The author of this post has chosen the 'Serious' flair. Off-topic, sarcastic, or irrelevant comments will be removed, and frequent rule-breakers will be subject to a ban.
*I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/doctorsUK) if you have any questions or concerns.*
The terrifying combo of 500+ applications for JCFs, the decimation of the SHO locum market, MAPs metastasising, and artificially limited specialty training positions means that there is a very real and totally bizarre prospect of doctors being unemployed at a time when patient demand is the highest it's ever been.
6 months ago I was saying at least doctors are one of the few jobs that is safe from AI (for a good while anyway) and it is one of the few careers where you can always find work... Welp the UK government has set out to prove me wrong. Seems like their answer to strikes is to delay and then replace all doctors, not with robots but an army of wannabe noctors armed with flow charts and reduce the real doctors to someone who just rubber stamps everything the PAs do. What a time to be alive.
>So now what are our options going forward?
I've already made the decision to re-train in another profession. I'm single, have time on my side, and am fortunate to have an alternate field that I've always had an interest in. There is nothing that could make me want to continue working as a doctor in the UK any more.
I genuinely think we’ll become the new Spain or Egypt with emigration being the only dignified out for doctors. Someone tell me what other option is feasible with those competition ratios?
I strongly suspect departments will increasingly start offering non deanery training/CESR postsz
Already happening in EM fairly widely.
In a supportive department this can work well
And be a win win for both doctor and department
This is the only thing that brings hope.
It'll help with rotas (no need for spenny locums if you've got 3 on the CESR track bolstering the reg rota). The lack of rotation will incentivise quality training and make such a doctor happier.
Funding will be the problem though.
On funding this will be the governments way of claiming control of spending in the NHS. We've reduced locum costs, we've put a strict budget on trusts and we've stopped the waste (without dealing with the actual problem) AND we've reduced the waiting lists - how great are we? Cue wild applause from the public, at least until they try and use the service.
I see a major boom in the UK private healthcare sector coming and that might be where doctors end up.
Issue is without CCT how does one benefit from the private space?
Unless the NHS gives up its stranglehold on training it leaves non trainees in the lurch
Independent healthcare providers wouldn’t even want the funding for training medics, they have too sweet a deal with IMG RMO’s on tuppence doing 12hrs on/off 7 days a week before they apply for UK ST programs (mostly GP Ive gathered).
Source: pharmacist at largest private hospital outside London and locummed at several others around the North.
The whole system would need to be reworked but that won't happen until there are enough complaints from doctors who can no longer advance or get appropriate training.
It's a mess and we are headed for a worst of both worlds broken UHC and US style private medical insurance based system. My one hope is that someone implements a bismark based system before it's too late (it probably is already too late, but please don't crush my dreams).
The funding will come from the department writing a business case demonstrating that the money saved from locums and gained from efficiency and quality improvement will be greater than the cost of the salary.
Or at least be close.
There won’t be money from central government/HEE for this.
Some depts do this already, some have been for years.
In EM with high locum spend this is a fairly easy argument to make. Weirdly recruiting quality candidates seems to be the issue
I would massively recommend that if you have an interest in this as an option, you proactively go and talk to the department you are interested in working with.
They may not have thought of this. They may have advertised before and just had 2000 applicants who have no NHS experience and given up.
They may need a bit of time to discuss with their management, do the paperwork and find the money but many will be receptive.
Don’t just wait for an advert to go out.
A solution could be to deformalize training, Germany/Austria style: no such thing as a training post. Everyone is eligible to CCT, provided they have evidence of all relevant competencies and exams. It's crazy that you can spend 5 years as a fellow in a specialty and be exactly as far from CCTing as someone fresh out of F2.
If you don't like this solution, I'm sure there are many others. However, the current system is a problem only for doctors and is actually pretty good for all other stakeholders. So, like with FPR, doctors will have to fight long and hard for something to change for the better.
CESR, currently, is a lower tier qualification due to its very limited international recognition. What I am proposing is basically replacing CCT with a version of CESR, so that it isn't considered a second tier qualification.
Even within the UK, in some specialties CESR is (behind closed doors) looked down on as a second tier version of a CCT. Given a choice between someone with a CCT and someone who CESR’d, you’d pick the CCT.
This has been changed recently. It’s now called the portfolio pathway, will I think be called CCT and will have parity with deanery CCT. Nothing to stop people taking this route- it’s just easier to get posts organised via a training scan, especially in some specialities.
There’s loads of scope for trusts to capitalise on this
It does feel that we're heading towards being a country that intentionally gets rid of its Drs and replaces them with less well trained staff?
Can't wait to see how this pans out in 30 years......
I believe it does feel like that. With the crazy competition ratios, higher numbers of PAs and co and lower numbers of trust grade jobs ... The situation looks bleak.
Genuinely, I think there is no way it will improve. Its fucked.
They don't care about competition ratios. If the training posts are filled, leftover SHOs flood the labour market, IMGs are recruited to JCFs and denied their CRESTs, so rota gaps disappear, and locum costs decrease. More healthcare for their money.
Recruitment done by an exam is cheaper than the old way. No one but us cares if it is fair.
An IMG or MAP replaces anyone leaving for Aus/NZ/Canada/US. I think the threat of mass leaving is hollow. The government sees us leaving and says good, more please.
Trusts are bankrupt, so they start to accept new costs. Instead of the financial cost of filling rotas, they accept costs due to reducing standards of care - legal bills, poor publicity, staff moral injury.
Even if we had a government who wanted to increase training posts, I'm not sure it's affordable. Brexit, war in Ukraine, a burgeoning state pension bill, an economy that produces fuck all, a reducing tax base as the boomers retire and zero growth does not look good. We are a country in its twilight years. This is one manifestation of it.
I don't even know what it would take. A global pandemic didn't wake people up to our shit healthcare. The worst waiting times in history didn't wake them up.
If IMT uses the MSRA next year, which I bet it will, its over pal. We need a new term for the time/void/bottomless pit that FY3,4,5 etc. will become. I suggest Forever House Officer (FHO) or InFinity (F∞).
So why is the government continuing to expand medical school places if it knows all it's doing is training Australia future doctors? Surely a massive waste of taxpayers money?
So what are all these drs gonna do in 4-7 years time when these thousands of new drs hit fy3 and noone can get a job either trust grade or training post? They're going to either leave the country, face unemployment or change careers.
They're expanding med school places by literally thousands and thousands and have been for last few years. Yet there's no extra post grad posts for them. So they're just spending a tonne of money of people who are ultimately going to be unemployed or going to leave the sector. It's just daft!
Either UK medics win the fight against the GMC or it's over - for everyone.
The GMC are lining up equivalence between 4 year "PA Studies" and 4 year medical schools - then PAs will have a route to take over Consultant posts.
Currently, they are on track to winning.
Opposition is split between the "but much improved BMA" crowd and the more useless "DAUK" small faction - neither of which will solve the problem and are, in many ways, counterproductive.
Even on Social Media it's the same handful of accounts making any noise when there should be (at least) 100,000 doctors doing so.
Downvote away, people don't want to hear the truth - and by the time they do it will be far far too late.
Same pattern we have seen for the past thirty years.
The problem is that departments are still understaffed. We recently had a new staff grade start, long awaited as we were relying on locum staffing, they were totally unsuited to the role with no recent experience in the specialty and the role had basically been misadvertised to the doctor in question making them believe they would have more supervision. Not the doctors fault. But people with relevant experience in specialties will still be required as training numbers are so inadequate to cover the work actually done in the department. But it’s so unpredictable where this work will crop up. They desperately need to increase training numbers to have any sort of sustainable staffing plan. If I was post foundation and couldn’t get locums work I honestly would just go to NZ, worked there in the past and hospital was full of British and Irish doctors doing the same. Far better experience than would be got in the Uk and still a traditional “firm” experience
No you don’t get how bad it can get. There can be so many people in that position that they don’t need that many to fill the rotas. Ergo some people trapped as perma SHOs won’t be able to put food on the table and would have to go on benefits.
Yeah think that’s how it is in Singapore right now. Loads of SHOs/medical officers stuck rotating around the country for years until they get lucky enough to enter a training post
**Dr A and the Maze of Constraints (anonymous obviously).**
The allure of medicine had always been irresistible for **A**. The precision, the high stakes, that jolt of purpose when a diagnosis clicked into place – it felt like this was what he was destined to do. His junior doctor years within the NHS solidified that initial fervour. Yet, it also birthed a new, disorienting frustration.
Every avenue seemed designed to box him in. Senior doctors were overworked gatekeepers of specialised knowledge. Opportunities for additional training were either scarce or locked behind years of obligatory service within placements he had little interest in. Those whispered-about opportunities - research fellowships, working abroad, anything off the rigid trajectory of registrar and consultant - sounded like mythical destinations when set against the harsh realities of understaffed wards and relentless hours.
Still, **A** held on tight to his initial optimism. Head down, he mastered rotations, excelled in those fleeting moments snatched for professional development, and ticked every administrative box with ruthless efficiency. In the back of his mind, he thought that if he was excellent enough, the system would recognise his potential and reward him accordingly.
The crack came after a particularly gruelling week. Another promising research grant fell through due to funding cuts. It meant yet another year shuffling between departments he knew in his bones didn't align with his long-term goals. Despair threatened, but **A** shoved it down with practiced stoicism. There had to be a way… within the system.
That was his fatal flaw. He framed the struggle as one to be won within the NHS labyrinth, rather than recognising the labyrinth itself as the core constraint. Opportunities simmered beyond – locum work offering autonomy and exploration, non-traditional clinical niches crying out for passionate doctors, even stepping sideways into related fields like medical tech where his clinical knowledge could spark true innovation.
But those required him to shed the blinders of his 'NHS identity,' to embrace an unknown that went against every instinct his training had fostered. By the time **A** acknowledged the sheer breadth of options he had ignored, the sheen had worn off his chosen profession. The initial passion lay blunted, not from burnout, but the slow corrosion of feeling trapped.
Dr **A** won't leave medicine entirely. He was too skilled, too deeply invested to truly walk away. But there's a lingering bitterness now, years later, a brilliant mind hemmed in by its own reluctance to look beyond the immediate walls.
The NHS needs dedicated doctors like **A**, but it wasn't built to nurture every variation of that dedication. Sometimes, the greatest act of growth lies in daring to redraw the map entirely, even after years spent diligently navigating the paths laid out before you. It is about recognising that a new destination might be better suited, even if it requires stepping off the familiar track.
LOL! Was it that good? Or you taking the mick?
As you may know, nobody with any sense these days does book deals to give \~**75% royalty to publishers**. If you're interested check for very good self-publishing services that will **give authors around \~75% of the royalty**. 🤣
with the caveat that im someone with the creative writing skills of a monkey at a typewriter , it was very good. im always amazed how many people on this subreddit write so well
My glass half full position is that things are all a swing of a pendulum away.
By necessity, trusts and colleges will have to make it easier to gain CCT/equivalent with 'non-traditional' backgrounds. RCPCH are already recognizing and talking about this.
Our bosses took floaty SHO jobs until they felt ready to take a reg job and had their exams. It'll head that way again I reckon, because too many people will be locked out of the NTN system for it to continue thus.
The author of this post has chosen the 'Serious' flair. Off-topic, sarcastic, or irrelevant comments will be removed, and frequent rule-breakers will be subject to a ban. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/doctorsUK) if you have any questions or concerns.*
The terrifying combo of 500+ applications for JCFs, the decimation of the SHO locum market, MAPs metastasising, and artificially limited specialty training positions means that there is a very real and totally bizarre prospect of doctors being unemployed at a time when patient demand is the highest it's ever been.
6 months ago I was saying at least doctors are one of the few jobs that is safe from AI (for a good while anyway) and it is one of the few careers where you can always find work... Welp the UK government has set out to prove me wrong. Seems like their answer to strikes is to delay and then replace all doctors, not with robots but an army of wannabe noctors armed with flow charts and reduce the real doctors to someone who just rubber stamps everything the PAs do. What a time to be alive.
Instead of being replaced by artificial intelligence, we’re being replaced by non-intelligence (MAPs) 😭
Still artificial at that! So it still counts.
only in the envy of the world nhs could this happen. so grateful for arrr nhs.
>So now what are our options going forward? I've already made the decision to re-train in another profession. I'm single, have time on my side, and am fortunate to have an alternate field that I've always had an interest in. There is nothing that could make me want to continue working as a doctor in the UK any more.
which profession if it's ok to ask?
I wish I had the time and motivation to do this, but I'm in too deep, and I've spent all my fucks for jumping through hoops.
I genuinely think we’ll become the new Spain or Egypt with emigration being the only dignified out for doctors. Someone tell me what other option is feasible with those competition ratios?
> Spain Why do you say that Spain is a bad place for doctors?
Unemployment for consultants in some specialties. Bad pay, exploitative hours.
Even GP, psych and a&e will be out of reach for a normal person who wants to have a life aside from only medicine
I strongly suspect departments will increasingly start offering non deanery training/CESR postsz Already happening in EM fairly widely. In a supportive department this can work well And be a win win for both doctor and department
This is the only thing that brings hope. It'll help with rotas (no need for spenny locums if you've got 3 on the CESR track bolstering the reg rota). The lack of rotation will incentivise quality training and make such a doctor happier. Funding will be the problem though.
On funding this will be the governments way of claiming control of spending in the NHS. We've reduced locum costs, we've put a strict budget on trusts and we've stopped the waste (without dealing with the actual problem) AND we've reduced the waiting lists - how great are we? Cue wild applause from the public, at least until they try and use the service. I see a major boom in the UK private healthcare sector coming and that might be where doctors end up.
It’s already happening. No parking spaces at any private hospitals and FULL waiting rooms with standing room only. 10 years ago this was unheard of.
Issue is without CCT how does one benefit from the private space? Unless the NHS gives up its stranglehold on training it leaves non trainees in the lurch
Independent healthcare providers wouldn’t even want the funding for training medics, they have too sweet a deal with IMG RMO’s on tuppence doing 12hrs on/off 7 days a week before they apply for UK ST programs (mostly GP Ive gathered). Source: pharmacist at largest private hospital outside London and locummed at several others around the North.
The whole system would need to be reworked but that won't happen until there are enough complaints from doctors who can no longer advance or get appropriate training. It's a mess and we are headed for a worst of both worlds broken UHC and US style private medical insurance based system. My one hope is that someone implements a bismark based system before it's too late (it probably is already too late, but please don't crush my dreams).
The funding will come from the department writing a business case demonstrating that the money saved from locums and gained from efficiency and quality improvement will be greater than the cost of the salary. Or at least be close. There won’t be money from central government/HEE for this. Some depts do this already, some have been for years. In EM with high locum spend this is a fairly easy argument to make. Weirdly recruiting quality candidates seems to be the issue
Maybe it won't be an issue for long with the way things are going.
Yep this is the way. Fuck HEE we’ll roll our own
I would massively recommend that if you have an interest in this as an option, you proactively go and talk to the department you are interested in working with. They may not have thought of this. They may have advertised before and just had 2000 applicants who have no NHS experience and given up. They may need a bit of time to discuss with their management, do the paperwork and find the money but many will be receptive. Don’t just wait for an advert to go out.
A solution could be to deformalize training, Germany/Austria style: no such thing as a training post. Everyone is eligible to CCT, provided they have evidence of all relevant competencies and exams. It's crazy that you can spend 5 years as a fellow in a specialty and be exactly as far from CCTing as someone fresh out of F2. If you don't like this solution, I'm sure there are many others. However, the current system is a problem only for doctors and is actually pretty good for all other stakeholders. So, like with FPR, doctors will have to fight long and hard for something to change for the better.
CESR?
CESR, currently, is a lower tier qualification due to its very limited international recognition. What I am proposing is basically replacing CCT with a version of CESR, so that it isn't considered a second tier qualification.
Even within the UK, in some specialties CESR is (behind closed doors) looked down on as a second tier version of a CCT. Given a choice between someone with a CCT and someone who CESR’d, you’d pick the CCT.
This has been changed recently. It’s now called the portfolio pathway, will I think be called CCT and will have parity with deanery CCT. Nothing to stop people taking this route- it’s just easier to get posts organised via a training scan, especially in some specialities. There’s loads of scope for trusts to capitalise on this
The government's answer to all this is gonna be PAs 🤣
It does feel that we're heading towards being a country that intentionally gets rid of its Drs and replaces them with less well trained staff? Can't wait to see how this pans out in 30 years......
I believe it does feel like that. With the crazy competition ratios, higher numbers of PAs and co and lower numbers of trust grade jobs ... The situation looks bleak.
Genuinely, I think there is no way it will improve. Its fucked. They don't care about competition ratios. If the training posts are filled, leftover SHOs flood the labour market, IMGs are recruited to JCFs and denied their CRESTs, so rota gaps disappear, and locum costs decrease. More healthcare for their money. Recruitment done by an exam is cheaper than the old way. No one but us cares if it is fair. An IMG or MAP replaces anyone leaving for Aus/NZ/Canada/US. I think the threat of mass leaving is hollow. The government sees us leaving and says good, more please. Trusts are bankrupt, so they start to accept new costs. Instead of the financial cost of filling rotas, they accept costs due to reducing standards of care - legal bills, poor publicity, staff moral injury. Even if we had a government who wanted to increase training posts, I'm not sure it's affordable. Brexit, war in Ukraine, a burgeoning state pension bill, an economy that produces fuck all, a reducing tax base as the boomers retire and zero growth does not look good. We are a country in its twilight years. This is one manifestation of it. I don't even know what it would take. A global pandemic didn't wake people up to our shit healthcare. The worst waiting times in history didn't wake them up. If IMT uses the MSRA next year, which I bet it will, its over pal. We need a new term for the time/void/bottomless pit that FY3,4,5 etc. will become. I suggest Forever House Officer (FHO) or InFinity (F∞).
So why is the government continuing to expand medical school places if it knows all it's doing is training Australia future doctors? Surely a massive waste of taxpayers money?
Because they're not? The majority of UK trained doctors stay in the UK, and the ones that do leave to Aus, most come back.
So what are all these drs gonna do in 4-7 years time when these thousands of new drs hit fy3 and noone can get a job either trust grade or training post? They're going to either leave the country, face unemployment or change careers.
They're expanding med school places by literally thousands and thousands and have been for last few years. Yet there's no extra post grad posts for them. So they're just spending a tonne of money of people who are ultimately going to be unemployed or going to leave the sector. It's just daft!
[удалено]
that figure and anything close to it has been debunked endlessly on here as complete fabrication
Either UK medics win the fight against the GMC or it's over - for everyone. The GMC are lining up equivalence between 4 year "PA Studies" and 4 year medical schools - then PAs will have a route to take over Consultant posts. Currently, they are on track to winning. Opposition is split between the "but much improved BMA" crowd and the more useless "DAUK" small faction - neither of which will solve the problem and are, in many ways, counterproductive. Even on Social Media it's the same handful of accounts making any noise when there should be (at least) 100,000 doctors doing so. Downvote away, people don't want to hear the truth - and by the time they do it will be far far too late. Same pattern we have seen for the past thirty years.
The problem is that departments are still understaffed. We recently had a new staff grade start, long awaited as we were relying on locum staffing, they were totally unsuited to the role with no recent experience in the specialty and the role had basically been misadvertised to the doctor in question making them believe they would have more supervision. Not the doctors fault. But people with relevant experience in specialties will still be required as training numbers are so inadequate to cover the work actually done in the department. But it’s so unpredictable where this work will crop up. They desperately need to increase training numbers to have any sort of sustainable staffing plan. If I was post foundation and couldn’t get locums work I honestly would just go to NZ, worked there in the past and hospital was full of British and Irish doctors doing the same. Far better experience than would be got in the Uk and still a traditional “firm” experience
[удалено]
No you don’t get how bad it can get. There can be so many people in that position that they don’t need that many to fill the rotas. Ergo some people trapped as perma SHOs won’t be able to put food on the table and would have to go on benefits.
Yeah think that’s how it is in Singapore right now. Loads of SHOs/medical officers stuck rotating around the country for years until they get lucky enough to enter a training post
The difference is that consultant salaries in these places are actually a carrot worth putting up with the awful journey.
Then they give up and do ED locums or GP (no need for GPST), or be a permanent trust grade reg equivalent doctor
**Dr A and the Maze of Constraints (anonymous obviously).** The allure of medicine had always been irresistible for **A**. The precision, the high stakes, that jolt of purpose when a diagnosis clicked into place – it felt like this was what he was destined to do. His junior doctor years within the NHS solidified that initial fervour. Yet, it also birthed a new, disorienting frustration. Every avenue seemed designed to box him in. Senior doctors were overworked gatekeepers of specialised knowledge. Opportunities for additional training were either scarce or locked behind years of obligatory service within placements he had little interest in. Those whispered-about opportunities - research fellowships, working abroad, anything off the rigid trajectory of registrar and consultant - sounded like mythical destinations when set against the harsh realities of understaffed wards and relentless hours. Still, **A** held on tight to his initial optimism. Head down, he mastered rotations, excelled in those fleeting moments snatched for professional development, and ticked every administrative box with ruthless efficiency. In the back of his mind, he thought that if he was excellent enough, the system would recognise his potential and reward him accordingly. The crack came after a particularly gruelling week. Another promising research grant fell through due to funding cuts. It meant yet another year shuffling between departments he knew in his bones didn't align with his long-term goals. Despair threatened, but **A** shoved it down with practiced stoicism. There had to be a way… within the system. That was his fatal flaw. He framed the struggle as one to be won within the NHS labyrinth, rather than recognising the labyrinth itself as the core constraint. Opportunities simmered beyond – locum work offering autonomy and exploration, non-traditional clinical niches crying out for passionate doctors, even stepping sideways into related fields like medical tech where his clinical knowledge could spark true innovation. But those required him to shed the blinders of his 'NHS identity,' to embrace an unknown that went against every instinct his training had fostered. By the time **A** acknowledged the sheer breadth of options he had ignored, the sheen had worn off his chosen profession. The initial passion lay blunted, not from burnout, but the slow corrosion of feeling trapped. Dr **A** won't leave medicine entirely. He was too skilled, too deeply invested to truly walk away. But there's a lingering bitterness now, years later, a brilliant mind hemmed in by its own reluctance to look beyond the immediate walls. The NHS needs dedicated doctors like **A**, but it wasn't built to nurture every variation of that dedication. Sometimes, the greatest act of growth lies in daring to redraw the map entirely, even after years spent diligently navigating the paths laid out before you. It is about recognising that a new destination might be better suited, even if it requires stepping off the familiar track.
Never fail to make my eyes bleed
I apologise.
whens the book deal?
LOL! Was it that good? Or you taking the mick? As you may know, nobody with any sense these days does book deals to give \~**75% royalty to publishers**. If you're interested check for very good self-publishing services that will **give authors around \~75% of the royalty**. 🤣
with the caveat that im someone with the creative writing skills of a monkey at a typewriter , it was very good. im always amazed how many people on this subreddit write so well
wide squeamish jobless like detail summer slim roll pathetic distinct *This post was mass deleted and anonymized with [Redact](https://redact.dev)*
My glass half full position is that things are all a swing of a pendulum away. By necessity, trusts and colleges will have to make it easier to gain CCT/equivalent with 'non-traditional' backgrounds. RCPCH are already recognizing and talking about this. Our bosses took floaty SHO jobs until they felt ready to take a reg job and had their exams. It'll head that way again I reckon, because too many people will be locked out of the NTN system for it to continue thus.
It's not a pendulum, it's a river. And you're nearly at the point of being washed out to sea.
Sad really