Foundation Training - medicine

[Feelingblue77]

https://www.bbc.com/news/health-68849847.amp

I saw this article today and as a parent of a 3rd year medic it’s quite worrying.

it sounds like places will be found for everyone in the end but I just wondered if anyone had any experience of this?

@Feelingblue77 there has been a wait list for the last few years, but deaneries were allocated by performance (so position in your year and the SJT). So wait list students hadn't got high scores. And were predominantly poorer students (who had to work through Uni)

This year it's a random algorithm so top performing students have been hit. And it's 1,000 students, some not hearing until
July - they start in July !

Unfortunately the situation is even worse for F2s, who are facing unemployment from August as there are so few jobs. Within 12 months the powers that be have meant that doctors are facing being jobless. But plenty of money for PAs.

Sorry to be the voice of doom. Let's hope the media pick this up fast and things change. Fast.

Thanks @mumsneedwine it must be awful for those waiting.

I didn’t realise that F2 could be hit worse - I thought once you were allocated somewhere for F1 you stayed there for F2 - DD is a couple of years off this stage so we’ve not really talked about it.

Out of interest do you know how F2 places are allocated?

There have always been some, allocated to a deanery, but without a job and essentially not knowing where you might be working until the very last minute. In the past it was more predictable. Low points meant fewer choices.

Now allocation is random. Yes you can show preferences, but having strong scores from medical school won’t give you priority over others. As importantly points won’t give you preference over rotations. DD had a fair number of points but opted for an unpopular deanery which meant she got her first choice of rotations, in busy and demanding roles. Under the old system apparently those who ended up in the deanery because they scored poorly tended to get the less popular rotations in quieter rural locations. It will be interesting to see what happens.

From observation, some of the students who did less well were from poorer backgrounds, often ethnic minorities. It was not necessarily about having to work, other things including adapting to effectively a white, middle class, predominantly Christian culture was sometimes as issue. The new system is designed to level the playing field. What it has meant is that some articulate high flyers are losing out, so making a lot of noise.

F1/2 is only the start of the problem. There is a very desperate shortage of specialist training places. I think space for only one in four. The media talk about young doctors moving to Australia for the money. Often instead it is because of the lack of an accessible training/career path in the UK.

That’s interesting @Needmoresleep and sounds like it’s a tricky time.

I’m not sure if the random allocation is better or worse. I guess at least with the previous system you could manage expectations and select somewhat strategically.

Are there stats year on year re which deaneries are most or least popular?

Re specialty training, DD doesn’t have an idea yet of which direction she would like to go in, but purely out of my own interest, are the specialties that are more popular and harder to get into, or less popular? Just would be interesting to know.

I’m glad it worked out for your DD and hope she’s enjoying her career so far.

The F2 thing surprised me as well. When allocated a deanery DD was given a list of 100 or more (no idea how many F1s the deanery took on) sets of possible rotations, covering F1/F2, for her to rank in order. She got what she wanted, which lined up well with the area she wants to eventually specialise in. Her deanery have quite a few F1s who went to medical school outside the UK, so I would have there was no excuse not to provide sufficient F2 places.

My understanding is that there is such a shortage of training places that all specialisations are hard to get onto, including, GP which used to be seen as one of the easier ones.

It apparently means that whereas in the past you might have applied during your F2 year, because you need good exam results and a strong CV it is increasingly normal to take a F3, or work as a clinical teaching fellow or as a locum. F1 hours have been brutal and F2 will be tougher, so DD has no plans to try to study on top.

There are stats on which deaneries are more popular, but I don’t have them. My understanding is that Wales comes bottom, in part because the hospitals are located around the edge so it is not easy to commute from one hospital to another. One advantage in going somewhere unpopular is that specialist training places also tend to be less competitive. Though it was a complete leap into the unknown, DD loves where she is so will be happy to stay. (She has discovered there is a world outside London and the South East!)

Thank you @Needmoresleep that's all very interesting.

I think I read somewhere that slightly more students graduating in 2024 got their first choice of deanery this year than last, but I think the percentage was very similar.

Maybe the process will all change again over the next couple of years.

Your DD's approach all sounds very sensible and I'm glad she's discovered, and is enjoying, life beyond London and the South. Good for her taking a leap.

It does feel a little like the random allocation of how they are ranked, takes away the ability to be strategic. Even if they were told their rank it would perhaps help them know how to rank the deaneries.

I do find it interesting to learn more about the processes going forward, even with 2 years still to go and many exams to tackle before she (hopefully-fingers crossed) reaches that point.

Thanks for sharing your experiences.

I saw the article too. Very close to home as partner of a DC who was in the top decile at Oxford last year and has worked incredibly hard for all six years has been allocated eighteenth choice out of eighteen. Seriously disillusioned especially at the short notice - having real doubts about what to do. Has always wanted to be a doctor since childhood and would be a fantastic one too.

My own DC has just got a specialty training place in London a couple of weeks ago -
very relieved and I’m just thankful that he went through a system where there was at least an element of ranking.

Glad your DD has come to enjoy life where she went Needmoresleep - it may be the same deanery so I shall pass it on.

mumsneedwine can you explain about the F2 thing - I thought the allocation was for two years not one but currently don’t want to ask DC too many questions while things are up in the air.

Ah I’ve just read your post again Needmoresleep - I hadn’t cottoned on to the fact that now the bit after F1 and F2 was in a mess. I was talking about the bit a couple of years on, the specialty registrar training which seems competitive - but now every stage sounds grim. I just don’t understand why.

It's terrible. At a time when the country really needs to be doing everything it can to keep hold of it's bright young people, particularly in the NHS it seems to be doing its best to alienate them.
I qualified back in the dark ages of the 1980s when you had to sort out your own House jobs. To be honest, at my University at least, most jobs were "promised" to students during 4th year or early 5th year attachments though interviews were held, and occasionally jobs went to unexpected people. I don't suppose it was "fair" by today's standards but you know what, I don't know a single person who didn't get a job that was at least acceptable to them and it was very rare for anyone who didn't want to leave the region to have to do so. For hospital specialties getting SHO jobs was up to you too, and they were all stand alone 6-12 month jobs. The Deanery didn't get involved until registrar level when you applied to the regional rotation. It was a bit chaotic and yes, it was stressful having to job hunt so frequently, but at least there was an element of choice. These days the pressure to decide on a specialty comes too early in my opinion and then it's none stop pressure to tick the right boxes at the right time. Some of the best doctors I know tried several specialties before they found their real calling and maybe failed a few professional exams along the way. They'd probably be out on their ears nowadays.
Despite the far better hours etc I wouldn't want to swap my junior doctor days with those of today. The baby has been well and truly thrown out with the bathwater. I don't blame any young doctor who chooses to go abroad and I'm really pleased that none of my children chose to follow in my footsteps.
No words of wisdom sorry but I wish all newly qualified medics luck.

Karolinska. I have sent you a PM in case it is the same deanery. DD's time at medical school was very affected by Covid. A surprising number of her friends, admittedly sporty outdoor types have opted for less popular places with lots of outdoors, and discovering the benefits of lower living costs and welcoming communities. It should not matter. A very senior consultant friend reassures me that as long as she gets onto training, London hospitals are crying out for registrars as so many that they train then leave London or leave for the City. It might actually be good to gain different experience, though that would depend on the extent to which you then get your preferred rotations.

I think we are talking about the same thing. The training after F2 for a specialisation. Places are seriously competitive, which is why some are tempted to give up and go to Australia and why most don't try to prepare for applications/exams whilst they are working F2. (I am not an expert, just aware of how despondent DD was a few months back when she was overwhelmed by her new responsibilities, whilst realising there were more hurdles to jump. Since then she has grown into the job and grown in confidence so much happier.) Well done to your DD for getting a place. I hope I can feel a similar relief in a couple of years time.

Mine will never come back to London. She's realised life is much more fun where you can afford to live. And surf.

Jobs are allocated for F1 & F2 usually, so once in you know where you are for those 2 years. After that it's a bunch of fight. Or Australia 🇦🇺

Unbelievably the story gets worse. Some students have been emailed and told their jobs were double allocated so they now have no job. Not sure what happens next.

It must get sorted after all this. In any normal organisation people would be fired for this level of incompetence.

It's not just at post fy2 stage there is a pinch point but again three years later at ct3 going into ST4. By this time the applicants are reaching thirty and are at the stage of house buying getting married having babies and are still expected to be moved all over the country

Asked for the above post to be deleted because I posted before I saw I was repeating myself about my own DS which looks ott. But the other point about only selecting certain areas to limit being moved around the UK holds good - apart (now) for F1.

No wonder young doctors are leaving in droves and heading to Australia and New Zealand.

Specialty Competition Ratios (2023)

Standouts are: Thoracic surgery 27:1, Core surgical training 4:1, GP 2.7:1
Almost all are 2:1 competition ratios.

It's all a mess, there is absolutely no incentive to work hard in the university and the random allocation of FP jobs is quite a bizarre decision. Junior doctors had an extra point allocated if they had intercalated when they applied for specialist training, in the past , but this is no longer the case. I understand that some won't be able to intercalate due to financial reasons but there should be some recognition for the candidates who do.
I used to interview for specialist registrars for my speciality in the past but have refused to participate in the process as i felt it was flawed and the last time I was a part of the panel, the whole process made me very angry!
Ageingdoc - I completely agree with you, my training experience was similar to yours.

I didn't qualify in this country and had to move from a different country to the UK for my training - yes, it was difficult adapting to a different culture , NHS structure, language and looking for jobs every 6 months or so. But I have learned and gained so much more in life in doing so.
I cannot understand why it is difficult for children born and raised in this country to adapt to different part of the same country?!
You need intelligence, hard work as well as tenacity and adaptability to succeed in medicine, how do you learn all this if you will only work within your comfort zone?
May be I am just old fashioned in my thinking !

@Needmoresleep - am really glad that your daughter is enjoying her job and is gaining confidence in her job, good luck to her.

@ProfessorLayton1 it's not about adapting to a new place. It's about having no choice where you end up. You make friends and then move on, every few years. Can't settle, can't guarantee you and your partner can live within 500 miles of each other, don't have any job security. They are treated like a number but a human. And have mountains of debt.

My own DD loves her life, but is 3+ hours away from us. Couldn't afford to live here. She'd just like a job after next year and will go anywhere in the country where she will know no one. Again.

But that's medicine isn't it?
Since the dawn of time it's been like that I don't think it's anything to do with a new system.

I trained a long time ago when foundation was only one year and that was allocated in the area you had been to medical school as it was a 'pre-registration' year and seen as basically still part of med school although paid. After that it was a free for all and you just applied to 'SHO' training jobs or rotations in whatever specialty and wherever in the country and you got it or you didn't depending on CV and interview like any other job.

Even then you always had to move every 6 months (within the same region on a 2-3year training rotation but anywhere at all at decision points for basic or higher training) and you usually didn't know where that would be until soon before, you could never guarantee you'd be near friends or your partner, never knew your shift pattern until the last minute. I thought people would know this stuff when they apply to medical school these days and it doesn't seem to put them off.

The random assortment thing sounds like a good thing to me. The justification always given for being moved around so much was to experience medicine in different hospitals in different contexts so that we all did our time in the small DGHs and no-one was in the ivory tower of the regional specialist centre for the whole time. That still seems a good principle to me. It's good that the less popular areas get to benefit from some of the high flying trainees for a little while. They can always move back for specialty training I assume.

@ThePure did you always get a job though ? Did you ever worry about being unemployed ? Earning £15.33 an hour equivalent ? Get hospital accommodation ?

@ThePure have you got £100,000 of debt because you trained ?