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 got my consultant post in the early 90s, so I worked at a senior level before and after things deteriorated. I remember cheering the incoming Labour government who promised that "things could only get better" - they didn't then, and I am confident they won't now.

I don't think it is appreciated how much consultants' time is wasted and how entrenched that is. Secondary care looks as though it was designed by stark raving lunatics.

Mandatory training in my experience is worse than useless, and completing an ePortfolio is not a substitute for actual teaching. By the end of my career I was spending not less than half a day and usually a full day every week on my or someone else's "continuing professional development" - not actually teaching and not on the wards or in clinic. When I was in clinic, patients did not turn up due to issues with central bookings, delayed appointments and changed circumstances, often they had become inpatients. I had inpatients on two acute sites and outpatient clinics on a third, every week I spent 1-2 hours cruising round hospital car parks looking for a non-existent space and then writing emails or making phone calls to the estates department to get tickets cancelled that threatened county court action.

But not to worry because according to NHS England:

"PAs are additional members of staff who help support service provision. They can see many new patients which enables more clinics to be offered and reduces waiting times and the likelihood of cancelled lists. They can also offer follow-up appointments which is useful as some consultants are unable to provide these appointments for many months. This helps to provide continuity of care and means that existing patients can be seen more quickly
A significant aspect of the PA role is supporting with ward rounds and reading and writing in patient notes. Because PAs can communicate with consultants during ward rounds, this provides an escalation path and saves senior staff looking through patient notes, which leads to increased departmental productivity." (My italics)

In a sane world, someone else would deal with any bureaucracy that was felt necessary and consultants could see "many new patients", "offer follow up appointments" and "look through patients' notes". Come to think of it, I'm pretty sure that PAs are not wasting quite so much time on mandatory training, revalidation, appraisal, and ePortfolios.

How would it be if they just swap job descriptions?

I am really grateful for the recent contributions.

Not a derail, in that the immediate problem:

• sky high competition for F3 jobs
• sky high competition to get a training number

No jobs for perhaps the majority of F2s is a symptom of a wider failure of workforce planning. The short term solution to shortage issues is overseas recruitment with no thought given to where the shortages are, leading to career pathway blockages for future home trained doctors.

The longer term solution seems to be training more doctors. This not only exacerbates the problem but puts pressure on standards. And adds to the burden on consultants and other hospital staff.

I assume some teaching methods, perhaps those that use fewer staff and lab resources, to be more attractive.

A consultant friend suggested that medical schools now don't seem to fail anyone, leaving them to do some of the weeding. (Though I am not sure how.)

In terms of "quality control" observation was that PBL and the widespread use of OSCI have left testing in a strange place. Covid did not help, with concern that the scope for cheating in online exams was not really addressed.

Some examples. Two of them being left to do group work for eight a week before first year exams. The group work needed to be handed in, so it became easier to just get it done. OSCI results across the two centres not being moderated, so one group scores 20% more than the other. The same scenario used during two days of OSCI. Students assumed that the scenario would be changed after the first session, so participants shared their experience. Those who took it on the second day won the prizes.

(Observation was Imperial's engineering department were much better at mixing group work with rigourous appraisal including vivas and an element of peer marking.)

My assumption is that when points were used to allocate F1 placements and rotations, there was some matching of those with good points to more demanding positions. Now there won't be, which I assume will exacerbate problems for busy consultants.

(Out of interest is management of Foundation programmes the same across the regions. I know DD has a different contract to English one. Though individual consultants are supportive of F1/F2s as well as the rest of their team, I don't think she is not getting anything like the cosseting suggested on here.)

I also understand that there is also concern around some of the widening access students, especially a disproportionate number from ethnic minority communities, doing noticeably less well. This was the driver behind the changes in F1 & F2 allocation. There needs to be some decision on when merit comes into play. Perhaps we need to be tougher and provide more support in the first year of medical school. (DD's medical school did not provide tutors, disastrous for one of her group who had gained access via WP and who really needed early handholding to ensure she was not overwhelmed. No one noticed she was not attending until members of the PBL group complained.) .

Some very bright and able students are going into medicine. They should be able to thrive, but it looks as if there are issues at every step of the way. I understand that there is a certain amount of "it was tough for us, so why should they have it any easier", and I recognise that some, who were totally dedicated from the getgo and that those who have strongly prioritised their future careers, will get ahead. But as a country we need doctors.

At the moment the system seems to jump from very little benefit from merit (appraisals points etc) to needing to have a CV that is good enough to get you to shortlist above, say, 800 other candidates. Or be able to succeed against international competition with some CVs laden with astonishing achievements for scare training positions.

There are a wide range of careers in medicine. When I see a GP (if I had one - the practice is currently homeless) I would want someone whose competence had been properly tested. I would not particularly prefer someone who had won all sorts of competitions, and who, to get enough points to get on the training had ignored a need for work life balance. A rounded human with an understanding of the needs of, particularly the more deprived members of, the local community would be good.

I completely get why some academic medical jobs need seriously academic doctors. But for most jobs, good graduates, with strong A levels, trained at Newcastle, Queens or Birmingham used to be able to forge careers in medicine. Why can't they now? Especially with a rise in doctors looking for part time work, not everyone wants to be a consultant.

And what happens to the NHS longer term if this essential core of sound doctors leave the country/profession. More burden can't be put on consultants. Further expansion of the PA role? More competition for PA places so higher academic standards, so it more like an American system of pre-med, followed by a two year medicine course giving us staff medically trained in specific areas, but without that wider medical knowledge. Who then trains our future specialists? PAs?

Sorry that was long.

Needmoresleep:

Your examples of chaotic marking during the Covid/ immediate post Covid years sound familiar. This was across all subjects and I assume all universities. My own DC wasn't affected personally and so was fortunate, but several of her friends and peers found that double marking reduced to single marking threw up some bizarre marks for more than a few students whose planned career paths were thereby scuppered.

I'm sure that someone at consultant level can explain this (by way of dismissing it) but I'm not clear why the UK couldn't harness the expertise of international consultants who are prepared to come to this country at a lower level/ pay grade by recruiting more of these clinicians specifically in order to train UK graduates - if the NHS does indeed go down the route of giving priority to the latter. I'm not sure if that would be something that would be in any way attractive to the international consultants now working at registrar level, but might it conceivably be?

I'm afraid you're again making a false distinction between 'competition winning' junior doctors and well rounded ones who value a work life balance. The fact is that plenty of the 'competition winners' are also completely well rounded, very capable of understanding the huge impact of deprivation, and yet manage still to maintain a social life. I think this is difficult for you to understand because you do seem to be determined that it's either/ or - and it really isn't.

It is not an either/or and I never said it was. I am not suggesting that any doctor who makes it onto training is not well rounded.

However the numbers accepted from within the UK for training are a very small proportion of the cohort.

What of that perfectly sound graduate from, say, Southampton, who in the past would have got onto training but is struggling to compete against international competition. Should they just try harder.

My point is that those who have done so very well, once they have got onto and through their specialist training, will probably get bored sitting in a GPs surgery in a not very attractive part of the UK and hearing about ear infections and UTIs.

(A further complaint I have heard is that those accepted for training tend to want to over-specialise, so no general anything, which is difficult for more rural areas.)

My assumption is that when points were used to allocate F1 placements and rotations, there was some matching of those with good points to more demanding positions. Now there won't be, which I assume will exacerbate problems for busy consultants

I think that this is a problem for any senior colleague, by no means just the consultants.

You haven't said so in terms but on a number of occasions you've set up the two stereotypes so the very strong implication is there.

Thanks for this Marchesman.

@Marchesman Another part of this extraordinary problem is that having been accepted onto training, people are being selective about where they then spend the next eight years.

DDs deanery has a problem in that less research is going on, so less chance to build the sort of portfolios that would enable F2s from there, who might like to stay there, to get accepted for training.

Because the acceptance for training is national, and F2s who are already in the area and who would be happy have not been accepted, they have to rely on people from outside the deanery applying for their positions. This is not happening.

Perhaps some of the IMGs also have opportunities in their home countries, are really only interested in coming to the UK if they can find a job in a well known teaching Hospital that will form the next stepping stone for a high flying career. Whilst others decide not to commit to a move but instead wait for more jobs to become available where they might choose to work.

Who knows, but the result is that people are not applying for their Registrar jobs. In one important area, where even urgent referrals wait two years for an appointment, the Deanery is missing eight Registrars out of sixteen positions. Consultants are having to try to pick up some of the slack with a horrific rota of on calls.

This then limits the time consultants have to get engaged in research and to support good and ambitious F2s who want to train in their area. Thus further reducing local F2s chances of getting through the national process for selection for training. And increases the chance of a consultant throwing in the towel and accepting a job offer abroad.

And they can't even give the unfilled job as a short term F3 type contract to their promising F2 as this would entail a recruitment process and applications from all over the world. Probably easier to try to identify elements of the work that might be given to a PA, and decide that it is better that the patient is seen by someone rather than no one. Crossing fingers that nothing major is missed.

UKMLE is for all medical students this year so it will now be v easy to see if there are big differences. There aren't in the PSA.

I should be up on jargon but I am not, and assume others are not as well.

What is UKMLE and PSA.

All my DD is looking for is a simple F3 job. Will she need either?

It is the MLA not UKMLE and it stands for Medical Licensing Assessment, it will be taken by all medical students graduating from UK universities from the 2024-2025 academic year onwards and they will have to pass it in order to be added to the medical register.

PSA is the Prescribing Safety Assessment which is an online assessment of NHS prescribing knowledge and skills, it is part of Foundation Programme competencies and all F1s have to show that they have passed it. Most of my F1s take it during final year med school, if they don't pass there are resits during their F1 year.

Thank you.

I seem to remember DD revising for some prescribing exam just before she left medical school. My impression was that simply a hurdle to be overcome, and not something to worry a normally diligent student.

The MLA too sounds like a reasonable idea. OSCIs particularly can be weird. DD complained about one scenario, where she was told to imagine the actor was a middle aged black woman or something, when he was in fact an elderly white male. I may be exaggerating, but she felt it was more a test of imagination rather than of observation. She was also unlucky that she was first in the room in her first ever Osci and the top of hand sanitizers fell off. No one had screwed it on. Though she hastily wiped most off, it did not make for a great exam.

Further up thread there people arguing that training positions were unfilled so there could not be a shortage of doctors. Could I be right in thinking that the problem may be caused by trying to match the number of positions nationally to those accepted. When those accepted, including serious academic high flyers, and overseas applicants wanting to have a famous teaching hospital on their CV, are really only interested in positions in major hospitals in major cities.

Back to Eamonn in Enniskillen, who was top of his class at school and top 25% at Queens, a long established medical school. Despite some posters believing he does not deserve anything because he is either rich, apparently everyone in Enniskillen is, because he is not in the top 15% nationally, he would like to stay in medicine (posts upthread) and in Enniskillen. And the training post in geriatrics has been unfilled for a couple of years. So the hospital is having to either recruit a locum (which is attracting applications world wide, many with more experience than Eamonn) or asking existing staff to work extra shifts.

His F2 supervisor would love to keep Eamonn on. Indeed he would love to see him progress through the ranks, believing that if you have a staff recruitment problem you need to work on staff retention. And he believes that he will be just as good as others in the department, trained in the days when you did not need an all singing all dancing CV.

How do we match national, indeed worldwide, recruitment for training positions, with filling training posts in less popular areas. And how do we ensure that Eamonn can forge the medical career he has been working for for seven years.

At the end of the day it is about the patient. Vacancies don't see patients.

@Transcontinentalcyclist apologies. It was originally the UK Licensing Exam when they trialled it. Think it's a v good idea as it will mean everyone takes the same exam - hopefully they might use it for foundation ranking. Usually fiasco today - one of the top Cambs graduates, who has a PHD, got his 18th choice. Random allocation seems so wrong to me.

My DD's friend diagnosed a heart issue during an OSCE. The 'patient' did not know they had one ! Made for an interesting station as assessor had to step in and listen too as wasn't what they were supposed to have wrong.

Back to Eamonn in Enniskillen, who was top of his class at school and top 25% at Queens, a long established medical school. Despite some posters believing he does not deserve anything because he is either rich, apparently everyone in Enniskillen is, because he is not in the top 15% nationally, he would like to stay in medicine (posts upthread) and in Enniskillen. And the training post in geriatrics has been unfilled for a couple of years. So the hospital is having to either recruit a locum (which is attracting applications world wide, many with more experience than Eamonn) or asking existing staff to work extra shifts.
His F2 supervisor would love to keep Eamonn on. Indeed he would love to see him progress through the ranks, believing that if you have a staff recruitment problem you need to work on staff retention. And he believes that he will be just as good as others in the department, trained in the days when you did not need an all singing all dancing CV.
How do we match national, indeed worldwide, recruitment for training positions, with filling training posts in less popular areas. And how do we ensure that Eamonn can forge the medical career he has been working for for seven years

Mine was an idle point, that NI medical students tend to be disproportionately middle class. It's a fact. I certainly didn't say that everyone in Enniskillen is middle class because as another matter of fact they aren't. There is no link between the fact that medical students in NI are disproportionately middle class (more so than in England is what I mean, and tbh the latter aren't that economically diverse to start with) and an entire town in NI which a fictional student hails from being middle class. Chances are that Eamonn's mum or dad or both are medics and it was you yourself who has been railing against the kids of medics having - in your eyes -an unfair advantage in securing career progression.

NI has put a plan in place to shake things up in the past few days hasn't it? It has obvious problems of its own so perhaps it needs a particular plan/ solution. I'm not sure that one can extrapolate the NI situation to the whole of the UK.

If you only train in one hospital / region you have avey polarised insular view of your speciality. This is why rotations exist - different perspectives on treating the same condition. This challenges doctors to think and learn more options.

I do not want to be treated by a doctor who stayed and trained in just one hospital be that teaching or dgh. You need a combination of them both for most specialities. Yes that means you need to move and it is disruptive in your early years but makes a much more rounded competent doctor in the end.

Sorry - Eamonn from Enniskillen will be a better doctor to his patients if he has left the village and been challenged.

Ah, but he will have been to Queens and worked across the region as F1 and F2, and his training post would almost certainly been in Belfast or one of the major regional hospitals. Or indeed elsewhere in the UK. The same will apply to those who say, stay in Scotland, Wales or London. And if lack of enrichment is a problem, surely it is easier to fix that than was the cost of training Eamonn.

I am not sure why you think Eamonn will make a better doctor is he is forced to move to Australia, or that Enniskillen (the largest town in Country Fermanagh) is better served by recruiting a Consultant from, most likely based on current recruitment patterns, sub-Saharan Africa. (The training post designed to ensure that Enniskillen hospital did have a consultant went to someone without links to the area who took the training and left for Dubai.) My understanding is that the UK consultants have lots of CPD and that there are plenty of opportunities to meet colleagues from across the UK and indeed elsewhere at conferences, training from tertiary referral experts, etc. I think it reasonable to argue that Eamonn's access to current thinking would be broader than his replacement who may studied and trained in a country with limited medical resources.

What do you see as the solution for hard to recruit rural areas? Continue to rely on overseas recruitment and give up training the likes of Eamonn. (Don't forget he was top of his grammar school class and then top 25% at medical school.) Or force doctors to be posted around the country. Or give up and ask everyone to go private.

https://www.gmc-uk.org/-/media/documents/workforce-report-2022-full-reportpdf-94540077.pdf

https://www.gmc-uk.org/-/media/documents/workforce-report-2023-full-report_pdf-103569478.pdf

https://www.gmc-uk.org/-/media/documents/somep-workforce-report-2024-full-reportpdf-109169408.pdf

Thanks. Any conclusions we should be drawing from this?

I bumped into an MP at an event last night, and was able to have a few words. By coincidence that afternoon the mother of a doctor had come into her surgery that afternoon. Her daughter had been working in Australia for two or three years and was desperate to come home but was unable to find a job. The MP was therefore interested that this appeared to be a major problem and jotted down my very quick briefing.

All Australia is likely to do is buy time and give some more experience. Jobs are the ones that Australians don't want, so perhaps not the best environment to add the sort of research etc needed to for a CV that will get you a training place. And probably won't come with guarantees of training. Even if there were, training in Australia means a multi year commitment.

You might actually bend up in a worse position because unless the Government decides to commit to changing immigration law, and/or someone sets up an agency to support UK graduate doctors in their job search in the same way doctors applying from overseas are supported, you will be in the same position as those just completing F2, just three years on.

The time for the Government/NHS to review workforce planning is long overdue. But perhaps time for agencies like BAPIO to open their doors to doctors of British origin (all ethnicities) as well?

The message is that it is worth contacting your MP about the current problems health care professionals, particularly the newly qualified and those returning from career breaks or wanting to return from overseas, are having. Most people I have spoken to are genuinely shocked. It is a bizarre situation and a complete waste of money.

The more decision makers who push for the issue to be moved higher up the agenda, the better. If something is not done quickly we will lose a whole generation of medical school graduates.

I see that Wes is continuing to shake up the top of the NHS. First the Chief Executive of NHS England Amanda Pritchard and the national medical director Professor Sir Stephen Powis, go. Now a real effort by the Health Secretary to wrest back control.
https://www.dailymail.co.uk/health/article-14483433/Wes-Streeting-cuts-NHS-HQ-staff-numbers-half.html

I hope it happens quickly. When Boris first started post Brexit trade talks with India I remember jobs for doctors being on of the items on the table. India wanted jobs and training for its newly qualified doctors, we wanted their more senior doctors to fill our skills gaps. With recent world events India is strategically more important than even and the Government is keen to get a deal signed. I hope they are not tempted to sell the futures of our DC as part of the bargain.

That’s the same in all industries - definitely the same in mine. If somebody is in the country legally and has the right to work then they should be treated in terms of seeking employment. When I have also been an immigrant in other people’s country I was not treated as a second class work seeker but as an equal.

You can argue if overseas workers should have work permits in the UK in the first place which is a fair argument. But once they do there should be equality in employment.

Yes, I agree with this.

My resident doctor still can’t believe that I don’t get supervision as a consultant. Where I work you are quite isolated and you just have to get on with it and make difficult decisions every week and hope you are doing the right thing. Of course you can chat to your peers when needed, but it is not the same as having structured supervision that is all about you.

I am of the generation of doing 56 hour shifts, never having induction and being thrown in at the deep end. I look back to some of the clinical situations I had to deal with on my own as a house officer in the 90s and wonder if the outcomes would have been different today with more support.

I also have no office or dedicated admin. But I’m used to it now.🤷🏼‍♀️

It’s fucking awful. There has to be some return of a social contracts, now we can surely all see what path the US and its economic model is leading us down. Surely? It’s been beyond disgusting, forcing people to pay for degrees and making them work on those degrees, paying to work - and then there’s nothing for them at the end.

Oyr elites betrayed us all over the last 20 years, of both coloured and all coloured ties. They thought it was funny to turn us back into a nation of aristos and serfs, with baby boomer backing, and calling on intercontinental wealth to force neoimperialist slavery down our throats. There has to be an end to it, somehow.

I thought a decent read might be useful.

The mood music of the reports is significantly less dramatic than MN has been, significantly less anti foreign doctor and significantly more constructive.

The sections on LEDs might be of interest too.

At the very least, the GMC reports provide a great deal more actual information than the anecdotes of four or five DC of MNers who are cross that their DC may not move effortlessly into a training post direct from foundation training. The information is also presented in a much more digestible way for those who want to be informed rather than have to read the anti IMG propaganda and anecdotes of how certain posters couldn't understand accents etc.