Junior doctors’ training: one year on

Authors: Rob Finch 

Publication date: 14 Jun 2008

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May 16 marked the close of the first round of recruitment for specialist training posts. Twelve months on from the chaos of MTAS, Rob Finch asks junior doctors if the system has improved

The mismatch of training opportunities coupled with the ill conceived change to immigration rules and the collapse of the medical training application service (MTAS) made 2007 a memorable year for junior doctors for all the wrong reasons.

It was a year that saw careers blighted, from the most junior doctors in the NHS, arguably up to the (then) health secretary Patricia Hewitt.

The reaction to these threats was fierce and considerable. We saw 10 000 doctors involved in one of the largest public demonstrations of its kind, and also rare sympathy from the media and the active engagement of many senior politicians in resolving the crisis.

Since then three inquiries have raked over the rushed implementation of Modernising Medical Careers. With the Douglas inquiry into MTAS, Sir John Tooke’s “Aspiring to Excellence” report into Modernising Medical Careers, and the Commons Health Select Committee’s inquiry into the whole sorry affair now gathering dust on the shelves, will junior doctors get a better deal this year? Will we get the best doctors trained in the most appropriate specialties? And perhaps most importantly, will doctors be treated with the dignity and respect they deserve?

Well, if the BMA is to be believed, the answer to these questions is probably “no.”

Speaking after publication of the recent select committee report, the BMA’s chairman, Hamish Meldrum, laid down a marker of what could be expected. He said: “This year’s recruitment process will, in some ways, be even more challenging than last year’s, with severe competition in some specialties and problems filling posts in others.”

And the BMA’s junior doctors committee chairman, Ram Moorthy, believes that while there has been progress from last year’s recruitment system, returning to locally based applications is “a step backwards.”

He says: “Last year the problem was that people had no information, the goalposts kept shifting and juniors felt completely at a loss. We’ve had better information this year. We’ve still had concerns over episodes where the process hasn’t worked, but the Department of Health has listened more and deaneries have been more eager to sort things out.

“Last year, because it was a national recruitment problems were identifiable as they occurred. With it at a local level it’s more difficult to tell. Until everything is finished we can’t say how it’s gone.”

And he warns that despite some progress, junior doctors are still being put through the mill unnecessarily because of the way the process is structured.

“Juniors want to be treated properly not making career- and life-changing decisions in a very short time. We’ve still got a number of people wanting to get into training who are likely to be denied the opportunity.

“My big concern since the beginning has been the significant mismatch in the numbers—we have a ratio of two to one, and in some specialties up to twenty to one. We really have to make sure we have ways for making sure we don’t lose the talent.”

Chris McCullough, chief executive of pressure group Remedy UK, agrees, adding: “Many of those who weren’t successful [last year] have realised that a 20:1 competition ratio isn’t feasible and people are taking rational decisions about their career.”

Despite this, he says, the motivations that forged the grassroots Remedy movement remain as relevant as they were over a year ago.

“From a medico-political point-of-view we’ve had the toughest year in living memory. Not much has changed and most of the Tooke report was thrown out and not received by government in the way it was expected.”

Dr McCullough’s worry now is for the “new lost tribe” of doctors who failed to get run-through posts last year and who face no relevant employment or training opportunities this summer.

One such member of this new lost tribe is Henri Sueke, with a fixed term specialty training appointment in ophthalmology, whose experiences seem particularly harsh.

Mr Sueke was convinced to take part in a pilot of Modernising Medical Careers having been told, he says, that his training would be run-through. It later became apparent that this was not so, and he then became embroiled in the 2007 recruitment fiasco, failing to get a much coveted run-through ophthalmology post. He also seems to have lost out this year.

Having just spent over £1600 on potentially useless exams, this August he is faced with having no job, a mortgage, a young family, and few choices.

Mr Sueke says: “I’ve got shortlisted for a staff-grade job in ophthalmology and one consultant asked me why I was applying for the job as I’ll be ruining my career. I explained my situation and he understood and said it was a shame.

“There’s no way back in—I’m too senior to apply for ST1 [specialty training year 1] and now I’m getting too senior to apply for ST2 [specialty training year 2]. It gets harder the more you’ve done, which is ironic. No-one has ever said to me I’m a bad doctor.”

He added: “They talk about the lost tribe—that’s very much how I’m feeling at the moment. And no-one’s really that bothered about me.”

And while some, like Mr Sueke, may have no viable opportunity to work towards a consultant level post, others are being forced into invidious situations simply to keep alive the dream of training to the highest levels within the NHS.

One such is Stephen O’Hanlon, who is currently working as a locum ear, nose, and throat (ENT) registrar after failing to find a specialty training post last year.

This year Mr O’Hanlon applied again for ENT specialty training under what he calls “son of MTAS,” with general practice as his back-up option. But because of the structure of the recruitment process the general practice interviews—and therefore the job offers—happened a long time before interviews for other specialties.

Because job offers are not held open, Mr Hanlon has been “forced” into accepting a second choice GP job without even having the option of going to his ENT interview. To do so would mean an 80% chance of having no job offers at all.

“I’m getting long-in-the-tooth so I said go along with general practice. It’s a shame as I have years of experience in ENT and even took 18 months off unpaid to do ENT research. So personally it’s disappointing. I’ve weighed it up and I think I’ve made the right decision. I’ve been doing fine at the job in ENT, but I now don’t have a crack at the whip.”

Asked why he didn’t take a shot at his “dream specialty” he says: “Part of it is when you’re kicked so many times anger leaves you and you get resigned to your fate and I think that’s where a lot of juniors are at the moment.”

And while most of the focus in the past 18 months has been on recruitment to specialty training, there could be trouble ahead for the foundation years.

Ian Noble, chairman of the BMA’s medical students committee, says that while he is delighted that no one from UK medical schools missed out on a foundation place last year.

But “We could have a problem with applicant numbers and places in the next few years and we’ll reach the point where some UK graduates won’t get a foundation place and therefore registration.”

And he adds a note of warning: “There’s not much point in worrying about specialty training if you can’t get on a foundation programme.”

But despite the success so far, recruitment to foundation training has not been altogether smooth. While around 92% of students managed to get their first choice of deanery in which to train, the North West Thames region saw only around 60% achieve their first choice, with many “local” graduates having to leave the capital.

One of these was Matt Mak, a final year medical student, who has been unfortunate enough to be allocated to his fifth choice deanery. He says: “The whole idea of the foundation programme was that it would enable people to move and it has done that but it has messed up the lives of people who wanted to stay.

“There were tears when people found out. People are being sent all over the UK to places they don’t know and have no friends and no support network when its one of the biggest changes in your life. We feel cheated because we know London—we know its demographics, its patients and we’ve amassed ‘London debt’ so when we go to these new places we’re not going to get London weighting to pay for that.”

But it is not all bad news. Matt Forbes, another final year student, says: “For me it went really well. I’m happy with the whole thing as it’s allowed me to apply for London, which wouldn’t have been an option in the past.

“I know it didn’t work out for all people, but as far as I was concerned I was all right. And I feel I was lucky. I realised that the application form was the most important thing I’d done in medical school.”

And that is where many junior doctors still have their reservations about furthering their training. It seems that in 2008 we are far from “aspiring to excellence” and rewarding hard work and high achievement, instead focusing on getting through an arbitrary bureaucracy to further the careers of tomorrow’s consultants and general practitioners.

Rob Finch freelance journalist London

roberto_finchley@hotmail.com