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?

Bapio, an extremely powerful doctor lobby group with strong influence within the BMA and GMC, seem to be changing their position.

https://bapio.co.uk/wp-content/uploads/2025/07/BAPIO-Letter-regarding-calls-to-prioritise-UK-graduates-for-training-posts-June-2025.pdf

I understand Bapio took the UK Government to court about a decade ago over access to UK training for those from outside the UK, and won. They run training colleges in both the UK and India to help prepare doctors from South Asia for work in the UK, and run 2+2 speciality training which allows doctors with registration in India to do some of their speciality training over there and then the rest in the UK.

Now they, unlike some posters here, seem to accept that this approach is unsustainable.

"At the outset, it is essential to recognise that UK trained medical graduates have every right to expect to be employed in training posts in the NHS. Medicine is a long, demanding and expensive course and if there is no assurance that doctors will be able to complete their training in the UK, this will result in students and newly qualified doctors choosing to study / train elsewhere, which will have a significant detrimental impact on the NHS."

Their solution to problems further up the supply chain are interesting:

• All posts should be considered training posts
• Doctors should be appointed to posts based on merit only
• All doctors currently working in the NHS should be eligible to apply for training posts, irrespective of their nationality or where they completed their medical degree
• The GMC should inform all candidates wishing to take the PLAB exam about the availability of jobs in the NHS so that candidates can make an informed decision about sitting the exam / coming to the UK

They also seem to accept, given the over supply of newly qualified doctors in the UK, that the large recruitment flows to the UK at this level are over. The PLAB exam sat in India has a much higher pass rate than the exams UK trained doctors are required to sit so was always controversial, but presumably a good money earner for BAPIO.

A call for grandfathering of Doctors already in the UK is to be expected, and probably inevitable. Other countries apply a Resident Market Labour Test which includes doctors resident in their countries wherever they trained.

The turning all posts into training posts would presumably do away with the current national competition for training places and mean local recruitment for hospital jobs, all of which could eventually lead to a consultant's post. Those already on training schemes would presumably no longer have sole access to ringfenced training posts but will now have to compete with experienced doctors working in that speciality. There would then be no need for the 2+2 which always, frankly, seemed unfair. Why should Indian registered doctors have access to a fast track training route in the UK not available, say, to second generation doctors of Indian origin.

Previously Auchencar, and a number of similar posters on the AIBU threads, were strong supporters of the then BAPIO position and of international recruitment even if it has mean large numbers of UK medical students faced unemployment. I think the argument was that the NHS needed to recruit the best, and that other than a few medical schools like Oxford and Cambridge medical education in the UK was of very variable quality. If the new BAPIO proposals are adopted it looks as if those working in staff level jobs will get another bite at the cherry.

Wes' changes, whatever they end up being, will take time to work through so too late for this year but hopefully in time for those now thinking about medicine. I really hope that those already in Australia and those who are about to leave, will have equal opportunity to come back. They wanted careers in the NHS. And despite what policy makers like Auchencar might think, they are good, hard working and dedicated.

Good morning. We've had some reports that a large number of posts on this thread are verging into personal attack territory. Please do try to keep within our Talk Guidelines to keep the thread on topic. Thanks.

Kim a significant number of posts on this thread are well inside the line in terms of personal attacks (using Wimbledon metaphor here, for obvious reasons). I tend not to report personal attacks on myself, because I think generally that these sorts of posts are best left standing, to speak for themselves. Unfortunately this does seem to embolden the posters in question who don't seem to quite get why they haven't been deleted.

😂😂😂 oh the irony.

mumsneedwine I'm not here to make friends. I post where I'm interested in a discussion, for whatever reason.

As you must surely know, statistics and graphs need context and interpretation. sendsummer supplied those things on the thread referred to, and in doing so completely undermined your position. That doesn't mean that you intentionally misrepresented; far more likely that a poster in the position of sendsummer has the expertise to understand the statistics and graphs in a way that you don't. As I said previously, her interventions were extremely helpful in terms of getting a proper understanding of these things.

None whatsoever mumsneedwine. The thread - indeed threads plural - all speak very clearly as to who is breaching guidelines and who is not.

It’s sooooo boring. Advocate for better health care for all, or shut up.

That doesn't mean that you intentionally misrepresented;
A scientist including a science teacher should always guard against confirmation bias though.

Due to the resurgence of this thread I have looked at the 2024 data which are now available https://medical.hee.nhs.uk/medical-training-recruitment/medical-specialty-training/equality-and-diversity/equality-and-diversity-2024-recruitment-data

For entry level training posts (CT1/ST1), UK graduate applications 20480, non EU IMG 45251 However again these headline figures are misleading.
Appointable applications UK 11156 (54% of all UK applications),
non EU IMG 17119 (38%)

Of appointable applications from UK graduates, 85% offers. That’s very reassuring for UK graduates who apply having reached the requisite standards.

Only 27% of appointable non EU IMG applications had offers.

Critically again UK applicants did not accept about a third of their offers (probably because of multiple applications or wanting to go abroad or retry for preferred speciality) - mainly for GP, psychiatry, acute care and internal medicine. It is these specialities which have the highest numbers of non EU IMGs accepted appointments. So as for previous years, the non EU IMGs appear to be filling posts which UK graduates don’t seem to want.

No personal attacks, it’s v simple. Or should be.

Statistics, damn statistics.

On the ground, certainly amongst the capable young doctors DD knows, the picture looks very different and perhaps interesting to understand why.

Was 2025 more competitive that 2024?

Do we have a breakdown per deanery. Now that allocation is random it matters if some are, by the luck of the draw getting advantage.

Are the criteria used for selection the right ones? The criteria gives advantage to those who have additional academic/research criteria. As competition builds, more and more of this is required (or that is the perception). At some point would it be better to agree that a certain level is sufficient and then start giving weight to other attributes. The F1/F2 who has been working 60 hours a week on the old contract, in a deanery with real deprivation and seriously strapped for resources, involved in procedures that elsewhere are restricted to those at senior registrar level and who has had lot of the hands on, carrying the bleep at night and coping with what comes up might get some credit for that. At the moment the career pipeline seems biased (I am not medical) towards the needs of major teaching hospitals, not towards the needs of hard to recruit areas.

You suggest the 11156 includes duplicate applications, so the number of successful applicants will be lower than this. My understanding was that about 25,000 leave F2 each year. My assumption, based on DD's observation is that the success rate is lower where she is than, say some of the deaneries in London and the SE. Because grants are not available to study elsewhere in the UK, quite a large number of her peers are from the area, studied in the area, and want to stay there, which should give you a useful assumption that the cohort is spread normally over the full ability range. (The local University is well established and regarded, offering quite a traditional medical degree.) So say a quarter of the cohort are getting offers (DD knows only 2, one of which is GP) what happens to the rest. They either leave for Australia, or hang around in F3 type positions, or seek out temp work. DD worked alongside a great temp from the year above when on the busy rotation she most enjoyed. Though it was not one of the out and out competitive specialities, she did not get through this year, not even as far as an interview (something which shocked her colleagues) but has landed one of the two Fellow roles in that Deanery. The assumption of one in four of those leaving F2 first does not take account of the higher competition rates in specialities outside GP, psychiatry, acute care and internal medicine. Nor does it take account of the growing "blockage" from previous years. NHS Bank rates, a useful proxy for oversupply of unemployed doctors, have dropped sharply. The one in four ratio, probably an optimistic assumption, will be deteriorating. And someone who is in the top 25% of their cohort or higher ought to be capable of an NHS career especially if they are willing to work in an area where all too often recruitment, even at consultant level, is from overseas.

You talk about the non EU IMGs appear to be filling posts which UK graduates don’t seem to want. In DD's deanery English graduates will take up posts in really competitive specialities alongside non EU IMGs. The problem is that neither group are in it for the long haul. If something better comes up in England half way through their training they take it, leaving de facto an unfillable vacancy and more load on consultants and the rest of the team. And almost certainly once through their training they leave. (One of DD's superbright and focussed friends from London, after load of applications, has finally landed a job in an unpopular part of a non English deanery. She is taking it, even though it means a real career sacrifice for her fiance and a long commute for her. The plan is 2/3 years and then hope for a move, whilst from the Deanery/patient's perspective, someone committed to staying and who spoke the minority language of the area might be more valuable)

The big, big problem now is not the bottle neck on training places but the lack of alternative jobs. DD had always intended to get through F2 before focussing on a training application, having seen many teaching fellows at medical school do the same. Whether you applied and failed or whether you intended to take an F3, non training jobs are now hugely competitive. I think you said earlier that the NHS as a whole don't keep statistics on application rates. Anecdotally, jobs no longer protected by the Resident Market Labour Test are attracting hundreds, in some cases thousands of applicants. Seen from an F2 perspective, the NHS is choosing to import IMGs leaving them with the choice of leaving the profession, the UK or surviving on whatever NHS Bank shifts they can pick up in the hope that next time.they get through.

I often roll my eyes at the use of statistics on MN, in part because my background is economics. DD is lucky in that her brother is a postdoc economist/econometrician at a well known University, specialising in a relevant field. He is willing to work with DD to put together some research. So Sendsummer, if you know of anyone wanting a deep dive into this issue, the offer is on the table. 😊DD will be effectively unemployed from August so has the time.

This is not statistics just simple frequencies from a publicly available dataset which anybody can access. Agree that the percentage of successful applicants may be slightly lower but that will reflect unrealistic applications for the more competitive specialities. Regional differences are not available.

Whether the point system is appropriate is another matter. Positive testimonies of being a team player and good at the basic medical duties performed by FYs would be acquired by almost all so is a flawed metric. It is clear from the data (again available at the link I posted) that most successful applications for core training are between 2-4 years post graduation with a tail thereafter.

DDs plan had been to apply 2.5 years post Qualification. A fairly normal pattern.

The problem is the huge competition for entry level jobs. OK for those who can afford to take a Masters or are able to survive on NHS bank shifts. (Time back in the childhood bedroom?) But what about the rest.

The NHS and current immigration policies are creating their own shortages.

Are the criteria used for selection the right ones? The criteria gives advantage to those who have additional academic/research criteria. As competition builds, more and more of this is required (or that is the perception). At some point would it be better to agree that a certain level is sufficient and then start giving weight to other attributes. The F1/F2 who has been working 60 hours a week on the old contract, in a deanery with real deprivation and seriously strapped for resources, involved in procedures that elsewhere are restricted to those at senior registrar level and who has had lot of the hands on, carrying the bleep at night and coping with what comes up might get some credit for that

The following is somewhat repeating what has already been said (Positive testimonies of being a team player and good at the basic medical duties performed by FYs would be acquired by almost all so is a flawed metric).

We've heard a great deal about your DD's own particular experience and environment Needmoresleep but I do very genuinely think that what you lack is the perspective of F1s and F2s from other deaneries, absolutely including London. This seems to have set you up to believe that there's an either/ or in in relation to 'academic' and 'good doctor', when that's a false premise. The idea that London F1s and F2s don't have the same level of responsibilities and support (or lack of) as your DD is incorrect (of course this will vary across rotas and rotations in the nature of things). But the generalising from her experience is not at all helpful, either to you or to anyone else. You seem to genuinely believe that she's unusual in how much effort she's had to put in but if you could speak to enough F1s and F2s from London etc you would have a better understanding that the team playing and hours and level of responsibilities that you describe so often are actually not in the least unusual.

The idea that there's no real deprivation elsewhere is unsustainable, unfortunately. It's endemic across the UK along with all the related health issues that it brings in its wake. Your DD seems surprised by the levels of deprivation that she's encountered, but she shouldn't be.

I also think that the repetition of 'low impact' publications (several posts above) is rather mean spirited to the young doctors who have at least made the effort to get published. Better low impact than no effort in that direction at all. People have to start somewhere, usually.

It is always difficult on a thread where several expert professionals are posting. Experts may be right. All I am trying to do is question.

My observation is based, by default, on London and the Deanery DD works in., I fully appreciate that you and Sendsummer will have wider experience. But it does allow me to say that, in my observation, Londoners have better access to tertiary care.

And my posts are about the system, even if by necessity based, is based on DDs experience.

Of course I know about deprivation. I spent eight years fighting to save an important local resource, including questions in parliament and major funding bids. We were helped by the fact that at that time and under one measure our postcode was considered the most deprived in the UK, the local secondary was 93% FSM and the GP was seeing cases of scurvy. And DD's Deanery is not the only one facing the health problems of large scale poverty, alcoholism, shocking levels of drug addiction, and the impact of inter-generational trauma.

Bottom line is that where DD is working there are huge staff shortages, and ironically some of the biggest problems are with recruiting and retaining for training posts. At the same time there is a cohort who would like to stay but can't get jobs.

I am trying to explore why that might be.

One reason may be the difference in contracts. The English contract was revised in about 2015 to allow for more support and more time for professional development. I assume that it has led to more F2s being more prepared for specialist exams.

Another reason might be the greater exposure to teaching hospitals and tertiary referral centres, where more research is going on. I assume that makes it easier for F1/F2s to get involved in the sort of work that enhances their CV.

There may be others.

My biggest concern is that the fallback of taking time out in some sort of short term contract to really focus on an application, or simply because someone is not interested in being more than a house position, has largely disappeared. Because of changes in immigration law these posts are now attracting fierce competition from across the world. The backlog of doctors without permanent jobs, either training or otherwise is growing.

So we have competent people who want to work in hard to recruit areas who are forced to look overseas or find another profession. Yet at the same time we have doctor shortages because people don't want to train in hard to recruit areas, and if recruited for either training or staff jobs, from either England or elsewhere in the world, tend not to stay.

Perhaps the NHS is getting everything right and that this is the way to deliver an effective balanced work force for the future. However in some parts of the country where waits lists can stretch into infinity and dedicated senior staff from the area are resigning to work outside the UK, it really does not look like it.

And interesting, as I posted above that BAPIO seem to have done a reverse ferret and are now admitting that unemployed British medical graduates are not good for the NHS or for the reputation of British medical schools. Rather than push for on going access to the UK job market they seem to have switched to wanting to grandfather the rights of those already here, and for better career prospects (all jobs to be considered training jobs) for them.

(DD will be OK. She wanted to do it on her own but accepts now that once she has given temping, then perhaps Australia a good shot, she has the option of gap year, childhood bedroom, Masters degree supplemented by bank work - where London really does have an advantage - and a very focussed go at an application. Where you and Sendsummer should worry is that her peers don't have the same options and could end up being lost to the NHS.)

Plenty of your DD's peers probably do have the same sorts of options tbh:

https://www.theguardian.com/society/2025/feb/27/only-5-of-uk-medical-school-entrants-are-working-class-data-shows

My last contribution was not quibbling about tertiary care but about the fact that you do seem to think your DD's hours and effort are exceptional, when in fact to me they sound fairly standard. A lot of young doctors find the coal face hard work after the relative cushioning of uni and a lot of parents seem concerned on their behalf. But it's a fairly shared experience as pp has said.

What led your DD to believe that she would have uniquely enriching foundation years in her current deanery?

Mines just come off a 7 day set of shifts totalling 78 hours. Rota was for 60 but staff shortages as usual scuppered that plan. Not unusual, neither have been the nights from first rotation (someone said F1s don’t do nights in London, but they do elsewhere). No one thinks it’s unusual, I just think it’s wrong that after doing this, while studying for exams, many of her friends still have no job come August. Only 52% of F2s have anything lined up for 5 weeks time. Not through merit, but because off lack of money and workforce planning.

As for working class students I’m very proud of the work done over the last few years to expand access. But studying medicine is expensive and unless know how to access bursaries and grants it can be off putting, if no bank of mum and dad on stand by. There are now more free UCAT courses and interview prep sessions available which will help, but it’s just not an attractive career to many bright, poor kids. They can earn more money, much easier elsewhere. Vocational jobs are the luxury of the wealthy these days.

NHS leaders (I believe a few are on here) need to be held accountable for the total shambles the NHS has become. In 2012 it was voted the best medical system in the world. In 13 years it has been destroyed. What a legacy to leave behind you.

Some London hospitals have F1s doing nights, others don't. By F2 they all do nights in London.

I haven't clocked any poster claiming to be an NHS 'leader' on these threads. Which posters are these? If they're declared their hand they can't object to being named. A number of consultants have detailed their level of experience, when taking issue with some (much?) of what has been said: perhaps those are the 'leaders' that you're referring to? (slightly odd terminology that's all).

mumsneedwine there are a lot of people I know personally who are involved in widening participation. It's a team effort across schools and unis - it amuses me that you almost always use the singular first-person pronouns when you refer to students from your own school getting into medical school (at least, I can't recall an instance when you used the plural). In any event. my link to the Guardian was directed to Needmoresleep who observed that a great many medical students won't have the financial support that her own DD does. It wasn't about anyone's efforts in relation to widening participation.

The inability to not insult and demean seems to be beyond the scope of some in the NHS leadership. To deliberately misconstrue just to be unkind. A ‘strange’ trait in an NHS leader ?

I must know lots of people you know and assume the conference in Glasgow was as enlightening to them as it was for me. Some fantastic work being done all over the country by lots of people and we all shared lovely success stories. It’s takes a village and all that.

Enjoy the sunshine.

Oh good. I'm glad you found it useful, even with disruptions on Avanti West Coast. I didn't really understand why you seemed confused about Glasgow when I first made a reference to it a while back. Obviously worth the journey.

Just waiting for Wimbledon to start tbh. I've had more than enough sun today. Might go back into it this evening.

I flew 😂

The BA flights were incredibly expensive that weekend - that must have cost the school many hundreds of pounds.

Just musing about cost while watching the start of the second set 😂Not sure a lot of Business Managers would be thrilled with that.

You really don’t know how to be nice do you. It’s like a disease.

Why would a school pay ? Cost £89 return. Booked months ago.

V v weird to know where I flew from and how much flights were on a random weekend. Strange thing for a NHS Manager to be worrying about 🤷‍♀️.

At one point that week Avanti was cancelled completely north of Carlisle and easyJet was sold out. Literally nothing available. The cheapest BA flight was £400 plus. For people needing to go north of Carlisle and travelling from London this was a very, very difficult week. My knowledge of the travel problems has absolutely nothing to do with you; it has to do with needing to know these things for people I was advising that week.