To cut through this medical debate.
Medicine is a great career. Working for the NHS is not. The levels of inefficiency, vested interests and lack of workplace planning is shocking.
This August DD was among the 50% of her year group finishing Foundation without jobs to go to. Over 10,000 of them. (That excludes those who had left the profession or who had already found work overseas.)
In total the UK had about 5,000 training places (including GP) on offer but over 50% went to applicants from overseas. So about a 10% chance of getting onto training if you don't count the backlog of those still trying from previous years. The competition is seriously intense so you both need to do well in the exams, and in the lottery that is the Situational Judgement paper, but also gain "points" with add-ons like research, competition prizes or additional qualifications. Really hard to do if you are in a hard-to-recruit deanery with no research going on. (Health is devolved and F1/F2 contracts are different across the UK. Selection for training is national. Those on the English contract actually get personal development time to help them prepare. Elsewhere even required training often happens in your own time.) It also helps if you come from a medical family or have access to networks that enable you to be part of research projects. The alternative is to buy the additional CV enhancements. One SHO told DD that his family had spend £20,000 ensuring he had the published research and competition prizes needed to to help him be selected for UK training. You look at the boxes that need to be ticked and ensure you tick them. Coming to the UK for training then opens the door to good, and well paid, consultancy level jobs in places like Dubai and Singapore.
The real issue is that the UK is pretty unique in not offering resident priority for health care jobs. In most countries you can only get a visa to employ an overseas applicant if there is no suitable local applicant. In the UK the job must go to the best qualified applicant, wherever they are in the world. This is supposed to ensure we can recruit the best staff. So entry level staff positions are spammed by hundreds of applications organised by overseas agencies, with at least some candidates likely to have the additional experience/qualifications that a newly qualified UK doctor does not have. Nor does the UK doctor, who does not have this type of agency support, have the time to apply for hundreds of jobs after busy shifts.
DD is currently locuming. No work at all for six weeks, but the agency told her not to worry. Most jobs start in August. By September people start leaving either because they don't like the UK or find a job somewhere they prefer, or because they are not good enough and have been let go. She had strong references so, assuming a "good" flu season, she would soon be in work.
True enough. Bizarrely she has wound up covering long term sick for a Associate Speciality Doctor, ie someone with decades of experience who is at the top of the tree for those not going down the training route, the equivalent of a consultant. Apart from a part-timer, DD is on her own with a ward of about 25 very sick and unstable patients and with a group of first year doctors to train and supervise. With just two year experience herself. No sick leave, no obvious way to book annual leave, no support or training - just get on with it. She probably earns half of what the post holder earns. It started with a one month contract. The agency told her not to worry. Yes the month had run out but she should keep going in until the NHS either stopped paying her or told her to go away. In fact her contract has just been renewed for the fifth time. DD thinks she is doing a good job but there is no feedback on whether she is doing well or where she could improve. Just a text from the agency confirming the NHS want her to stay. They did not even invite her to the Doctors Christmas lunch. (Which the nurses found very funny. DD is the fifth locum in the position but the only one to be kept on. Luckily they are very competent, and seem to appreciate her.)
Her friend, in contrast, is locuming in the world's most boring job. Some sort of community hospital where they need a doctor on hand and to write discharge notes.
In practice both could probably stay for as long as they want in their respective roles, but don't want to. Zero hours, not great pay, a long commute, and no career prospects. DD is becoming exhausted. It is the sort of role where she needs to have conversations about resuscitation (DNR) on a daily basis, and crises happen through the day so delayed lunches or unpaid overtime are the norm. She is resilient but burnout is looming. She can't really take more than a day or so off, as getting a locum in as a short term replacement for a locum already on a short term contract is unlikely. She is trying to manage first year doctors but without experience or training. And if she did burn out she gets no sick leave or support. Her next role might be no better. You don't get to choose. The agency puts you forward for jobs, in multiple places, in multiple specialities. It is luck what you get, and you can't afford to turn any job down.
Demotivation is endemic. Streeting talks about NHS productivity falling. Does he not realise that if you fail to provide 90% of doctors with a career path, a regular job, or even acknowledgement of their contribution, you end up with a demotivated workforce. Some overseas trained doctors are good, some are worrying weak. The same applies to UK trained doctors. The training career path takes no note of ability, experience or references. Just exam performance and add-ons like research. Yes perhaps we need the best of the best from across the world to be our future consultants (if they choose to stay...). But we also need to value and reward those who are hands-on, dedicated and capable, especially those willing to work in busy hard-to-recruit places.
The NHS is still bringing in armies of doctors in from overseas. This is almost certainly saving money as it has created a hidden army of under-employed, relatively low paid doctors living from one short term contract to another. Some will be those whose initial contracts have come to an end, but increasing numbers have been through UK medical schools. (One Cambridge graduate we know is in a similar position. He locumed for a year, then got a year long fellowship in his preferred speciality at a London teaching hospital. Unfortunately he did not get into training and budget cuts meant that the role he hoped to move onto was cancelled so has been forced to take a short term contract abroad.)
DD is lucky. She has a great job in Australia to look forward to. A year's rotational contract in a major hospital group in a state capital in her preferred speciality. Seven out of the 11 are Australian, the remainder are Brits. She knows seven from her deanery and six from her medical school all headed to the same hospital in the same city. More than she knows who got onto to UK training in any speciality anywhere in the UK. Within the year her deanery stand to lose 25% of her year group to Australia alone. As well as the tremendous waste of tax payer money, this approach to work force planning may be keeping the NHS going in the short term, but suggests disaster in the medium to long term.
If she does well she can apply for specialist training after a year. Unfortunately that then risks a bit of a one-way journey as, apparently due to BMA opposition, we do not recognise Australian qualifications, even though the training is practically identical. Returnees have to spend years of applying for equivalency. So same-old, same-old. If she wanted to come back she could not be appointed to an NHS role but, because we are short of consultants, there will probably be a locum job somewhere.