The NHS Consultants' Association

UNEMPLOYED DOCTORS

We have been aware for many years that this country has fewer doctors per head of population than our near neighbours in the EU. The NHS accepts that we have 2.2 doctors/1000 people compared with France and Germany (3.4/1000) and Italy (4.1/1000). One of the principal aims of the NHS Plan was to train more doctors to rectify this discrepancy, because we currently import private agencies to reduce the long waiting lists of hospital patients resulting from a chronic shortage of senior doctors

It is therefore astonishing that unemployment has become a serious threat to junior doctors. This situation was not anticipated by the NHS, the Department of Health or the junior doctors themselves.

There are 49,000 junior doctors in the UK of whom 5,300 are Pre-Registration House Officers (PRHOs) or "housemen" and 19,200 are registrars. SHOs make up about half of the junior doctors (24,500). The intense competition for posts is focused at the Senior House Officer (SHO) level.

Until this year medical students on qualification have spent a year as PRHOs before gaining medical registration. They then enter further training in the SHO grade over 3 to 5 years before becoming registrars and ultimately consultants.

Most SHO posts are now of 6 months duration with jobs starting at the beginning of August and February. PRHOs on gaining registration compete for SHO1 posts (first year SHO posts) and existing SHOs compete for more senior SHO posts (SHO2 to SHO5). In September 2004 there were 5,322 PRHOs. In mid July the BMA made a quick survey of PRHOs whose e-mail addresses were registered with the BMA. 38% of the 276 who responded had not obtained a post.

This year each recognised SHO training post has received about 200 applicants; this rose to 500 in early July and to 1000 in mid July. Tom Dolphin, a current member of the Junior Doctors Executive Committee, told The Sunday Times (7th August) that he had failed to get an SHO post. He obtained an interview for a post that attracted 1100 applicants. He had believed that his successful career as a medical student at Barts and as a first year SHO would have stood him in good stead. He now collects his unemployment benefit and contemplates his £32,000 debt. He has decided to return to live with his parents to reduce his living expenses.

There is an undoubted fall in the number of advertised SHO posts. The BMA compared the number of SHO advertisements in BMA Careers (the chief careers journal) for the months of May 2002 and May 2005. There were 50% fewer jobs in May 2005. This might mask a greater fall as there were more rotational jobs in 2002 (a rotational job might consist of 3 posts).

The Secretary of State claimed that there had been no reduction in SHO jobs (BMA News, 9th May). The Minister of Health, Rosie Winterton, has investigated the problem and found that only 122 PRHOs were unplaced, although she did not comment on SHOs seeking posts (3rd August, Daily Express). The BMA is to conduct a survey which it is expected will counter these remarks.

SUGGESTED REASONS FOR UNEMPLOYMENT AMONG DOCTORS

It is clear that the reasons for the shortage of jobs are complex and they will be considered separately.

1) When The NHS Plan was published it was considered that an increase in consultants was needed if its ends were to be achieved. The training of doctors is extremely lengthy. The Chief Medical Officer, Professor Sir Liam Donaldson, reviewed the current "apprenticeship scheme" and decided to introduce a more intensive training system entitled "Modernising Medical Careers" (MMC). He decided that on qualification a new doctor would enter a Foundation Course for 2 years. The first year (F1) would replace the PRHO year and the second year (F2) would replace the SHO1 year. F1 began for the first time on August 2nd 2005. The effect would be to abbreviate the training of doctors and produce consultants more quickly. A number of SHO posts have been subsumed into F2. This scheme is being implemented now and the withdrawal of jobs from SHO level is necessary to fund it. The existing SHOs could become the "lost generation"

2) The European Working Time Directive (EWTD) reduced the number of hours junior doctors worked from 60 or even 100 hours to about 56 hours. This reduced the number of hours that junior doctors contributed to the service commitment for the NHS. NHS Hospital Trusts countered by advertising new Trust grades whose terms and conditions of service were determined by the Trusts. These posts are not recognised for training and are devoted to satisfying the service commitment. Consequently SHO posts have been reduced and trainees cannot find jobs.

3) Funds for postgraduate education are administered by the postgraduate deaneries and it had been hoped the increasing numbers of Trust grade posts would be converted to substantive training posts by the deaneries. Unfortunately funds allocated by the Department of Health to deaneries were cut severely last year at a time when the deaneries required increased funding to set up the MMC programme.

4) The government sets out in the NHS Plan that, in order to increase substantially the numbers of doctors, the numbers of medical students must be increased. It aimed to achieve this by increasing the intake of all existing medical schools in 1999. They also created three new medical schools, i.e. Leicester/Warwick, The Peninsula School (Exeter/Plymouth) and that at the University of East Anglia (UEA).The medical students from all these schools who are pursuing a 5 year course, will qualify this year. This has increased the number of applicants for PRHO (F1) posts. Those on accelerated (4 year) courses will obtain medical registration this year and will be competing for SHO1 places this year.

5) The government has been conducting overseas recruitment campaigns which have been successful. The GMC has expanded its facilities for conducting qualifying exams both abroad (IELTS and PLAB1) and in this country (PLAB2). Frequently overseas doctors have more experience than those from this country and are formidable competitors

Conclusion

I have described the current situation which I believe stems for a lack of foresight by the Department of Health and the government. It is unbelievable that the momentous changes which have been introduced so rapidly have been done without any regard for their disadvantages.

The difficulties will be compounded in less than two years when junior doctors will be emerging from Keele University and Hull/York medical schools to swell the numbers.

The establishment of the new method of medical education has a lot to commend it but its authors concentrated on the development of the new scheme, ignoring the transitional phase. Under the new programme junior doctors will proceed from F1 toF2 and to the registrar posts seamlessly, i.e. Specialist Training Year 1 to 5 (STY1 to STY5) and then to consultant jobs. Those left in the SHO grades will find no further SHO posts as they are phased out and their revenue used for F2 posts. SHOs will compete against those successfully leaving F2 for specialist registrar jobs. The influx of International Medical Graduates (IMGs) will make this competition more vigorous.

The major failure has been in medical workforce planning and it will require the creation of more SHO and Specialist Registrar jobs in the short term. At the Annual dinner of the CBI on 17th May 2000, the Prime Minister said that "our job is not to resist change but to help people through it". Some interpreted this as meaning that the unemployed will get counselling. That day may have arrived.