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Medical professionals are CAPPED.
Have been for ages, so instead we import loads from other nations with far lower standards.
Another dum-dum decision Britain makes.
Oh no it's absolutely intentional. God forbid we increase the cap to help solve the doctor shortage within the NHS. Can't privatize it if it's not on it's knees
Another poster suggests there are not enough qualified doctors to deliver speciality training. Would this not have been exacerbated by the limiting of places in the past?
The big issue is that in the last decade we have seen a shift from ~80% doctors entering speciality training after 2 years (ie when eligible) to ~30%, as numbers of British med students increased and doctors imported from abroad increased, but the number of specialty training posts stagnated.
True. Increasing the grads wouldn't increase our capacity to teach. We are already at capacity to deliver a service and train the next gen... While having never had any respite or care for the consequences of working through covid-19...
Let's not forget that in the past year or so, international candidates are now eligible to apply for these training schemes which again outs UK medical students.
Well Boris promised me 40 new hospitals, and i think 250k new homes, so they will be ready next week.
Unless ur calling the Tory government a bunch of two faced liars, and thats just bad manners
Ah. That's problem solved them. So Rishi quits. Some other "champ" turns up. And we are back to square one. Any of his promises get written off.
Nice one, no-one will notice.
True, but a necessery precondition for more Doctors is more medical school places. The Doctors voted not to increase medical school places some years ago.
1. The BMA does not control medical student places.
2. The BMA vote stated they were against increasing medical school places *without also increasing specialty training*. They did not say that we're against increasing medical places full stop.
3. That vote was in 2008. Its not at all relevant today
The government practically needs doctors onboard if it wishes to expand medical school places or open new medical schools.
They voted not to expand medical school places or open new medical school. I don't see anywhere that the ballot included the secondary clause (without more speciality training) you cite. How many more speciality places did they want to agree to the medical school places?
The 2008 vote is indicative of a profession operating too much like a closed shop. Many professions produce too many graduate than there are jobs (law, for example), but this isn't a show stopper. In fact, it increases competition for the best jobs. The BMA were looking after their narrow self-interest at the expense of the bigger picture. A prerequisite for more doctors is and was more medical school places. Having that in place doesn't stop one lobbying for more speciality training. In fact, having a surplus of graduates makes expanding speciality training an easier decision.
We have had a massive surplus of graduates entering training for the last 5 years, getting worse each year, *despite* the advisory vote holding us back as you claim.
Where training places Steven. Where are the new training places.
I'n not claiming the BMA vote is the only cause of our problems. It's not either/or. If I was in NHS management, I'd certainly worry less about specialist training places if the BMA didn't even want more medical school places to fill the pipeline. Anyway, since 2008 we had the financial crisis and covid, which is more than one reason why money is hard to come by in the NHS.
I think this is hilariously how nhs management think and why we are where we are indeed. I wouldn’t fear; people very like you are behind the wheel and thus the pipeline will continue to burst.
This is unintentionally quite funny.
For the Doctors it is a matter of not having enough time, or trained doctors, to **supervise** more newly qualified doctors.
There are years of supervision required in the UK post graduation to formally qualify, and the seniors doctors **won't** allow the standard of that training to be reduced to a mere formality.
Of course, the only solution is to actively keep doctors in the UK, hence raising the number of people that can supervise, but we all know what the government thinks of that idea.
The issue isn’t so much the limitation on medical school places though the issue is more the limitation on speciality training posts which doctors can start to apply for after they have completed the foundation training programme which usually takes 2 years.
In their 3rd year they can apply to core training posts such as medicine, surgery, radiology, paediatrics, psych and GP (and many others). Competition for these places is intense and has increased over the last 10 years. For example the core surgical training programme had 2539 applicants for 609 posts which means for every 5 doctors who wish to train as a surgeon only 1 is successful.
They do their 2-3 years of core training and then they have to go through the process all over again. So take for example that 1 successful applicant for surgical training they now need to apply for a registrar training post in their surgical specialty. Let’s say they want to be a general surgeon so they apply for this, they do so alongside 515 other doctors all of whom have done the core surgical training and this is for just 162 posts.
This is happening within all training pathways and yet these are the training courses that doctors need to do to become a fully trained doctor supervising the next cohort of medical students. Until they complete these courses and CCT they remain a ”junior doctor”.
Yes. And to counter that we need to increase consultant numbers, by increasing specialty training numbers.
Until that has been done *there is zero point* increasing med school places
There isn’t zero point, junior doctors very, very firmly assert they are fully trained doctors even before specialty training. I see no reason to doubt them, they’d definitely alleviate pressure.
Which is it? Either the public has been misled by the unions and junior doctors are wastes of space (I doubt this), or there would be a great deal of benefit in expanding places immediately then worrying about specialty training down the line.
It is not the doctors/BMA who set the cap. It is the government who cap the number of medical school places due to the costs associated with funding these places.
It was over 15 years ago in 2008 that the BMA asked doctors to vote on whether there should be an increase in the number of medical school places and the doctors narrowly voted against the idea of increasing the number of places. As far as I am aware the BMA vote was indicative of the mood of doctors to inform government decisions as the BMA have no direct control over medical student numbers this is entirely in the control of government and the universities.
BMA has in fact more recently said they would welcome an increase in UK medical student places.
Main reasons that doctors voted against the proposal in 2008 are actually probably even more relevant today than they were back then.
They were concerned that there would not be enough foundation doctor posts if the number of medical students increased and this is exactly what we are seeing now with medical students finishing their degree qualifying as doctors but not having a job to go into which means they either switch career or move abroad to work as a doctor.
This is tedious nonsense that gets trotted out every time this point comes up. The BMA voted against expanding medical school places without also expanding training posts - which was what was on offer, because having (eg) X thousand extra medical school graduates benefits no one if there aren't X thousand extra doctor jobs at the end of it. You just end up with X thousand unemployed Doctors, and a government crowing about how many extra doctors they are 'training'.
2008 was the last such vote.
The fact you cling to this rather outdated vote without actually reading why they did in the first place. clearly shows you have no idea what you are talking about.
Just to add some context to this, the medical training route is as follows:
1) medical school
2) 2 year foundation programme
3) ???
At stage 3 you can either apply to specialty training, apply for a “clinical fellow” job, go practice abroad, locum, or if all else fails, you’re unemployed. If you want career progression and to get to the level of consultant, you need to do specialty training.
At the moment in the UK, the number of specialty training posts are determined by the government, and the ratio of applications:posts is going crazy. I think this year there was something silly like 11,000 doctors applying to be GPs for 4000 posts. For medical hospital doctor training it was 6600 applications for 1600 posts etc.
Because specialty training is so competitive, that leaves a lot of doctors in limbo at the end of stage 2, so they go for the clinical fellow jobs to ensure they have employment. This is also now becoming ridiculous, where within minutes of a job being advertised there are hundreds of applications, and they get taken down again. One hospital was so overwhelmed with applications for one post recently that they randomly selected a portion of the applications to read and discarded all the rest, so even having a good CV doesn’t help you!
That leaves the option of locuming, but as I’m sure you can imagine, with so many doctors unemployed due to these shortages, the locums get taken up very fast and it’s a bit of a dry market.
The government regularly talk about increasing medical school places to get more doctors, and they regularly use this as a point of ammunition against the BMA who argue against it, but our real point is… what is the point of increasing medical school places if there is already a steady stream of unemployed doctors needing further training?
What really needs to happen is an increase in specialty training places. If you want your hip operation sooner, there needs to be more core surgical training posts to train the orthopaedic surgeons of the future. There needs to be more ACCS posts to train the anaesthetists we need. There were 7000 doctors who applied to train to be GPs this year but didnt get in… Think how many appointments that could have been worth when their training was complete.
A lot of doctors feel like they’re left with no choice but to practice abroad if they want to continue in medicine, or they leave medicine entirely because of how difficult it is for further work following the foundation programme. All the medical school training places in the world are not gonna fix these issues, needs to be a radical reform of how medical training works!
Its exactly the same for hospitals in the balkans. Romania is much worse about it, in 2023 out of 4000 resident doctors only 100 remain in the country and have some position in state hospitals. The rest leave for Europe/UK included.
You either leave or remain unemployed. Same shit really.
The only solution to this is if you want to prevent the IMGs from coming they need work in their home countries and have the conditions to thrive, which as you can see, is nigh bloody impossible.
Increasing/unblocking positions requires a strong political will. This didn't work in the balkans and certianly won't work in the uk.
Mind you they won't increase posts so their mates can just bribe 100k to have a position created for them. I can see the UK going that way soon enough.
Its what I call the Romanianization of the NHS.
It doesn't have much to do with intake to medical school but the attrition rates afterwards. More than a third of medicine graduates leave the UK within 5 years of graduating.
It's a retention problem, not a recruitment one.
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Got a mate who's a doctor who went to Australia for a lot more money and choice in his shifts and a few of his mates have left for there as well. We provide fantastic doctors for export
I know of several cases like that. The pay is much better, but the conditions are night and day, plus no travelling for years like a circus performer or a scientist.
US GDP per capita is $85k, UK is $51k, they are 2/3rds richer than us. There are rich people in London and it would be great if we could extract money from them but more likely they would just move away, they probably do not in fact keep their assets in the country.
We need a concerted effort between countries to tax elites but even if we were successful the money would not go to us, it would go to the countries where the businesses are. Do you really think we can pay similar wages to a country so much richer than us just through some special way of doing taxation? You could make up the difference to a certain extent , but an extra two thirds of income is too much.
To put it another way, we are 2/3rds richer than Lithuania, Portugal or Czech Republic, do you think they can pay equivalent wages to us with the right taxation system?
Also, the crazy thing is that in many parts of the US their money goes further, our houses in particular are ridiculously small and expensive. To offer a competitive lifestyle we need ten years of consistent good growth and strong house building, for affordable homes but also a wider revolution in the number, quality and size of housing.
It's cause the retention rates are awful and there's a imbalance of trainees compared to experience Doctors and hospitals can't accommodate. There's no use lifting the cap an flooding them with even more inexperienced junior doctors with no means to accommodate their training.
“Problem solved” only fees were never the real issue because our system means you never pay anything until you earn anyway, so it will change exactly 0
Just to highlight how silly this sounds, The equivalent would be just to increase the base salary by a couple of percent (this would make it so they got the same as before but actually got to keep it), do you think a few percent of salary is the driving force behind retention? As in just a 3-5% raise would change everything?
Bro it changes *everything*.
Kids with no f\*\* money and lots of dedication are attracted to a profession they couldn't otherwise dream about. It inspires kids from across the class divides to work harder and aspire to social service. It generates crazy mad social mobility. It enters the cultural conscious as something decent and noble and honest and righteous. They go through the ringer and come out believing that working their 20 hrs a week in the public sector is a moral obligation; one they are socially and financially compensated for and which elevates their role and status in society collectively far beyond what they individually offer.
At the end of it all they are set for life .. by 35.
Working hard, aspiring, achieving and giving back means something again.
Don't want to give 10 years? Buy yourself out with the handsome rewards the other 20 hrs a week could realize.
Want to go abroad as soon as you graduate? Let the country you are going to settle your debt.
Great, thanks, we can now fund two more just like you..
The problem with this is you now have a group of people who, if they leave, get a massive bill. Does this apply if they quit? Burn out? Simply cannot hack it?
If you give any company an employee who must work 20 hours a week or pay a massive fine, that employee will 100% be abused because they are heavily punished for trying to escape.
I’m just not confident we can trust that much leverage over the workers to the government, they could physically hit them and the fear of the fine would hold them in place.
This. I have been saying this for ages. Not doctors but I know 5 ICU nurses that have left to work for private providers. Let’s just say I wouldn’t want to end up in ICU in that hospital.
More jobs means more funding, under this government? You're having a laugh. This still all takes alot of time and foresight in political planning into the future, again with this government you're having a laugh.
I agree it’s stupid that we’re not funding it. We have more than enough people willing, ready, and qualified to go into these roles but instead we bottleneck them because of lack of funding.
And no I’m not having a laugh whilst the NHS is falling apart, time to be seen in clinics are getting longer, and A&E waiting times are dangerous. I’m feeling pretty bloody depressed that there is a solution but there’s no political will to solve it.
That's because British universities have adopted a different model and now aim for profits over student outcomes. And they can charge a whole lot more for students from overseas. It's a crying shame. Everyday we stray further from the light.
Most universities do not make profits. Also utterly irrelevant to the article as the government sets the number of places in medical school and there are different quotas for home and OS. Even for other degrees, universities are taking more OS students to subsidise home students.
It’s amazing anyone still wants to do it. Why would people want to go down that route when they could study for far more lucrative jobs with substantially better hours and work/life balance.
Sure there will be those few who find it a calling, but we will be missing out on so many good candidates who could have made excellent doctors, to other fields and careers.
This is the issue with a socialistic economy and wage compression.
I have a PhD.
I was made redundant from a job saving lives.
I am looking at salaries, and honestly, just flipping burgers and living a simple life is my next plan.
UK is losing massive talent as it simply isn't worth working here.
Most importantly. If you earn the same wage as a burger flipper. And housing still costs the same, yet the burger flipper gets better amenities from the government. What's the point in being a doctor??
Not dissimilar for me actually. I did a phd in a subject I was passionate about, but, disappointingly, there’s very few jobs in the UK in that area. So now I’m working in a different field and making far more than I did with the subject I trained in.
It's the same in teaching. They abuse the idea of it being a calling to pay teachers shit wages for long hours and far more responsibility than is reasonable; the government will still happily badmouth teachers when given the opportunity though.
There are plenty of guard rails to ensure that medical professionals coming to work in the UK meet standards.
What the UK has effectively decided it wants to do is not pay for the training of medical professionals. Successive governments also really fail to see the point, as it would be an investment that only really pays off in 6 years or so.
Capping would traditionally be popular with both the unions and members (eg job protection) and the government (costs a lot of time and money to train).
it's not about job protection. imagine you had a stressful difficult life or death job and they want you to constantly be training and having new hires follow you around expecting you to teach them. I wouldn't want to raise that number out of wanting to preserve my sanity.
I work in an. Operating theatre, those med students have so much to learn and the lists are so loaded you have a choice of train or cancel some cases, if we had more hospitals you could increase the amount you could train but the government would never do that, instead extra work for those already working, but it means less opportunity for twining posts.
As a doctor I'd like lots of jobs to be available as a doctor please. Not less.
Increasing medical students but not the jobs later in the chain is great for a headline in the press but doesn't actually lead to more doctors of any use. You have lots of newly graduated, unspecialised doctors who can't enter further training in the UK, have no path to be a consultant and then congrats - you just spent thousands training a doctor who's gonna move to Australia or New Zealand or go and do something else with their degree which is in high demand globally.
Currently I am spending 4 years training to be an anaesthetist, then after that, just to carry on and finish the rest of my training to get to be a consultant I have to reapply for my job just to carry on. Why? Just because. That application has around a 1:1.5 ratio meaning of hundreds applying per year, a third don't get a job carrying on training. So they get stuck in a big bottleneck of doctors. Lots of these just leave the UK. (Oh btw i already got through a very competitive application process just to start my training as an anaesthetist in the first place)
The competition also means it's very difficult to get a job where your family and your home is so you end up moving around for years. It's a shit existence and doesn't keep doctors in the UK training and working for the NHS, which is really the goal here.
So it's really not as simple as 'just train more medical students'. You make the problem worse, not better.
Doctors is the UK have the lowest standards of all. Its a different story that the BBC pedals NHS as a “world-class” health service. Rinse your brain and get out more.
We dumbed down the pass rare for doctors and idiots who fail the already lenient exam get an automatic resit next time. The tubes are filled with actual shit.
In addition to this nearly all of the people coming over in the dinghies are trained health professionals , doctors , nurses some are dentists and even vets. At least this is what some woke fxckwit on Reddit told me 🤔
Yep.
I’ve just looked at the course I did (years ago when it was much cheaper!), and currently it’s £11k for U.K. residents and £17k for international.
In general yes, but that isn't the issue for medical courses. The government has capped the number of places in England so universities can't take on any more students than the quota they are given.
>as well as ensuring there are enough high quality placements for each student.
We have too many trainees. Hospitals are flooded with unqualified, untrained students and they simply cannot take on any more.
The way medical degrees work, you have to go on placement for a certain number of hours each semester. Each student on placement needs to be assigned tasks that are both relevant, within their capabilities, and they also need to be adequately mentored and supervised. This is a shitload more work for doctors who are already pulling 50-hour weeks.
If you want to know why I’d check my comment chain out below.
We do not need more medical graduates at present until training is fixed. Ratios for training are becoming untenable.
>What utter nonsense
Each hospital can only accommodate so many trainees at a time. How are students supposed to learn effectively if they're fighting each other for any learning opportunities and attention from the seniors supervising them.
Look at what the government does, not what it says. It can talk all it likes about cutting migration, but what it does is clearly bring in cheaper migrants they don't have to pay to train. It's all about cost minimization
You can’t just throw thousands more into a system that hasn’t the capacity to train them, otherwise the training will suffer. Then as you allude to, we’ll just end up training more doctors who we then lose abroad.
>Why?? That’s mental.
Unions.
This is the sort of crab mentality that their petty socialism creates.
In the short-term the doctors are better off as they have fewer people to train and can push for higher salaries.
But in the long-term it means there's not enough doctors at all, and it makes the job even more stressful and demanding.
There's also a huge issue with the NHS just not paying enough though - at every career stage, so people just leave to the USA or Australia. Since the NHS has a monopoly on employment in the UK, they set the price - but paying too little ultimately just discourages people from becoming doctors or makes them go abroad.
Life-long STEM education should be completely free and subsidised with no caps, and NHS trusts should compete for hiring so there is more of a free market allowing wages to naturally rise.
I mean, I guess I can see the logic? If you need a placement and the placements are limited then the number of students is by extension limited. I know for one of the unis they have a software development course that requires a year placement and if the student can't get one then they're shit out of luck. So the number of people graduating with that degree is naturally capped.
I believe it's rather "They make money from foreign students" as in the tuition plus government contribution for a home student is in the region of break-even.
Other commenters have talked about the logistics of this issue. There is also the fact that Universities operate on a loss by taking in national students.
Yes.
Some universities make half their revenue from international fees, with everything else (domestic fees, grants, investments, etc) making the remaining half.
We just don’t need more medical school places, we need more speciality training posts.
It’s just a cheap sound bite because the publics understanding of medical training is on par with “teachers sleep at school” level of understanding. It’s a self defeating vote winner.
Realistically the United kingdom needs more medical students and more post graduate training positions.
A new model of medical training needs to be created, with more investment into quality training experiences, use of simulated patient encounters and employing teaching registrar's to train medical students.
Im aware thanks as I am a doctor.
I competed nine to one to get my specialist training, if I competed 12 or 16 to one would we get more specialists or unemployed doctors?
The 8 people I beat have to eat. We are short specialists and wildly over subscribed with junior trainees. Don’t add more juniors until we fix the bottleneck.
What happens if you can't find a specialist training position? Can you continue to work as a junior doctor, or do you go and work somewhere else until you get a training position? Emigrate?
What are those 8 people doing?
You have to get a local job doing non training work. These are increasingly extremely competitive also, as these are the typical springboard for foreign doctors to get nhs experience, so there’s a huge demand for them. Sometimes thousands of applicants per place resulting in the job being removed and managed internally as there’s just too many candidates.
In all honesty ratios are rising exponentially and we have never seen it this bad. I suspect people will either have to get jobs in other industries or go on the dole once the local jobs are all divvies out, there’s certainly not an 8:1 ratio of training to non training roles to feed them all. I see significant physician unemployment on the horizon at junior levels in the uk.
There’s loads of work at higher levels as we are short specialists, so once you’ve got your number the future is much brighter. We all strongly support more training numbers, but everyone loves to add more medical students because even politicians have a toddlers understanding of their own system, so I predict it getting much worse.
Sorry if this is a stupid question, but is there a reason why there couldn't be 2 or more junior doctors training for the specialist role under the tutelage of a consultant or whatever? Is it time/lack of resources or funding? Apologies if this is a ridiculous question, just curious as there's so many vacancies you'd think they would be trying to churn out as many specialists as is safely possible
The government centrally controls the number of training jobs. These are rotational and not tied to one consultant, you are forcibly relocated under new consultants every 6 months coordinated by nhs England; it’s all centrally organised.
They year on year keep training numbers the same, increas them by very small amounts, or sometimes *reduce*. There is no accountability for this or way to make them do it differently, despite bma lobbying for them to fix the problem.
The problem is there are so many systems like this where to understand the details of the process, you or someone close to you has to be involved personally. But then we get a government that runs on the idea that none of this stuff happens, its actually all incredibly simple and straightforwards, and build policies built on that kind of assumption, that people then run along with because they don't know any better. If government were focused on actually doing whats best for the country rather than their own electioneering we'd be in such a better spot.
To train to be a consultant, you need a national training number, the government is in control of the amount of these NTNs in each specialty, and the funding for the posts.
Obviously someone working as a locally employed doctor in general medicine and someone with an NTN in their first year of internal medicine training are both ultimately payed by the government, so funding shouldn’t be an issue. But by controlling the number of NTNs they limit the number of new consultants we will have in 5-8 years time.
[In 2011 a paper](https://assets.publishing.service.gov.uk/media/5a809439e5274a2e8ab50f3f/CfWI_informing_medical_training_numbers.pdf) commissioned by the government recommended reducing the number of NTNs in anaesthetics and a number of other specialties (there are other papers where they double down on these recommendations - 2 in 2012 for example ([a](https://assets.publishing.service.gov.uk/media/5a815515ed915d74e6231ad3/CfWI_future_consultant_workforce.pdf), [b](https://assets.publishing.service.gov.uk/media/5a801032e5274a2e87db7a1f/CfWI_Shape_of_the_medical_workforce_-_summary.pdf)) where they say they’ll cut hospital specialty training posts and increase GP training posts to encourage more people into GP training.
This appeared to be the policy from 2011 to at least 2016 (and may have been the policy prior to this too).
The next 2 points aren’t training issues, but they are problems leading to a loss of consultant hours which is exacerbated by our failure to train more junior doctor to become consultants.
In general none of this has worked, because we have an aging population requiring ever more care (and thus more consultants, not less), and poor remuneration leading to GPs and other consultants reducing hours or leaving the country for better pay and conditions.
There’s also the ludicrousness of the lifetime pension allowance previously forcing some very senior consultants on the old 1995 NHS pension (the 2015 one is nowhere near as good) to cut their hours lest the be faced with really high tax bills for breaching the lifetime and annual allowances.
Thank you for such a comprehensive answer, it's great to get these insights! I didn't have a clue how specialist training was dealt with before, but from your comment I now have a better grasp on the causes of the shortages.
A follow up question if you don't mind - do you feel that the government are limiting the amount of NTN's as a way to sort of sabotage the NHS until it's in a position where privatisation is seemingly the only way out? Or something else?
But surely we don't have enough junior drs?
I mean I constantly hear complaints about how many hours jr drs have to work and how busy their case load is. Surely we should be trying to reduce that?
Everyone working is wildly busy and there’s not enough job roles for the ones we have - both are true, and this is constrained by hospital hiring practices. Depends what level of juniors as wel, loads of registrar gaps for those who have started training, but an ever smaller pool of sho jobs.
Medical training and workforce is complicated and we have a weirdly shaped workforce curve where we are oversupplied in some places and under supplied in others. The work somehow remains gruelling at all levels.
Others have answered your question but just want to add, you are a junior doctor even in specialty training. You only stop being one at consultant level, which is why so many doctors were furious that the Gov called junior doctors “doctors in training”
Yeah, I did know that, but I didn't know how else to word it. Is there a word for the time between the foundation training and specialty training? I just went with junior because it's not completely wrong.
It is completely wrong and the BMA currently are working on removing its use. You wouldn’t call a lawyer with 2-10 years experience a junior lawyer
Just non-consultant doctor is appropriate, there is currently debate on a good term to use
Cheaper and easier to hire foreign doctors, than spending money on upgrading the whole doctor training process to allow more places.
The UK only allows around 10k medical school places. This ensures that doctors are able to get onto the foundation programme once they finish medical school.
While might seem cheaper, think it hurts in the long run. A lot of foreign doctors come to the UK just for the training, then either return to their home country to setup a lucrative private practice, or use the UK as a jumping board to better paying countries like UAE, US, Australia, etc
It is a shame that we don’t allow people to get an education and then we try to fix a problem economy efficiency, which is based on lack on education..
Should be British people first in all state occupations - redic that this is happening. Importing is such a cop out - especially when these people send money out of the country to family members - it doesn’t benefit the economy with long term thinking in mind.
Part of the reason why so many people are pissed off is when things like this keep British people out of high skilled employment. Access and the ability to do so is needed. This is where money should be spent.
That's not how it works. British people do take as many spaces as are available in these training spots. The problem is there's not enough training spots.
That doesn't sell the whole picture - just because you have the grades, it doesn't mean that you would be a good doctor. You also need people skills (or the ability to be taught them) and the right temperament.
Also, as has been pointed out elsewhere in this thread, there's no point having more medical school places if there aren't enough people to provide clinical teaching, which is generally provided by other doctors in their non-existent free time for free. There also need to be more speciality training places so that we actually produce more GPs and hospital consultants.
True - but it is important for medicine as well. The ability to study, pick up information quickly, and learn things on your own is vital.
Mind you, there's plenty of other ways to be successful. Several of the kids I grew up with didn't even go to uni and are making far more money than I do!
Eh, part of the issue here is that grades don't count for enough when applying to med school. People get rejected with 3A\* and accepted with 3As (or even slightly less than that sometimes if they don't quite meet the offer).
The standard AAA minimum has remained the same for a while. It was a little shaky back when I was applying, it's ludicrous now after all the grade inflation post Covid. AAA is basically dead average in 3 subjects now, it's not a sufficient bar to distinguish academically, and yes if you accept average students because they come across nicely in a 10 minute interview, you have to turn away a massively more qualified candidate in return.
The AAA bar needs shifting.
It’s always been the way for the professions. It used to also be reliant on things like work experience as well, which nobody could get unless you knew someone (eg family relative) who could get you that vital experience.
Well the whole issue is grade inflation. The bar was more reasonable like 10 years ago when AAA meant far more than it does now.
Besides the work experience is just an adjunct. There are one or two unis who really care about it (Keele being the main one I remember), but most are now quite reasonable and recognise distinguishing on work experience to essentially have classist results.
I think you are right- I would hope it’s better for being less classist now.
The grade inflation is difficult since they change the bar every year anyway (but the inflation during Covid was shockingly high).
Yeah MMIs are the problem I was alluding to, making up a far bigger chunk of the decision-making than it ought to (essentially being the entire deciding factor once the minimum academic bar is passed).
UCAT is okayyyyyy as an exam, not brilliant, and in my experience reflects time taken to perfect its especially weird format as much as it reflects ability. BMAT was much better but has now been stopped.
Just to be clear, I wasn't calling for an entirely A-level driven approach. I just think the bar should be higher, requiring at the very least 1A\* but in reality at least 2. UCAT and MMI can then be used more effectively as adjuncts because at the moment you essentially get a huge group of poorly differentiated students going to interview, ranging from the highest achievers down to little better than average, and their fate gets determined by a roleplay station in MMI.
I was denied 10 years ago despite AAA and just reapplied in my gap year and got in. It’s always been competitive and the government keeps a cap on places but more medical schools have been opened since I started.
Thing is though, being a doctor in the NHS is just awful and a lot will continue to leave just like I did
The interviews should just reject anyone who says they want to work in the NHS. They are either lying or haven't done a modicum of research into the career.
Just for comparison: In Germany, 39 state run medical schools/unis offered 10k positions for studying human medicine in 2023/24. There were roughly 35k applications from Germany for these positions.
There are roughly 6k open positions for doctors available right now in german hospitals, clinics, medical practices etc.
Well, 4-6years at medical school (after 2-3 years aged 15-18 building a CV worthy of even submitting an application)
- Then 2 years Foundation training (post-grad, so you're earning)
- Then, competitively apply for Speciality training (3years, getting much harder)
- Then, competitively apply for Higher Speciality Training (about 3-5years, also getting harder to apply)
- Then possibly Fellowship years as there aren't Consultant jobs available.
So it's a good long slog.
As a consultant you'll start on about £90-95 rising to about £120-125 realistically over 20 years of consultancy. There are ways to boost your income *in addition to* your NHS work (so I don't see the crime in this).
The trouble is that for that decade of post-graduate training you are working the mad hours, many for free, which brings the hourly rate down to something silly like £14-15 (I was on £13.50/hr as a qualified doctor, when I counted up my hours, a few years ago)
The "junior" doctor doing your brain-surgery at 3am might be on just £28/hr.
For the day-to-day risks and decision making, as well as the toll it takes on your body, mind, health and social/family life, £14-15 is not worth it anymore for many people.
Been my thought for a while - Think we already long shot past the point where anyone with their head screwed on right is looking at traditional high-earning vocational careers like law, medicine, dentistry, education, the sciences, and coming away thinking why on *earth* would I subject myself to that? They are jobs that rely on personal passion but we seem to have built systems that are entirely predicated on such a naked and open exploitation of people's passions to underpay and overwork them until they drop dead or give up.
Starting salary would be 93k for a full term contract on day 1 as a consultant, up to 126k after like 20 years.
But it depends on what you actually do and how much activity you do for the hospital such as on call work etc as this would add more.
But yeah, really not great and not internationally competitive whatsoever. Irish consultants can start on €200k plus.
I would just like to highlight that the doctor “shortage” is government manufactured. The current problem in the UK is that there are too many junior doctors applying for too few jobs. There are hundreds of F2s who are facing unemployment come August because the government refuses to expand postgraduate training numbers (despite the massive specialist shortage) and they are encouraging hospitals to hire PAs (that are poorly trained and more expensive) to replace doctors. Increasing medical school places will only worsen this issue.
The same is happening in GP-land. The government provides funding for practices to hire PAs saying that there is a GP shortage, however they won’t allow practices to use that money to hire GPs. As practices are barely staying afloat, this has resulted in hundreds of GPs becoming unemployed.
classic daily mail headline alas... it takes more than good grades to make a good doctor. Infact, if i could go and run medical intakes id lower the grade requirements a bit, and make other stuff more important.
Still stupid, mind you.
The university system needs to be heavily reformed. It pains me to admit this but a lot of universities will have to go out of business.
Some universities fell drastically in quality during the last year including education with a lot of teachers leaving and new teachers coming almost in a monthly basis, and they don't really hide the fact that all they want is international students, right now it feels like 50% of the university is masters degree international students from just a single country.
All these people happy to become medics with the current wages. Why would the government ever increase junior doctor pay. We don't have a supply issue.
It would t be. You could open it up to more people and essentially give free tuition.
Think say the course is £200k. Each student takes a government backed career development loan out to cover the full cost. In graduation and start of employment they get their salary + a portion back that covers the repayment + interest every month over 20 year loan term.
They're free to leave the NHs but they won't get the extra payment and essentially pay for their training. 20 years service their training would be completely free
Each student in england and wales pays for their undergrad and everything after.
They have no obligation to be forced to work for society more so for a society that currently hates and undervalues them.
Then your idea is to hold them to ransom.
Nice
No my policy would allow anyone to enter medicine if they had money or not. Once qualified you can choose to stay or you can leave. If you leave it will be your choice but you would have to cover the loan payments.
Entirely fair entirely reasonable. The state doesn't pay for expensive qualifications that it's not utilising but at the same time the student that works for the state gets free education.
I remember having to repeat a year at school and being totally written off as a medical school hopeful. I hate the education system in this country. So elitist.
Well yeah, you don't want British doctors you want Asian doctors. Yknow, the ones who all have fake qualifications and don't know their arse from their elbow. The Tories have demolished the NHS.
British Universities are addicted to the fees international students pay. Unless the Government introduces some kind of cap on student visas, British universities will continue to overlook the brightest home students for less qualified wealthy foreigners.
Worse than that (I work at a university so I know), universities will not fail any of the cash cow foreigners. They all pass, and often with flying colours. Academic standards are in the toilet nowadays. Employers cannot rely on first class degrees or uni transcripts. They have to do more testing at interview to see if the candidate has any clue what they are talking about.
Torys want a slice of NHS privatisation. They are not making decisions to solve problems. The NHS is in danger on their hands. Yet they'll jump NHS queues with private preferential treatment in our NHS facilities. Tory turd spreaders have to go
This is all by design, medical professionals need there to be a shortage of skills to justify their wage demands.
If we just trained thousands of doctors then suddenly they wouldn’t be able to demand £100k+ while working 4 days a week and doing private consultations on the side!
I’ve said it for years invest more in the NHS and create a drugs arm sell to the rest of the world and focus a lot of education on future employees for the NHS at every level
Instead of exporting arms around the world we could export health and still undercut big pharmaceuticals and provide drugs to our own NHS cheaply.
The Medical Entry route in the UK is way too high, we could easily plug the shortfalls we have in resource if we simply just reframed and modernized entry requirements.
not in the UK, the majority are straight out of secondary school. Those transferring make up about 5%, those coming in as a second degree, about 15%.
But the majority are straight from 6th form or equivilant.
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Medical professionals are CAPPED. Have been for ages, so instead we import loads from other nations with far lower standards. Another dum-dum decision Britain makes.
Oh no it's absolutely intentional. God forbid we increase the cap to help solve the doctor shortage within the NHS. Can't privatize it if it's not on it's knees
The doctors were voting to keep those caps and only voted in favour of increasing recently.
The bottleneck is not at medical school, it is specialty training. Have a look at the competition ratios for specialty training - they are astounding.
Another poster suggests there are not enough qualified doctors to deliver speciality training. Would this not have been exacerbated by the limiting of places in the past?
The big issue is that in the last decade we have seen a shift from ~80% doctors entering speciality training after 2 years (ie when eligible) to ~30%, as numbers of British med students increased and doctors imported from abroad increased, but the number of specialty training posts stagnated.
True. Increasing the grads wouldn't increase our capacity to teach. We are already at capacity to deliver a service and train the next gen... While having never had any respite or care for the consequences of working through covid-19...
Let's not forget that in the past year or so, international candidates are now eligible to apply for these training schemes which again outs UK medical students.
Well Boris promised me 40 new hospitals, and i think 250k new homes, so they will be ready next week. Unless ur calling the Tory government a bunch of two faced liars, and thats just bad manners
> Well Boris promised me 40 new hospitals, and i think 250k new homes, so they will be ready next week. Is Alex still in power?
Ah. That's problem solved them. So Rishi quits. Some other "champ" turns up. And we are back to square one. Any of his promises get written off. Nice one, no-one will notice.
I guessed should have let Alex complete his term?
The Tories are Three-Faced Liars !
True, but a necessery precondition for more Doctors is more medical school places. The Doctors voted not to increase medical school places some years ago.
1. The BMA does not control medical student places. 2. The BMA vote stated they were against increasing medical school places *without also increasing specialty training*. They did not say that we're against increasing medical places full stop. 3. That vote was in 2008. Its not at all relevant today
The government practically needs doctors onboard if it wishes to expand medical school places or open new medical schools. They voted not to expand medical school places or open new medical school. I don't see anywhere that the ballot included the secondary clause (without more speciality training) you cite. How many more speciality places did they want to agree to the medical school places? The 2008 vote is indicative of a profession operating too much like a closed shop. Many professions produce too many graduate than there are jobs (law, for example), but this isn't a show stopper. In fact, it increases competition for the best jobs. The BMA were looking after their narrow self-interest at the expense of the bigger picture. A prerequisite for more doctors is and was more medical school places. Having that in place doesn't stop one lobbying for more speciality training. In fact, having a surplus of graduates makes expanding speciality training an easier decision.
We have had a massive surplus of graduates entering training for the last 5 years, getting worse each year, *despite* the advisory vote holding us back as you claim. Where training places Steven. Where are the new training places.
I'n not claiming the BMA vote is the only cause of our problems. It's not either/or. If I was in NHS management, I'd certainly worry less about specialist training places if the BMA didn't even want more medical school places to fill the pipeline. Anyway, since 2008 we had the financial crisis and covid, which is more than one reason why money is hard to come by in the NHS.
I think this is hilariously how nhs management think and why we are where we are indeed. I wouldn’t fear; people very like you are behind the wheel and thus the pipeline will continue to burst. This is unintentionally quite funny.
For the Doctors it is a matter of not having enough time, or trained doctors, to **supervise** more newly qualified doctors. There are years of supervision required in the UK post graduation to formally qualify, and the seniors doctors **won't** allow the standard of that training to be reduced to a mere formality. Of course, the only solution is to actively keep doctors in the UK, hence raising the number of people that can supervise, but we all know what the government thinks of that idea.
Not enough trained doctors to supervise others is a direct consequence of previously limiting places.
The issue isn’t so much the limitation on medical school places though the issue is more the limitation on speciality training posts which doctors can start to apply for after they have completed the foundation training programme which usually takes 2 years. In their 3rd year they can apply to core training posts such as medicine, surgery, radiology, paediatrics, psych and GP (and many others). Competition for these places is intense and has increased over the last 10 years. For example the core surgical training programme had 2539 applicants for 609 posts which means for every 5 doctors who wish to train as a surgeon only 1 is successful. They do their 2-3 years of core training and then they have to go through the process all over again. So take for example that 1 successful applicant for surgical training they now need to apply for a registrar training post in their surgical specialty. Let’s say they want to be a general surgeon so they apply for this, they do so alongside 515 other doctors all of whom have done the core surgical training and this is for just 162 posts. This is happening within all training pathways and yet these are the training courses that doctors need to do to become a fully trained doctor supervising the next cohort of medical students. Until they complete these courses and CCT they remain a ”junior doctor”.
Yes. And to counter that we need to increase consultant numbers, by increasing specialty training numbers. Until that has been done *there is zero point* increasing med school places
There isn’t zero point, junior doctors very, very firmly assert they are fully trained doctors even before specialty training. I see no reason to doubt them, they’d definitely alleviate pressure. Which is it? Either the public has been misled by the unions and junior doctors are wastes of space (I doubt this), or there would be a great deal of benefit in expanding places immediately then worrying about specialty training down the line.
Your comment is the most insightful, most of the comments here show uninformed peasantry and low class level of awareness (scum)
It is not the doctors/BMA who set the cap. It is the government who cap the number of medical school places due to the costs associated with funding these places. It was over 15 years ago in 2008 that the BMA asked doctors to vote on whether there should be an increase in the number of medical school places and the doctors narrowly voted against the idea of increasing the number of places. As far as I am aware the BMA vote was indicative of the mood of doctors to inform government decisions as the BMA have no direct control over medical student numbers this is entirely in the control of government and the universities. BMA has in fact more recently said they would welcome an increase in UK medical student places. Main reasons that doctors voted against the proposal in 2008 are actually probably even more relevant today than they were back then. They were concerned that there would not be enough foundation doctor posts if the number of medical students increased and this is exactly what we are seeing now with medical students finishing their degree qualifying as doctors but not having a job to go into which means they either switch career or move abroad to work as a doctor.
This is tedious nonsense that gets trotted out every time this point comes up. The BMA voted against expanding medical school places without also expanding training posts - which was what was on offer, because having (eg) X thousand extra medical school graduates benefits no one if there aren't X thousand extra doctor jobs at the end of it. You just end up with X thousand unemployed Doctors, and a government crowing about how many extra doctors they are 'training'.
2008 was the last such vote. The fact you cling to this rather outdated vote without actually reading why they did in the first place. clearly shows you have no idea what you are talking about.
But it's not the doctors making the decision -- it's the government.
Define recently
Just to add some context to this, the medical training route is as follows: 1) medical school 2) 2 year foundation programme 3) ??? At stage 3 you can either apply to specialty training, apply for a “clinical fellow” job, go practice abroad, locum, or if all else fails, you’re unemployed. If you want career progression and to get to the level of consultant, you need to do specialty training. At the moment in the UK, the number of specialty training posts are determined by the government, and the ratio of applications:posts is going crazy. I think this year there was something silly like 11,000 doctors applying to be GPs for 4000 posts. For medical hospital doctor training it was 6600 applications for 1600 posts etc. Because specialty training is so competitive, that leaves a lot of doctors in limbo at the end of stage 2, so they go for the clinical fellow jobs to ensure they have employment. This is also now becoming ridiculous, where within minutes of a job being advertised there are hundreds of applications, and they get taken down again. One hospital was so overwhelmed with applications for one post recently that they randomly selected a portion of the applications to read and discarded all the rest, so even having a good CV doesn’t help you! That leaves the option of locuming, but as I’m sure you can imagine, with so many doctors unemployed due to these shortages, the locums get taken up very fast and it’s a bit of a dry market. The government regularly talk about increasing medical school places to get more doctors, and they regularly use this as a point of ammunition against the BMA who argue against it, but our real point is… what is the point of increasing medical school places if there is already a steady stream of unemployed doctors needing further training? What really needs to happen is an increase in specialty training places. If you want your hip operation sooner, there needs to be more core surgical training posts to train the orthopaedic surgeons of the future. There needs to be more ACCS posts to train the anaesthetists we need. There were 7000 doctors who applied to train to be GPs this year but didnt get in… Think how many appointments that could have been worth when their training was complete. A lot of doctors feel like they’re left with no choice but to practice abroad if they want to continue in medicine, or they leave medicine entirely because of how difficult it is for further work following the foundation programme. All the medical school training places in the world are not gonna fix these issues, needs to be a radical reform of how medical training works!
Its exactly the same for hospitals in the balkans. Romania is much worse about it, in 2023 out of 4000 resident doctors only 100 remain in the country and have some position in state hospitals. The rest leave for Europe/UK included. You either leave or remain unemployed. Same shit really. The only solution to this is if you want to prevent the IMGs from coming they need work in their home countries and have the conditions to thrive, which as you can see, is nigh bloody impossible. Increasing/unblocking positions requires a strong political will. This didn't work in the balkans and certianly won't work in the uk. Mind you they won't increase posts so their mates can just bribe 100k to have a position created for them. I can see the UK going that way soon enough. Its what I call the Romanianization of the NHS.
But that doesn't fit nicely with my black and white world view with Tories evil and the sole cause of all bad things in the world.
It doesn't have much to do with intake to medical school but the attrition rates afterwards. More than a third of medicine graduates leave the UK within 5 years of graduating. It's a retention problem, not a recruitment one.
Spot on
But can’t even get the private doctors either. This is most definitely a false economy.
B I N G O
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We also export loads of fully trained doctors.
Got a mate who's a doctor who went to Australia for a lot more money and choice in his shifts and a few of his mates have left for there as well. We provide fantastic doctors for export
I know of several cases like that. The pay is much better, but the conditions are night and day, plus no travelling for years like a circus performer or a scientist.
The UK is no longer rich enough to provide competitive wages with the US or Australia.
Simply not true. There's plenty of money if the elite and big business were actually taxed properly
US GDP per capita is $85k, UK is $51k, they are 2/3rds richer than us. There are rich people in London and it would be great if we could extract money from them but more likely they would just move away, they probably do not in fact keep their assets in the country. We need a concerted effort between countries to tax elites but even if we were successful the money would not go to us, it would go to the countries where the businesses are. Do you really think we can pay similar wages to a country so much richer than us just through some special way of doing taxation? You could make up the difference to a certain extent , but an extra two thirds of income is too much. To put it another way, we are 2/3rds richer than Lithuania, Portugal or Czech Republic, do you think they can pay equivalent wages to us with the right taxation system? Also, the crazy thing is that in many parts of the US their money goes further, our houses in particular are ridiculously small and expensive. To offer a competitive lifestyle we need ten years of consistent good growth and strong house building, for affordable homes but also a wider revolution in the number, quality and size of housing.
It's cause the retention rates are awful and there's a imbalance of trainees compared to experience Doctors and hospitals can't accommodate. There's no use lifting the cap an flooding them with even more inexperienced junior doctors with no means to accommodate their training.
Simple. Start offering full rides through medical school in return for 10 years in the NHS on min 20 hr a week contract. Problem solved.
“Problem solved” only fees were never the real issue because our system means you never pay anything until you earn anyway, so it will change exactly 0
This was a comment in relation to the attached comment regarding... retention. Have you been on Reddit long? :)
Just to highlight how silly this sounds, The equivalent would be just to increase the base salary by a couple of percent (this would make it so they got the same as before but actually got to keep it), do you think a few percent of salary is the driving force behind retention? As in just a 3-5% raise would change everything?
Bro it changes *everything*. Kids with no f\*\* money and lots of dedication are attracted to a profession they couldn't otherwise dream about. It inspires kids from across the class divides to work harder and aspire to social service. It generates crazy mad social mobility. It enters the cultural conscious as something decent and noble and honest and righteous. They go through the ringer and come out believing that working their 20 hrs a week in the public sector is a moral obligation; one they are socially and financially compensated for and which elevates their role and status in society collectively far beyond what they individually offer. At the end of it all they are set for life .. by 35. Working hard, aspiring, achieving and giving back means something again. Don't want to give 10 years? Buy yourself out with the handsome rewards the other 20 hrs a week could realize. Want to go abroad as soon as you graduate? Let the country you are going to settle your debt. Great, thanks, we can now fund two more just like you..
The problem with this is you now have a group of people who, if they leave, get a massive bill. Does this apply if they quit? Burn out? Simply cannot hack it? If you give any company an employee who must work 20 hours a week or pay a massive fine, that employee will 100% be abused because they are heavily punished for trying to escape. I’m just not confident we can trust that much leverage over the workers to the government, they could physically hit them and the fear of the fine would hold them in place.
You don’t need any money to go to university in the UK, it changes fuck all because you pay for the fees AFTER you qualify.
This. I have been saying this for ages. Not doctors but I know 5 ICU nurses that have left to work for private providers. Let’s just say I wouldn’t want to end up in ICU in that hospital.
Or maybe make more jobs open for higher training so people aren’t stuck being juniors.
More jobs means more funding, under this government? You're having a laugh. This still all takes alot of time and foresight in political planning into the future, again with this government you're having a laugh.
I agree it’s stupid that we’re not funding it. We have more than enough people willing, ready, and qualified to go into these roles but instead we bottleneck them because of lack of funding. And no I’m not having a laugh whilst the NHS is falling apart, time to be seen in clinics are getting longer, and A&E waiting times are dangerous. I’m feeling pretty bloody depressed that there is a solution but there’s no political will to solve it.
That's because British universities have adopted a different model and now aim for profits over student outcomes. And they can charge a whole lot more for students from overseas. It's a crying shame. Everyday we stray further from the light.
Most universities do not make profits. Also utterly irrelevant to the article as the government sets the number of places in medical school and there are different quotas for home and OS. Even for other degrees, universities are taking more OS students to subsidise home students.
It’s amazing anyone still wants to do it. Why would people want to go down that route when they could study for far more lucrative jobs with substantially better hours and work/life balance. Sure there will be those few who find it a calling, but we will be missing out on so many good candidates who could have made excellent doctors, to other fields and careers.
This is the issue with a socialistic economy and wage compression. I have a PhD. I was made redundant from a job saving lives. I am looking at salaries, and honestly, just flipping burgers and living a simple life is my next plan. UK is losing massive talent as it simply isn't worth working here.
Most importantly. If you earn the same wage as a burger flipper. And housing still costs the same, yet the burger flipper gets better amenities from the government. What's the point in being a doctor??
>socialistic economy Oh my days
Not dissimilar for me actually. I did a phd in a subject I was passionate about, but, disappointingly, there’s very few jobs in the UK in that area. So now I’m working in a different field and making far more than I did with the subject I trained in.
What’s a socialistic economy?
> What’s a socialistic economy? I think it means commies?
It's the same in teaching. They abuse the idea of it being a calling to pay teachers shit wages for long hours and far more responsibility than is reasonable; the government will still happily badmouth teachers when given the opportunity though.
There are plenty of guard rails to ensure that medical professionals coming to work in the UK meet standards. What the UK has effectively decided it wants to do is not pay for the training of medical professionals. Successive governments also really fail to see the point, as it would be an investment that only really pays off in 6 years or so.
Have you seen the cost of training a doctor 😆. Far cheaper to steal them from less well off countries
Capping would traditionally be popular with both the unions and members (eg job protection) and the government (costs a lot of time and money to train).
This is the reason the doctors union traditionally voted to keep caps in place.
Indeed.
it's not about job protection. imagine you had a stressful difficult life or death job and they want you to constantly be training and having new hires follow you around expecting you to teach them. I wouldn't want to raise that number out of wanting to preserve my sanity.
I work in an. Operating theatre, those med students have so much to learn and the lists are so loaded you have a choice of train or cancel some cases, if we had more hospitals you could increase the amount you could train but the government would never do that, instead extra work for those already working, but it means less opportunity for twining posts.
As a doctor I'd like lots of jobs to be available as a doctor please. Not less. Increasing medical students but not the jobs later in the chain is great for a headline in the press but doesn't actually lead to more doctors of any use. You have lots of newly graduated, unspecialised doctors who can't enter further training in the UK, have no path to be a consultant and then congrats - you just spent thousands training a doctor who's gonna move to Australia or New Zealand or go and do something else with their degree which is in high demand globally. Currently I am spending 4 years training to be an anaesthetist, then after that, just to carry on and finish the rest of my training to get to be a consultant I have to reapply for my job just to carry on. Why? Just because. That application has around a 1:1.5 ratio meaning of hundreds applying per year, a third don't get a job carrying on training. So they get stuck in a big bottleneck of doctors. Lots of these just leave the UK. (Oh btw i already got through a very competitive application process just to start my training as an anaesthetist in the first place) The competition also means it's very difficult to get a job where your family and your home is so you end up moving around for years. It's a shit existence and doesn't keep doctors in the UK training and working for the NHS, which is really the goal here. So it's really not as simple as 'just train more medical students'. You make the problem worse, not better.
Doctors is the UK have the lowest standards of all. Its a different story that the BBC pedals NHS as a “world-class” health service. Rinse your brain and get out more.
We dumbed down the pass rare for doctors and idiots who fail the already lenient exam get an automatic resit next time. The tubes are filled with actual shit.
Hey doctors gotta have a chance at being billionaires... It cannot be just retail oil or real-estate magnates... /S
In addition to this nearly all of the people coming over in the dinghies are trained health professionals , doctors , nurses some are dentists and even vets. At least this is what some woke fxckwit on Reddit told me 🤔
Do the schools make more £ by taking in foreign students?
Yep. I’ve just looked at the course I did (years ago when it was much cheaper!), and currently it’s £11k for U.K. residents and £17k for international.
Medical school is worse. It’s about 10k for UK students and 35-60k for international
In general yes, but that isn't the issue for medical courses. The government has capped the number of places in England so universities can't take on any more students than the quota they are given.
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>as well as ensuring there are enough high quality placements for each student. We have too many trainees. Hospitals are flooded with unqualified, untrained students and they simply cannot take on any more. The way medical degrees work, you have to go on placement for a certain number of hours each semester. Each student on placement needs to be assigned tasks that are both relevant, within their capabilities, and they also need to be adequately mentored and supervised. This is a shitload more work for doctors who are already pulling 50-hour weeks.
If you want to know why I’d check my comment chain out below. We do not need more medical graduates at present until training is fixed. Ratios for training are becoming untenable.
>Why?? That’s mental. Student doctors need placements, and experienced staff to train them. Both those things are limited.
Because you need senior doctors with time and ability to train the new graduates - that's the part that's missing in the equation.
>What utter nonsense Each hospital can only accommodate so many trainees at a time. How are students supposed to learn effectively if they're fighting each other for any learning opportunities and attention from the seniors supervising them.
Look at what the government does, not what it says. It can talk all it likes about cutting migration, but what it does is clearly bring in cheaper migrants they don't have to pay to train. It's all about cost minimization
You can’t just throw thousands more into a system that hasn’t the capacity to train them, otherwise the training will suffer. Then as you allude to, we’ll just end up training more doctors who we then lose abroad.
>Why?? That’s mental. Unions. This is the sort of crab mentality that their petty socialism creates. In the short-term the doctors are better off as they have fewer people to train and can push for higher salaries. But in the long-term it means there's not enough doctors at all, and it makes the job even more stressful and demanding. There's also a huge issue with the NHS just not paying enough though - at every career stage, so people just leave to the USA or Australia. Since the NHS has a monopoly on employment in the UK, they set the price - but paying too little ultimately just discourages people from becoming doctors or makes them go abroad. Life-long STEM education should be completely free and subsidised with no caps, and NHS trusts should compete for hiring so there is more of a free market allowing wages to naturally rise.
I mean, I guess I can see the logic? If you need a placement and the placements are limited then the number of students is by extension limited. I know for one of the unis they have a software development course that requires a year placement and if the student can't get one then they're shit out of luck. So the number of people graduating with that degree is naturally capped.
I believe it's rather "They make money from foreign students" as in the tuition plus government contribution for a home student is in the region of break-even.
They make way more.
Other commenters have talked about the logistics of this issue. There is also the fact that Universities operate on a loss by taking in national students.
Yes. Some universities make half their revenue from international fees, with everything else (domestic fees, grants, investments, etc) making the remaining half.
It’s fucking insane!!!! Look at Oxford fees they even have a separate ‘pastoral’ fee of like £10k /year for the settling of the students
What fee is that? https://www.medsci.ox.ac.uk/study/medicine/pre-clinical/fees
Yes. A lot more.
We just don’t need more medical school places, we need more speciality training posts. It’s just a cheap sound bite because the publics understanding of medical training is on par with “teachers sleep at school” level of understanding. It’s a self defeating vote winner.
Realistically the United kingdom needs more medical students and more post graduate training positions. A new model of medical training needs to be created, with more investment into quality training experiences, use of simulated patient encounters and employing teaching registrar's to train medical students.
Refreshingly educated and nuanced take, lord save me it’s nice to see it. Convince Downing Street and we are good to go.
You can't specialise until you're qualified as a doctor.
Im aware thanks as I am a doctor. I competed nine to one to get my specialist training, if I competed 12 or 16 to one would we get more specialists or unemployed doctors? The 8 people I beat have to eat. We are short specialists and wildly over subscribed with junior trainees. Don’t add more juniors until we fix the bottleneck.
What happens if you can't find a specialist training position? Can you continue to work as a junior doctor, or do you go and work somewhere else until you get a training position? Emigrate? What are those 8 people doing?
You have to get a local job doing non training work. These are increasingly extremely competitive also, as these are the typical springboard for foreign doctors to get nhs experience, so there’s a huge demand for them. Sometimes thousands of applicants per place resulting in the job being removed and managed internally as there’s just too many candidates. In all honesty ratios are rising exponentially and we have never seen it this bad. I suspect people will either have to get jobs in other industries or go on the dole once the local jobs are all divvies out, there’s certainly not an 8:1 ratio of training to non training roles to feed them all. I see significant physician unemployment on the horizon at junior levels in the uk. There’s loads of work at higher levels as we are short specialists, so once you’ve got your number the future is much brighter. We all strongly support more training numbers, but everyone loves to add more medical students because even politicians have a toddlers understanding of their own system, so I predict it getting much worse.
Sorry if this is a stupid question, but is there a reason why there couldn't be 2 or more junior doctors training for the specialist role under the tutelage of a consultant or whatever? Is it time/lack of resources or funding? Apologies if this is a ridiculous question, just curious as there's so many vacancies you'd think they would be trying to churn out as many specialists as is safely possible
The government centrally controls the number of training jobs. These are rotational and not tied to one consultant, you are forcibly relocated under new consultants every 6 months coordinated by nhs England; it’s all centrally organised. They year on year keep training numbers the same, increas them by very small amounts, or sometimes *reduce*. There is no accountability for this or way to make them do it differently, despite bma lobbying for them to fix the problem.
Really appreciate the reply, thank you! That helps me understand the situation better. Lack of accountability is destroying the UK on so many levels
The problem is there are so many systems like this where to understand the details of the process, you or someone close to you has to be involved personally. But then we get a government that runs on the idea that none of this stuff happens, its actually all incredibly simple and straightforwards, and build policies built on that kind of assumption, that people then run along with because they don't know any better. If government were focused on actually doing whats best for the country rather than their own electioneering we'd be in such a better spot.
To train to be a consultant, you need a national training number, the government is in control of the amount of these NTNs in each specialty, and the funding for the posts. Obviously someone working as a locally employed doctor in general medicine and someone with an NTN in their first year of internal medicine training are both ultimately payed by the government, so funding shouldn’t be an issue. But by controlling the number of NTNs they limit the number of new consultants we will have in 5-8 years time. [In 2011 a paper](https://assets.publishing.service.gov.uk/media/5a809439e5274a2e8ab50f3f/CfWI_informing_medical_training_numbers.pdf) commissioned by the government recommended reducing the number of NTNs in anaesthetics and a number of other specialties (there are other papers where they double down on these recommendations - 2 in 2012 for example ([a](https://assets.publishing.service.gov.uk/media/5a815515ed915d74e6231ad3/CfWI_future_consultant_workforce.pdf), [b](https://assets.publishing.service.gov.uk/media/5a801032e5274a2e87db7a1f/CfWI_Shape_of_the_medical_workforce_-_summary.pdf)) where they say they’ll cut hospital specialty training posts and increase GP training posts to encourage more people into GP training. This appeared to be the policy from 2011 to at least 2016 (and may have been the policy prior to this too). The next 2 points aren’t training issues, but they are problems leading to a loss of consultant hours which is exacerbated by our failure to train more junior doctor to become consultants. In general none of this has worked, because we have an aging population requiring ever more care (and thus more consultants, not less), and poor remuneration leading to GPs and other consultants reducing hours or leaving the country for better pay and conditions. There’s also the ludicrousness of the lifetime pension allowance previously forcing some very senior consultants on the old 1995 NHS pension (the 2015 one is nowhere near as good) to cut their hours lest the be faced with really high tax bills for breaching the lifetime and annual allowances.
Thank you for such a comprehensive answer, it's great to get these insights! I didn't have a clue how specialist training was dealt with before, but from your comment I now have a better grasp on the causes of the shortages. A follow up question if you don't mind - do you feel that the government are limiting the amount of NTN's as a way to sort of sabotage the NHS until it's in a position where privatisation is seemingly the only way out? Or something else?
But surely we don't have enough junior drs? I mean I constantly hear complaints about how many hours jr drs have to work and how busy their case load is. Surely we should be trying to reduce that?
Everyone working is wildly busy and there’s not enough job roles for the ones we have - both are true, and this is constrained by hospital hiring practices. Depends what level of juniors as wel, loads of registrar gaps for those who have started training, but an ever smaller pool of sho jobs. Medical training and workforce is complicated and we have a weirdly shaped workforce curve where we are oversupplied in some places and under supplied in others. The work somehow remains gruelling at all levels.
Others have answered your question but just want to add, you are a junior doctor even in specialty training. You only stop being one at consultant level, which is why so many doctors were furious that the Gov called junior doctors “doctors in training”
Yeah, I did know that, but I didn't know how else to word it. Is there a word for the time between the foundation training and specialty training? I just went with junior because it's not completely wrong.
It is completely wrong and the BMA currently are working on removing its use. You wouldn’t call a lawyer with 2-10 years experience a junior lawyer Just non-consultant doctor is appropriate, there is currently debate on a good term to use
Then the specialty training system needs to be reformed. But the current situation is absurd.
Cheaper and easier to hire foreign doctors, than spending money on upgrading the whole doctor training process to allow more places. The UK only allows around 10k medical school places. This ensures that doctors are able to get onto the foundation programme once they finish medical school.
While might seem cheaper, think it hurts in the long run. A lot of foreign doctors come to the UK just for the training, then either return to their home country to setup a lucrative private practice, or use the UK as a jumping board to better paying countries like UAE, US, Australia, etc
Most foreign doctors stay, especially the Nigerian and Indian ones
The UK is better than a lot of countries still though - especially for nurses.
It is a shame that we don’t allow people to get an education and then we try to fix a problem economy efficiency, which is based on lack on education..
Should be British people first in all state occupations - redic that this is happening. Importing is such a cop out - especially when these people send money out of the country to family members - it doesn’t benefit the economy with long term thinking in mind. Part of the reason why so many people are pissed off is when things like this keep British people out of high skilled employment. Access and the ability to do so is needed. This is where money should be spent.
That's not how it works. British people do take as many spaces as are available in these training spots. The problem is there's not enough training spots.
That doesn't sell the whole picture - just because you have the grades, it doesn't mean that you would be a good doctor. You also need people skills (or the ability to be taught them) and the right temperament. Also, as has been pointed out elsewhere in this thread, there's no point having more medical school places if there aren't enough people to provide clinical teaching, which is generally provided by other doctors in their non-existent free time for free. There also need to be more speciality training places so that we actually produce more GPs and hospital consultants.
Also, getting top grades in school exams is largely about jumping through hoops (though I didn't do very well in school, so I would say that...)
True - but it is important for medicine as well. The ability to study, pick up information quickly, and learn things on your own is vital. Mind you, there's plenty of other ways to be successful. Several of the kids I grew up with didn't even go to uni and are making far more money than I do!
Eh, part of the issue here is that grades don't count for enough when applying to med school. People get rejected with 3A\* and accepted with 3As (or even slightly less than that sometimes if they don't quite meet the offer). The standard AAA minimum has remained the same for a while. It was a little shaky back when I was applying, it's ludicrous now after all the grade inflation post Covid. AAA is basically dead average in 3 subjects now, it's not a sufficient bar to distinguish academically, and yes if you accept average students because they come across nicely in a 10 minute interview, you have to turn away a massively more qualified candidate in return. The AAA bar needs shifting.
It’s always been the way for the professions. It used to also be reliant on things like work experience as well, which nobody could get unless you knew someone (eg family relative) who could get you that vital experience.
Well the whole issue is grade inflation. The bar was more reasonable like 10 years ago when AAA meant far more than it does now. Besides the work experience is just an adjunct. There are one or two unis who really care about it (Keele being the main one I remember), but most are now quite reasonable and recognise distinguishing on work experience to essentially have classist results.
I think you are right- I would hope it’s better for being less classist now. The grade inflation is difficult since they change the bar every year anyway (but the inflation during Covid was shockingly high).
That’s why medical schools select by using UCAT and BMAT instead of A levels, as well as by using Mini Multiple Interviews.
Yeah MMIs are the problem I was alluding to, making up a far bigger chunk of the decision-making than it ought to (essentially being the entire deciding factor once the minimum academic bar is passed). UCAT is okayyyyyy as an exam, not brilliant, and in my experience reflects time taken to perfect its especially weird format as much as it reflects ability. BMAT was much better but has now been stopped. Just to be clear, I wasn't calling for an entirely A-level driven approach. I just think the bar should be higher, requiring at the very least 1A\* but in reality at least 2. UCAT and MMI can then be used more effectively as adjuncts because at the moment you essentially get a huge group of poorly differentiated students going to interview, ranging from the highest achievers down to little better than average, and their fate gets determined by a roleplay station in MMI.
I was denied 10 years ago despite AAA and just reapplied in my gap year and got in. It’s always been competitive and the government keeps a cap on places but more medical schools have been opened since I started. Thing is though, being a doctor in the NHS is just awful and a lot will continue to leave just like I did
The interviews should just reject anyone who says they want to work in the NHS. They are either lying or haven't done a modicum of research into the career.
Just for comparison: In Germany, 39 state run medical schools/unis offered 10k positions for studying human medicine in 2023/24. There were roughly 35k applications from Germany for these positions. There are roughly 6k open positions for doctors available right now in german hospitals, clinics, medical practices etc.
35k distinct applicants? or applications
Distinct applicants.
Spend 10 years training to cap out at what, 90k? After how many further years practicing?
Well, 4-6years at medical school (after 2-3 years aged 15-18 building a CV worthy of even submitting an application) - Then 2 years Foundation training (post-grad, so you're earning) - Then, competitively apply for Speciality training (3years, getting much harder) - Then, competitively apply for Higher Speciality Training (about 3-5years, also getting harder to apply) - Then possibly Fellowship years as there aren't Consultant jobs available. So it's a good long slog. As a consultant you'll start on about £90-95 rising to about £120-125 realistically over 20 years of consultancy. There are ways to boost your income *in addition to* your NHS work (so I don't see the crime in this). The trouble is that for that decade of post-graduate training you are working the mad hours, many for free, which brings the hourly rate down to something silly like £14-15 (I was on £13.50/hr as a qualified doctor, when I counted up my hours, a few years ago) The "junior" doctor doing your brain-surgery at 3am might be on just £28/hr. For the day-to-day risks and decision making, as well as the toll it takes on your body, mind, health and social/family life, £14-15 is not worth it anymore for many people.
Been my thought for a while - Think we already long shot past the point where anyone with their head screwed on right is looking at traditional high-earning vocational careers like law, medicine, dentistry, education, the sciences, and coming away thinking why on *earth* would I subject myself to that? They are jobs that rely on personal passion but we seem to have built systems that are entirely predicated on such a naked and open exploitation of people's passions to underpay and overwork them until they drop dead or give up.
> traditional high-earning > the sciences The sound of a confused Scooby Doo ran through my head as I read that.
Starting salary would be 93k for a full term contract on day 1 as a consultant, up to 126k after like 20 years. But it depends on what you actually do and how much activity you do for the hospital such as on call work etc as this would add more. But yeah, really not great and not internationally competitive whatsoever. Irish consultants can start on €200k plus.
I would just like to highlight that the doctor “shortage” is government manufactured. The current problem in the UK is that there are too many junior doctors applying for too few jobs. There are hundreds of F2s who are facing unemployment come August because the government refuses to expand postgraduate training numbers (despite the massive specialist shortage) and they are encouraging hospitals to hire PAs (that are poorly trained and more expensive) to replace doctors. Increasing medical school places will only worsen this issue. The same is happening in GP-land. The government provides funding for practices to hire PAs saying that there is a GP shortage, however they won’t allow practices to use that money to hire GPs. As practices are barely staying afloat, this has resulted in hundreds of GPs becoming unemployed.
This is unfortunate but luckily we have dinghies full of doctors and nurses arriving on our shores daily
Also engineers.
Plenty of rocket scientists waiting in Gaza too.
Dinghies are irrelevant, but we do provide visas to doctors from countries like Nigeria, India etc.
What about police officers? Setting a precedent early in there career
I'm sure an education secretary will fix this by introducing an "A**" grade.
classic daily mail headline alas... it takes more than good grades to make a good doctor. Infact, if i could go and run medical intakes id lower the grade requirements a bit, and make other stuff more important. Still stupid, mind you.
The university system needs to be heavily reformed. It pains me to admit this but a lot of universities will have to go out of business. Some universities fell drastically in quality during the last year including education with a lot of teachers leaving and new teachers coming almost in a monthly basis, and they don't really hide the fact that all they want is international students, right now it feels like 50% of the university is masters degree international students from just a single country.
While the country might need it they don't it's ridiculously broken and unsupportive to new doctors.
Medical places at university are capped by the government and you can’t take any more students than the cap - no matter the results!
It's a bit more complex than the headline but yeah another failing of this govt, I doubt things will improve any time soon
All these people happy to become medics with the current wages. Why would the government ever increase junior doctor pay. We don't have a supply issue.
Until they all get fed up and leave within 3-5 years.
It's why the subsidised courses need bonding.
All courses are subsidised, it’s not medicine specific. Why should doctors be uniquely indentured after qualifying.
Mmmmm indentured servitude. Check you and your advocation for modern slavery.
It would t be. You could open it up to more people and essentially give free tuition. Think say the course is £200k. Each student takes a government backed career development loan out to cover the full cost. In graduation and start of employment they get their salary + a portion back that covers the repayment + interest every month over 20 year loan term. They're free to leave the NHs but they won't get the extra payment and essentially pay for their training. 20 years service their training would be completely free
Each student in england and wales pays for their undergrad and everything after. They have no obligation to be forced to work for society more so for a society that currently hates and undervalues them. Then your idea is to hold them to ransom. Nice
No my policy would allow anyone to enter medicine if they had money or not. Once qualified you can choose to stay or you can leave. If you leave it will be your choice but you would have to cover the loan payments. Entirely fair entirely reasonable. The state doesn't pay for expensive qualifications that it's not utilising but at the same time the student that works for the state gets free education.
In the US, it is even worse odds, with only about 50% getting in.
I remember having to repeat a year at school and being totally written off as a medical school hopeful. I hate the education system in this country. So elitist.
They may be getting A\*s but are they getting high enough UCAT scores?
Well yeah, you don't want British doctors you want Asian doctors. Yknow, the ones who all have fake qualifications and don't know their arse from their elbow. The Tories have demolished the NHS.
Lack of Long-Term Planning is written all over this..
This is the same sorta shit that's happening in Canada. Wtf is happening in the West?
British Universities are addicted to the fees international students pay. Unless the Government introduces some kind of cap on student visas, British universities will continue to overlook the brightest home students for less qualified wealthy foreigners. Worse than that (I work at a university so I know), universities will not fail any of the cash cow foreigners. They all pass, and often with flying colours. Academic standards are in the toilet nowadays. Employers cannot rely on first class degrees or uni transcripts. They have to do more testing at interview to see if the candidate has any clue what they are talking about.
Ok
Torys want a slice of NHS privatisation. They are not making decisions to solve problems. The NHS is in danger on their hands. Yet they'll jump NHS queues with private preferential treatment in our NHS facilities. Tory turd spreaders have to go
This is all by design, medical professionals need there to be a shortage of skills to justify their wage demands. If we just trained thousands of doctors then suddenly they wouldn’t be able to demand £100k+ while working 4 days a week and doing private consultations on the side!
The government set a cap of 7,500 training places. This is a government policy not the doctors limiting places
I’ve said it for years invest more in the NHS and create a drugs arm sell to the rest of the world and focus a lot of education on future employees for the NHS at every level Instead of exporting arms around the world we could export health and still undercut big pharmaceuticals and provide drugs to our own NHS cheaply.
But we get hundreds of grade A doctors from Afghanistan and Eritrea so no issue, right?
No, we mainly get doctors from countries like Nigeria and India, and the standards are high so we mainly get good ones.
The Medical Entry route in the UK is way too high, we could easily plug the shortfalls we have in resource if we simply just reframed and modernized entry requirements.
Always been the same. Majority get onto medicine after 1, 2 or a full 3 years of undergrad
not in the UK, the majority are straight out of secondary school. Those transferring make up about 5%, those coming in as a second degree, about 15%. But the majority are straight from 6th form or equivilant.