A lengthy essay. I have a lot to say!
Well its been two days since DD joined the ranks of the unemployed, along with 50% of her year. A lot have already gone to Australia. She and her friend are trying to tough it out but it won't be easy.
They are lucky they are in a hard to recruit area, where doctors recruited from overseas or those on specialist training tend not to stay long term, so there is work. In other parts of the country those in her position will be struggling to get more than a handful of shifts each month and having to make up the rest with other zero hours jobs. Bizarrely they are even short of F1s, the first level of foundation training. In the past when F1 allocation was done on merit and British medical graduates seemed to get some priority, DDs deanery was one of the least popular which meant taking those on least points, but also making up numbers with some very good IMGs. Her area still operates the 2005 contract, rather than the English one, so pay is lower and working conditions are tougher, and where F1/F2s form the backbone of cover. DD may find herself back in her first F1 job but paid £26 per hour. (She is older and wiser and knows to avoid shifts around pub closing times on a Friday or Saturday night.) My guess is that word has got out to IMGs that it is tough working for a part of the NHS that is on its knees with limited chance of training or even a job afterwards.
Her friend has a short term contract in geriatrics. The sort of job where experienced nurses do much of the work and consultants/senior registrars can be called if there is a crisis but a doctor is still needed for prescriptions. Difficult hours, an hour's commute, relatively unchallenging, and little learning, career progression or opportunities for the sort of research etc now demanded to progress. She is very very good, the first in her working class family to go to University and wants to stay in the area she comes from. She sees no future and is applying to Australia.
DD, in contrast comes from a much more advantaged background: a well known private school and grandparents, parents and a sibling who have all spent time at Oxbridge. (Stealth boast alert.) She is also very good and hard working. She took five A levels, had a senior school leadership position, went to national championships in one major sport and represented the county and region in two others, whilst spending Sundays at a regional arts programme later teaching it at Camp America. She gained good fluency in a MFL and had good exposure to hard work through a vacation job and a gap year. She gained an intercalated degree from Imperial in Engineering, and spent her elective in a research lab where she was invited to apply for a PhD if she ever decided to leave medicine.
DD picked medicine because she wanted to be a hands on hospital doctor. She rejected school advice to try for Oxbridge as she is dyslexic and though bright, does not enjoy writing essays. Lockdown happened in the middle of her medical school training and she, like many in her outdoorsy friendship group, elected for F1/F2 outside England. She also liked the idea of starting her career with solid experience. She loves where she is, intended to try and complete specialist training there and has even bought a house. The rotations she picked have been very heavily loaded, and she is still unsure what she wants to specialise in, so had planned an F3 to give herself a chance to think and prepare.
It was only in about March this year when panic hit. Boris' decision, supported by the BMA, to withdraw the Resident Migrant Labour Test (RMLT) for all doctor jobs including the sort of entry level jobs DD and her peers need, as well as for specialist training opportunities, offering exemptions and expedited settlement rights, has been catastrophic. DD only knew two who got on specialist training, one who had been under the wing of a consultant from the get-go and another who wanted to be a GP. Over 50% of posts went to graduates from overseas medical schools. This region risks losing a generation who were born in the area, studied at the local University and who would have contributed for a full career. As a London landlord I recently interviewed a young doctor who was about to start a year-long F3. Because that sort of job will attract hundreds of overseas applicants he reckoned he had spent 6 months FTE to land anything. I would have given him, and his doctor companions, the tenancy even though their base salaries were unlikely to have been sufficient for affordability checks. Unfortunately I suspect he had only just landed the job, as he needed to start without two weeks but was still naive about how fast he needed to move to grab a rental property. (He also confirmed that his mother is as angry as I am.)
DD is lucky. Longer term we have the resources and contacts to allow her to take time out to prepare for a specialist training application. One reason why those in her deanery do badly is that selection for several specialities is national and with heavy work schedules and lack of access to research, conferences etc, they cannot compete with those, say, on two year courses gathering the paperwork (published research etc) that the NHS seems to think makes a good senior doctor. A junior registrar she was working alongside confirmed that his parents had effectively bought him his training place. Paid for publication in "low impact" journals in China, a year out to gain a Masters degree with a research element and so on. Is this what patients want? Given so many mid career specialists now leave the NHS/UK for the private sector either in the UK or overseas (last month one English, newly appointed, consultant I know decided to upsticks with her family and head for Dubai) the current approach seems short term. Particularly in the regions. Local staff are surely much more likely to stay post training than those whose roots are elsewhere.
Short term, DD has done well in her placements, and so is likely to be chosen for locum work ahead of those less known. She bumped into a consultant from a busy department which still has a locum budget and he has offered as many shifts as she wants. Inevitably NHS bank have taken an age to process her application, so yesterday she tried a private agency who phoned her within 15 minutes and had it all done and dusted, including compulsory on-line training and references, within three hours and who expect to have her work for this weekend. I guess they will charge the NHS more, but no one seems to care. She is effectively self employed so has to cover things that the striking doctors take for granted like pension and insurance, but there is scope to work hard and earn a lot. The irony is that she can, as happened during F2, expect to spend time supporting doctors senior to her, or who are on specialist training, who are new to the NHS. Without touching the question of whether overseas doctors are "better", I would suggest that there seem to be more filters in UK medical education. DD has come across more senior doctors who are unaware of well known and established research that forms the basis of NHS treatment protocols, or are unused to working with women or reluctant to listen their juniors whether they are nurses, doctors or other HCPs. One more senior colleague asked her so many basic questions she wondered whether he actually had any medical training.
In parallel she has started applying for Australia. It may be that she won't be able to stay in medicine and will have to switch to engineering but given she has already invested eight years she thinks it worth giving it another go, in a health service that is under less strain. Her assumption was that because Australia uses a RMLT she would be in an isolated mining or farming town. The application form impressed her as it focussed on what she had done and the procedures she was used to. (In her case a lot - her deanery works F1/F2s hard and gives them quite a lot of responsibility.) Unlike the NHS she was asked for references, which again strengthened her application. She got an interview almost immediately in her chosen speciality at a major hospital in a state capital. A question about what she did outside work allowed her to exhibit her understanding of the differences between RFL and Aussie Rules. (Posters on previous threads who clearly were close to NHS policy making went as far as to say that F1/F2s should be focussing on training applications and if they had interests outside work it was their fault they were not progressing.) She really hopes she gets it as the job offers her the chance to be involved in research and to conduct audits. She would like to build her career in the UK but it looks as if the only career pathway available (other than us throw money at the problem) is to move overseas.
DD and her capable and hard-working friends simply do not understand why there is no reward for merit at any point in the process.
TD:LR the NHS is a shit show and is letting its young doctors down badly. The BMA is equally culpable for its delay in saying anything, its prioritisation of doctor pay, and its failure to address the root of the problem: Boris' lifting of the RMLT.