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?

PAs are supposed to support doctors. Not take their jobs and training. But hey, they don't rotate so ...

www.bbc.co.uk/news/articles/cd1w84dl4pzo.amp

@Needmoresleep I'm very impressed your DD has managed to buy during F1. Saving a deposit in under a year is wonderful. Their rent must be tiny !

And does anyone thinks £15.33 an hour is well paid ?

Sendsummers post about Australia recruiting UK doctors to fill vacancies in unattractive locations is interesting. There are less attractive locations in the UK where rents are significantly lower than in the SE, and houses are affordable. Doctors in those places are considered well paid, and indeed seem to enjoy a status not found in London.

With us putting us putting a small amount of money in, DD was able to buy a three bed semi in a quiet street in a reasonably central area. It is perfectly possible to find a two up, two down terrace for £100,000-120,000. Rents are also low, and though pay per hour isn't great, F1s work a lot of hours, so saving is definitely possible. (DD does not have loans so had already decided to put that money aside, but was also able to save the difference between her rent and a London rent and a bit more as most things are cheaper.) She is not alone. The teacher son of a friend was able to buy in Lincolnshire aged 23-24. Whilst the North East is supposed to be cheaper still.

Everyone has wobbles in their careers. Medicine can be both secure and long lived. A friend say is enjoying her "retire and return" after being a senior consultant in a busy London hospital. Ditto my GP cousin who is happy to locum a day or two each week without the responsibility of running a practice. Different from the bankers who start looking over their shoulders when they hit forty and the next wave of redundancies looms.

The shortage of training places is a real problem and needs to be fixed.

That, the shock of the new and the brutal hours were the cause of DDs initial despondency. However since then she had grown in confidence and experience so work is less stressful, has made medic friends and friends outside medicine, and really does seem to be having a ball. I think it is great that she getting new experiences. I lived abroad a lot in my 20s and don't regret it for an instant. She may well return to London at some point, but that is a choice for her to make further down the line.

My recommendation for those close to having to select preferences is to look carefully at the less popular deaneries, and decide if there are any that appeal for whatever reason. For example we knew someone very keen to do a form of extreme emergency medicine, who selected Newcastle and busy Friday night shifts in A&E. Or Scotland, with all that outdoors and a good festival in August ? Perhaps grandparents in Wales? Then put four top preferences and a fifth that you are almost certain to get, and which becomes the least worst outcome.

And mumsneedwine, in terms of research, this is not down to money. DD opted not to apply for an F1 research post because she felt she wanted to focus fully on her day job, but others did. She worked in a research lab for her elective, something she got by simply writing to people working in the field she was interested in, and which qualified her to be one (of many) authors. Training slots are now extremely competitive, so the more you have on your CV the better. The number of training positions needs to be expended so that they are available to good hard working doctors who will make good consultants, not just the high flyers.

I think this has always been the same.
In the first few years of my married life I left for work at about 6am, got home between 7 and 8, did a couple of hours study and went to bed. And every third or fourth night I didn't come home at all as I was in call. Ditto weekends which were 48 hours at work. And when I wasn't on call a weekend was precious study time. We didn't really have time to make a baby, never mind look after one!
I do know quite a few women from my cohort who had children relatively young but most of them either had substantial support, such as a Mum who did a lot of the childcare, or they didn't go on to become Consultants. I can only think of one of my friends who had her children before she had passed her professional exams, didn't have help from anyone besides her husband and is now a Consultant and I have no idea how she did it. She was full time throughout as well. Less than full time is an option of course but it's still very challenging.
I had my first whilst I was still a trainee, but post Fellowship, then the others once I was a Consultant. I wouldn't say that it was easy but it was definitely easiER because with the exams out of the way, a much higher percentage of my free time was actually free. Professional exams are the hardest exams most doctors will ever do and you are studying for them on top of a very demanding full time job. I can't see any way that can ever be fundamentally different unfortunately and certainly in my experience it is that which leads to most women doctors having children relatively late. Sure, improvements in attitudes, support etc could be made but I think it always has been and always will be very challenging to have your family before you've got your exams.

Her rent is low. And her hobbies (mainly sport, or say, hitting the beach) are cheap. She is working so many hours that she does not get too much of a chance to spend and her days off have been at such odd times that she has not been able to find a friend to go on holiday with. (Currently annual leave is allocated not chosen, which is a real pain.) The trick is to have a good look on Rightmove especially at more marginal areas where some of her peers may be buying (DD was not the first) or colleagues who are slightly senior or more established might be living, discuss affordability with a good fee-free mortgage broker (happy to recommend) and then do the sums. If houseprices are low enough, a two bed on a 40 year mortgage, with a flatmate can be surprisingly affordable. Buy something with rental potential as this gives flexibility.

In many places junior earn as much as anyone their age, so in cheaper places they should be OK, and really not need much deposit.

If money is an issue, as it seems to be for your DD, there is a lot to be said for spending F1/F2 in a low cost area in order to build up savings, and to experience something different.

When you say that some of your former pupils are doing their specialist training abroad, where are they going? Hopefully DD gets something in the UK, or though luckily did an intercalation in an employable field so could switch, but a Plan C would be useful.

My DD lives in one of the cheapest parts of the UK but no way could have saved £10,000 for a deposit in 10 months (are 10% deposits still needed - not bought for over 25 years !). And she regularly works 70+ hours a week. But then she also had to borrow upwards of £60,000 to be able to become a doctor. None of her F1/2 friends can buy either. But they do have an amazingly fun life - loads of outside to play in for free. Think she'll try and stay there as house prices are affordable eventually.

And it's not that research costs money. It's that some people have to take a job near their home to pay bills so don't have the luxury of doing a relevant job if nothing near by. Lots of specialities don't even need a portfolio- exam score and if good enough you're straight in. But I think they obviously do need to show interest, even if it's just to make sure it's what they want. My own DD has lots of stuff going on just in case.

And all her consultants have been so supportive and agree with the strikes. DD had to teach one v senior doctor how to use the computer during the last action (was a Xmas day cover day so she was in).

@Needmoresleep thank you. I never knew you could get a 40 year mortgage !!

DD has chosen somewhere nice and cheap so hopefully she can buy there if she can stay for training. If she comes home she'll have to live in our shed 😂

@Needmoresleep sorry, pressed too soon.

Lots of my students have gone to Aus and NZ. If prepared to go to an unpopular location you seem to be able to get into training relatively quickly (1-2 years). A few in Middle East - pay v v good but takes longer. Couple gone to Cyprus. And several now in US with really good training positions but took a few years to settle. One is in South Africa (no clue how).

He must have scored fairly highly in the random allocation as he managed to secure his first choice area and is very happy with his rotation. He’s been fortunate but many of his friends are deeply disappointed. He knows a few who are tempted to pull out this year and reapply next year, but this is going to put even more pressure on the system going forwards.

Now completely off topic, but 40 year mortgages are now pretty standard for people in their 20s who have good careers and who have a pension age of 67. 10% overpayment is allowed each year. Once a flatmate's rent is factored in DD actually saves money, so she ought to be pay down the mortgage that way. (Though it depends on the size of her IKEA buying spree - luckily the vendor is offering her white goods, curtains, two beds and a sofa for a very small amount.) A two year fix then allows her to remortgage and change terms once she knows where she will be - and indeed whether it then becomes a BTL mortgage. From the brokers initial figures it seems as that getting four times salary would be fairly straight forward. Giving her some deposit gave her access to a particularly low interest rate, but I am sure a much lower deposit (5% should be possible with the right broker, a quick Google brought up NatWest, Halifax and Nationwide, but you also need to allow for £2,000 solicitor/surveyor fees) on a cheaper property would work. The open house viewings were full of younger people in their very early 20s. Like it used to be in the SE.

And yes DD has been able to save those sorts of amounts, and still have a life. Its not much per hour but the hours add up.

‘It’s almost like it’s being done on purpose’

Part of the plan to privatise the NHS perhaps ? Those who can afford it will pay to see properly qualified doctors, the rest will be seen by a hierarchy of PA’s.

I believe they used to be called Physician Assistant but the title was quietly changed to Physician Associate - far less clear boundary demarcation

There’s an organisation called AHP which places UK doctors in South Africa mumsneedwine, we went with DH about 5 years ago. At the time at least one deanery was affiliated with them as part of GP training (an extra year I think).

Neurodiversitydoctor I'm getting my books/ tv programmes muddled. Yes I watched that when it was first screened.

Sorry, thought it was pretty obvious.

On your other point, I only told my parents (and actually my DP now DH) a fraction of what was going on in my professional life. I might kindly suggest that your perception is skewed by only being given the highlights

With respect, my DS is not you and I'm not your parent. We talk a good amount and I ask plenty of questions and get frank responses.

Many issues being conflated here

sendsummer but surely they're inextricably linked? The difficulties thrown up by the current housing market including savage rental market has huge ramifications for those moving around the UK but not necessarily having adequate notice to plan. I'm not sure it can be overstated tbh.

Thanks for your response. Yes, that's what I've heard too - the considering options bit.

Thanks @Needmoresleep. Passed that all on to DD. She's sitting at the beach looking at houses now 😂

The thread has moved on a lot but honestly I really don't feel as though my experiences in the late 90s/ early 2000s were somehow so much easier.

Did I worry about not having a job? At times yes. When MMC came in 2007 just as I was about to have my first baby I was absolutely looking at having no job to come back to. My contract was cancelled (everyone's was) and I had to reapply for a job I already had. No-one remembers that particular bit of NHS fuckery but it was terrifying at the time.

Did I get hospital accommodation? Only for the 1st year and it came out of my salary and was very very shit.

Did I have debt? Yes obviously I had 5 years of student loans. I realise it is a lot more now but according to MSE at least we should think of uni debt as a graduate tax really now and not so much of the actual amount (my DC are applying to uni age now so have been checking up) Student loan debt has never been the same as credit card debt. I believe it isn't taken into account by mortgage companies

-some people were not allocated and had to wait to the last minute to find out about foundation jobs when I trained too

• people went to Australia and NZ for a few years all the time. Most came back
• Jobs in London were not easy to come by and many people were disappointed back in the day too
• for certain specialties especially surgical it was very oversubscribed and people were often disappointed. They had to wait or choose something less popular. How do you think pathology and radiology ever recruits anyone if it weren't for failed surgeons.
• there was huge competition from IMGs then too. They used to run PLAB exams in India and encourage people to come from there.
• it was never easy to be married to another Dr or have young kids and be in early training. Most people waited until registrar or even consultant level to have kids. As someone else said none of my friends who had kids earlier than that made consultant.

These have always been the realities of medicine

Yes it's true I bought a house with DH (non Dr) within a few years of graduating but so has Needmoresleeps DD so looks as though it is still possible outside of London at least.

I am not somehow mega rich. I could not afford to send my DC to private school and I still live in the terraced house I bought back then, drive a Skoda and go on one summer holiday abroad a year. I work in an unpopular specialty and don't do private work. I really don't think my lifestyle will be unachievable by today's junior Drs.

Things that are better these days are:
-It is acceptable to be a female Dr with career aspirations including in surgery. In my day this was basically impossible certainly if you had kids.

• flexible working and less than full time for men as well as women is completely acceptable and easy to get. I had so many hoops to jump through to beg to be granted LTFT and had to take shit jobs no-one else would do and male consultants made me very unwelcome.
• you are not subject to routine sexual harassment (banter) You will not be laughed at or bullied if you report it which I was.
• the hours might seem bad now but they were definitely worse. Working a whole week, weekend and then the next week with no break was a perfectly normal shift pattern. You never had a day off the next day after working until 11pm you were back in at 7 or 8am.
• training is taken much more seriously. You actually get protected time and study leave and proper formal feedback and assessments. I had a little booklet that I had to chase my surgical consultant down to the theatre smoking room to get signed off. He had zero interest in training me and quite a lot of interest in pinching my bum.

I know this stuff is better because I still actively train junior Drs so I do know how it was and how it is and my opinion is that it really is not worse. The NHS has always treated young Drs badly. I just think we were socialised not to complain back then.

Adam Kay's This is Going to Hurt is basically my life. That was exactly what it was like
One of my colleagues died in a car crash on the way home from a night shift when I was an SHO. We never knew for sure if it was accident or suicide. The response to that was just like on that programme 'so sorry she was too weak to hack it' Brutal.

I am super glad my kids don't want to be Drs
I have not sought to influence them in any way but I was relieved they don't
There's easier ways to make money
You should only do it if you really really want to make a difference in peoples lives and be prepared that will be at the expense of your own.
I do still feel a sense of satisfaction and pride when I can make people better. I don't need them to thank me it's satisfying in itself. It's always been all I care about really so to that extent I enjoy my job.

And people can piss off saying senior Drs have not been supportive of the JD strike I have worked my arse off to cover the wards safely on strike days doing my own job and others. I have been nothing but supportive although frankly I think striking is futile and clearly not working.

And people can piss off saying senior Drs have not been supportive of the JD strike I have worked my arse off to cover the wards safely on strike days doing my own job and others. I have been nothing but supportive although frankly I think striking is futile and clearly not working

Just to clarify: a comment I made earlier about the junior doctors' strike was aimed 100% at the government and 100% absolutely not at senior doctors. I'm well aware of the support the senior doctors have given; it's been impressive.

I think it's just different @ThePure
I'm probably a bit older than you, having graduated in the late 80s. Some things are definitely better now. In my House jobs a weekend began at 8am on Friday and finished at whenever your work was done on Monday and that was 1:3 with prospective cover so every other weekend for chunks of the year. Nobody would do that now, and quite right too. Plus of course in those days nurses weren't allowed to give IV drugs, take blood, request any kind of investigation, put cannulas in and so on so the physical list of jobs to be done was just never ending with nobody to share any of it. I wouldn't want to go back to that. And despite seeming to have an interminable list of repetitive tasks to do we also did ridiculously difficult things largely unsupervised. When I look back to my early days in anaesthesia I did cases and made decisions as a very junior junior which would require a Consultant now for sure - and anaesthesia was GOOD at supervision relative to lots of other specialties! Nobody sane would see that as being better than now.
There has been a lot of progress in some ways but I do think the baby has gone out with the bath water in some respects. The NHS is a very different place and overall, I wouldn't want to be starting out now.
I think there's a tendency for every generation of doctors to think the one below them has it easier. I remember my consultants telling us we should be grateful to get ANY pay for on calls as they hadn't done so. Its like every generation thinks teenagers are out of control and listen to shit music, but there parents thought the same about them. There's an element of truth in it but it's not black and white.
But I'm happier to be at the end of my career than just starting and I hope things do improve for the current generation as they're the ones I'm likely to be relying on in the not too distant future!

When MMC came in 2007 just as I was about to have my first baby I was absolutely looking at having no job to come back to. My contract was cancelled (everyone's was) and I had to reapply for a job I already had. No-one remembers that particular bit of NHS fuckery but it was terrifying at the time.

What was this ThePure? Googling doesn't seem to yield anything.

I think I must be the same age as you Pure, I remember this, they recruited the last SpRs the week my daughter was born. I actually took a couple of years " out" as a clinical fellow while the whole sorry mess was sorted out.

Here
https://en.m.wikipedia.org/wiki/Modernising_Medical_Careers

Before that was Calmanisation there has always been something.