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Student doctor numbers to rise by 25%

Thoughts?

http://www.bbc.co.uk/news/health-37546360

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I would be much more concerned about the compulsory 4 years service. I would advise anyone to seriously reconsider if they want to be signing themselves up to four years of whatever terms mr hunt (and his successors) dictate.

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Original post by ForestCat
I would be much more concerned about the compulsory 4 years service. I would advise anyone to seriously reconsider if they want to be signing themselves up to four years of whatever terms mr hunt (and his successors) dictate.


The public interest is clearly met by not wasting the funding for training on people who emigrate immediately after completing their training. Four years' salaried service is a small price to pay for training worth £200,000 in subsidies.
Are they all going to go into A&E, psych and GP then? Or are they going to qualify and realise what a cluster**** the whole system is and we're left with bottlenecks in other specialties, worse shortages than before, and non-existent morale?

It will always be easy to get people interested in going to med school, the smart thing to do would be to think about why we have problems retaining doctors. But this is all deliberate Tory policy anyway.
Original post by Democracy
Are they all going to go into A&E, psych and GP then? Or are they going to qualify and realise what a cluster**** the whole system is and we're left with bottlenecks in other specialties, worse shortages than before, and non-existent morale?

It will always be easy to get people interested in going to med school, the smart thing to do would be to think about why we have problems retaining doctors. But this is all deliberate Tory policy anyway.


I was having this conversation earlier. How far is Hunt going to go? Is he going to dictate that if you're one of the extra 25% that you have to go in to an under-filled speciality? Not only do you have to stick around for 4 years but you have to be a GP at the end of it.

What about all the people who realise clinical medicine isn't for them. Are we going to enforce people staying in medicine, so we have even more burnt out, depressed doctors who are working simply so they don't have to pay the debt back. That can't be safe.

Original post by Good bloke
The public interest is clearly met by not wasting the funding for training on people who emigrate immediately after completing their training. Four years' salaried service is a small price to pay for training worth £200,000 in subsidies.


Ok, if we're going along these lines, are we going to pay other countries the training fees of the numerous, recently qualified doctors, who come to this country? In essence we're the ones benefiting from another country's expenditure.
Original post by ForestCat

Ok, if we're going along these lines, are we going to pay other countries the training fees of the numerous, recently qualified doctors, who come to this country? In essence we're the ones benefiting from another country's expenditure.


Those are the entirely reasonable lines Hunt is going along, and one reason for raising the number of training places (apart from the obvious one of aiming to be self-sufficient in medical staff), he has specifically said, is that it is morally unacceptable to take advantage of training in other countries.

However, they should take their own measures to protect their training investment.
Original post by Good bloke
The public interest is clearly met by not wasting the funding for training on people who emigrate immediately after completing their training. Four years' salaried service is a small price to pay for training worth £200,000 in subsidies.


Absolutely disagree with this.

Anyone signing up for med school knowing that they must submit to whatever the DoH wants in a decade's time is stupid. You absolutely cannot trust the DoH with 4 years of your life given their record. This is not the military. You are not paid. Med students have the highest student debt of any graduates. Without the option to leave you have no power - its not like there's an alternative to working in the NHS. Managers can do whatever they want, and what with Jeremy at the helm I'm sure they will, with your only option to quit medicine entirely. Not acceptable.

This is not a benign step . Its a direct response to the new contract, which JH knows is going to drive people away in droves. This is not about generic 'public interest' - its about resorting to indentured servitude on a workforce he has attacked and demoralised so much its the only option left for him.

To be consistent in your argument, I assume you are also in favour of 2+ years government service on the rest of the population (to repay the cost of their primary and secondary education), yes?
(edited 7 years ago)
Original post by nexttime
Absolutely disagree with this.

Anyone signing up for med school knowing that they must submit to whatever the DoH wants in a decade's time is stupid. You absolutely cannot trust the DoH with 4 years of your life given their record. This is not the military. You are not paid. Med students have the highest student debt of any graduates. Without the option to leave you have no power - its not like there's an alternative to working in the NHS. Managers can do whatever they want, and what with Jeremy at the helm I'm sure they will, with your only option to quit medicine entirely. Not acceptable.

This is not a benign step . Its a direct response to the new contract, which JH knows is going to drive people away in droves. This is not about generic 'public interest' - its about resorting to indentured servitude on a workforce he has attacked and demoralised so much its the only option left for him.

To be consistent in your argument, I assume you are also in favour of 2+ years government service on the rest of the population (to repay the cost of their primary and secondary education), yes?


The level of debt is, frankly, trivial compared to what is on offer. Training as a doctor is pretty well a guarantee of a privileged, fully-employed, financially risk-free life and, in the eyes of the tabloids, sainthood. The prospect of enormously supplementing your income with private practice is a major upside too.

Why should there not be a price to pay for this privilege? Is your sense of entitlement so over-developed that you think the public owes you a living and a get out of debt free card?

All that is asked is that you repay the commitment made to you by working in Britain for four years after training. If that is not for you, then get your training elsewhere at someone else's expense.
Original post by Good bloke
The level of debt is, frankly, trivial compared to what is on offer. Training as a doctor is pretty well a guarantee of a privileged, fully-employed, financially risk-free life and, in the eyes of the tabloids, sainthood. The prospect of enormously supplementing your income with private practice is a major upside too.


Wow, you make it sound like winning the lottery! There are, unsurprisingly, a huge number of negatives associated with the job, all of which are increasing year on year, and its a long, unpaid course for the most highly qualified group of students in the country to get there. I don't have time to give you a breakdown of all negatives, all of the unpaid compulsory extra hours, the moving house every year for the first 8 years, the thousands of pounds of hidden fees... google is your friend. Some relevant highlights though:

Most doctors will expect to repay well over £150K student debt over their career. Based on projections (which get really complex with the new contract), most will be repaying for the full 30 year term of the loan. Also remember that doctors are paid less per hour than a newly-qualified nurse for the first 3-4 years of the job, more if you consider the opportunity cost of the degree being 3 years longer.

The new contract bans doing private work in NHS hours. You can do private work, normally at least 20 years down the line, but its in addition to your normal 48 (unofficially more like 55-60) hour work week.

Why should there not be a price to pay for this privilege? Is your sense of entitlement so over-developed that you think the public owes you a living and a get out of debt free card?


I'll try to remember how privileged I am when I'm working my 7th consecutive 14 hour night shift on the dementia ward due to under-staffing.

All that is asked is that you repay the commitment made to you by working in Britain for four years after training.


I'm not so against this if I'm honest. What I am against, which you have completely failed to respond to, is the notion that for four years I have no escape clause to get away from an employer that seems determined to ignore all expressed concerns, spin and lie to turn the public against its employees, and not do anything about its dangerously understaffed and straining hospitals. Removing the one escape route we have left is frankly terrifying, not to mention the precedent it sets.

You also failed to respond to the completely comparable situation of the government requiring everyone to do 2 years of service to pay for secondary school. For or against?

If that is not for you, then get your training elsewhere at someone else's expense.


If I were starting med school now I would, and if this goes through I will make it my mission to ensure that as few people as possible sign up to be the powerless servants of the DoH as it is currently run, because they absolutely will not care about what they do to you. They have made that very clear.

I will recommend people try to train in another country. One of the many that do not have this kind of clause because, funnily enough, its not necessary.
(edited 7 years ago)
Original post by nexttime

I'll try to remember how privileged I am when I'm working my 7th consecutive 14 hour night shift on the dementia ward due to under-staffing.


Non-medical graduates, like engineers, have similar problems, sometimes physical danger and a strong risk of redundancy through economic downturn or company failure.

I'm sorry, but doctors may have a long training period and work long hours, but they have a far more privileged life than most. And I do know the details as my quasi daughter-in-law is a doctor. My engineer son works worse shifts, and hours that are just as long.
I think it's excellent news. We are struggling to find a replacement for our senior partner who is retiring in March and I'm probably going to need to work more hours than I want for a few years. There are several GP vacancies in the area, plus a shortage of many hospital consultants.

I don't think having to work for the NHS for 4 years after you qualify is that unreasonable, if you don't fancy it then don't study medicine. We need doctors, not just people with medical degrees.
We also need 50% of medical students to become GPs.
As general practice covers all of medicine and GPs need a greater breadth of medical knowledge than most consultants I do feel that if you are thinking of being a doctor but definitely don't want to be a GP you probably don't really want to be a doctor.
I think there should be an incentive to stay in the NHS, particularly in areas of need though, like reducing your student debt or abolishing it after x no of years' service.
Original post by taysidefrog
I don't think having to work for the NHS for 4 years after you qualify is that unreasonable, if you don't fancy it then don't study medicine. We need doctors, not just people with medical degrees.


I agree; as a person from a country which doesn't even provide student loans, this deal is bliss. 220 000 pounds is a lot of money, and for someone with my background, working it off in 4 years doesn't seem so bad. It still provides with opportunity.

I know the majority will disagree with me, probably even calling those 4 years slavery, and that's fine. We all have different viewpoints :smile:
With the best will in the world and having done work experience, shadowing etc, nothing will really prepare someone for the realities of day to day life as a doctor. What if they get to clinical years or F1/F2 and realise actually it isn't for them? Then they have to pay back thousands or be trapped in a job they hate.....4 years is a long time in this scenario. I have a place at med school deferred to start next September and find all this really worrying to be honest.


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I think this is, in general, a good idea. However I'm slightly confused as to what would happen about the 4 year commitment to work in the NHS.

Say you want to join the army as a doctor and get a medical bursary for the final 3 years of completing your medical degree. By commitment to the army, you then go on to do officer training etc straight after foundation years and then onto commission. So how would that work?
Original post by Good bloke
The level of debt is, frankly, trivial compared to what is on offer. Training as a doctor is pretty well a guarantee of a privileged, fully-employed, financially risk-free life and, in the eyes of the tabloids, sainthood. The prospect of enormously supplementing your income with private practice is a major upside too.

Why should there not be a price to pay for this privilege? Is your sense of entitlement so over-developed that you think the public owes you a living and a get out of debt free card?

All that is asked is that you repay the commitment made to you by working in Britain for four years after training. If that is not for you, then get your training elsewhere at someone else's expense.


The only real privilege of working in medicine is knowing that you'll never be unemployed.

The rest of your post is blown entirely out of proportion and you're ignoring the many downsides of being a doctor.

Lmao if you think doctors are seen as saints by the tabloids. You clearly haven't seen the extensive media hate campaign against junior doctors in the last 12 months. We're talking newspapers scouring the personal photos on facebook of JDF members, posting their holiday snaps and describing them as "moet swilling" and living champagne lifestyles just because they have a photo of themselves on the beach.

Private practice is something done only as a consultant (i.e. a good 10yrs post-graduation) and even then, the income isn't as wild as you make out, and is on top of an already busy working week. Compare that to non-public professions of equal experience and qualifications and it would probably pale.

Also who said anything about being "debt free"? My student debt is astronomical and I make significant repayments (probably more so than most graduates). Medics never asked to be debt free.

Also consider the thousands of pounds that we pay in additional training, courses, exams, college fees, insurance, portfolio fees. All the free hours we're expected to put in producing and presenting audits, research, publications, posters. Then tally up the (financial and social) cost of moving house every year and changing jobs every 4 months.

That's not even mentioning the fact that doctors hours are incredibly detrimental to a quality of life. In fact, I work almost entirely antisocial hours while my friends and family are having fun, spending time together. Most of my shifts are either post 5pm or nights, and I work every other weekend on top of that.

Finally, throw in to the mix that the department of health continues to treat junior doctors with utter contempt, and now trying to restrict our freedoms to work. You're having a laugh, mate.
(edited 7 years ago)
Original post by ForestCat
I would be much more concerned about the compulsory 4 years service. I would advise anyone to seriously reconsider if they want to be signing themselves up to four years of whatever terms mr hunt (and his successors) dictate.

Posted from TSR Mobile


This isn't putting me off medicine one bit; I would go so far as to say that the guaranteed job security is a bonus in such unstable economic times as this.
Original post by Etomidate
The only real privilege of working in medicine is knowing that you'll never be unemployed.

The rest of your post is blown entirely out of proportion and you're ignoring the many downsides of being a doctor.

Lmao if you think doctors are seen as saints by the tabloids. You clearly haven't seen the extensive media hate campaign against junior doctors in the last 12 months. We're talking newspapers scouring the personal photos on facebook of JDF members, posting their holiday snaps and describing them as "moet swilling" and living champagne lifestyles just because they have a photo of themselves on the beach.

Private practice is something done only as a consultant (i.e. a good 10yrs post-graduation) and even then, the income isn't as wild as you make out, and is on top of an already busy working week. Compare that to non-public professions of equal experience and qualifications and it would probably pale.

Also who said anything about being "debt free"? My student debt is astronomical and I make significant repayments (probably more so than most graduates). Medics never asked to be debt free.

Also consider the thousands of pounds that we pay in additional training, courses, exams, college fees, insurance, portfolio fees. All the free hours we're expected to put in producing and presenting audits, research, publications, posters. Then tally up the (financial and social) cost of moving house every year and changing jobs every 4 months.

That's not even mentioning the fact that doctors hours are incredibly detrimental to a quality of life. In fact, I work almost entirely antisocial hours while my friends and family are having fun, spending time together. Most of my shifts are either post 5pm or nights, and I work every other weekend on top of that.

Finally, throw in to the mix that the department of health continues to treat junior doctors with utter contempt, and now trying to restrict our freedoms to work. You're having a laugh, mate.


All of the problems you describe apply to plenty of other occupations. Anyone would think doctors are the only people who work shifts. Few of those occupations receive the effective guarantee of permanent employment and a generous index-linked, salary-based, government-underwritten pension.
Original post by taysidefrog
I think it's excellent news. We are struggling to find a replacement for our senior partner who is retiring in March and I'm probably going to need to work more hours than I want for a few years. There are several GP vacancies in the area, plus a shortage of many hospital consultants.



They aren't talking about having more doctors though - just more doctors TRAINED IN THE UK. They want to get rid of doctors who have trained elsewhere from the NHS.

[plus the "funding" identified to pay for this is a complete red herring...it's very unlikely to happen. I'm very keen to see the official med application numbers when they're released by UCAS in November - I'd bet anything that they're down significantly...they were down 3% last year, the publicity around the junior doctor contracts came after that]
Original post by PQ
They aren't talking about having more doctors though - just more doctors TRAINED IN THE UK. They want to get rid of doctors who have trained elsewhere from the NHS.


That would be a very, very, very long term aim. These new trainees won't emerge from their FY2 training until 2025 at the very earliest and they won't replace anyone of experience - just fill some junior holes. No consultant will be replaced by one of these extra people until 2035 at the very best.

I can see no sensible argument against Britain moving towards being self-sufficient in developing medical staff. It is a scandal that we aren't already.
(edited 7 years ago)
Original post by Good bloke
That would be a very, very, very long term aim. These new trainees won't emerge from their FY2 training until 2025 at the very earliest and they won't replace anyone of experience - just fill some junior holes. No consultant will be replaced by one of these extra people until 2035 at the very best.

I can see no sensible argument against Britain moving towards being self-sufficient in developing medical staff. It is a scandal that we aren't already.


I would certainly be of the view that your views are in the minority of medical students and doctors for whom this change should not affect; but at least they are very knowledgeable around the subject (Sorry, not sure of your job or study).

Whilst employment is almost guaranteed as a doctor, the working conditions are incredibly hard - due to a multitude of factors that are not appreciated until you are on clinical placement or do the job yourself. Work experience is not realistically able to make you decide whether you want to be a doctor for the rest of your life, although it may help.

The very fact that junior doctors can currently leave the UK (in huge amounts of debt) encourages the government and Trusts to make working conditions safe and considerate of their employees - so that the majority of UK medical students remain in the UK.

If a doctor is nevertheless incredibly dissatisfied working within the NHS, I wouldn't particularly want them begrudgingly coming into work to count down the number of days until they leave whilst feeling demotivated and possibly depressed.

Don't get me started on the joke figure of £220,000.

On the flip side, Etomidate made some fantastic points that you overlooked and show you are perhaps not aware of the current morale within the NHS. For example, you said doctors are considered saints in the tabloids - it's the complete opposite.

Very few other courses have the astronomical fees post-qualification as shown by Etomidate.

Very few other courses only have one employer, meaning if you are unhappy with working conditions (e.g. a completely inappropriate Junior Doctor Contract negotiated in the future), you cannot change employer within the U.K. And as the BMA now view strikes as a No-Go and you could potentially not leave the country either, that means any future contract could be implemented regardless of doctors highlighted risks which is wholly unnacceptable.
(edited 7 years ago)

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