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?

@ThePure there are not enough speciality training places so many many F2s wont get one. For years. If ever.

And they did not know this 6-7 years ago when they applied, because it was not the case then. They knew about rotating, they knew they'd never be rich like older doctors, but they did expect to have a job.

Selecting certain areas can still mean being moved around - the whole of Scotland is a deanery, the south stretches from London to the sea, northwest includes Liverpool Manchester and the lake district.
The extra points for intercalated year (holding a B.Sc) got stopped as some med schools awarded some sort of degree after second year, Oxbridge give out MA after five years if you pay a fee.
People publish in Mickey mouse journals to get publication and conference points.
There are not enough training places whether it be FY1, CT1, ST1 or ST4 but apart from FY1 (before full registration) there are hundreds of gaps in medical staffing at all levels in most specialties throughout the country

Hmm. Oxford medical courses are six years so automatically include an intercalation year. It's not a paid for MA.

The NHS is recruiting thousands of Physicians Associates. In the past doctors who had finished F2 might have taken locum jobs until they had a specialist training offer (I don't know the jargon.) Now locums are being replaced by PAs. Junior doctors are excluded from applying for PA positions.

There may be lots of vacancies, but young doctors are genuinely worried that there might not be jobs for them. They have less than a 50% chance of getting on specialist training. Options then are to go to Australia, find another career or slog around the country taking one short term job after another.

I hope they are wrong. But that is the feedback we are getting from our young medics.

Well yes obviously Whyhaveibeencutoutofmamsnot, these medics are well aware of the issues with certain geographical areas. So when I said DS had selected London only, for the stage before last - after completing F1 and F2 - his choice was London which I think was at that stage divided into three and on this latest round - for specialty registrar - it was South London or North London with three places for North and four for South. But still, he would have made either work - it still narrowed the field by selecting only those two London options.

Thanks Needmoresleep. Whyhaveibeencutoutofmamsnot I think you misunderstand the Oxbridge offer. The course amounts to the usual offering plus an intercalated year and the idea of a paid for MA somehow giving fake points is in itself false. Not massively impressed by the suggestion that people publish in 'Mickey Mouse' journals since a good number of students seem to publish research which has real value. Not everything is a con to bag extra points.

I cannot understand why it is difficult for children born and raised in this country to adapt to different part of the same country?!
It's good that the less popular areas get to benefit from some of the high flying trainees for a little while. Agree with the greater good principle and benefit of wider experience. However the current FY system appears ever more Kafkaesque due to decisions taken by a faceless random system.
Also agree that specilist training has always been competitive for some specialities and requiring geographical separation between partners even when far fewer medical students were being trained. Unfortunately, even when numbers are expanded, senior doctors including GPs are overstretched with little to no time for training juniors. It can’t really come as a shock that NHS management teams are compensating for workforce and financial gaps aggravated by junior doctor strikes through expanding PAs and specialist nurses.

Well the greater good principle may go tits up if bright young applicant F1s vote with their feet and don't take their eighteeth/ eighteen allocation and move sideways into other careers, many of which would be delighted to have them. Twenty three year olds quite rightly want to (and should be able to) have a social life, usually with peers from their old uni. Work to live don't live to work and all that. The greater good is a fine principle especially when it's other people making the sacrifice.

And some of the available training resource is being funnelled into PAs leaving even less time for senior doctors to give to help develop junior doctors.

All Oxbridge graduates can upgrade their BA to an MA a few years after graduating whatever subject. Up till a year or so back a masters degree got more points than the BA (now stopped) - the extra year is compulsory also at imperial, UCL and st Andrews.
One of the registrars I work with showed me some of the papers - they freely admit it's one of the hoops you have to go through.
But it boils down to this bloody government trying to cut costs and destroy the NHS.
Looks like in ten years there will be a real shortage of consultants in this country

The random allocation is one thing, the number of students who still don't know where they're going is another. My daughter got her first choice deanery in the lottery but is a placeholder meaning she won't know anything until the end of May at the earliest, or could even be end of June, whereas she had been told it would be mid-March.

While she understood that she wouldn't necessarily be able to stay where she is for F1/2 she did think she'd get sufficient notice if she had to move house - she's a mature graduate entry student and owns her own home. Her deanery is so large that many positions will not be commutable and so she may be faced with an impossible timeframe for selling up and buying or renting somewhere new. The NHS knew student numbers coming through and seems extraordinary poorly prepared and may lose new doctors as a result

I do despair of the senior doctors who are supervising PAs. Training time should be used to train young doctors, like consultants were trained when it was their turn.
And yes, it's always been rotational training. But the perks that were available no longer exist, like hospital accommodation, so it didn't matter so much if you were flung to the other side of the country with a few months notice.
And it's not like pay is what it was either - FPR is needed so they can pay rent, heat homes and eat.

@calyppso it is not fair. I know some deaneries have groups of doctors willing to give rooms to F1s while they find somewhere to live. I'm pretty sure the F1/2 would do this too if have space (DD has a sofa she could lend out).

There are NOT enough jobs for this years F2, as IMGs flooding the market so less locums, 500 people applying for one post. Training ratios of 30:1 in some specialty training.

It is not what they signed up for. It was not like this even 18 months ago. Part of my job is to mentor students to study medicine but at the moment I can't see one good thing I can give them. Except to go abroad once qualified. How v v sad.

Make allocation random, or do F1 in your Uni deanery so at least have friends to support. But the NHS needs to learn to count - they know how many students are set to graduate so they know how many jobs to pay for. But this happens every year !

Current 4th years are watching on in horror as they know it's unlikely to be better for them. I know 1st years dropping out and changing to other degrees as they can see themselves as unemployed doctors with massive debts. How did we get here ?

My only hope is seeing some senior doctors really fighting back and trying to change things. If they don't there will be even more doctors heading abroad, often left with no choice as the NHS won't employ them.

Whyhaveibeencutoutofmamsnot thanks for clarifying - it’s certainly not of any benefit to upgrade to the ‘MA’ whereas you implied it might be.

Agree with all of this - it seems to have suddenly become a complete mess.

F1 at the university you studied at would have signicant merit. Pros seem to outweigh cons anyhow.

Does anyone think doctors deserve £15.33 a hour ? On Christmas Day ? If not, how do you suggest they get fairer pay without striking ? If the NHS thinks PAs are better value (they earn 30% more so not sure how) for being able to do less then why would anyone go to medical school ?

Doctors either need to have rigorous training, rotate for years, study for expensive exams, or they don't. And they can do surgery after an English degree and an 18 month PA masters.

I now insist on a doctor. Had 3 PAs try to tell me they are 'specialists', but they eventually give in as to say they are actually a doctor is a criminal offence. Playing at being one doesn't seem to be though.

I will be a bit controversial and wonder if there is more behind the new system. I understand from doctors friends that medical schools no longer fail as many students as they used to, not least because of fear of lawsuits or discrimination allegations. I assume most medical students will be aware of peers that they would not want to share an F1 rota with, perhaps because a drinking habit became more severe in lockdown, because they had no concept of time keeping, were struggling with MH or with dealing with pressure, perhaps because medicine was a family ambition that they do not share. These students were over represented in the group that did not receive many points. (Not all, there were others who prioritised personal study over ward experience. If attendance was not checked they were not there, and who then wound up with loads of points but less real experience.) Doctor friends claim that it is left to them to then sort any issues out at F1/F2. Some shape up, some quit.

Quite a few of the less reliable peers ended up in unpopular deaneries, and with placements only allocated at the last minute. In DDs deanery, since choice of rotation was also allocated by points, they would be allocated to the least popular, often more remote, rotations.

Perhaps these deaneries/hospitals have raised concerns and have called for a bigger share of more talented F1s. Perhaps some of them have resorted to recruiting F1s from overseas (it is very difficult for countries with large private medicine sectors to provide sufficient early training yet their medical schools often pump out plenty of hard working graduates) leaving insufficient places for lower ranked UK grads.

I understand the numbers not getting their preferred deanery are about the same. (In reality it won't be as previously if you knew you would not get London you did ranked London towards the bottom and focussed on those deaneries where you stood a chance.) Now we have a situation where those new doctors just about managed to scrape a pass may be allocated to seriously demanding F1 jobs (DD had five deaths on her first night shift, all expected, but still tough) and high flyers might find themselves in the middle of nowhere, knowing no one and in specialisations they have little interest in.

If I am right and this is the problem, there are better solutions.

Interesting Needmoresleep. The idea certainly seems to be to spread the talent pool more widely.

There could be an argument for incentivising applications to the less popular deaneries rather than demoralising and worrying the current generation.

That was not the idea though. And being able to pass exams well does not make the best doctor in many cases. I know many many students who had to have paid work through Uni and therefore had less time to study and just 'scrapped a pass'. Because they were knackered and doing much more than their richer friends. They are all becoming amazing, caring, highly qualified doctors.

The random allocation was supposed to help these students. The WP ones who don't have the luxury of a mummy and daddy to fund their rent or food. Or fund an intercalated year, or a fun elective abroad, or to go to a conference to warn all those extra points.

I've not heard of less failing, in fact I've heard the %s have gone up at several Unis. Not sure why.

Random allocation is not bad, and as many guy first choice as usual. But the numbers getting below their 5th choice re I've this year. Getting your 18th pick didn't happen before !

There should be a swap system as many students could then be happier. But for some reason they won't allow that.

And offering more money for those less popular places would seem a sensible idea. Although certain deaneries that were less popular are be king mire so as cost of living bites. London and Bristol too expensive for many now.

And sorry, but ALL F1 jobs are demanding. My DD first days were on call 13 hour shifts, covering AMU and 13 wards.

If you can pass medical school you can be a doctor - if a student had a drinking problem I seriously hope the others have told someone ! And if you are rubbish you won't pass F1. All doctors deserve a support system around them and a place they can afford.

Many typos. Marking year 13 mocks. Really should go 😊

But spreading the talent pool more widely is a driver behind this random allocation mumsneedwine, even if it's not the declared motive.

@Karolinska but what is the talent pool ? What makes one F1 more talented than another ? Exam results ? Because that so heavily disadvantages poorer students who have to work. Some get to just study 5-6 hours a night, some get to work in a bar 5-6 hours a night and then cram in their study. Who is the more 'talented' when they both pass ?
Define talented for me so I can understand.