To think the BMA have misjudged with another doctor's strike? Thread 2

[Locutus2000]

Rolling this over as people still seem to have something to say but no new poll.

Original post

AIBU to think the BMA have misjudged with another doctor's strike?

Last year they got more than anyone else in the NHS along with an improved deal. Nurses and other AHPs received lower rises.

BMA have just announced another 'resident' doctor strike continuing to chase pay restoration to 2008 levels.

Having just had the major win with changes to IMG prioritisation and the clamp-down on PAs it feels a bit tone-deaf and I can't see Streeting going for it.

Of the international doctors that secure training contracts (in competition with those completing F2), how many stay in the uk long term, and how many take their uk training back to their home country?

I've no idea, but assume it has changed over time as more well paid private work is available in places like Dubai and Singapore.

Current long term stats probably won't tell you much as these will relate to people who started training 20 years ago. Demand for experienced doctors is really strong across the world. One reason why though UK training is well regarded the NHS is having to recruit at consultant level from Africa and elsewhere. But why the fact that UK born/educated/trained consultants now also seem to be tempted by the Middle East seems worrying.

A doctor friend who trained in the UK but then returned home to have a very distinguished career in Malaysia, had clear plans for her DC. They were not academic high flyers so it was private medical school in Malaysia twinned with a medical school in Ireland for clinical years, and training in the UK to return to private practice in Asia. Why would you want to stay in an overburdened NHS on the other side of the world when you can have well paid work in a gleaming hospital setting closer to home. Another friend's DD is hoping to do the same. She unfortunately only got Cs at A level, not enough for the UK but sufficient to get into a foundation year at home, and then onto medical school proper. Both will have every support they need to gain that training place, and indeed may be advantaged by the fact that private medical schools have little access to patients so very much focus on the science. (Lack of patient experience can be a bit of a handicap when Doctors first show up in the UK, but the good ones soon work it out.)

@Needmoresleep I am sure that you have been told this before, but you don't seem to take it in.

The actual replacement number of doctors needed every year to cover retirement or people giving up is somewhere between 2000 and 3000.
The number of medical graduates in 2022 was 9000( and will be more now, I can't find more up to date numbers) NOT ALL OF THOSE GRADUATES WILL GET JOBS. So long term we only need about a quarter of the people graduating with a medical degree, medicine has become like law where people have to gain employment as something other than the thing they are qualified for. Wes Streeting has stated clearly that there will be no more Consultant posts, and as there is no need for a massively growing number of junior doctors they will to a large extent have to find something else to do.

There was never an easy path for doctors who felt that kindness and empathy and a work life balance were what would make them succeed, it's just become more competitive. In all honesty it will still be the same group of highly intelligent, focussed and ambitious doctors who will make the grade, and that is as it should be.

Doctors children traditionally became doctors, I don't know any who have done that now. I genuinely feel sorry for young people who have been encouraged to do medicine but who didn't realise that it didn't offer a guaranteed job for life. I believe that the numbers are still being expanded so the problem will only get worse. We should be cutting the training numbers, and closing all but the most successful medical schools.

What do you suggest the UK should do about the Resident Market Labour Test that was abolished in January 2021 leading to the explosion of IMGs applying for Specialty Training?

In 2025 there were 20,803 IMGs and 12,305 UK medical graduates applying for specialty training. So a total of 33,108 applications for around 12,743 specialty training places.

So why are we recruiting so many doctors from overseas if we have an oversupply of graduates. I had dinner with a consultant friend last week. An IMG from India who has stayed the course and who is embarrassed by the BAPIO push to prioritise overseas recruitment. She said her trust is on another big recruitment drive in India. (I forget the number but it was surprisingly high.)

I don't know if you would agree, but the best overseas doctors are obviously very good, but the weaker ones can be very weak, weaker than our own weakest graduates. DD came across one who had to result to asking F2s about basic medical procedures and care, to the extent they started to question whether he had had any medical training.

Not everyone wants to be a consultant, but most want jobs.

I am confused by "doctors who felt that kindness and empathy and a work life balance were what would make them succeed". Not true of DD and her friends. DD was quite shocked at how many would skip group work at medical school. If they did not receive obvious benefit they would spend their time in other ways, with the most ambitious very focussed on ticking boxes and burnishing their CV. At least a couple of times members of the group would demand that they did their best to get the work in publishable form - yet they themselves failed to contribute. At the end of her first year the two of them completed a group project which nine of them should have done, a pattern which continued through both medical school and her intercalation.A very quick lesson was that you cannot spend too much time worrying about what others are not doing. You make sure you do your share and more, because then you get the learning.

Good doctors may or may not be kind and empathetic. They need to be professional, hard working, experienced and knowledgeable.

Ditto when it came to selecting deanery. She was attracted to where she is because she had heard she would learn a lot. The 2005 contract is tougher than the one England uses, especially now the NHS is on its knees, and going in with good points meant that you could choose demanding and interesting rotations. DD's peers on her rotations were good. 16 out of 18 from the first rotation were from the local area and medical school and would have needed to be top of their year. These threads were the first time I heard of exception reporting. DD once had to dig in and threaten to go to the BMA when admin tried to get her to start a day shift an hour after finishing a run of nights, but by and large you expected to stay to compete a handover etc.

We probably differ in whether people need downtime after working 60 busy hours. DD saw it. Some speciality doctors who had dropped out of training because the demands were so intense. (One rotation had a particularly strong macho culture and though the team did an extraordinary job in getting through a heavy workload there were some silly hours being worked and quite a lot of shouting.) Some people are content being good at their jobs, working their contracted hours and having a life outside work. It is a choice that should be able to be made. We should not give up on the current generation right at the start. Not when we are bringing in overseas doctors in such numbers. DD had a horrid weekend recently where patients seemed to be doing their best to die - including the relative of a colleague. Her antidote is to hit the sports field. Others are different.

There are lots of children of doctors studying medicine. Seriously. Plenty enjoy medicine, the challenge and the responsibility. Pity the NHS cannot offer them jobs. (Children of doctors seem to do better when looking for local short term contracts in their chosen field - in the current chaos with huge numbers of applicants, networks help.)

Anyway Australia seems to prioritise actual experienced gained and skills practiced and take note of things like references. Some of her friends have already left, and as only two seem to have got training, others are planning to follow. It is such a pity., Why do we not build merit into the system.

@needmoresleep Not sure about directly recruiting from India part.

The Resident Market Labour Test needs to come back quickly before Oriel opens again in January 2026.

We need to go back to pre January 2021 where UK medical graduates took priority for specialty training as now the backlog caused by a few years of IMGs applying on an equal footing has caused UKMG under or unemployment.

Or government should make sure the backlog of UK medical graduates is cleared by giving them jobs and at the same time close down all UK medical schools and just recruit doctors trained abroad.

There is no point having this hybrid system where 63% of applicants to specialty training in 2025 were IMGs. It is not a level playing field now as most IMGs will have been doctors far longer than the F2s applying to a points based system that favours experience. Specialty training posts system is for doctors with 2 years experience.

@PurpleFairyLights I don't know how it works. I do remember DD being surprised at how many staff, including Doctors were brought in by agencies in her deanery. My friend, who seemed not to approve, against talked about a large number of overseas staff being brought into jobs in her trust via agencies.

I have assumed it was a bit like Australia. DD could sign up for an agency. The agency is aware of vacancies and puts staff forward. Whether there is any attempt to advertise locally is unknown. However if the post is hard to recruit and the agency has a number of well qualified staff on their books they will presumably be successful.

The solution instead might be for suitable posts, to first set a condition like having done a rotation at F2 in that speciality in the NHS. This would give our young people a chance to have a go without having to spend three hours on an application in order to compete against hundreds with more experience.

As an aside, I was not aware of the facts the FancyDuck was quoting. I have been away for two weeks. Is FancyDuck a regular with a new user name or new to the topic. Scolding seems to be their speciality.

@needmoresleep on other threads there were very argumentative people whose posts made them appear to have a different agenda.

I don't think having done a rotation at F2 would help as a lot of specialties do not have F2 rotations or if they do the F2 may not have had a chance to do the rotation during foundation training.

Wes Streeting has mentioned priority for UKMGs and IMGs that have worked in NHS for an unspecified amount of time.

Australia has a form of Resident Labour Market Test so UKMGs only get the Australian doctors left overs. This is similar to UK policy before RLMT was abolished.

It's helpful to have numbers of IMG's at the lower levels, some of them will go home and help to cut the numbers nearer the top to the required 2000.

No matter how much you think that people should be able to work their contracted hours and then go home needmoresleep that isn't the way that medical training works, and anyone with an inclination to do that will probably be judged, not least because the ones who haven't toddled off will be picking up the slack.

What do you think we should do with the 7000 extra doctors graduating every year? Let them all join the workforce every year? The NHS is already unaffordable I can't see how that would help matters.

If your daughter feels that the system in Australia suits her better she should go. The system here won 't change to suit the way that you and she think it should be run.

oddandelsewhere and TheFancyDuck may have a point: it does seem, having read all of your many lengthy posts Needmoresleep, that the NHS might not be a good fit for your DD. Perhaps a sideways move out of medicine or Australia permanently might short circuit a lot of your/ her current angst. I particularly object to the idea that you think you can ‘throw money’ at the problem. I’m also wondering - since you do mention your wealth repeatedly - whether that very wealth might be a real hindrance to your DD’s outlook and approach to life.

Although that said, I do know a large number of young people from very well off backgrounds who are doing incredibly well and climbing the path towards consultancy steadily. But then they all did what was required to get there, just like their less affluent peers, so clearly it’s about an attitude rather than the fact of wealth itself.

You misunderstood me.

I also strongly object to the fact that the system is such that you can throw money at the problem. But the evidence suggests you can:

The young doctor boasting of taking paid courses and then buying publication in China in order to get on very competitive specialist training.

BAPIO offering two year courses in India for £30,000+ where you come away with an MBA and additional medical qualifications, for those registered in India and aimed at accessing UK training.

My Asian friends whose DC have struggled to access education and training in the state system in their own country, who see the alternative route as studying our requirements and making sure they meet them.

The flood (as I am reliably told) of better off Oxbridge graduates who having failed to get onto training and were unable to land an interesting F2, are now taking "gap years". A year off where they get a relevant Masters, possibly including some research, and have time to prepare both for the exams and activities to bolster their CV.

It is frankly unfair.

There is also an unevenness in terms of those who, now randomly allocated, who end up on rotations in tertiary referral centres where traditionally F1/F2s were encouraged to get involved in research etc as in the past those hospitals were the breeding grounds for future consultants. Or those on lightly loaded rotations, including those which do not involve nights. Some Trusts do not ask their F1s to do any nights and, as older medics will know, life is a lot easier if you have a routine. Or on the newer English contract. In many ways it is a disadvantage for would be doctors, as you gain less experience, but it helps if you want to get onto training. (Built in personal development time etc.)

The point I am making is that though DD decided she wanted to use F1/F2 to get the maximum hospital experience as she wants to be a good doctor, good references and appraisals count for nothing. And yes she could buy her way in, something her equally competent peers can't, but she would prefer to make it on her own. She and her friend would like to stay in the UK, but short term contracts in undemanding jobs in unpopular specialities in a rural location far from the cutting edge, will not help. DD might be luckier locuming as the work is likely to be faster paced, and consultants have already offered to give her the shifts she wants, but again it is imperfect.

My point about Australia seems to be that they seem much more interested in young doctors who are willing to work hard and get on with it. And who have picked up relevant experience and skills along the way. The initial fear was that because they operate a RMLT doctors from the UK would be limited to small rural towns but this does not seem to be the case. And, based on the job DD has been interviewed for, it is possible to get a good variety of experience over a two year contract and get engaged in the sort of stuff that the NHS is looking for.

Several months ago a medic mum who is also a consultant (IMG) posted that she had been involved in selection interviews for training places but had had to give up. No one seemed to check the accomplishments boasted of on CVs, and no more weight was given to the BMJ over very obscure publications elsewhere. She felt they were rejecting some very good candidates with good and relevant NHS experience, in favour of others, including those from overseas, whose CVs could have been, to use DDs colleagues phrase, "bought".

I really don't blame those who play the system. My Asian friends will simply look at what is required and ensure their DC meet those requirements. I blame the system that is (post lifting of the RMLT) both so absurdly competitive that you have to have close to maximum points, and a system that values specific accomplishments over being good at your job.

My stealth boast was in relation to the weird discussion about UK medical students simply not being bright or hard working enough to progress. That is simply not true for DD and her friends. I think they have been let down badly by the medical school system. Yes those that designed current courses may have felt that more emphasis needed to be put on softer skills, but why then does access to training revert back to an emphasis on science knowledge. Giving advantage to those educated in science heavy, patient light private medical schools abroad. I also wonder why medical schools have taken the approach of more or less passing everyone. No checks on attendance or participation in group work. Poor moderation of OSCIs. Tales of widespread cheating during COVID. We are producing some very good, dedicated, young doctors but the system is not designed to identify them.

My Oxford educated F2 DC is aware of all of the issues but can categorically say there is no 'flood', as you suggest. These are not huge cohorts and the cohorts tend to know those above and below. Perhaps it's a thing among Cambridge graduates only, but that would be odd as Cambridge seems quite good at what it does too. More likely your source is less reliable than they think. Gossip about one individual has a way of getting wildly exaggerated to feed fears/ drama.

I understand some of your other points though; it's a shame that much gets lost as you distract by being dismissive of those who have had success. Comments such as 'low impact' research. Your posts don't seem generous to those who've managed to do well through ability and hard work and a lot of burning of the candle both ends.

Then why the hell is the NHS still bringing in large numbers of overseas doctors. Why did we lift the RMLT, with the argument that we have a skills shortage even for entry level jobs and for training places. We don't. Restoring the RMLT and giving priority to those already resident in the UK, including those who came over for fixed term contracts and now struggle to find work and t doctor spouses of doctors already working in the UK.

My understanding is that first training posts and F3 posts often cover the same work. It is just that training posts are limited as they allow career progression through to consultant and we only have space for 2,000 consultants.

So rather than argue that we take 50% international candidates because a good proportion of them will leave, why not reduce the numbers entering the training pipeline and create more entry level jobs which can be accessed by our young doctors. My understanding was that in the past it was quite common for doctors to take several F3/staff jobs before deciding on speciality and starting applications. With plenty then deciding that they were content where they were and did not want to go through the process required to become a consultant.

Bizarrely a consultant friend in a tertiary referral London teaching hospital advised DD that, in her speciality at least, it did not matter where she trained. They were absolutely calling out for consultants. It was always a relief when interviews yielded a single appointable candidate. Ditto another friend ended up locuming as a Senior Registrar as the job he had been due to go into was suddenly cut. A consultant post had been vacant for several years and though relatively young and inexperience (to be a Consultant) he applied and got it. Where DD is, hiring Consultants from overseas is not unusual but can create problems as at a senior level familiarity with the NHS is useful.

All anecdote but further anecdote is that an increasing number of consultants, regardless of background, find conditions in the NHS increasingly challenging and are becoming tempted by well paid jobs overseas.

Rather than rely on headline and possibly historic figures the NHS needs some proper pipeline planning. It also needs to do more to understand motivation and retention at all levels. Young doctors should not be frustrated that merit and hard work counts for next to nothing. Experienced and senior doctors should not be at the point where they feel they cannot carry on.

I recognise that these are controversial views and will not be supported, especially by those who work at senior levels for the NHS. I will simply take it that this is why the NHS is in the mess it is in. Perhaps Doctors, including the BMA, should focus on treating patients and leave workforce planning to those better qualified.

Ah my source was Cambridge and claimed a few months back that there was some real panic amongst F2s who had failed to get training and who were struggling to get F3 work.

And this is from graduates who first did a six year degree, and needed strong academics to get a place.

Those who graduated elsewhere including from some long established medical schools, are also looking at options. It seems to be reasonably agreed that 50% or so have not been able to access even short term contracts in the UK. Most won't be able to afford a Masters, but it is an option for those who can. And what training colleges abroad seem to be offering overseas candidates. I personally would prefer to see those who have put their all into their F1/F2 jobs and contribute to do so in whatever work they can pick up, and have good appraisals and references, have advantage. But that is not how the system currently works.

Needmoresleep it is true that around January there did seem to be an element of panic. Largely fuelled by gossip. I think that it's all abated now, as they've seen their peers get posts.

All Oxbridge graduates have done six years as standard and have strong academics. That's exactly why they tend to do well. But that doesn't immunise them from worry or panic, unfortunately.

I am not dismissive of who has success. Like with medical schools some graduates are very good, others less so. Our current selection process for specialist training picks up some extremely bright and dedicated doctors. But also some who have looked at what is required and have prioritised those requirements. Rightly realising that it is so competitive that this is what is needed. The fact that the system does not give weight to actual performance during F1/F2 I think is a short-coming and means that some very good, capable and dedicated young doctors are lost to the system. Not least in areas where very few even consider applying to Oxbridge, but which co-incidentally tend to have recruitment and retention problems across the board. (Having to use locums to cover missing F1s, having 8 out of 16 training posts vacant in one speciality, recruiting consultants from overseas.)

This thread seems to be very argumentative. My view is that there is a problem and that we would get further with a constructive discussion.

From PMs I have received (the thread is too combative for several regular medic mum posters) there seems to have been a cluster of F3 jobs come up suddenly in the last couple of weeks. Perhaps like the three missing F3s that another poster referred to. And that some applications are now specifying they want F1/F2 experience in the UK.

My guess is that having had hundreds of applicants and appointed the best candidate, perhaps someone from outside the UK who is offering a lot more than a current F2 can, word has got out on Reddit and elsewhere that getting a training place in the UK is tough and that we are likely to clamp down on the number of successful IMGs, so better to look elsewhere. (Interalia the USA has started to open up a lot more.) Hence no-shows, and local grapevines saying that "informal" applicants willing to start immediately are in with a chance. (DD is currently only aware of posts in geriatrics but if she asked around there are probably more.)

But too little too late. A lot have already left or have started the process of leaving.

Silly really. A quick look at Reddit would suggest that the UK is only one of several countries good young IMGs are considering, and that it is not the preferred. Any professional recruiter would suggest that the no-show rate of overseas hires is likely to be higher than of local hires. Retention too.

@Needmoresleep I think you are angry and sad that your girl can't get a job. It doesn't help to listen to anecdotes about other people, stories tend to get twisted in the telling. Your consultant friend was out of date when she said that it didn't matter where you qualify. That was the case when there were 18 medical schools all with the same stellar standards. Now I think there are 45 medical schools some with shall we say less than stellar standards. 50 percent of graduates struggle to get a training post. It's easy to see why, there are twice as many of them. I know mumsneedwine will say that you need AAA to get in, but at some one of those A's might be in PE or art. As explained in the data linked above prior attainment affects outcomes, as does teaching method. Students who start with 3 A stars in science subjects are just more likely to succeed. I know that you think it's a pity that training becomes more science focussed, but that is because ultimately that is what matters.

It does really sound very entitled to think that someone who is good at some things but not the things that are actually required should be employed before someone who has worked out what is needed and done it.

I am really not trying to be argumentative and scold, but the system is as it is. Twice as many graduates as we need, and some will lose out. You would probably feel better if you realised that no one is buying or influencing their way to the top, there's no way that can work. (Someone with C grades at A level, if that story is even true, is vanishingly unlikely to get through Royal College membership exams).

Then why are we still recruiting overseas doctors throughout the system?

I recognise that to get the training post you need to be good at the things that are required. I would argue that the intense competition that has been created by the fact that there is no RMLT means that the add-ons, things that give you extra points have assumed to great an importance. So many people have so much that it has becomes an arms race, and nice-to-haves have assumed too much importance. Whilst things that should matter like performance on the job, are not taken into account.

Yes I am angry. A prospective tenant I met (I am a landlord) who had finally landed a one year F3 contract after 6 months of dedicated job search confirmed his mum was angry. An MP I know confirms mums have been turning up at her surgery, angry.

I am particularly angry for DDs peers. The vast majority went to a long established and well regarded local medical school, known to be strong on science. In an area where the NHS has genuine recruitment and retention problems, and where local health services are known to be struggling. DDs immediate work colleagues are on competitive rotations so will have started with lots of points. Am I completely mad in thinking that more effort should have been made to retain them?

One fantastic F3 on a year long temporary contract provided support to both the F2s on a very busy ward and also to the newly arrived overseas doctors. For the second time she did not get a training place, not even an interview, though has been rewarded with one of the two Training Fellow posts in the Deanery. If things don't improve, and UK residents still fail to get priority, it is hard to know what she does next.

Much is made of the new medical schools and the low calibre of some of the graduates, but we have plenty of good long-established medical schools and good graduates. The system is not doing enough to identify them. Maybe not training, but surely they should get priority for entry level jobs.

(Oh and I am watching the progress for my friend's child with interest. Though she is a hard worker I personally think her upbringing is too affluent and sheltered for her to make a good doctor - a driver to take her to medical school as her parents wont let her on public transport - but anything that can be bought will be and any influence that could be useful will be brought into play. My other friend's DC are doing just fine. They will offer what the current selection system requires. Nothing about contributing to a public health system, all about qualifying for that well paid job in the private hospital the mum co-owns.)

Your consultant friend was out of date when she said that it didn't matter where you qualify. she meant where you did your training. Those that training in London often aim for consultant posts outside London or overseas, or switch to banking. Meaning that despite the prestige of their department they struggle to recruit at consultant level.

She told me this a couple of years ago so I don't think it is that out of date. She did suggest though that DD would be at a disadvantage if she did not opt for London or a similar Deanery when it came to accessing training. DDs post lockdown choice - but the year after allocation became random.

Kindly, they don't have to face competition for entry level posts, they get F1 and F2 jobs with no competition. They also know that in 2 years time they will face stiff competition so they need to use that time to make themselves more employable. Has she sat and passed MRCP part one? That would help.(So would actually applying for jobs).

Your anecdotes are getting wilder and more ridiculous. A student with a driver? A fully functioning adult with a professional qualification wanting to work for his mother?

You honestly would be better to take less interest in what your adult daughter is doing. It's plainly not helping her. Do you know the quotation 'love is in the letting go'. You are only angry that you're not getting your own way. At 26 I hardly knew what continent my children were on. They've grown up completely independent, and have never needed anyone to be angry on their behalf.

By the way, you should have mentioned before that you are a lanlord.

Sorry, landlord.

Landlady. And I do think people have forgotten the name of this app 😂.
Who wants to live in London these days ?

50% of F2s didn't get a job - many of these are current IMGs who now can't get a visa to stay. Who got into training has no bearing on the Uni they went too. I know Aston and ARU graduates who are now ST1s and Oxbridge grads who have not got a job. Because of the stupidity of the points system. And the MSRA, an exam that is used for many specialities while it includes no questions on those specialities.

I wish those consultants on here who think newer Med Schools are producing such rubbish doctors would inform the GMC. Who seem intent on expanding them. Never heard anyone raising a noise about closing those they say aren't up
to standard.