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Original poster

The BMA being irresponsible in failing to raise issues other than pay. (Sorry another Doctor one.)

28 replies

Needmoresleep · 09/04/2026 10:23

50% of those who finished their second Foundation year in the NHS last August were unemployed. Some have managed to stitch together enough locum work to pay the rent, but a good proportion have had to look further afield, especially Australia.

Unemployment numbers have been growing. It is not just about training. Very few ever got onto training directly from F2. Some might need more time to think about what speciality they want to go into. Some need more time to prepare their application, or to reapply. Others don't want the long slog of more exams and endlessly moving around the country, and are content with a Locally Employed Trust job and the SAS career route.

Unfortunately local and Clinical Fellow jobs are listed as skill shortage jobs and open to applications from across the world. Vacancies routinely attract several hundreds, if not thousands, of applicants. Newly qualified doctors finishing Foundation cannot compete with experienced doctors from overseas, willing to take entry level jobs because: the pay is higher in their home countries; they hope they will be able to get onto training; or they are attracted by the offer of relatively fast family settlement. Also jobs come up through the year whereas all F2s finish in August. A UK F2, working long hours and strange shifts, might need to complete hundreds of applications before they even get an interview, and that would probably be a job far from where they would like to live and away from a speciality they would like to work in.

In short a huge army of unemployed and under employed doctors has built up. Both UK medical graduates (UKMGs) who have failed to establish themselves on the bottom step of the rung, and International Medical graduates (IMGs) who have come to the end of a fixed term contract. (This type of entry level job is often fixed term.) There is no resident priority, so both groups are struggling whilst the NHS continue to bring in doctors from overseas. .

Hence the pay erosion. If you can employ experienced doctors into entry level posts you start increasing the number of jobs at that level. (I don't have a medical background and so don't have access to figures. However I read that this is happening, and it is certainly confirmed by DDs observation/experience.)

Unless the basic problem is fixed, ie restoring resident priority, the problem will continue to get worse. More pay will simply increase the number of overseas applications. Doctors, of all people, should know that you treat the disease not the symptom.

The partial fixes means that IMGs working for the NHS are already facing more problems. This year UKMGs (and a few others) are now prioritised for training, whilst Shabana Mahmood is threatening to increase the time required to achieve settled status.

The BMA position is odd. You would have thought that they represent their members, UK resident doctors, whether UKMG or IMG. Instead they hailed the lifting of the Resident Market Labour Test as a brave move. Despite this together with listing all doctor jobs as skill shortage jobs, causing the rapid worsening of the career prospects for new doctors. And only expressed concern about access to training a year ago. Their focus remains pay. Streeting acted quickly on training, and no doubt would act quickly on other career bottle neck issues, but is presumably waiting for the Doctors Union to raise them.

There are a wealth of other issues. Training selection is heavily weighted towards exam and research performance. The old adage that the closer you are to London the better your chances, still holds true. The talented, experienced and super-busy clinician based in somewhere like Blackpool, will struggle. Too busy holding the fort to find time for extras, and less access to mentoring or research. Those in DDs deanery had it even harder. New graduates are on the old Foundation contract, so with more hours and less time for study or formal mentoring. Yet training decisions are often UK wide. Virtually none of her F2 peers got onto training, yet most were from the area, went to the local University and wanted to stay. One of the few who did, an IMG, seemed surprised. HIs parents had paid £20,000 to ensure he had the right research, the right competition prizes and the right publications from his home country, all of which strengthened his application. Why weren't they doing the same? Instead those who get through will often leave the hard-to-recruit area as soon as a job comes up elsewhere, leaving senior posts within the training pathway vacant, and essentially unfillable.

There are so many things that could be done if NHS management were to really look to retain their good doctors. Long term, retention would save money and add stability. More pay is not the solution.

My daughter wanted to stay but it was unsustainable. She left for Australia at the weekend. She already knows of 15 from medical school or Foundation who are working in the same hospital. Each cost £400,000 to train and they will all be good. (Australian recruitment places a lot of emphasis on clinical skills, and this is a major hospital in a popular city.) She hopes that the NHS will get to a place where it is possible for her to return.

Long post, simple question. Why are the BMA just talking about pay, not about not talking about doctor un/underemployment. It is a very real issue.

OP posts:
Whyhaveibeencutoutofmamsnot · 10/04/2026 14:03

Needmoresleep · 10/04/2026 12:59

It is worth being clear. Good doctors can be educated in the UK, or educated overseas. Poor doctors can be educated in the UK or overseas. I think most of us would agree we need a system that promotes good doctors and weeds our poor ones. Resident priority when recruiting is a bit more tricky. Most would agree. Those that don't should consider the number of doctors from overseas who would like to work in the UK, and consider whether we need to train our own doctors at all. What is seriously unfair is to allow the taxpayer to spend £400,000 on them, and for them to dedicate 7/8 years building up huge debt, only to be without work.

Both the Government and the BMA now seem to agree that training is an issue. Measures are being taken to improve it. Not enough as @Whyhaveibeencutoutofmamsnot says, but then in a pyramid structure not everyone can be a consultant.

The issue I think is both the lack of work for the large pool of unemployed doctors (either those finishing F2, who have come to the end of a fixed term contract, or who are coming off a maternity break.) And the large number of doctors (either UKMG or IMG) who are stuck on entry level grades with no where to go.

The latter are fed up. Especially IMGs who are seeing their chances of accessing training evaporate. The BMA is suggesting strikes for more pay. If good performance and dedication are not going to get you a promotion, more pay would be at least a partial solution.

The BMA should also be talking about the unemployed. Because of the lack of resident priority the NHS is happily recruiting large numbers from overseas. UKMGs come onto the job market in August. This is when they need work. But Trusts recruit year round, and are obliged to select the "best" applicant. Very often that will be the one with the most experienced over an F2 with great appraisals and references. But there does not seem to be a BMA "unemployed Doctors committee" giving them a voice.

There are shortages of higher level trainees actually working in the system due to a combination of more women in these posts who will be in their early thirties who have or want to have children and are either on mat leave or want to do reduced hours to fit in with childcare.

This is not the only reason. DD did an F2 rotation in a department that had 8 out of sixteen training posts vacant. It was a hospital in a deprived area serving a large rural population. A reasonably sought after speciality, but urgent referrals were already up to two years, consultants were having to do one night on-call in four and there was little to no research happening. Not the sort of place that high fliers, whether Oxbridge/London or IMG would select. Better to wait till something comes up in a major teaching hospital or tertiary referral centre. Or do two years, apply elsewhere and leave.

DD and her peers would have been interested in one of those jobs and the department would have been pleased to have them. Unfortunately training selection is UK wide and they had not had access to the research opportunities available to other UKMGs and IMGs, nor the study time that those on the English F1/F2 contract have. When she started to locum and had to wait six weeks for her first shift, her first thought was to go back to that department and offer to do some audits. Unfortunately as she was not an NHS employee they could not give her access to patient data.

The work is covered by a locum (whether direct or through an agency) who cannot easily use it to help with their own development.

I agree with this. After six weeks waiting for NHS bank to process her application, DD switched to a private agency who told her not to worry. A lot of recruitment happened in August but by September people would start to leave. (A particular issue with some IMGs who will move to more diverse areas as soon as they can.) She became the fifth locum appointed to cover a Specialist Associate in a niche area with 25 very sick patients. Her predecessor lasted a day. 50% of the time she was on her own, with 4 F1s reporting to her. She was kept on six months, and would still be there had her Australian visa not come through. The work is relevant to the area she would like to specialise in. But because the work was zero hours, through an agency and not classified as a Clinical Fellow role, she gets no credit for it and she can't log it on her record.

The NHS is saving money through pay erosion and by recruiting experienced staff into lower grade jobs. It is a false economy if you can't retain. In a couple of years time, when the reduced access to training makes recruitment of IMGs more difficult DDs Deanery will wonder where all their capable F2s went. Overseas private medical schools in places like Penang, live or die on their success in getting students into good programmes abroad, and provide strong support. All that happens in the UK is a P45. At least a quarter are now in Australia. Dedicated young doctors who would have been only too happy to build their careers in a hard to recruit area.

Agree about the lack of permanent medical staff in parts of the country which are either remote or in areas of deprivation where consultants wouldn't want to bring up their families.
The Scottish training programme involves rotations for the whole of the country - hard to put down roots in your mid thirties eg in Edinburgh when your next job is in Inverness (including clinics on the islands).
Even the London ones could include time in Southend.
The vast majority of trainees getting their CCT will become consultants often after a couple of locum posts (usually mat leave cover), I know of a fair few who do less than 50% NHS combined with teaching, research or private work.
Just wondering if the British born students who go off to med schools such as Prague count as UK or international.

Whyhaveibeencutoutofmamsnot · 10/04/2026 14:06

Btw @Needmoresleep NHS bank (actually a private agency pretending to be NHS) are absolutely useless.

Original poster
Needmoresleep · 10/04/2026 14:40

Whyhaveibeencutoutofmamsnot · 10/04/2026 14:03

Agree about the lack of permanent medical staff in parts of the country which are either remote or in areas of deprivation where consultants wouldn't want to bring up their families.
The Scottish training programme involves rotations for the whole of the country - hard to put down roots in your mid thirties eg in Edinburgh when your next job is in Inverness (including clinics on the islands).
Even the London ones could include time in Southend.
The vast majority of trainees getting their CCT will become consultants often after a couple of locum posts (usually mat leave cover), I know of a fair few who do less than 50% NHS combined with teaching, research or private work.
Just wondering if the British born students who go off to med schools such as Prague count as UK or international.

Show quote history

My understanding is that British born students who go overseas for medical training count as international. There is some obvious unhappiness about this. DDs observation was that some are very good, but some started barely having seen a patient, presumably because they had insufficient grasp of the local language.

Entry requirements can vary a lot, and lower grades will be a major reason why UK student choose to study abroad. Which perhaps explains some of the hestitancy.

Interesting about Bank. A couple of months after trying to register, they had not even taken up DDs references. She took a friend's advice and went with a private agency, who got the paperwork done within a day, and promptly set about building her confidence and putting her forward for jobs. (Though even they were surprised that she landed a Specialist Associate post which got extendedfor 6 months.) Bank gets priority so DD and her friends ended up with hour long commutes to more problematic jobs. Since she had previously worked with some quite weak Bank locums, it was all a bit odd.

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