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?

Junior doctor earnings, at least out of high cost areas, are not the main issue. Conditions and training/promotion opportunities are more of a worry.

Spoke to DD this morning, straight off a shift with a lot of very sick people and an every growing list of urgent things she needed to do. I think their rotation started off a couple of people down. An overseas locum was fired last week. Another in their group is clearly struggling. Day off will be spent on compulsory training as there is no time in the work day. Our bright resilient people can cope but they need to be valued.

They might initially. My income will be £180,000 this tax year. A PA will never make that.

Well I would think that a Biochem degree plus a two years MSc was a pretty solid foundation. I'm asking the question as a non medic: is there really a significant difference between a PA with that background (as presumably many will have) and an F1?

But, if you do a cumulative earnings chart from the same start point, it takes about 20 years to reach the total-career-earnings crossover point comparing a PA to a Dr who progresses to hospital consultant.

That's just the raw figure. Once you factor in total student debt, and debt repayments, professional memberships exams and indemnity, taking longer to get on the housing ladder, having to move region on a regular basis, the difference becomes significantly narrower.

Also, what hours are you working for £180k - it's more than 40 which is what a PA will be working - if you factor that in as well, there'll be next to no difference.

I am contracted for 48 hours a week I work either 7:30-4:30 /8-5 or 8:30-6:30 depending on the day/teenage taxi service - all monday to Friday. From this it seems £50K is the maximum salary

All fine if you can get through the training bottleneck. Not so great if you have, as in Karolinska's example, been given your 18th choice out of 18, far from home, knowing noone, are working up to 80 hours a week, sometimes 10 days on the trot, plenty of nights, and have to fit in training in your own time....

and then don't have a job at the end of it.

May as well have become a PA as you choose your job location, choose your specialty and choose to only work 9-5.30. No nights, no shifts. And 30% more pay.

Our kids were sold a dummy becoming doctors.

If an F1 is deemed equivalent to a PA why can't they take their jobs ? Why can't an F2 act down - consultants do ? Why can't doctors work as PAs ? Bit weird.

Doing a first degree in biochemistry and then 18 months of the medical model is not the same as 5 years dedicated to the study of medicine. You've missed massive chunks of anatomy, physiology etc. which might come in handy one day - you don't know what you don't know.

It was a question not a statement mumsneedwine.

And 100% success rates on the PA masters course too. Sounds like the ultimate gravy train.

@Karolinska I know it was from you 😊. But it's something I'm struggling to understand the logic of. PA can work on the doctor rota (but can't prescribe or order scans) but a F1 can't work as a PA (even though cheaper, can prescribe). None of it makes sense in my tiny brain.

The question to this is why. There are not 350 more jobs being created for them.

Well exactly mumsneedwine. I've asked the same thing above, to the senior medics who might know: what is the strategy behind increasing places and why, when pressed, will no politician say how the training of this new wave of doctors will be effected if there isn't an expansion higher up? A poster referred to the overt strategy of the government in terms of recruitment from overseas so what is this overt strategy intended to achieve?This expansion of medical school places has been widely boasted about by both major parties - but the question about who can train them further up is blanked and the same old thing about increasing places gets trotted out on repeat. I'm completely baffled. especially since the problem appears to be of long standing, so why compound it? To what end?

A big supply of junior doctors with no hope of career progression, who work the hours and go where they are told?

And owe lots of money to SFE.

@Karolinska <is there really a significant difference between a PA with that background>
Academic level at entry and eventually ability to take ultimate responsibility for decisions. You would hope that a junior doctor would evolve beyond algorithms for complex diagnostic and treatment decisions and of course harder surgery.

Junior doctors have to be safe but they should n’t dumb down their intellectual capacity. They have to ultimately demonstrate added value to a PA or AI system to justify their higher salaries beyond the scale of a PA. Many (not all) will be more than capable of that.

By the way recruited internationally trained doctors iare often outstanding with a very solid knowledge base. So our home trained doctors do have to compete with those as well.

So our home grown doctors may as well do PA as they are just as qualified. And ours is the ONLY country that does not prioritise its home grown doctors so they are disadvantaged everywhere. Woo hoo. And they've £100,000 debt too. Lucky little things.

PA - take a course with 100% pass rate it's so hard. No rotation, more pay for at least 6 years. Need others to do your job (as you can't give drugs). Might do it myself. They earn more than a teacher too.

I'm British in the USA and work in public health (not a doctor). We are grabbing up IMGs for unpopular specialties and locations. The American system for training (Canada uses a similar system but runs their training separately) seems more straightforward: in your final year you apply for residency in the specialty of your choice and the National Residency Matching Program matches everything up. There's fierce competition for the popular specialties (and the government hasn't expanded Medicare funding for residency slots since 1997!) but there are some, like family medicine (North American equivalent of GP) that are very undersubscribed. Most residencies start as PGY-1 and include the intern year, so when you get your match, you know where you will be for the next 3-6 years unless you fail.

Statistically the UK doesn't have enough doctors, but it also fails to provide jobs and training for them! It's a self created bottleneck.

WRT to PAs, part of the reason American doctors like them is that using midlevels (as PAs and NPs are called) means not expanding medical schools and keeping their own salaries high. But in the correct position they are very useful. They can write prescriptions here and if trained do minor surgery such as derm.

To be fair, most consultants will be lucky to make anything like that too - top of the payscale is £132k. So you must either be doing private work or have a substantial CEA (which is an option not open to new consultants) as well as working 12PAs.

So our home grown doctors may as well do PA as they are just as qualified.
if I were an NHS manager (with the usually short term view before I move to my next job) I would answer because a PA currently does n’t present issues with having to cover strike action. Plus many DGHs don’t get SpRa so a PA may bridge that gap partly.
As for the coordination (lack of) in training posts, welcome to the NHS as PPs have said. Your DCs generation will get there despite all the uncertainties.

@Karolinska I particularly like your name,, outstanding reputation.

@sendsummer oh so it's strikes, that's why PAs are so important. Just wow.

It's not lack of coordination in training posts. It's lack of training posts.

A PA can in no way make up for a lack of SpRs (if you think they can, maybe that’s why your department lost them?).

FY1s maybe. Band 5 CNS possibly, depending on what you are using them for and how closely you supervise them. They can in no way replace an SHO or SpR level doctor (or a Band 6/7 CNS with their Advanced Practice/prescribing qualifications)