‘Medfluencers’, that is, TikTok influencers who are doctors, are appearing on social media extolling the joys of locum work.
“Shifts are paid at significantly higher wages than the normal basic wage,” one tells his 55,000 followers; another, that his hourly wage as a substitute “is so different from the normal hourly wage that it’s crazy.”
Coupled with the junior doctors’ strikes, this questionable use of social media and stories of small fortunes made has helped change many people’s minds about our junior doctors (now officially called ‘resident’ doctors).
But what few of them will know is that over the last two decades, the NHS has failed to address the key problem that is actually driving young doctors out of the health service.
There is no doubt that we need more doctors: it is estimated that we will need to train between 3,000 and 6,000 additional doctors per year to meet the expected demand of an aging population.
However, NHS Labor policies, coupled with a complete failure of leadership from organizations such as the Royal Colleges, the General Medical Council (GMC) and Health Education England, have sabotaged it.
Last month, GMC released its latest workforce report. Hidden in the data charts and tables detailing plans for the medical workforce is a glaring error. The increase in the number of qualifying medical students does not correspond to the increase in training programs, by thousands.
When a doctor first earns his degree, he undergoes two years of basic training; This involves six four-month jobs in different areas, to gain extensive experience, preparing them to begin formal training programs to become the GPs and consultants we need.
Young doctors are quitting their NHS jobs in favor of lucrative locum salaries before spreading the word on TikTok. Pictured: Dr. Monika Sharma
Dr. Summer Kennedy tells her 1,792 followers that her hourly rate “is so different from your normal hourly rate it’s crazy.”
Except they aren’t starting those training programs. In 2022, only 22 percent of new doctors did what needed to happen: enter a training program after their initial jobs.
There are currently 11,757 doctors who have completed their basic training but have not started any training programme. That’s literally thousands of highly qualified doctors who could treat our loved ones and reduce the amount hospitals spend on substitutes while they train to be specialists.
And the reason? There are not enough training positions. So we have brilliantly trained British doctors who want to work in positions we are desperate to fill, but with no training jobs for them.
For example, for every psychiatry training job, there are more than nine applicants.
I have a friend who wants to be a psychiatrist – she’s an amazing doctor, but there are only two jobs starting each year for a psychiatry training program in Cornwall, where she lives.
So, like so many others, he works as a locum psychiatrist (in his case, as a locum psychiatrist).
Sure, this is for a lot more money but with little training to help her become a better consultant psychiatrist. He is now considering accepting a job offer in New Zealand, where he will also receive that consultant-level training.
If she leaves, it will not only cause family upheaval, but it will also be a terrible waste of the money the NHS spent training her to be a doctor and putting her through basic training.
In a TikTok video, Dr. Lizkerry Odeh talks about how the salary for substitute shifts is significantly higher than the normal base salary.
Fundamentally, it will be a disaster for our patients who need her skills now and in eight years’ time when she could be a consultant.
The problem is that the figures for formal training programs are not set by hospitals, but by the NHS. One band-aid solution used by hospitals is the creation of “untrained” jobs. But while these are often identical to formal training jobs, they cannot lead to the doctor becoming a consultant.
And without formal training programs to attend, many young doctors leave the country and take their skills, experience and potential to countries like Australia and New Zealand. Meanwhile, we still need patients to receive treatment, so we waste millions on substitutes.
Some of the best young doctors we have leave the NHS and untrained positions are filled by doctors not trained in the UK; they now make up the majority of new doctors in the NHS.
Because of all these changes, our workforce is becoming less experienced: 9 per cent of doctors enrolled in the GMC have been there for a year or less, compared to less than 6 per cent less than a decade ago. This lack of experience affects the quality of care our patients receive.
And everything is going to get worse. The number of medical students is increasing significantly, but there are no formal plans to expand training programs by an equivalent amount.
You couldn’t make up for it. We risk spending millions training brilliant new doctors to provide excellent service to patients…in Australia.
It is even worse for some specialties: some doctors, such as anesthetists, have to apply for a basic training program and then, after passing a series of exams, apply for a higher training program.
The funny thing is that the number of jobs for these two programs does not match, so after five years of training, they cannot complete the final step to become a consultant.
This recently happened to a whole cohort of anesthetists. Many of my friends left the NHS at this stage of their career to move to (yes, you guessed it) Australia.
Between 2019 and 2023 there was a 6 per cent drop in the number of doctors training to be anaesthetists.
If you’re wondering why there is such a backlog of operations, don’t blame doctors or nurses for not working hard enough and instead question the medical workforce decisions made by those at the top of the NHS.
Even worse is what is happening to other doctors who have completed their postgraduate training. We have fully qualified GPs who cannot get jobs despite the dire need for those GPs. They are leaving the NHS or returning to locum shifts as junior doctors.
This is because much of the budget allocated to GP surgeries cannot be spent on GPs, but must be spent on alternatives to GPs, such as Physician Associates (PAs).
At the same time, the narrative is being woven that there is a shortage of doctors, so we must expand alternatives to doctors such as personal assistants. As Good Health has long reported, there are real concerns that PAs are taking on more responsibility than they are qualified to do, in some cases with tragic results.
Let’s go back to our doctors in training. There is an alternative to this fiasco: let hospitals run their own training programs. I set up a plan at my hospital to do this 12 years ago, breaking with convention.
We currently have more than 75 of these doctors, who often combine clinical work with teaching and research. If only we were allowed to convert those jobs into training jobs, it would be the kind of scheme that could be replicated nationally.
Our young doctors have been let down by those in charge of workforce planning and education, as have our patients and us, the taxpayers. We must change the way we do things; We cannot afford not to.
@drobgalloway