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?

And I'm not sure anyone thought the SJT defined talent. Must thought it was rubbish. But it carried the most weight last year 🤷‍♀️

All those things that gained you extra points cost money. Fund them for everyone, make the NHS bursary liveable and level the playing field and then using all those things makes sense.

No one seemed quite so upset with the old waiting lists for F1. Am I cynical in thinking that's because it didn't affect the richer students whereas random allocation has.

My own DS worked at uni and never asked for any extra funds at all from me mumsneedwine, at any stage and certainly had no savings to back him. He's just been ranked second nationally in the specialty he applied for so I'm not sure it's all about richer versus poorer, it's far broader than that. Some students with the richest backgrounds are simply very, very good - it would be unfair to deny that. I think maybe this division is a bit black and white.

Not sure I can come up with a pithy definition :) But the most popular deaneries have certainly been the place a lot of the brightest students gravitated to (if only on a lemming basis) and there are clear problems with that. I think incentives are the way to go but mention money atm and it will be met with a no.

mumsneedwine I'm not clear that a research paper costs money. In that DS did one or two maybe and was asked to some conference (European only) but he didn't self fund - I never asked who paid but I assume a scholarship of some sort? He stayed in an AirBnb and flew cheap so perhaps he made a net profit :)

@Karolinska I do realise it's not a clear cut thing. And your son has done amazingly well I assume in the MRSA (although was he top in medical school and working too ? Some of my ex students need to work 5 evenings a week to cover rent and food - they can't afford heat l). It just annoys me when the points needed cost money, and people don't have it . Even building a portfolio costs money, to help you get into some specialities. Attending an extra course - costs money.

I paid my own DDs rent all through Uni but she still worked in the holidays. But was lucky not to have to during term time. She got her first choice deanery and first choice of jobs and is currently loving ED.

Lots of rich students are very good, lots of poor ones are. It's just easier to study if that's all you have to do.

@Karolinska but having the time to do that research is not a luxury you have if you are having to do paid work.

@Karolinska can you ask him how he did 20-30 hours work, studied and did research papers. I am genuinely interested as it would help students I know who struggle to get time to sleep. Even F1s need to do extra locums so have less 'spare' time.

Sorry to sound so negative. But it's very v hard to encourage my wonderful, bright, incredibly hard working students to now study medicine. Before I always knew they'd have a job. Now they risk £100,000 debt, repaying £250,000+ with no guarantee of a job. It's sad.

My friend’s son is currently unemployed - he’s applying for specialist level stage of training. His girlfriend is trying to support him financially. He’s gutted, never in a million years did he worry that getting a job would be difficult.

The situation with the proliferation of PA’s (Physician Associate) is scandalous. Two years training but double pay of junior doctors with 6 years training. They are also clogging up the specialist training posts which is why junior drs cannot progress.

My Oxbridge educated son is qualifying this year after 6 years training and he’s got a few plan b’s up his sleeve if things don’t work out including retraining. His friends are the same. They will give it their best shot but will move on if necessary. Sad but true. They are super intelligent and their skills are highly transferable. It makes me upset and sad but who can blame them ?

mumsneedwine I think the research paper was in his F1/2 years rather than at uni but it helped (very marginally) with the next round of applications for core training.

He did well at uni yes. Not top but whatever his ranking was it got him his first choice of deanery and top choice of rotations but I do remember him saying that he picked a set of rotations which included two placements which were less popular than others (Geriatric and Psychiatry). That gave him four that he really wanted. So an element of strategy - but he was clear he wanted London.

I don't think he has any secret method of managing. He just seems to manage life well and is resilient. I'm sure he gets tired like everyone else and I'm almost certain that he's gone short on sleep over the years. He worked at weekends, not five nights a week but that was obviously sufficient to pay his rent as well as subbing a social life. He worked in the holidays too, it almost goes without saying. He just crams a lot in - I couldn't.

I'm with you. The situation is dire for the newest applicants. It's bizarre given the political noises we hear.

PeonyBlush10 apologies if you've already said this - but what number choice did your DS get, purely out of interest. Is he at least set for the next two years?

F1 and f2 are allocated together (but always different hospitals within a region), it's post foundation there are bottle necks to go into training jobs

The foundation thing happens annually... never heard of anyone not getting a job

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 intense work bond between colleagues at a hospital is usually fertile ground for friendships and social life for a junior doctor.
I wonder what medical school applicants would say if asked now whether they were keen enough on medicine as a career to accept working in different regions for the NHS. Might be quite a good filter.

Disclaimer for my view on PAs, I am not involved in their training or decisions to employ them. I have however observed for some time their successful deployment in the USA and elsewhere. I don’t see doctors there complaining, quite the contrary. PAs will have 5 years in total of bioscience / healthcare (degree and PA postgraduate) or sufficient relevant work experience to compensate for a non-bioscience background. They are currently more reliable and stable employees to deliver certain aspects of basic medical care. They are certainly less expensive than consultants and GPs having to cover these tasks in the absence of junior doctors in the medium term. Their pay is according to the appropriate NHS band, a different scale to doctors. I personally would rather see a PA or nurse to initiate care than wait longer to see the doctor.

sendsummer a complete lack of control over your destiny, having put in the slog for five to six years, for very mediocre pay, is dire. The idea that those in charge of strategy think they can dismiss the social life (and therefore an important component of happiness) of all F1s because 'they can make new friends in a hospital' is remarkably weak. They're messing up lives and are highly likely to mess up the quality of future recruitment. There was no real warning of this year's change - not even that courtesy afforded to young people who by definition have worked incredibly hard.

I think my daughter feels like this. She's robust, hard working and should make a good doctor but as a result of the situation she's in her commitment to the NHS might wane. Students were given no notice that foundation places may not be confirmed until shortly before they start. As well as those who own their homes the 800 unplaced students include those with families and long rental leases who have significant logistical problems

@sendsummer please do not equate PAs in US and here. They do not have to have a science degree. They do not have 5 years training, they do not prescribe or order ionising radiation. They legally have to be supervised by a doctor. And if they make a mistake it is the doctors fault as PAs gave no regulation or scope definition.

BUT this is not happening. Some PAs are doing surgery (untrained), giving anaesthetists on their own. And taking doctors jobs, so doctors are little more than ward monkeys.

We have unemployed doctors because 18 month trained staff have taken their job.

@sendsummer and do not, DO NOT, try and claim that PAs are more useful as they don't rotate. Bloody hell. Doctors don't want to rotate, but they are forced to, they'd like to be constant members of a team too. But apparently they have to move every 4-6 months.

In this country you can become a PA with a drama, English, history degree. No basic anatomy or physiology. As doctors keep saying, you don't know what you don't know. They are dangerous and people have died from their lack of knowledge. Would you like your family member seen by a GP or a PA ?

WE HAVE ENOUGH DOCTORS. WE DONT HAVE ENOUGH JOBS.

Oh and PAs out earn doctors in the UK for up to 8 years . So an ST6 will still earn less. Cost effective ?

Of course we did - there was always a mad panic every six months when contracts came to an end. I got one SHO post two days before my start date. I lived in London, DH and I owned a flat in London, I didn’t manage to get a job in London between graduation and ST4 equivalent. Accommodation only provided in F1, the rest of it was private rentals. Even in ST4-7, I moved between Hillingdon, Stevenage and Southend (all technically part of the same deanery).

This is the reality of the job unfortunately, and if it comes as a shock, your daughter has been very badly advised.

I think the lower-performing students accepted it as their “punishment” for not being such high-flyers. I agree, so many problems with this, and random allocation is much fairer. And yes the outcry may well be because the “Golden Boy” students are now affected (don’t think it’s rich kids per se, there were some very rich people in my year’s lowest quartile).

The intercalated BScs, research papers etc all accrue points in IMT/Specialty applications, so hardly wasted.

@Saschka at no point have I been talking about my daughter. I have supported hundreds of students to do medicine. My own DD is fine thanks - she'll just piss off to Australia or US (she has the exam thing already)

You were paid a decent salary as an F1 in comparison to rent. And it was a lot easier to find places - I know, I rented for years too.

Sorry. It's this lack of understanding from senior doctors that is causing the issues. No understanding that the world has changed.

Again, you always found a job, some days with 2 days notice. Wow, so not 500 applying for one job ? What were the ratios for speciality training ? 15:1 ?

@Saschka not many specialties use the extra degree anymore. I think it's gone from IMT next year too (might have got the wrong one though).

@Saschka you owned a flat in London. As an ST4. Just wow. Most young people will never own a flat in London as a doctor. Ever.