on working hours. The “specialists” produced by this process are to be put onto the medical labour market, but with numbers within specialties carefully balanced to ensure that there is no real competition for senior positions."

As Kay states, soft skills were also being weighted more heavily than academic achievement by then. The medical school in which I interviewed provided guidance for shortlisters that explicitly excluded highly focussed academic achievers who failed to score for soft skills.

The new system started from the position of what an ideal family doctor looked like and worked backwards to select for that. It completely failed to take into account that a very large proportion of doctors have no contact with patients; and traditionally a highly academic scientist entering medicine would naturally find (usually) his way into laboratories, the mortuary etc etc..

Hand in hand with this, basic sciences were systematically removed from undergraduate curricula.

So medical school admission went into a death spiral of reduced academic competitiveness and desirability for scientific high achievers. However, the attributes that underpin academic achievement - memory, resilience, intelligence, perseverance etc - are still necessary in order to function at a senior level in the medical profession. These are difficult or impossible to teach but it is possible to teach all but the frankly sociopathic to be professional, respectful and kind.

The fact that now 5 out of 6 medical students are disatisfied at the prospect of working in the NHS - i.e. before they have even directly experienced any of the responsibility and stresses - does rather suggest that selection in the good old days was better.

Thank you @Marchesman. Very interesting.

In terms of the medical school selection element, in order to get candidates of the right calibre and suitability, would it help to set the bar at say -

• Minimum three A star A-levels achieved in maths/sciences (with any WP adjustments being non-generic but rather dependent on a combination of individual flags),
• a better test of ability than the somewhat strange UCAT,
• a mandatory year post A-levels as a HCA,
• interviews to assess motivation/resilience and the other softer skills as well as the ability to think (and act) on your feet. In my profession, I find the latter is hugely important but not all very bright DC can do it.

This is how the thread started.

A group of us who had come across each other on the Higher Education board when our DC were first applying to medical school swapped notes and realised they were all very gloomy about the prospect of landing either a training place or job.

One will try to get NHS bank work whilst having another go at getting a GP training place. With budget cuts this sort of work is hard to find (which is why you will hear of doctors also taking on other zero hours type work such as driving Ubers) but he can apparently live cheaply.

The others all seem to have decided that they have no option bar Australia. Some have sat exams or applied for fixed term contract work (F3) but because of the lifting of the RMLT the competition is extraordinary, as the various numbers show. There are regular anecdotes of very ordinary entry level jobs receiving hundreds of applications within a few hours. The posts will probably go to those with experience, which by definition our DC don't have.

DDs thinking was to spend her two foundation years gaining good experience. She is in a relatively unpopular deanery where she got her top choice of rotations. It is a Deanery which is known to be willing to give responsibility to those they trust, and she is working very hard. (Only one rotation without nights. Lots of very sick patients. The next rotation in particular should be really interesting but very busy. ) Then seek an F3 position which would give her time to focus on landing a training number.

As it turns out this was a bad plan. She should have aimed for a deanery in England ( better contract terms), perhaps one that does not expect F1s to work nights, and then selected her rotations so that the fourth and fifth rotations were regular hours jobs like community or psych giving her lots of time to study. She has had a great time, learned loads, and loves where she is (and indeed where she has bought a house aiming to progress her career there) but is now hit by a curve ball. No jobs, or rather the few that there are will go to "better candidates", most probably experienced doctors from overseas. Apparently many are supported by agencies and overseas recruitment is at every level up to consultant level.

I don't think she knows what to do next. The easiest option is to apply to Australia and use being in a small town in a hard to fill job as the F3. She sees a silver lining in the chance to discover whether she enjoys medicine by working in a less chaotic environment. She can then decide whether to stay, have another go at a career in the NHS, or to leave the profession. She is lucky that an Imperial engineering intercalation gives her options, indeed Imperial regularly send her job adverts with six figures starting salaries. She spent her elective in a research lab there, and has been told to approach them if she wants to take a PhD.

The alternative is to return the childhood bedroom in London, take on whatever bank work she can find, and hope to get her foot in the door somewhere. This is the approach used by a friend's son who, after Cambridge, opted for a deanery outside London. He did bank for perhaps a year and has now landed an F3 position in a London Teaching Hospital. He is hard working and bright so should eventually get a training position. Or she could take a Masters somewhere, which would add to her points score, and simultaneously study for exams, prepare her training application and work a few shifts.

She has already spent eight years on her medical career. It looks as if it will be a minimum of two years before she even gets her foot on the bottom rung of the training ladder. She absolutely wanted to go into medicine and almost certainly has the right attributes (resilient, practical, personable, hard working, bright with an astonishing memory) but the NHS don't care. They are more interested in the quick fix rather than ensure that there is a career path for those who don't have the experience yet but who have genuine long term potential.

The same applies to many of the others she studied with or works with. Lovely sporty bright people from a diversity of backgrounds and with a diversity of ambitions. Some of whom, if given the chance will make a great fit for some of the skilled hard to recruit vacancies that the NHS knows it will have in the future. Great to have some brilliant world leading academic doctors should you opt for private treatment in London. But what happens if you need A&E in some remote spot or the support of geriatricians near your rural retirement home.

My previous post was a reply to this.

Great to have some brilliant world leading academic doctors should you opt for private treatment in London

Needmoresleep, I'm sure that you're better than this. These same doctors work in the NHS and plenty aren't in specialties which lend themselves to private work. Beyond that, plenty refuse on moral grounds to work anywhere other than the NHS. One of the first consultants my DS worked under as an F1 told him that he would never work in the private sector due to moral qualms (a cardiologist, so could very easily have done). He was renowned but he just wasn't prepared to do it.

These doctors use their expertise to help those across a range of socio economic groups including, much of the time, the distressingly poor.

I do understand your upset at the level of competition for posts the current F2s are facing but please respect the work that these 'brilliant world leading academic doctors' do, the sheer graft that got them to their current positions and try not to let your current disappointment cloud your judgment to this extent.

The anecdotes on here are getting stranger. At 12.45 I suggested that mumsneedwine's child was thinking of going to Australia. At 12.47 she huffily told me that wasn't true, her daughter wanted to stay in the U.K. Naturally I apologised, I thought I had confused her with someone else. 13 minutes later she said her offspring had a job 'down under'. Did she accidentally get the job? Or get it without thinking about it? Or did she just get it in those 13 minutes?

Seconded. That was really informative and interesting Marchesman. Thanks.

And this suggestion of JulietteBravissimo makes a great deal of sense. (to me at least).

What is becoming ever more apparent on these threads that the mantras 'you only need one offer' for Medicine and 'all doctors are equal on graduation' are full of the most massive holes. It's actually incredibly unfair on the less able and the mass of anecdotal evidence with the increased squeeze on places is making it ever more irresponsible to encourage young people into medical school who are just going to find themselves at a loose end seven years later.

It's no surprise that almost all graduates from certain medical schools make it through the bottleneck, even if that's on the second attempt, and yet graduates from the less traditional medical schools report carnage at the bottleneck.

Schools have a responsibility to warn, as do parents of course.

Oh no I don't think they're getting stranger to be fair. There's a whole heap of contradiction been flying everywhere, all across the threads. Very tangled but very good exercise for memory, so I'm quite grateful.

Not strange. I think the unemployment problems and the level of competition for training have taken many of this group by surprise. It certainly seems to be a surprise to many of the people I have spoken to. Even my MP was unaware and is looking into it. I think they assumed that as long as they were not fussy, there would be something. Most of them, say, have been able to find HCA bank work through medical school and have come across regular locums since. Even this type of work has very largely dried up.

Apparently there was even a rush to get an exam slot.

So they are all feeling their ways to Plan's B & C. My guess is that it will be a mixture, apply for some jobs here with fingers very crossed. And also make sure that you have something in Australia. Given the numbers involved, it is very possible that Australia too will become saturated.

My impression given recent statements it has also taken others by surprise. Wes Streeting, the BMA, etc.

Junior Doctor posts on Reddit covering this issue are also within the last few weeks. Part of the problem is that so far newly qualified doctors have not had to do job search. DS's peers at LSE were going to networking events, visiting the careers office and talking about internships in their first term. The assumption was that the NHS were short of doctors. If you were not too fussy there would be something.

It is slightly off to blame them. Surely someone in NHS workforce planning saw this coming and could have warned them, and perhaps offered support in line with the level of support the UK government is funding for overseas applicants.

Not the first time either. It seems to happen very 20 years.

What do you suggest? Do you have views on Boris' lifting of the RLMT? There clearly is some sort of problem. What might be a solution?.

To clarify, so no more stalking behind the scenes. My DD has a job Down Under. But she'd rather stay in the UK, but not be unemployed. She has not taken an exam as her chosen speciality doesn't use one.

Clear ? Now please let's keep this away from the personal.

From this afternoon's FT letter:
Demoralised young doctors
The Nuffield Trust has calculated that fewer than three in five doctors (56 per cent) in ‘core training’ — that’s the part after you’ve completed medical school and two years foundation training — remained in the NHS in England eight years later.
As things stand now, around 8 per cent of doctors finishing foundation training didn’t receive an offer after applying for a speciality, according to Billy Palmer, the Nuffield Trust’s senior health policy fellow.
That’s incredibly demoralising for young doctors who have already invested seven years of their lives in that career; and wasteful for the British state which now spends £327,000 on getting each student through med school.
That leads to the perverse situation described by third-year med student Eli Sassoon, on X on Tuesday, where his faculty was “encouraging students to look at careers outside of medicine” because of a lack of speciality training jobs.
As Sassoon told my colleague Laura Hughes, he’s now looking at the possibility of going to Australia: “It isn’t rocket science: there really is no point doubling the number of medical students if you can’t train those students afterwards.”
Workforce “refresh”
So without significant investment in training or a change of tack, the situation is going to get worse since the current NHS Workforce Plan (a 2023 scheme drawn up by the last government) has a target of 15,000 medical students by 2030-31.
That’s 5,000 more in five years, entering a system that already can’t cope. That is not sustainable without change.
This week NHS England commissioned a review led by the national medical director Stephen Powis and chief medical officer Chris Whitty into postgraduate training for newly qualified medics.
Labour also knows change is necessary. It is promising a “refresh” of that 2023 Workforce plan which, in the best traditions of recent Whitehall policymaking, was, to put it kindly, not very joined up.
As the Nuffield Trust’s Palmer says: “The ‘plan’ seems to have been to put all eggs in the basket marked ‘lets just ramp it up, turn on the training taps’ and then hope for the best.”
The new Labour government is trying to rationalise the approach when it comes to the NHS, deferring the Conservatives’ unfunded new hospital building programme to realistic levels given the state of public finances and looking to ‘refresh’ the NHS Workforce Plan.
Early indications from health secretary Wes Streeting are that there will be a shift to community health services and more GPs — another area of pent-up demand that requires a significant (but managed) domestic expansion programme.
Because per the Nuffield Trust, on average, nearly two GP training posts are required to get one fully-qualified, full-time-equivalent GP joiner as a result of dropout rates and increased flexible working requirements.
But there is domestic demand — as is demonstrated by the number of UK students who can’t get places in UK med schools so go to European countries like Bulgaria to get their medical degrees before returning to the NHS.
(That’s why I was away last week; you can read my report here. Anyone who likes bashing flaky ‘Gen Z’ kids should meet these students who were prepared to go and study in the Balkans for six years to realise their ambitions. They were very impressive.)
The key, however, if the UK is serious about growing its domestic talent pipeline, will be to manage that expansion across the entire training period which — from undergraduate to consultant doctor — can take 16 years.
In a world where doctors increasingly want flexible working, the Nuffield Trust argues that may also mean more inventive ways of retaining NHS staff — from staggered student loan forgiveness to preregistration employment that offers a paid bridging year between finishing education and being a fully-registered clinician.
Because, as the Nuffield Trust argues, fixing the leaks in the pipe may be as impactful as continuing with a profligate increase in supply.

I am not sure I recognise all of this. Only 8% didn’t receive an offer after applying for a speciality after Foundation training. I am not aware ofr anyone in DDs rotation getting one. The high drop out after core training sounds more likely. Oddly no mention of the fact that jobs are open worldwide which has really bumped up competition levels.

Still there is recognition there is a problem. Lets hope they something can be done so our DC can build careers in the UK.

This "solution" maintains or reduces the current number of hospital beds and therefore senior hospital posts, in the hope that general practice takes up the slack. Good luck with that.

That Nuffield Report is from September 2023 before the IMG explosion.