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 think where Finallylostit and others will agree is that things are not working as they should. Identifying what the problems are and what the solutions might be are not "gotchas". My experience is that if you take a deeper dive, quite often people find their thinking is closer than they thought.

This person is probably (and I really don't like the phrase) a grunt doctor. Doing one of the sort of jobs Finallylostit believes all doctors should do if they are to have a proper experience base. I don't disagree. And she could well me in one of the entry level jobs that our DC or other doctors already in the UK might be interested in. (It may be had to recruit, but it is contract so better than bank.)

So why is the Trust hiring this type of agency worker. Is it because they will accept the minimum pay for the grade. Is it because they will be less assertive and accept rough shift patterns, can easily be made redundant, and won't strike.

To be honest I don't think it is that different from the Indian doctor who sunk his lifetime savings and paid £31,000 to a training institute who would help him find work in the UK. Wages in the UK are higher than in parts of Asia, and people are finding ways to profit from this desire to migrate.

Doctors already in the country and looking work, seem to be not just competing for jobs, but competition against other doctors who are supported by influential commercial interests.

It should be noted that Pakistan is a WHO red list country.

Open letter from BMA t send to Wes

Not sure how doctors being in a form of 'modern day slavery' is a gotcha ? I found it incredibly sad that this country is exploiting humans from other countries. But maybe that's just me !!!!

It's cheaper and easier to exploit overseas staff. Their visas are dependent on their trust and so less likely to strike or complain about pay and conditions. Still exploitation and wrong.

I agree with all of the points made here. (Except perhaps the point about Elderly Medicine - I don't think anyone said that it is a speciality that attracts people who are not academic, just that when long-stay beds were a thing forty years ago, it was unpopular.)

Anyone who takes the trouble to look at the ratio of annual retirements to new graduates should be able to understand that Medicine has gone the way of Law in terms of numbers and structure, and few will reach seniority.

Those with poorer prior attainment can expect the greatest difficulty. Medical schools that ironically pay lip service to "compassion" should make this clearer before drawing people into it.

There are 9,000 UK graduates and 12,000 training posts

Trusts only pay agency rates when it's the only way to fill a vacancy.

And 2000 available consultant/GP jobs. Do you see the problem?

@Marchesman yes. It's a massive problem. However many of those 9,000 will never want to be a consultant. They might become a GP, or go LTFT. But currently we have 9,000 UK trained and paid for F3s and there are 12,000 jobs available for them.

I foolishly raised the difference in approach between different medical schools, and inadvertently restarted the age old and often quite nasty "Oxbridge" debate that can regularly be found on the higher education boards.

My point was not that Oxbridge is better because it attracts more able students. Though this is true to some extent, medical school admission is an inexact science and they will also be attracting some duffers. Equally a lot of very able students will chose to go elsewhere. Those from Scotland and NI will mainly stay away for financial reasons. Others with schools who perhaps don't want the effort of Oxbridge admissions, will be told "a doctor is a doctor is doctor" and that there is no difference wherever you go. I know that there are some strong, even trenchant, views, but the strength of Oxbridge grads vs the rest is a debate for another place.

My earlier point was that a lot of medical schools have been encouraged, even forced, to adopt PBL type approaches. Yet when it comes to professional exams they might have been better served with a more science based degree.

This is a workforce planning issue. Medical schools should be equipping their students with the tools to be able to thrive in the profession. Not all will make consultant. Some won't be good enough, plenty won't want to.

I know a couple of women, both very fast track, who opted out of training. One because she became a single mum to two young children so felt, for her sanity,that she needed to go part-time. The other's husband landed a really impressive position in a University city so her burgeoning career was sacrificed. Very similar to lawyers. Some go onto head Magic Circle firms. Most are sane enough not to want to.

It seems madness to push medical schools into a certain approach to training, and then prioritise those whose medical schools take a more traditional approach. Without telling the students. Most University departments are measured on the employment levels and earnings of past graduates. This should be a metric used for medical schools.

The 2000 vacancies includes GPs.

However, you are right about part-time working, which has a significant and probably increasing bearing on the matter. The link may be of interest but I don't think shows trends for it. www.rcp.ac.uk/media/dzdbho0o/focus-on-physicians-the-uk-2023-census-of-consultant-physicians.pdf

Yes but if the agency are only paying the doctor half the normal salary, they can presumably change the Trust just the normal salary and still make a good profit. So no more expensive than a direct hire, and more flexible.

(We don't know the details, but I assume this is possible.)

@Marchesman think the whole thing is a mess. Workforce planning is non existent. At a time when waiting lists are so long as we have an aging population.

The press were saying we have a doctor shortage. They are now not, so it's a start. We are not short of doctors, they are short of jobs.

There is a huge debate about whether and how the NHS can cope with the growing demands on it. We also have a growing and aging population.

I assume that Consultants working part time or leaving the NHS will be an increasing problem as our private sector grows. Equally as an increasing number on the training track are from overseas, we may find that they are tempted to return home once they reach consultant level, for family and career reasons.

Lots of reasons why the pipeline needs to take in factors other than the number of consultants retiring.

Doctors don't do it because they get paid less than the normal salary. It costs trusts a fortune. Not exactly current (it will be worse now) but for the scale of the problem: www.bmj.com/content/354/bmj.i4359

We have been here before - the decision in 2006 is here:

• In March 2006, the Home Office announced the immediate end of "permit-free training" arrangements, potentially preventing non-EEA doctors from obtaining training posts. Although highly unpopular, this measure ultimately had little impact as thousands of non-EEA doctors were subsequently accepted on to the Highly Skilled Migrants Programme (HSMP), allowing them to compete freely for training posts.
• In June 2006, the Department of Health asked the Home Office to restrict opportunities for HSMP doctors through changes to the Immigration Rules. The Home Office did not comply with this request until February 2008.
• Later in 2006, the Department issued employment guidance instructing NHS organisations not to consider non-EEA doctors, including those with HSMP status, for training posts unless no suitable UK or EEA applicant was available. The guidance did not take effect in 2007 due to an ongoing legal challenge.
• In October 2007, the Department issued a consultation proposing to implement its employment guidance from 2008 onwards. The following month, however, the Court of Appeal upheld BAPIO's challenge to the guidance and declared it unlawful. Thus in 2008, non-EEA doctors were again allowed free access to training posts.
• The Department appealed against the Court of Appeal's decision and a final verdict on the legality of the guidance is expected from the House of Lords in May 2008. In February, the Department issued another consultation proposing to implement the guidance from mid-2008 onwards, providing it is upheld by the House of Lords.
• Also in February 2008, the Home Office made changes to its Immigration Rules, originally requested in 2006, preventing doctors gaining HSMP status in future from applying for training posts. The Department of Health acknowledged that this change would not have any impact until 2009 and would only then make a limited difference. The Home Office emphasised that this was a temporary "stop gap" measure...

https://publications.parliament.uk/pa/cm200708/cmselect/cmhealth/25/2509.htm

In 2010 there was a shortage of junior doctors and a recruitment drive overseas.

Needmoresleep I realise that in spite of posting a thread in AIBU you wish to retain an iron grip on the narrative. However.

There is only one single poster who sees dark red when Oxbridge is mentioned and I myself took care to name other institutions with science heavy courses so as to try to avoid any angst. Those are the course which by and large are seeing good success in terms of their graduates getting training posts. It's not difficult to see the causal link. I also made the startlingly obvious observation (again, to try to prevent being jumped on) that very appointable students will have chosen to do their degree elsewhere for a myriad of reasons. Uncontroversial you'd have thought. But I really do think that unless you know what the interviews are like to get a Medicine offer from Oxford (and I assume Cambridge interviews are similar), you really can't hope that many will accept that duffers get through. I agree that some with less than optimum interpersonal skills might sneak though, but not duffers.

The idea that it doesn't matter for future employment where you do your medical degree only holds water at the shallowest level. And the effect is seen even more keenly when training places are particularly short.

So this is intrinsically related to the issue of career progression whether you like it or not (although the consultants on this thread have already mostly vindicated the science heavy approach, so probably not much more to say). It's obviously too late for those who are out the other end of medical school but it may be a useful pointer for those who are on the cusp of applying.

There is a very insightful article in the Spectator that covers many of these issues. (I think one article per week is available without a subscription.)

www.spectator.co.uk/article/the-unstoppable-rise-of-the-locum-doctor/

Exactly. So they expanded medical school places.

But then opened up entry level jobs to people from all over the world, without priority for those we have trained, or have brought to the UK.

Resulting in newly qualified doctors not able to get jobs, with some then going overseas to find work and others leaving the profession. And the NHS ends up even more reliant on overseas recruitment.

The solution. More emphasis on retention. Why are people leaving the NHS at all levels? This should then inform workforce planning.

Absolutely.

This is the v sad reality this year. From doctors from all Unis and backgrounds. I so wish it wasn't

@Marchesman do you think some medical schools should be closed then ? Genuinely interested as I support students to go to Uni.

What would you see as the solution to the current problem. Large expansion of medical school places to meet a real demand for more junior posts.

These posts exist. Yet the newly qualified doctors are struggling to get them and they can't offer the additional experience that some of the overseas applicants have. And because of the sheer weight of numbers applying.

Getting a training slot straight after F2 can happen. However as another consultant on the thread has suggested, doing some "grunt work" (still hate that expression) won't do any new doctor any harm whilst having experience of different areas of medicine will probably do them some good.

What do you think should happen to these doctors, and to others already in the UK.

Do you think that we should prioritise competent doctors already here and enable them to get the experience they need to stay within the profession. Or do you think we continue to work to attract applications from overseas with the aim of selecting the best for that job.

Training is a separate issue. The concern sparking this thread was that some perfectly good newly qualified doctors, albeit not ones who went to science heavy universities, seem to think that they can't get jobs in the UK. Other than one who is hoping to get by on a few bank shifts each month.

Their perceptions may be wrong, but a group of them seem to have come to this conclusion independently and report that their peers feel the same.

So... what is your take on the lifting of the RMLT? Essentially should we give priority to those we have trained.

Where does it say in the BMJ article (your link) that the trainee doctors/fellows are paid 'less than half of the money by the Trust' (the claim in your screenshot)?

The article only says 'can be paid less' - not 'paid less than half' - plus the regional director at Birmingham told the BMJ that their fellows do not pay income tax. On the face of it, the claim that the doctors are paid less than half appears to be a gross exaggeration.

Also, the article says around 7,000 fellows have participated in the overall scheme since 2009 - 1,000 from Pakistan (over 10 years or so) - the screenshot (incorrectly?) suggests the majority have come from Pakistan.

But you can't make the job less attractive to high calibre school pupils and massively expand places in medical schools with lower entrance requirements and reduce their academic offering - and then give them priority over potentially better foreign graduates.

That would be madness.

Apart from anything else, the NHS needs a large number of middle grade staff who do not intend to stay here. Traditionally they came from abroad, where they returned once they gained experience and British qualifications, which more or less made everybody happy.

I think they should be avoided. Let the market decide.