To be or not to be a doctor?

[MrsDThaskala]

DD said today that she’s been in thinking about becoming a doctor. Not sure what area, not sure what kind, just said it out of the blue today. I mean she’s doing well in her sciences. But quite honestly, the doctors I know, GP and hospital doctors, and a surgeon always say how stressed they are, how much pressure hospitals are under, how hard medical school is….etc. not necessarily for my DD but what do you think? With all that we know about the NHS right now, what’s your take on becoming a doctor?

My youngest wanted to be a doctor until she did some shadowing and realised that she would be signing herself up for a life of stress.

You can read back yourself Needmoresleep. I think you may have the luxury of time.

I don't think any of the posters who took exception to the entitled tone of parents on these threads (myself included) ever, at any point, said that prioritisation of UK medical school graduates wasn't appropriate. There was simply the caveat that not all of those are going to be sufficiently able to make it far up the career ladder. And I think there was also a general revulsion at what appeared to be hostility to overseas trained medical graduates. Again, myself included. Merit has to play a part in who progresses and who doesn't.

I don't intend to go round in circles, yet again. The posts are there: read if you want to; don't if you don't.

In a world where you can be anything, be kind. Let’s not derail another thread with ridiculous comments.

There's clearly a consensus that what was published yesterday lack detail, despite its 140 pages. The detail about workforce planning is yet to come, due in a couple of months time.

I certainly agree it is silly to import doctors and exportt ours. I think a lot of people in the UK would like to be treated by a doctor even one local to them or at least one who is born here just because all the cultural nuances etc are more likely to make things easier. So if we could stop the brain drain out and brain drain in that might be better - a kind of Fortress UK system. It is not likely to happen, however. My doctor sibling did a lot of research - I see from the threat research is mentinoed; and has a doctorate (as well as being a normal doctor of medicine) and a professor and I think that has helped with earnings and career. However that is past experience. Whether the one starting medicine this Autumn will have a similar career path remains to be seen. My own father did a lot of lecturing as well as his normal NHS consultant job and court work and expert witness work (and also sat on mental health tribunals too) and seemed often to be going to Durham prison I remember when I was a little girl, to see patients. His own brother read medicine from 1936 before the NHS even existed.

Sorry OP.

I will say I am baffled. The warning from me and other "entitled" parents was that a large proportion of UK medical graduates finishing F2 this year have been unable to access either jobs (F3s) or training, with over half of all training places going to doctors from overseas medical schools. A lot of these will have done well at F1 and F2 and received good appraisals, with their consultants not wanting to lose them. But they have been struggling to compete for entry level jobs against experienced doctors from overseas motivated in part by accelerated family settlement arrangements.

This is what I think Auchencar considers racist, and I recognise that there is an argument to say that being able to recruit experienced doctors on entry level pay scales is cost-effective for the NHS. But there is a real cost to young people who have been training and working for 7/8 years, with huge debt, only to find that is no work. It is not about how far they might progress. Only time will tell. It is about the fact that the current policy is not allowing them a job.

I quite like the snarky comments about my leisure time. Rachel Reeves need not worry. I am working very hard so I will be able to pay her tax increases. Deflection? Auchencar clearly spends a lot of time on NHS policy and strategy. Yet he/she will not even hint at their role within, or without, the health service. Something to do with the agencies making a lot of money running overseas recruitment, and lobbying hard to retain the status quote.

Xenia, there is research and research. NHS recruitment does not look closely at the quality of research that a junior doctor took part in. It is a tick box exercise. So pay to be published or pay to win a competition is perfectly possible. Indeed there are organisations overseas who, for a fee, will help a doctor achieve the CV required.

Mumsneedwine. It is not "be kind" but "be fair". Being kind involves allowing overseas doctors priority for entry level jobs our young people need. Being fair is giving British trained doctors a fair shot and factoring in the benefits of better long term retention, increased chances of loan repayment, keeping families together, potentially better communication with patients and colleagues etc. (The latter can be cultural, such as not being used to listen to more junior colleagues including nurses, or a lack of familiarity of working with female colleagues as equals - two things that a male nurse and a female doctor have mentioned to me as causing them problems.) Interestingly BAPIO, the group that trains Indian doctors for work in the UK and that lobbies for recruitment from overseas (and who, judging by their various posts, Auchencar may work for) is now lobbying for the resettlement here of the parents of overseas doctors and their spouses. No mention of the equally difficult separation faced by British doctors forced to go abroad.

@Needmoresleep I was referring to our friendly poster to be kind, not something they find easy. Bored of the constant patronising and insults. Thought maybe the discussion could avoid this - can see it has not already.

EVERY OTHER COUNTRY IN THE WORLD GIVES PRIORITY TO ITS OWN STAFF, so I assume you think they are all racist too ? And international UKGrads will be treated the same as UK born - it’s where you train not the colour of your passport.

I think there is enough detail to be able to see that entry to medical training is very rapidly going the way of Law, in terms of numbers per vacancy and the variable quality of applicants, without any of the later career benefits.

"We are currently ahead of plan" to increase medical training places from an intake of 7,500 in September 2023 to 8,200 places by September 2025, 10,000 by 2028/29, and then 15,000 places a year by 2031/32 (from a letter from NHS England to the RCP in 2024). As this is taking place, resources will shift to primary care where non-medically trained staff will undertake work presently performed by GPs. (In mitigation there will only be a trivial increase in speciality training posts, 300 pa. for three years, and foreign graduates in training will decrease by 1.5 percentage points p.a..)

The good news is that Mumsneedwine will find that it gets easier to shovel her pupils into medical schools.

As for the OP's question, after nearly forty years as a hospital doctor and twenty-five as a consultant, I can only give the same advice that I gave to my children. If you want a satisfying career with professional autonomy, choose something else.

Yes. I whistled out that badly typed post to try to stem the stream of childish/ capitalised responses. Overly optimistic as ever. Thanks for the numbers Marchesman.

One of the resident doctors she works with is open. He bought the lot: international competition prizes, name on research papers published in obscure journals.
As that is fraudulent, even if he does n’t get reported, faking experience or taking shortcuts in work will likely get found out as he tries to progress. This type of behaviour is not restricted to IMGs.

EVERY OTHER COUNTRY IN THE WORLD GIVES PRIORITY TO ITS OWN STAFF
Parroting statements ad nauseam does n’t make them true. This is an example. The above is not the case within the EU for graduates from other EU countries as long as language criteria are met. Until Brexit that was also of course the case for the UK. In other countries including the USA and Canada merit outweighs prioritisation as talented, dedicated IMGs will get the scores etc needed.

Meeting the minimum standards to qualify does not create a homogenous quality of UK medical graduates. There is an increasing mix of academic abilities and training amongst them. In parallel to this there appears to be a reluctance in many to engage in projects that are “additional” to their working hours even if these projects are aimed at improving the quality of patient care. However UK medical graduates will have to be cognisant that (the devalued currency of) a medical degree and FY posts won’t be sufficient to demonstrate added value to an increasingly skilled allied health professionals let alone to their more ambitious, able and energetic peers. The latter will continue to include those trained overseas.

Meeting the minimum standards to qualify does not create a homogenous quality of UK medical graduates. There is an increasing mix of academic abilities and training amongst them. In parallel to this there appears to be a reluctance in many to engage in projects that are “additional” to their working hours even if these projects are aimed at improving the quality of patient care. However UK medical graduates will have to be cognisant that (the devalued currency of) a medical degree and FY posts won’t be sufficient to demonstrate added value to an increasingly skilled allied health professionals let alone to their more ambitious, able and energetic peers. The latter will continue to include those trained overseas

This is quite a killjoy thing to say. I've been enjoying the idea, stemming from certain posters' insistence on the homogenous nature of UK medical graduates, that students get into Oxford, Cambridge, Imperial etc and then the tutors at those unis take time out to numb the ability of their undergraduates in order that they don't have an unfair advantage for subsequent training. I've been wondering how they do that but, you know, these are clever tutors, I'm sure they've found a way.

And yes to the very irritating idea that certain F1s and F2s decide that their own spare time is so much more precious than others' that they feel a right to ignore what all their more ambitious, able and energetic peers knuckle down and do in terms of adding value to their CVs, and assert that they need to do sport or socialise instead, rather than as well as. Very arrogant indeed.

EVERY OTHER COUNTRY IN THE WORLD GIVES PRIORITY TO ITS OWN STAFF Parroting statements ad nauseam doesn’t make them true

Also, in the circumstances, extremely killjoy and very definitely lacking in empathy.

😂 seriously. The sun is shining, get outside and have a life. Just because you keep saying something doesn’t make it untrue.

To be fair, removing any merit based element from the F1 job allocation isn't helping promote excellence, just encouraging people to aim for the pass mark... that's without even thinking about international graduates

Not clear if this is addressed to Marchesman, sendsummer or myself.

I happen to already be on the beach :) Technology is a wonderful thing.

@sendsummer

My understanding is that competitions and publications are not weighted or strongly scrutinised. I am not medical so rely on anecdote, but my observation is that successful young UK based doctors often enter heaps of overseas competitions. My local tailor is extremely proud of his second generation doctor son and would tell me about the competitions he had won in all sorts of obscure places. Makes his own struggles as a newly arrived asylum seeker worthwhile. Until I understood the system I was confused as to why he would bother. (The son also vowed at 16 that he would not take any holiday until he had got through the system. Impressive yet frightening.) Whilst a friend, a very young consultant, gave me his CV to pass on as on to a Ukrainian doctor as an example of what the NHS were looking for. (In the event there was no equivalency for Ukrainian qualifications and at 60+ it has proved difficult to get his english proficiency up to the level needed.) Again slightly baffling pages of overseas publications and prizes. Not cheating, simply responding to NHS priorities when assessing merit. And yes, not limited to IMGs, and a proportion are obvious from the get go, missing unmonitored placements or ducking out of group work at medical school to give priority to CV enhancement activities. Those with the money to attend conferences. Those who don't stay the extra 15 minutes after a busy shift to ensure a proper handover as they need to get back to their books.

(DD chose challenging F1 and F2 rotations in a busy deanery because she wanted to have good hands experience with the full intention of then taking an F3 with time to make applications. This route is now barely open, with people she and I know largely having to survive on bank and agency work for a year or so before landing the F3. Or the richer ones going back to University for a Masters as a way of having time and enriching their CVs. These can only be temporary measures, against the background of a growing blockage caused by the lack of training opportunities grows.)

A while ago a regular poster (medic mum and consultant, an IMG herself) suggested she had given up being on a panel to select people for training as she felt the method of selecting was so "imprecise" because CV claims were not tested. Not to mention the mistake when people were given the wrong results and were some way into training before being told they should not be there.

Yes the EU has a single market for doctors. But for EU doctors. Not UK ones. Australia and New Zealand regularly recruit UK doctors and the US and Canada, but they prioritise their own residents. We do not.

There is no argument about the fact that medical school and F1/F2 cohorts have individuals of quite varying abilities. Not just academic but softer skills like communication, empathy and resilience. Doctors I know sometimes question whether medical schools fail anyone, claiming that it is left to them at F1 to sift them. The process is quite cruel. DDs current rotation is down 50%, mainly stress and long term sick. One really capable friend from an earlier rotation was doing very well till something awful happened one shift. Older doctors claim they had it tougher but now there is more stress on the system, and the departmental support structures have broken down. If something happens you are expected to cope. And if you can't you are, effectively, out.

There is also no real argument about merit. If a department advertises a contract for an entry level speciality doctor position (I think that is the name for the old house doctor) attracting 1000+ applicants from all over the world it might well go, on merit, to the doctor from Malawi with 10 years experience and advance qualifications happy to be paid at the bottom of the scale. The capable F2 who had a successful rotation in that department does not get a look in. There or elsewhere. Compounding the problem is whilst the overseas recruit will probably have had support in identifying vacancies and in ensuring that they present their CV in an optimal way, there is no equivalent of a University careers office for the F2.

The argument is more about priorities. Entry level jobs, where there are plenty of professionals already in the UK, are not skills shortage jobs, and really should not be listed as such. Yes short term you might get a cheaper, more experienced doctor from overseas. But there are costs. Unemployment, student loans not repaid, the huge waste of UK taxpayer investment, loss of genuine talent. And this hits the hard to recruit areas hardest. Overseas recruits, whether on training of simply recruited to a position, will often move to somewhere they prefer when they can. Locals, if allowed a career path within the NHS, won't. And this is before you start on the social and other costs of family separation as grandchildren are born and parents get older.

However UK medical graduates will have to be cognisant that (the devalued currency of) a medical degree and FY posts won’t be sufficient to demonstrate added value to an increasingly skilled allied health professionals let alone to their more ambitious, able and energetic peers. The latter will continue to include those trained overseas.

Australia seems happy to focus on the experience achieved and skills obtained, leaving very little space for add ons. They are recruiting for hard-to-recruit places and want people capable of getting on with the job. I don't know if DDs experience is typical but it has been long tough shifts in very busy hospitals, lots of nights and weekends, an average of 60 hours a week, and a surprising amount of responsibility. Overseas education is not necessarily better. Some private medical schools have very little patient contact leaving quite a lot of catch up when recruits arrive in the UK. Whilst others seem unfamiliar with research results and treatment protocols taken as standard in the NHS.

You talk about needing "projects" in addition. Fine in London/Oxbridge teaching hospitals, with Consultants with research grants and time to carry out research and able to include their medical students and F1/F2s. But what about places where everyone has their backs against the wall. Where the consultants are "retire and return" or recruited from overseas and prioritising getting to grips with NHS systems. Where because of vacancies existing staff are fighting burnout or, for those with EU passports looking at tempting job offers elsewhere. In one place DD worked, 50% of specialist training places were vacant and could only be filled by those who had been approved at a national level, leaving consultants on call one night in four. When she enquired about providing maternity leave cover for a speciality doctor there she was told there was "no budget". (The department had a PA who was much more limited in the hours she could work and the tasks she could perform, but who was paid a lot more than a newly qualified doctor. Presumably different budget.) As a result patients wait two years for an emergency GP referral. Interestingly when she left that department as well as a good appraisal two consultants wrote personal notes to her praising her clinical and diagnostic skills. Even if some F2s are weak there are plenty that senior doctors would like to retain. They can't. Instead a consultant from another department has been asking contacts in Australia if they have a job for her, and her current consultant has, unasked, just granted her two personal days to apply for temp jobs in the UK and for more permanent roles down under.

What you seem to be saying is that the 7/8 years of UK training on its own, is insufficient to land a job in the NHS (and here I am talking about a normal bright hardworking F2s with a track record of strong work appraisals.) They need "projects" on top. Why? Why can't strong F1 and F2 appraisals, perhaps including a box saying that this young doctor is capable of progression, be given equal consideration. The NHS does need academic doctors and those completely dedicated to their career. But they also need good general paediatricians, surgeons, obstetricians, geriatricians, GPs etc in smaller hospitals in the Highlands, in the West Country and elsewhere. People who are sensible, knowledgeable, good managers and who stay. (People who are content with their work life balance and who are less likely to demand more pay - perhaps deserved given the hoops the NHS put them through. Or desert for private medicine in the UK, or elsewhere.)

Sendsummer's post should be useful to OP. It is possible to progress in medicine, but you need to be able to compete with the best in the world, using the NHS' definition of merit. Being a good doctor is not enough.

Its bizarre. Medical schools have been encouraged to support the development of softer skills as this is apparently what is needed. And more recently took merit out of F1/F2 placements. Equality was more important.

Yet selection for training posts, as Sendsummer suggests, is absolutely based on "merit". Tough if you are somewhere remote and busy. As well as the utterly dedicated, the NHS prefers those who have been able to take a year out (UK or overseas) to pursue "projects", or through the luck of the lottery have landed in places where there is a lot of support for research.

In short, handicapping our young doctors before they start. The medical education needs to be reformed to enable UK grads to compete equally against academic criteria or the definition of merit needs to be revised to include soft skills, good F1./F2 performance. Young doctors should not be getting to the end of eight years and large amounts of debt to discover that they are not considered good enough and that their educaiton/training is inadequate.

You are very coy about saying which part of the health sector you work for, despite your oft proclaimed expertise and knowledge of the detail.

Nice to know that you are allowed to work from the beach.

(Unless - the other hypothesis. You are just a bored housewife who gets their kicks out of being nasty to others on the internet. If so you should take up golf, or make some RL friends.)

To add. Those that are not likely to be good enough, and for some it is pretty evident from the start of medical school, whilst others start to struggle along the way, need to be warned, given support and if still not meeting standards be signposted elsewhere. Again they should not have to wait 8 years before finding out they have no career.

Needmoresleep there are at least a dozen more plausible explanations for being on the beach that I can think of.

It's not a sympathetic trait, bitterness.

Also time to stop the imputations.

To be fair, removing any merit based element from the F1 job allocation isn't helping promote excellence, just encouraging people to aim for the pass mark...
Those lacking the intrinsic motivation even at medical school to get the best knowledge base possible certainly won’t provide added value to allied health professionals or AI algorithms.

@Needmoresleep entering competitions or contributing to abstracts or publications (even low impact journals) requires additional effort and learning. The example you gave was distinct as you implied fraudulent behaviour. I do agree that the point system should have an adjustment for those FYs who are outliers for average hours worked.
District general hospitals are perfect opportunities to engage in quality related projects such as audits.

@sendsummer.

First I really welcome you entering the conversation.

Experience on other threads was that those who claimed knowledge, presumably as professionals involved in the NHS in some way, were also quite nasty. We mums, concerned about our DCs looming unemployment, faced a barrage of comments about our entitlement and racism, and about our DCs laziness and unsuitability. That the NHS is right to offer over half the available specialist training places to doctors from overseas because they are, well, better.

I have been left baffled. DD is lucky in that she has benchmarks. She went to a very competitive sixth form where she passed five A levels (whilst playing county level sports, was selected for a responsible school leadership position, and spent Sundays engaged in a London wide arts activity). She then went on to get a first from Imperial in bio-medical engineering and indeed was invited to approach the research team where she spent her elective, should she ever change her mind and want to take a PhD. Her ambition though is to be a doctor so her priority was to get good hands on F1/F2 experience in demanding rotations. She is the person who stays on to complete the handover at the end of a 13 hour night shift. She and her friend were the first year medical students who completed the group work, when the six others decided that recising for first year exams was more important. She is the one who, when on placement, turned up promptly at 7.30 ready for a ward round at 8.00am.

Not all are so diligent and I share concerns around the low failure rate, and indeed around the bizarre testing process that, especially during lockdown, was very open to bias and cheating. But plenty, indeed most, will make good doctors, even if a good proportion don't make it to consultant. Getting into medical school is competitive and the majority of recruits are bright and engaged, with a real vocation. DD was the last year that F1/F2s were allocated on a merit basis and she got her first choice of rotations. She may have come from a more privileged educational background (there were no grants for her peers to study in England so they stayed local) but the majority of her peers on the same rotations are equally talented and able, and indeed have the advantage of understanding local expectations. (A small example, death and funeral arrangements are different from SE England and DD unwittingly upset grieving relatives by not anticipating what they would want.)

The NHS has seven/eight years of background on their own graduates. Consultants will know which ones pull their weight and have the skills (including resilience) to make it through. So easy, and a lot more relevant, to have a box on the appraisal suggesting who is promotable as part of a selection process for speciality training. .

Yes, entering competitions or contributing to abstracts or publications (even low impact journals) requires additional effort and learning. But surely being a full and productive member of a team is equally important. And surely even senior doctors are aware that people function best long term if they have a work life balance, especially if the work bit is 60 hours a week full stretch.

I have just been interviewing prospective tenants for a rental property in a popular bit of London. One group were doctors. The young man who came round was lovely. He had not got a training position but had landed a 12 month F3 position. He knew he had been very lucky. It had involved a nightmare six months of coming off busy shifts and spending hours completing job applications. In a country that apparently has such a shortage of doctors that such entry level positions have to be opened up to world wide competition. He said his mother is very angry about the way the NHS is treating him. He also confirmed that he thinks the proposed strike for more pay is mad. The priority has to be the reestablishment of the broken career path. (Or maybe it suits Resident Doctors already on that career path to have a shortage, or places filled with those unlikely to stay in the UK post training.)

DD does not have anything yet though her consultant has kindly offered her two personal days to complete job applications. She bumped into a HCP from a former rotation who suggested she contacted the consultant there as a maternity leave was coming up, but unfortunately they don't have budget for cover. More usefully a consultant in notoriously busy department casually asked her what she was doing next. Unemployment or Australia. He was shocked, saying "you can't go!", so she is applying for temp vacancies in his department, not an area she wants to work but a job all the same. Because so many doctors are unemployed, NHS bank rates are at an all time low, and she has a mortgage to pay.

DD is lucky in that when she decides to really focus on getting into training we can pay for her to take the time off in order to tick the boxes in terms of low impact journals etc. She can also return to her childhood bedroom, which will give her access to London F3 and NHS Bank jobs. (The poor prospective doctor tenants seemed naive about how brutal the London property market is. I would have let to them despite them only having a 12 month contract and a relatively low salaries if they had made up their minds on the spot. So it went to more savvy and higher earning investment bankers.The doctors needed something for 1 August. Having witnessed the level of demand from the other side, they will be lucky to find anywhere.) If need be we can pay for her to get involved in something overseas.

This is not true of others in their late 20s with big student debts, and possibly partners or families. What happened to the much vaunted commitment to widening access? The NHS bend over backwards to stress equality over merit all the way up to the end of F2, then prioritise those with resources, support from recruitment agencies, or educational advantage.

The process by which training places are allocated is equally bonkers. DD selected her deanery because it would give her two years of solid hands on experience (and something different post lockdown). A senior consultant friend, one who goes across the country training others, advised her not to do it. We did not fully understand at the time, but the system there is too stretched so no time for the support and research access she might get in, say, a London teaching hospital, with lower pay and longer working hours/more unsocial shifts. For many specialities selection for training is handled nationally. So the children of friends in Asia (and indeed those with affluent parents in the UK) are able to take perhaps a couple of years out for advanced degrees, get into the low impact journals etc. DD's peers have to achieve the same CV enhancements and exam results whilst working flat out, with time also spent looking for the elusive F3 job as a fall back. (In fairness DD's Deanery is allowed to select its own trainees in some less popular specialities. I understand that there is now tension. Competition for any form of training has increased so the GMC is keen to take away this concession.)

It is madness. Getting into training is so tough. If you make it, whether from Oxbridge, London or Asia, you don't want to work in the back end of beyond in a part of the NHS that is on its knees, perhaps being supervised by consultants new to the UK. You wait for the job in a London teaching hospital or take up alternative offers in Australia or your home country. So in one speciality eight out of the 16 training places are vacant, and a two year wait for urgent referrals. (Yet no money for a maternity leave cover.)

At what point are the NHS going to think about retention? Retention of the able young doctors who have spent 8 years in UK medical schools and hospitals. Retention of Resident doctors willing to work in hard to recruit areas, who wont leave as soon as a similar job comes up elsewhere in the UK or as soon as they qualify. Retention of experienced doctors who are burning out, a noticeable proportion of who have EU (Polish, Irish) passports.

A long long rant, but the NHS should be very worried that they have nothing to offer DD and her able and dedicated peers. Perhaps those involved in policy such as Auchencar and some of those on AIBU threads, should get out more. Patients don't just live in London and the South East. You don't need to have won competitions to be a good doctor.

Though it had not been her original intention, ideally she would stay where she is to build a career, DD now sees advantage in having experience of a functioning health service. Not that long ago she had to tell a patient with a life-impacting major hernia that despite an eight year wait he was nowhere near the top of the list. Unfair, awful and not why she became a doctor. She wants to treat, not manage the results of a poorly run and failing health service.

Oh and I do think she does audits. But getting a training place has become so competitive that CVs need a lot more than that. Virtually no one she knows, from her year or still around in F3 or temp roles, from the year above, got training places. Just one GP and one, with lots of contacts, for a popular hospital speciality.

@sendsummer.
First I really welcome you entering the conversation

Needmoresleep that's refreshing, given that you were much less warm on the previous thread ('Ideal University for Medicine') where sendsummer decimated mumsneedwine's 'interpretation' of various statistics and graphs. It was extremely useful for the rest of us.

😂 do you ever say anything nice ? Not my figures and graphs, mainly from DHSC and GMC. Don’t like the truth, that’s not my problem.

As someone high up in the NHS dealing with policy you are proving why it’s in such a mess. Angry rhetoric that is so anti doctor. How sad. If the leaders of the NHS backed their staff this mess wouldn’t be happening.