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?

Calmanisation for those who are interested
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(05)64065-2/abstract

Also led to a lack of training places, notable in obs & gynae I seem to remember.

Ah thanks very much Neurodiversitydoctor

This quite a good summary I think it is aimed at Australian Doctors but it helps demystify some of the terms.
https://intensivecarenetwork.com/89-postgraduate-training-in-the-uk/

I remember this too. Only 50% of the posts created for the number of SHOs in post. 5+ years of trainees condensed into 2.

Not a single medical SHO in my big tertiary training hospital got a post. People were coming into work and sobbing. We were told, explicitly and in so many words at a public meeting by Dane Carol Black, that if we didn’t get a post we should just accept we weren’t cut out to be doctors and leave the profession.

Many did - I was an ST1 equivalent, and hung around in clinical fellow posts for a year until I got an ST3 number. Two of my colleagues did similar. Most of the rest became GPs, about a quarter moved to Australia. It was truly awful.

So nothing changes…it was awful. It still is awful.

I really follow the wiki and the Australian link, though I now understand DD’s despondency. Throw in PA’s who are soaking up available training and replacing CTF or other locum type roles, and the outlook appears as grim as it ever was. One way through is to ensure you are top in everything, write the research papers, enter the competitions, and attend the conferences, though observation suggests a level of selfishness amongst some of those who aimed to be high fliers. The system also needs honest hard working hospital doctors who go the extra mile when the job requires, to be able to build solid careers, in order to fill the senior vacancies the NHS has and will continue to have.

Yes I think that is the difference you could alway locum or pick up a clinical fellow job. But am I right in thinking PAs just do Mon-Fri 9-5 ? So there still must be rota gaps ?

Which specialty is your Dd interested in ?

Those were a very informative read for a lay parent of a junior doctor like me. The whole thing seems nuts and has been nuts for decades, unless I’m missing something. Not surprising that all that the politicians - Labour as well - seem prepared to say is that they’re increasing the number of medical school places. It’s extraordinary.

Difficult to say in that she was always determined to go for one of the very competitive ones. (As far away from Psych and community as she could get.) However she missed that part of her medical school training because of Covid, and has had little opportunity since. She has racked up a relevant intercalation and some time in a research lab (rather than swanning off to the Far East) for her elective, and also spoke at a couple of UCL conferences - albeit to teachers giving a pupils view of education with dyslexia. She needs more than F1 to really decide as so far it is general medicine and surgery and the latter has just been booking in patients for day surgery and some scary nights looking after those patients too unwell to go home. My best guess is that she will wait till towards the end of F2 to decide and then try to do a more targeted F3. The realisation that there might not be a job at the end of F2 seems to have come as a shock, and at the moment she is enjoying the moment, both work and play and trying not to think too far ahead or fix her ambitions until she knows what chances she has of success.

She is lucky as she could lever her intercalation into a research job/PhD, but I pretty sure being a Doctor suits her more.

Needmoresleep my own DS had vague ideas but didn't settle on one (not one of his original choices) until after F2.

This is where we are.

Telling people who have consistently performed in the top 1% of all their peers, often since their mid teens, for over a decade, or longer that they should be grateful for being able to scrape enough together for a house half the price of the average first time buyer, in a less desirable area, forgoing foreign holidays and sticking to cheap hobbies.

And we wonder why they're e considering moving countries or careers....

In fairness she has only been working nine months, and it is not just Doctors. Housing is pretty unaffordable for many young professionals without two incomes and a couple of years saving for a deposit, in much of the country.

As much a housing problem as a Doctor problem.

Thanks for the links NDdoc

'In order to implement MMC, all trainees not appointed to specialist registrar posts for 1 August 2007 were required to apply for posts on the new MMC curriculum, with far fewer posts than applicants. However, the application process had technical problems and was criticised over the weighting and marking of the applications with one London training school calling it "unfair and ineffective" in resigning from the process.
There were also concerns expressed over the number of training posts available and the subsequent risk that trained doctors would be forced to emigrate or leave the profession as they would be unable to find jobs in the UK. Government claims that there were 23,000 posts for 32,000 applicants[17] were revealed by subsequent work to be 4,500 out, with the actual number appearing to be 18,500.[18]
On 17 March 2007 doctors marched in mass protest orchestrated by Remedy UK against the system in London and Glasgow.[19]

Does the above sound familiar at all?
Perhaps you can understand from that why I feel the current situation is nothing new?
The Government has been fucking NHS workers over since the dawn of time. It's literally part of their game plan. The only thing that changes is the acronyms.

I had my MMC interview for my top choice specialty and region the day before I gave birth in 2007 waddling along and having Braxton Hicks intermittently the whole time. I had asked what would happen if I missed that interview and was told 'tough shit. You just won't have a job' There was no allowance for illness or being otherwise engaged giving birth and no mechanism to get back into the system at the same level if you didn't get a job in that round. The choices seemed to be start over from the bottom or be a staff grade forever. I had planned my life and career based on the old rules and got my exams done before getting pregnant but I reckoned without a whole new system coming into play with 6 months notice when I was already pregnant. At the time it felt devastatingly unfair.

Thanks for that pure, with 2 small children and a clinical fellow job I made the opposite choice and sat it out. I was appointed to the only ST3 post in my deanery in early 2008, just as well as the finacial markets subsequently crashed and I was the sole breadwinner for the next 4 years. I agree that junior Drs with short term contracts and insecure employment is nothing new. I did have a mortage but doubt they would lend to someone on a 6 month contract these days .

@mumsneedwine <Pas do not need a science degree. Sadly. But can take your gall bladder out all on their own.>
As you may be advising your students to apply to these roles instead of medicine, I am sure that you will not just rely on sensationalist reporting and go through the entry requirements for all the universities that offer the MSc.
i don’t want to keep repeating myself but a minority of the 23 universities currently offering the programme may allow non bioscience undergraduate holders but with <Applications from non-standard applicants will be considered on a case-by-case basis by the programme team. If you wish to be considered for admission, and have a significant level of healthcare experience, but do not fulfil the criteria above, please contact the admissions team to discuss this further.>. Also at the other end of the scale some universities require UKAT. I got this from a rapid perusal of the various entry criteria.
This article from the Royal College of Surgeons bulletin gives an insight into the training of two PAs working at a DGH with staffing issues. https://publishing.rcseng.ac.uk/doi/10.1308/rcsbull.2023.42

Junior doctors have suffered in their training and general experience as they no longer practise continuity of care and are over reliant on algorithmic decision making. The latter heavily overlaps with what a PA could do or even an AI system in the future.

The one from DCs school generation who became a PA, studied sports science, which I assume counts. They were not academic.

The point about algorithmic decision making is interesting. I hope our bright young doctors, after their years of study, their ward experience and especially those nights being called from one crisis to another, can offer more than an algorithm. From a patient perspective, my experiences over the past year with a couple of locum GPs (I got the choice between a PA or a locum, and only one in person appointment) suggested the same decision making as I could access myself on the NHS website. Abdominal pain, not appendicitis, probably not gastric, need to rule out ovarian. Then what. No ideas from the GP, other than an attempt at a gastric referral when I pointed out that the pain had not gone away. (The referral was refused. I was informed by text with no suggestion the GP saw me again.) Nothing obvious from Dr Google either. Presumably I am part of a 5% or so who don’t fit the algorithm. The question is how to access patient focused care. Four months later I have still to decide whether to re-engage with the GP, given the process of getting an appointment is Byzantine, perhaps demanding to see the experienced head of practice, or learn to live with the pain, or save to go private (though with little confidence that their algorithms would be any better.)

I felt surprisingly angry when I realised there was a real risk DD could go through eight years of education, training and hard work and still end up unemployed. I am worried now I am of an age where I will need NHS primary care that it has become both hard to access and algorithm driven and, effectively, might not be there for me. And after reading this thread I am shocked to learn that the system of recruiting, training, retaining and motivating future specialists has been broken for a long time.

And after reading this thread I am shocked to learn that the system of recruiting, training, retaining and motivating future specialists has been broken for a long time

I’m beyond shocked that given how long that system seems to have been broken for, and given the excessive hand wringing and claims by politicians about improving the NHS, that nothing appears to have been done or even to be in the pipeline.

By adding PAs to the mix as a stop gap solution rather than addressing the fundamental issues, they may have made the problem worse, and again risk losing a good number of medical school graduates.

sendsummer that narrow caveat from a minority of the universities plus two years MSc surely means that almost all PAs start out not far short of what an F1 has under their belt?

Sad to say it is in their interests

They never train or intend to train enough home grown UK Drs as it's too expensive

Part of the governments overt strategy is to lure overseas grads and they have always attracted huge numbers from India, Hong Kong, Singapore and Africa usually Commonwealth countries with good medical training done in English. Anyone who's ever used the NHS can't fail to spot its huge reliance on immigration. I went to a deanery training event recently and they had a lecture from someone whose job it is to 'ethically recruit' Drs from developing countries to the U.K.

They obviously cannot predict how many Drs they'll get in vs how many they lose to Aus and NZ so that results in a certain degree of chaos and usually over supply at points where overseas Drs enter. I am not sure how it works now but it used to be they had to pass a language and competency exam called PLAB and the government actually had exam centres in India to make it easier for people to pass and come here. I think it is safe to say the government does not want to train sufficient Drs in the U.K. to staff the NHS when it can get them for free trained elsewhere.

Overseas Drs traditionally were happy to work in places and specialties that U.K. Drs turned their noses up at and filled rota gaps in staff grade roles until they could get into training rotations.

Also having too many Drs for jobs keeps us toeing the line and keeps wages down...

I had not made this connection before but maybe PAs are a response to less supply of IMGs (international medical graduates) post Brexit and pandemic?

When I started we loved PAs because they just did all the menial jobs like blood taking and ECGs that junior Drs otherwise had to do. There was no idea of them diagnosing anyone or doing anything beyond basic procedures. They were great at that level.

But ThePure the government is making a big thing about increasing medical school places. What is the overt strategy going on there?

When I started we loved PAs because they just did all the menial jobs like blood taking and ECGs that junior Drs otherwise had to do. There was no idea of them diagnosing anyone or doing anything beyond basic procedures. They were great at that level.

Junior doctors can be quite vulnerable in a poorly managed department. F1s will only be around for four months. Permanent staff may be tempted to use them for the more unpopular tasks: catheters, cannulas, admin. It already happens, but may be made worse with the new overlap between PA and F1 roles. As permanent staff PAs may have a better chance for the more interesting opportunities. And won’t need to move every year or two to keep their jobs, nor do they have to work nights.

If a PA is the same standard as an F1, what is the point of studying medicine ?

@Needmoresleep and they earn more.

WE HAVE ENOUGH DOCTORS. WE DO NOT HAVE ENOUGH JOBS FOR THEM.