Ideal university for Medicine

[Kayt79]

DS is in Y12, and set on Medicine. He's been to a few open days already, but until he's done his UCAT next summer it's impossible to know where will be realistic to apply.

So, just out of interest, and putting aside entry requirements and "prestige", which would be your ideal universities for Medicine, based on the overall student experience?

@mumsneedwine as per all my previous posts, I think we're all in agreement. UK graduates before IMGs. I was treated by an IMG recently and I had to rephrase a question several times as she didn't understand it and kept giving me general answers. This wasn't acceptable to me as I was worried about a potentially cancerous cyst. The consultant wasn't in that day so I had no one to ask until my next appointment which hasn't been scheduled yet. She performed a nasoendoscope which caused me pain and a terrible headache for 2 days. I had the same procedure done a couple of years back with no pain. The pain btw was due to her accidentally yanking the nasoendoscope when she reached to press a button.

@OneMorePiece for me and needsmore this is personal. It's forcing our children to move thousands of miles away just to do the job they've trained so hard for. And got into £000,000 of debt to do.
They worked through Covid, have only known a post pandemic NHS and just get on with the hell that is A&E. And they are repaid by being made unemployed.
Angry doesn't even start covering how I feel.

@mumsneedwine @Needmoresleep I totally get how angry you are. I'm worried too. My eldest is in medical school now a few years behind your DDs. Not sure how much he's aware of what lies ahead. Daren't ask because I don't want to frighten him. At the moment he tells me positive stories of hospital placements. Youngest is thinking of doing medicine too. Not sure if to discourage him as I don't want to be disappointed at the end when he is let down by the lack of a job. Although not as bad as in the NHS, my middle DC has encountered the same levels of competition with overseas students in a non medical sector with home students potentially losing out due to not being prioritised for those vacancies. The current immigration system put in place by the Tories needs changing to prioritise UK applicants for jobs like they do in other countries. For the sake of all our DCs, I hope they change the system soon. It's not fair to have nothing at the end after years of working hard in school. I wonder if we should pressure our MPs and explain as they surely don't seem to understand the true impact of what is going on!!

I've been following this discussion with a deeply sinking heart but not contributed thus far as Needsmore and Mumsneed have said it all already (way more articulately than I can!)
My ds is in the same F2 cohort currently planning (panicking?) about what to do next, with Australia as his predicted but not preferred option.
DS has just applied for a teaching fellow role in the department he's currently based in. The vacancy was closed after only a few hours because of the overwhelming volume of applications, 90% of which were from IMGs. He's been now told they're going to run the recruitment again with tougher selection criteria to try to whittle down the unmanageable numbers.

My question is what can we and our brilliant young resident doctors do to raise awareness of this problem and get things changed? I guess Wes Streeting feels he has more pressing issues to solve. After the strikes the unions don't have the mettle to face a new fight so who actually cares?
How do we get attention on this and make things change for the next cohort and the next...?

To put FY1 pay in context. In the USA, residents get paid a fixed salary whatever the number of hours worked, Hours will range between 50 to 100 by attachment. A first year resident with an average fixed salary of $60 will get paid less than UK £15 per hour for many rotations. Additionally there is time needed to study for step 3 of licensing exams which is taken by the end of the first year. And of course USA medical school debt is much higher.

Someone should start a post in AIBU and see if it gets picked up by one of the newspapers which seem to pick-up stories from there. Make the post title clickbait-like.

Yes, but the US system is no model. It can be argued that the grim conditions for residents are one of several ways in which senior doctors restrict entrants in order to preserve their exceedingly high salaries and thus very expensive health provision.

In the UK we have a monopsonistic employer and good but not exceptional consultant salaries. Young doctors are being recruited and trained, paid for by the state. The trouble is that the state is prioritising overseas candidates over its own.

And again, it is not about salaries. Yes F1s and F2s don’t get exceptional salaries and this is particularly noticeable in London where young doctors struggle to keep up with the lifestyle of their friends. It is about the package. Most F1s/F2s will put up with a low salary and long chaotic hours if there was a career, actually even employment, ahead of them. Take that away and it is a very cruel exploitation.

I don’t know if anyone can find it but there was an AIBU perhaps a year ago with a doctor, married with kids who had been working is a psychiatric hospital for a decade. The job was technically a locum position but an essential role within the organisational chart. She was being replaced by a Physicians Associate, who would be on more money and work fewer hours, and even though there was awareness that psychiatric issues can have physical roots so a trained doctor could bring a lot more to the role. Because the cost of the PA would come from a different pot. For family reasons she could not relocate, and with a scarcity of other positions, faced unemployment. There were lots of constructive suggestions from other doctors but consensus that the NHS has lost the plot. It is as if senior doctors are fine so no need for them to protect the next generation.

My concern is that Australia will run out of jobs.

DD decided that rather than swan off to Asia for her elective she would work in an Imperial research lab in the same area as her intercalation. She worked on the start of an interesting research project and, had she made a bit of effort, had her name on the eventual paper. But it was final year medical school and though she had done the work she had other priorities. (Though they have said she should approach them if she ever wants to do a PhD.) No one told her that actually it was tremendously important, not to have had the good research experience, but to have got her name on the a paper, effectively any paper. That her ability to work in the UK as a doctor will hang on collecting points, rather than focus on using these years to become the best doctor you can be.

The Daily Mail would be interested. The Daily Mail has its uses.

I was talking to a friend about the problem. She is a data analyst and, because she as not sure she could believe me, went away and did some number crunching of her own. We bumped into each other briefly earlier this week, and she showed me some graphics comparing international recruitment in medicine compared with other professions like hers. The graph was extraordinary and very sobering. I will ask her for it.

I think we need a really clearly worded ‘article’ type piece which outlines all the key points very succinctly, possibly with quotes from doctors going through this. Probably yes, a high emotion headline is needed to grab attention. Figures need sources with links to back up anything said to prove the points such as the competition from IMGs. There would also need to be some mention of the legal wording that changed (in 2019?) the employment criteria that trusts use to choose candidates.

At the moment we have lots of itty bitty posts here, but we need a proper letter or article written.

As an outsider to this world until recently I didn’t know what F1, F2 and F3 were, so again while we would not need reams about what these positions are, a couple of sentences explaining why they are so important and key to getting long term work in the nhs is important.

Links to the likes of the YouTube channel I found with number of subscribers would help demonstrate how this is becoming an industry in itself.

Important to keep it factual and non emotional. This is hard I know but if the piece is strongly constructed, emotions will fly elsewhere which is the intention.

This could then be used as a general piece to send to MPs, send out to radio stations, like LBC, Nick Ferrari etc, there are quite a few talk shows where this could be picked up initially.

It could also be used as the basis for starting a national petition.

It could be sent to all the dailies.

Can anyone have a stab at this? I can write and organise articles and try to help.

Something like:

Hundreds of British Medical Graduates Lose Out To International Doctors In Unfair Recruitment Practice

Or Daily Mail style

International Doctors Swipe Hundreds of NHS Jobs from Young British Medics

Junior doctors in the U.K. are facing an employment crisis as they seek to secure key training with the NHS, only to find that recent recruitment changes have destroyed their chances of a long term career with the NHS. Many are now seeking employment elsewhere in locations such as Australia and the USA who are only too happy to have these outstanding trainees.

Please edit etc… just a starting point

Ahh https://www.dailymail.co.uk/home/contactus/article-3701082/Contact-DailyMail.html

Other than that I guess write to MPs. Post on AIBU. Talk about it. The problem is escalating. More medical students in the pipeline. More backlog from earlier years. More understanding overseas that UK jobs are available if you can tick the right boxes for NHS selection. The sooner someone does something the quicker the situation can be resolved. Longer term the NHS surely cannot afford to lose most of a generation.

@Needmoresleep please see post above.

Plopsofa, sounds great. (And cross post!)

I have done some successful community campaigning and my experience is that the more different channels you try the more likely to are likely to pick up some resonance. Having a clear story to effectively use as a press release would be perfect. Could go to media, BMA, MPs etc. I will ask my friend for her (shocking) graph.

Does anyone else remember the earlier AIBU thread?

As far as career progression goes I'm interested to lean more about what's happened in the past three or four years to create what appears to be a road block after F2, or at least a serious lane restriction. It certainly sounds dire.

As far as pay goes, my response to mumsneedwine was purely to say that the £15 on the BMA slogans gave a false picture of the actual annual take home pay for F1s. mumsneedwine was presumably aware, since she posted only the top two lines of the payslip leaving out the night and weekend pay then said 'many' F1s don't do anti social hours, which was a distortion (a limited but unfortunate group), then said not all F1's are in placements which have night or weekend working so I commented on that too. It's better not to double down on any argument if it can be chipped away at because then credibility fails. If anyone does want to send an article to any journalists then as a pp said, the arguments need to be absolutely watertight and properly sourced not merely with stats but with senior as well as junior doctors contributing.

But the concern is not about pay.

Yes pay is not great, especially for those in expensive areas. In contrast DD, with cheap cost of living and long hours, has been able to both save and buy a house. The quid pro quo is that the health of the patient body she works with is deeply affected by deprivation.

And yes, as has been said many times previously, not all deaneries require F1/F2s to work nights. DDs own experience is that her conditions/hours are worse than many of her peers. Though with the compensation that many she works with are very supportive and that she is getting lots of very valuable experience and she is doing something useful and meaningful. (FWIW I doubt she even knows what Australian salaries are. As long as there is enough, money is not something DD thinks much about. She intercalated from Imperial in bio-med engineering so regularly gets job ads via their careers office with six figure starting salaries. But she wants to be a doctor.)

The concern is the road block. It is devastating for our young people whether they were in heavily loaded or lightly loaded jobs.

Needmoresleep the BMA were concerned about pay. This thread has morphed from a medical school thread into a thread about the limited progression opportunities after F2 but as a general observation, I think it's absolutely fine to challenge exaggerated claims - which the pay claim was and has been shown to be (both on this thread and generally). Because if one thing is exaggerated by a representative body, which other of their claims might be? Credibility is important.

I agree with the pp that NHS has lost its plot. If someone if going to take this further, I would recommend them to see the GP numbers as well. The GP surgeries are choosing to employ PA's rather than doctors!!
Having worked with PAs for the last 6 years, they lack the in depth knowledge a medical doctor ( even at FP level) has and this does reflect on how they deal with the problems. I think they have been short changed as well as there is no clear career progression for them.

Junior doctors used to work closely with the nursing staff and it is a very important aspect of medical training but this does not happen now as PA's are telling the junior doctors what to do and it's not always right!!
I am an IMG who came to this country more than 2 decades ago, I did not know how the NHS or the social services worked but it is not that difficult to learn. Yes, there are cultural differences and nuances but human compassion and empathy trumps them all!
If you are an IMG hoping to come to UK,
The norm was you did a 6 months ( sometime more ) honorary observer job ( not allowed hands on at all) and worked closely with your team, took the opportunity to do any exam needed, your consultant assessed you and you needed at least two consultants' references from the UK to get a job. You were generally given a 6 months job and in those days, all of us applied for jobs every 6 months to a year. If you are not good, you never made the cut!
The application process now is just a tick box exercise. I could have been in a panel recruiting IMTs today but have not engaged at all for the last couple of years as it's so disheartening to be part of the process.
We may be wrong ( my DH is a medic too) but we keep advising our daughter to make sure that she learns the basics right, work in a busy hospital and gain as much experience as she can get as that's what makes some one a good doctor. It's not the pointless point collection !

Yes pay is not great, especially for those in expensive areas. In contrast DD, with cheap cost of living and long hours, has been able to both save and buy a house. The quid pro quo is that the health of the patient body she works with is deeply affected by deprivation

My own DC's stamping ground for much of his training has been Tower Hamlets, not known for its affluence. So he had to make do on his F1 and F2 pay not only with fearsome rents but also with the same issues that your own DD has encountered elsewhere. Exacerbated in 2020 and 2021 of course (their F2 and F3 years).

I agree with the pp that NHS has lost its plot. If someone if going to take this further, I would recommend them to see the GP numbers as well. The GP surgeries are choosing to employ PA's rather than doctors

Wasn't that because the previous government mandated what mix of staff GP practices were allowed to employ? Different pots of money for each staff group? Does that still remain in place with the new government? Are GP practices now allowed to employ more GPs?

@bookmarket - I am not sure how the primary care employs its staff but what I know is that the GPs are finding it difficult to get jobs. PA's are employed instead.

My understanding is that the BMA, like many professional unions, has been captured by special interest groups. Hence its enthusiastic adoption on gender woo and more. Most ordinary doctors including F1/F2s are too busy to get involved.

There are a range of issues, like F1 allocation, where they have allowed an odd idea of equality to trump merit, which suggest they either don't care about young doctors coming through or don't understand. It was interesting that even when they finally sparked on the bottle neck issue they had to add a sentence on exploitation of overseas doctors. Yes I get that an overseas doctor with ten years experience may feel exploited in an F3 position. But equally so too will the F2 who is having to help them learn the NHS administrative ropes, and who themselves face having to work on the other side of the world or sit at home waiting for some short notice daily locum cover work to turn up. As if exploiting UK trained doctors is OK.

The strikes were about pay because doctors already in posts want more. My own view is that F1/F2s were misled. As DD said. She wanted better conditions and better prospects.

Yes, I think my DD could end up in this position (science degree). She's in her final year now. Obviously for many reasons the graduate recruitment picture is not looking pretty but if companies have no mandate to employ or prioritise UK applicants, they'll easily get what they need from the rest of the world without investing in training our graduates. Add to this that companies can't now access the apprenticeship levy for level 7 training (masters) which takes away some entry level roles.

It feels like it will only be the wealthy and well connected who can afford multiple internships and top university masters degree fees who will be able to end up in the interesting and well paid jobs.

I plan to write to my MP.

Sorry - that was in response to someone who said other graduate jobs are being impacted and to write to our MPs. I meant to quote and now can't find it. I'll definitely be making a fuss about the lack of speciality training roles for UK FY2s. No medics in our family but DD considered it and she'd definitely not have wanted to emigrate to get a job.

I agree there is a more general problem, but there is a greater impact on young doctors because there is only one employer. And that employer has chosen to use criteria which can, if you have enough time, be gamed. (Poor quality research papers, conferences etc.) It is also very difficult to argue that you are the better candidate for a locum/CTF/F3 job is you are up against people who have 10 years experience in their home countries.

It used to be that you had to be willing to be mobile until your early 30s. Now if young doctors want to build careers in the UK they will have to factor in spending at least a couple of years overseas in order to gain the sort of experience that will put them on level pegging with IMGs for entry level jobs. So even more time needed to invest before they can settle down somewhere.

DS who would like to be an academic is also affected by international competition, but this was known and understandable. When completing his PhD in the US he applied to possibly 250 jobs world wide. He had a couple of dozen second interviews and about half a dozen final interviews (flyouts) and got one offer. It happened to be in the UK, but that was chance. He knew that some countries (France, Taiwan) are quite chauvinistic in who they consider, though he did get a fly out to a very prestigious Asian University possibly because their existing token European was leaving. He also knew that, as a white male, certain Universities would be beyond reach (there was a fantastic job ad for a Californian University which seemed far more interested in how many drops of Native American or Latinx blood you had than whether you knew any economics) but there was a sense that by ignoring merit these were digging their own hole for the future. He also had the disadvantage of being monolingual so could not, unlike many of his colleagues, apply for jobs where teaching was in a language other than English. The UK University sector tend to be nationality blind, which helps us recruit some of the best but which means that DS has no particularly advantage in being British and, once his current contract expires, will have to go anywhere in the world where he can get a job. So I have two DC who on the surface did well at school and University but who, in their mid late 20s are seeing their career prospects, at least in the UK, dry up. They are hard working bright and resilient so something will work out, but probably though both would prefer to work in the UK, it will probably be elsewhere.

I should add, that if DS cannot get an academic job he can work for a bank, for a consultancy or something. So it is not just one employer with one rather odd set of selection criteria.