To finally agree with a junior doctors strike

[Horsehow]

Junior doctors have decided to strike as they are being overlooked for jobs / training posts which are instead given to international applicants. I’ve always abhorred their money grabbing strikes in the past, but support this one 100%. UK doctors should be recruited where possible, and international graduates only turned to where we cannot find a suitable recruit in the UK.

Would suggest some less well informed people look at the actual published rations on here

https://www.specialty-applications.co.uk/competition-ratios/

It might surprise you, popular specialities more competition but some specialities have a 1:2 which anyone would consider good odds

So due to the ridiculous competition ratios created by so many IMGs applying for specialty training posts UKMGs are left with the specialties that no doctors want?

How about we go back to the pre-2019 position and reinstate the RLMT so UKMGs take priority. 93 other countries prioritise their own graduates.

Just because a UKMG F2 or ST2 doctor does not get a training post does not mean they are deficient in some way. They are following the UK medical training pathway. Specialty training is for F2 doctors and not doctors with 20,+ years experience. Why are these IMGs not applying for consultant posts in the UK?

Most sensible people would see how unfair the system is that a doctor of 2 years is in competition with IMGs that have been doctors for 20+ years.

@stuffedpeppers how do you suggest they get that extra experience when there are no JCF/F3/locums ? What do you suggest they do ?
And Purples DS should be an ST3, but IMGs got more places than UKGs. If he's not a competent ST3 then that's the fault of the seniors.

@stuffedpeppers where are these 1:2 popular specialities. ?

@mumsneedwine during ST1/2 he had no issues and was highly thought of. He was also in a competitive deanery, and passed both surgical exams first time. How can he compete with someone that has 16 years more experience and most likely has managed to get a paper published internationally etc to get more points?

Yet again there appears to be an underlying tone of bias against UKMGs and no understanding of the impact of the Resident Labour Market Test being dropped which caused the so called Boris Wave.

I’m not a doctor I just have lots of truly excellent young friends who’d make brilliant doctors that are off New Zealand or Australia as it’s impossible to find work here. Others are off travelling with nothing to come back to. Two were in tears the other day in the pub with me as they just didn’t know what to do. Not everyone makes a good doctor but the ones that wouldn’t should be weeded out before letting them run up thousands of pounds at uni.

@PurpleFairyLights it's utterly ridiculous that any UK trained ST2 can't get a job as an ST3 ! What a stupid system and waste of money. V glad mines in run through training but makes me angry for our young doctors. Thankfully the argument is being listened to and things are likely to change v soon. Labour do not want the headlines of unemployed doctors this winter (hospitals I know are already going into black alert and it's only October).

And the bias of a few towards IMGs is weird. It's almost like they have some reason to prefer non UK trained staff ?? Strange when it's NHS doctors who train them ? Maybe, if anyone thinks the training is not good enough, they should raise it urgently.

@Horsehow those young doctors are v likely fantastic, but have been shafted by a system that is broken.

I would say if they have got through to F2 in a robust medical training pathway of medical school then F1 and F2 without concerns then they should be able to continue their training with the normal checks and balances.

At the moment, the system is broken. When this becomes more widely known it will cause problems especially with the debate about immigration.

Who on earth would defend the UK investing in training doctors to the tune of 250k and giving IMGs priority due to mismatch in years of being a doctor 2 years vs 20+ years that gives them an advantage.

Thank you for posting a link to that study @Marchesman , it was an interesting read and I appreciate you taking the time to share it. I wasn’t surprised by the complex causal nexus for half the measures studied, but a couple of surprising observations were:
-schools producing more GP trainees have poorer performance at MRCGP exams schools - not sure what’s going on there (and the authors seemed equally perplexed!)
-more GMC sanctions occurring at schools with higher historical proportions of male graduates (my surprise was that the difference was significant enough to be noteworthy).

However, I didn’t ask a specific question on standards per se - my question to @Sevillian was if they were inferring that it was a deliberate sifting due to deteriorating quality that was causing the current issues under discussion. They replied that they went beyond that, which I took to be a yes. However, I did not see any evidence in the paper that the cohort facing competition this year were of any less quality than those back in 2019, when ratios were significantly less. Especially as the paper tracks outputs between 1990 and 2009, but doesn’t include any temporal analysis that could be extrapolated forward.

@stuffedpeppers thank you for sharing the ratios, although they look similar to those previously quoted.

I do agree competition is important, and should be inevitable for rising to the top in any career. However, you have piqued my interest on this and would be keen to hear your thoughts:

X starts medical school in 2011, keen to become a paediatrician. Sees the competition ratio for specialty training that year is 1.8:1, so pretty good odds but can’t be complacent. Graduates in 2017 (assuming a 6 year degree) and ratio is still pretty stable at 1.3:1, still feeling confident. Upon applying for training in 2019, it is now 1.2:1, so a bit of competition but still pretty good odds. Assume X is now a registrar, close to consultant?

Y starts in 2017 and also wants to be a paediatrician. Sees what X is doing and aware of competition ratios. Upon graduation in 2023, ratio has already gone up to 2.43:1, so things have already changed. Then whilst they do their foundation training, the ratio over doubles to the 5.63:1. It’s quite the shift.

So is X a poorer doctor because they have not faced anything close to the same level of competition as Y (on a numbers basis)?

How much competition for training places is optimal to ensure the best quality of medical care for patients?

How much should we be investing in medical training (from medical school through specialty) to ensure we are getting a reasonable return for the taxpayer?

I could only find one in 2024 that was ratio 2/1 and that was Max fax which I believe needs a dentistry degree?
None for 2025 at ST1?

@Marbles10
There is a demonstrable relationship between attainment prior to medical school entry and metrics of postgraduate performance, and between post-2000 medical schools (and PBL) and postgraduate performance. With the opening of new medical schools (mostly PBL, and all post-2000 - obviously) with lower entry requirements, It is fair to assume that the average standard of graduate has fallen. They are intrinsically less able on average, and taught less well.

But that is not the reason that many do not have jobs. Even before medical students graduate, a third have decided to leave medicine entirely or practise abroad before the end of F2, and nearly two thirds are dissatisfied with the idea of working in the NHS. Half of F2s do not apply for the next step in training.

As to what is a healthy competition ratio, that is an impossible question to answer. I have been on panels that shortlisted and appointed only one suitable candidate from half a dozen applicants and others when ten times that number applied and none were suitable.

Regarding cost, the claims of it costing "250 k" etc to educate a doctor are misleading. Student loan plus interest comes out of that and the remainder is paid to health care providers and universities, it is not "wasted" as some people claim.

Having said that, it would clearly be a much better system if retention were better, and only the best qualified applicants were admitted to a much smaller number of medical schools, unfortunately that ship sailed many years ago.

it's utterly ridiculous that any UK trained ST2 can't get a job as an ST3 ! What a stupid system and waste of money

No it is not ridiculous. Not every ST2 is up to being an ST3, either knowledge or competence wise. By advocating what you are, you are saying even if you are low end of the scale of competence we should train you up as a less skilled surgeon because you graduated from a GB med school, when we could have another Mr Yacoub.

How is a 1:2 to 1:4 competition ratio bad as in many cases

I would say if they have got through to F2 in a robust medical training pathway of medical school then F1 and F2 without concerns then they should be able to continue their training with the normal checks and balances.

Such naivety as to the reality of training doctors. I have seen many FY2s set on a career in X, who are now doing things utside medicine, completely different specilaities in different roles.

And Purples DS should be an ST3, but IMGs got more places than UKGs. If he's not a competent ST3 then that's the fault of the seniors.

How do you know more IMGS got the places
Why should he have a job against
Why is him potentially not being a competent ST3 the fault of his seniors - some people just do not have the co ordination to be a surgeon, mindset etc - not the fault of the seniors in anyway.

Such sweeping statements really do display your ignorance of what it takes to train someone from FY1 to ST8

But it shouldn’t affect the opportunities for people already here. It’s a poor show if a country won’t employ locally born people who also want to pursue a better life for themselves and their families - partly by staying near them. I don’t understand how wanting to stay in your country of origin and make your contribution there should be anything but reasonable - or why a country would not prioritise those people, particularly if they are younger (more taxable years ahead 😃).

I agree - it’s reasonable and sensible to train roughly the number of doctors we need, and it’s unreasonable to train doctors and then not employ them. There has been a tranche of stories over the last few days about the mess the GMC (?) have made verifyong that foreign trained doctors have the qualifications they claim. This is a problem you encounter less when you have a limited supply and know the training centres and their standards.

He is/was a highly competent ST1/ST2 and had references to support that from a well respected hospital/deanery.

Currently he is working in a surgical specialty in a tertiary centre in a competitive deanery.

The inflated ratios also exclude high calibre UKMGs as due to being doctors for 2/4 years it is harder to get maximum points unlike a doctor of 20+ years who possibly were unable to become a consultant in their own country.

Exactly!

Also there was the article a out GMC missing previous restrictions/convictions in other countries that the GMC did not pick up.

Completely agree.

I am not ignorant of the system at all. Your assumptions are wrong.

Yes max fax needs medical and dentistry degree

Are they owners/partners in the business though? So they will be also getting a % of the profits

Marbles I see that Marchesman has answered your question. As I said twice before, these things are entirely separate with no necessary causal link between decline in standards and the success rate for training posts.