Say goodbye to doctor
"Give me your tired, your poor,
Your huddled masses yearning to breathe free,
The wretched refuse of your teeming shore.
Send these, the homeless, tempest-tost to me,
I lift my lamp beside the golden door!"
It is quite extraordinary how little the country is missing Tony Blair. This, more than anything, proves that he was all spin and no substance. A superficial scratch on the political side board, soon polished over and forgotten.
The MTAS debacle is more than a "superficial scratch" and cannot be polished over. Indeed, there is another crisis approaching. The government has nonetheless deftly moved MTAS to the back burner. Indeed, MTAS is now being window-dressed as some sort of triumph. The government has proudly announced that on 1st August there will "only be 2320 medical posts unfilled."
Only two thousand three hundred and twenty medical posts unfilled.
There will also be around 10,000 unemployed doctors. But that is tough. That is the "market". Doctors do not have a divine right to employment. Never mind that it costs the taxpayer £250,000 a head to train them. Why do they not stop whining and sign on? There are plenty of jobs at McDonalds.
Many of these doctors have first class honours degrees, prestigious post-graduate qualifications and a significant number of academic research publications. The most under-publicised and damaging selection criterion of MTAS was that doctors applying for jobs were not be discriminated against on the grounds of inexperience. And so, in this crazy world of pseudo-egalitarianism, the better qualified doctors were more likely to end up unemployed.
We should pick pilots like that.
How is the government going to solve the looming 1st August crisis? It is going to do what it always does with the NHS. It is going to throw another huge wadge of taxpayers’ money at the problem, and employ temporary locums until the system “settles down”. (Full details here)
The country, meanwhile, is going to lose some of its finest doctors. These young men and women are highly intelligent and highly motivated. They will mostly be in their mid-twenties, some a little older, and will have been training for seven to ten years. They are vocationally motivated. They want to do the job for which they have prepared.
If they cannot do it in the UK, they will do it elsewhere.
Some will go to the USA, where they will be both welcomed and well rewarded. Forbes Magazine has just published its annual review of the top paying 25 occupations in America. Top of the list is the anaesthetists. Eight of the next nine places are occupied by other doctors:
When we first looked at America's best- and worst-paying jobs a year back, we asked the question, "Why do financially pushy parents want their children to marry doctors?" Our answer then: Because, as Willie Sutton said of banks, that is where the money is. Still is.+++++++++++
The medical profession continues to dominate the top end of our list of the 25 best- and worst-paying jobs in America. Anesthesiologists have flipped places with surgeons to take the top spot, but the next eight places are firmly in the healing hands of various sorts of specialist practitioners. (Full article in Forbes here)
I have just received an email from a medical SHO in Lancashire. He has been qualified for three years and is, as he admits, one of the "lucky ones". He has a substantive job for 1st August, albeit not his first choice. He says:
"I thought you'd be interested to know of the depths trusts are having to stoop to fill jobs by next week. I received an email from the clinical director of one of the hospitals in my trust, saying that he'd just found out that his SHO/STWhateverthefuckitis post wasn't filled and did any of us (current SHOs) know of anyone who might fancy it.Dr Crippen would strongly advise anyone planning a serious illness in August and September to take a long holiday in Europe. Note that E111's are no longer valid. You will need a European Health Insurance Card (EHIC) to receive necessary health care during a visit to a European Economic Area (EEA) country or Switzerland.
So now, following the disaster of MTAS, and the frantic local selection process, consultants are reduced to desperate emails scouting for employees. So from the sanctimonious 'cronyism'/bias-reducing wonder that was MTAS, we've ended up with jobs being given out with no interview to friends of friends.
And the point of disrupting all of our lives in this way was.....?
I wish you could see the state my hospital is in at the moment. And it's ALL because of MTAS. I suspect even you might be shocked."
Full details here
Labels: MTAS
36 Comments:
"A superficial scratch on the political side board": I warmly congratulate you for the subtlety of your suggestion that we can expect be spitting on him and wiping for years to come. But he will, in retrospect, be seen to have been far more damaging than that.
Dearieme
I agree. Iraq in particular.
But nonetheless it is staggering how little Blair is missed.
Gordon Brown may just be a better PR man and spinner, but he is a joy to listen to after the vacuous, pseudo-sentimental clap trap that Blair spawmed for ten years.
John
good to see you get round to my advice of many years standing, if you need an op get yourself on eurostar and have it done in mainland europe, why risk the dirt and lack of docs in the uk?
no one
The figures in the Forbes article sound very impressive, however even the best paid jobs only equate to around 90k sterling.
With GPs average salary topping 100k are the streets really paved with gold over in the states?
Still, any job is a job and my heart goes out to those left unemployed. Perhaps come august those responsible will see the destruction they've caused and have the good grace to resign.
90k or the dole office...hardly a choice.
Then again 90k in the states goes a very long way... Canada too, big house, nice car and the ability to work in medicine.
I'm doing my canadian exams in my F2 year just in case.
"Still, any job is a job"
Well, I agree and disagree anonymous. A job, especially a fairly comfortably paid medical job, is better than the dole.
But, one of the analogies is saying to an economist who wants to work in the city that they have to be a bookkeeper in Hull and be happy with it.
anonymous 4.57, agreed; and even though 90,000 will buy a better standard of living over there, I have a feeling that (despite no home visits) rather more working hours might be required.
saying to an economist who wants to work in the city that they have to be a bookkeeper in Hull and be happy with it.
renal, some junior doctors' view that they are entitled to a training post in their first choice specialism in the city of their choice is, to put it mildly, irritating in the extreme. And just for the record, economists who might have wanted to work in the city and certainly wanted to work as an economist *do* end up as the equivalent of 'a bookeeper in Hull', and highly qualified top university doctorate + publications (and very bright, I add) political theorists do end up as librarians. (Etc.) Moreover, senior registrars(as they then were) sometimes couldn't get a consultancy in the locality of their choice or even one suitable for their partner. Sometimes the reasons were nefarious (e.g. women surgeons known to be unwelcome), sometimes, simply, the jobs were not there. In the second type of case, the doctor simply had to put up with it (and in my experience of such doctors, they did and they do). Why the current alleged creme de la creme can't see that not all medical graduates can be surgeons at Kings, I don't know; but it speaks ill of their intellect, education and social isolation.
That MTAS appears to have shafted some very good junior doctors is a totally different point.
The salaries published by Forbes are the average of physicians in Academics and Private Practice (PP). Obviously the PP works harder but his income is usually 50-100 % greater that academicians. In fact the top paying job in medicine is invasive cardiology where incomes easily top 500K for a private practitioner. Urologists, orthopeds and cardiothoracic surgeons also get close to half a million dollars a year. Unfortunately Uncle Sam and the home State of residence take away 50 % of the income in taxes. And this does not count health insurance. oncologists used to make well over $ 200K per year but the reduction in payments by Medicare has started to reduce our income.
Performing procedures make money. Using your brains to spend time with patients will not even cover the overheads of running the office.
Meanwhile, the local 2 hospitals have contacted the GPs and told them not to refer anything that isn't urgent on the 1st and 2nd of August as they will be training their new doctors. I hope they aren't too badly affected by the > 2000 vacancies that have yet to be filled, thanks to MTAS. I presume that the GPs will put all semi-urgent patients in a big freezer for those 2 days, as the district nurses are already on "red alert", whatever that means. In 25 years of working for the NHS, I've never heard of community services going on "red alert"
Jayann;
And just for the record, economists who might have wanted to work in the city and certainly wanted to work as an economist *do* end up as the equivalent of 'a bookeeper in Hull',
I'm sure they are, but if PWC offer them that job they have the option of going to Morgan Stanley.
Of course junior doctors do not have a divine right to their dream job, but does that mean that they practically forfit the right to work in this country if they don't take the nightmare job?
The difference between the economist and a junior doctor is that the economist can take his skills to a number of different employers in a wide range of sectors.
The junior doctor who wants to practice medicine has one option - the NHS.
The same can be said for many of the professions (a lot of AHPs are unemployed in terms of not having a job related to their training at all, never mind being able to choose speciality).
That said, should I be predicting in increased likelihood of botulism from my next Botox? (first week of August).
re "The junior doctor who wants to practice medicine has one option - the NHS" exactly, moving away from state running of the health sector would help the staff as much as the patients
I'm not sure a private sector run health care system has either the patients or staffs best interests at heart
I'm sure they are, but if PWC offer them that job they have the option of going to Morgan Stanley.
of course it all depends on what you mean by 'economist', but if you think even all Ph.D. or D.Phil. economists can work at Morgan Stanley, you can think again. (Why are doctors so silly and pig-headed and *ignorant* about points like this?)
anonymous at 7.08 I agree someone with a first degree (or higher) qualification in economics can work in a variety of jobs, but you know what? so can a doctor.
Of course junior doctors do not have a divine right to their dream job, but does that mean that they practically forfit the right to work in this country if they don't take the nightmare job?
(I already said MTAS was a separate issue) how far are you going to push this, renal? If a would-be surgeon will only work at Kings or leave the country, they may have to leave the country. If being a trainee surgeon at Royal Preston Hospital's unacceptable, so be it.
' I'm not sure a private sector run health care system has either the patients or staffs best interests at heart'. Do the people who run the NHS care about anything but their careers?
Give us your tired, your poor, your huddled masses yearning to eat swan.
.....arf
Jayann,
WTF?!?!
"If a would-be surgeon will only work at Kings or leave the country, they may have to leave the country. If being a trainee surgeon at Royal Preston Hospital's unacceptable, so be it."
Apparently, depsite your normally excellent posts, you do not get the MTAS fuck up. It is not a case of Kings or Preston. A number of us cannot get a training job in the country full stop. That is to say, part trained gastro wannabes like me cannot become full trained gastros - instead they can apply to become a psych STR. It's a well known crossover physician to psych.....
It actually is a case of having to leave the country to continue a career.
Dr Sniper
Speaking of leaving the country - the pissed off would do very well to look at Oz.
The AMC exam UK grads used to have to do (a la PLAB) is being highly simplified for UK grads. For those of us in QLD in post it may mean filling out a form instead of 2 very expensive exams. There is still the bugger of having to redo the MRCP, but at least it is one less prob.
Dr Sniper
Dr sniper (thanks for the compliment) I *do* get the MTAS fuckup. Above, I said, first
That MTAS appears to have shafted some very good junior doctors is a totally different point
and later
(I already said MTAS was a separate issue).
You say
It is not a case of Kings or Preston. A number of us cannot get a training job in the country full stop.
I know. The government didn't provide enough training posts for all doctors applying. That's a separate issue from MTAS' apparently managing to reject very good candidates.
That is to say, part trained gastro wannabes like me cannot become full trained gastros - - instead they can apply to become a psych STR.
I'm really sympathetic (I genuinely am). My annoyance is a reaction to renal's (and others') assumption that people in other jobs, people with other forms of training, don't have to change city or even country to get the kind of job they want, or change job or specialism. Renal's if PWC offer them that job (an inferior one) they have the option of going to Morgan Stanley is absurd but we've seen enough posts/comments, admittedly by people under MTAS stress, complaining they might have to move city to get the kind of medical traineeship they want, and also, saying that in no other job are people treated like that. It's very bad PR and it's also rather thoughtless.
Yes some people have to change city and most don't ever get the job they want.
But, previously, if a doctor did not get their dream job at King's, say, they could then apply for another job at King's, or Tommies, or Charing Cross or whereever.
I don't get your point though. Where else does a monopoly employer have the power to practically force people to move to continue their career?
It doesn't have to be economists, if that doesn't take your fancy. I don't see McDonalds telling their brand new burger flippers which city they have to work in - and if they did, I bet that Burger King's recruitment would go up.
Renal - the armed forces spring to mind.
Maybe, maybe.
But only in some trades. Drivers, pilots, mechanics, chefs (ha!) and so on, in theory, don't have to join the military to be drivers, pilots, mechanics or whatever.
But, previously, if a doctor did not get their dream job at King's, say, they could then apply for another job
I agree. MTAS' restriction on applications is one of the (various) bad things about it.
Where else does a monopoly employer have the power to practically force people to move to continue their career?
a monopoly employer isn't a necessary condition; in the US, doctors who can't get training posts may have to move (or, they may have to move to get a training post); in this country and the US (and elsewhere), political theorists, highly specialized economists (and so on and so forth), may well have to move to continue their career (or to continue their career and be with their partner). I agree that in the case of MTAS, a monopoly employer in effect reneged on implied job promises and I see a potential for breach of contract (implied) suits. My objection is to the notion that in any other career, people would not have to move city or even country/continent to pursue their career, and/or, would not have to take a job and perhaps a series of jobs, perhaps temporary, to remain within reach of their partner. That is, simply, untrue.
It doesn't have to be economists, if that doesn't take your fancy.
your example doesn't 'take my fancy' because I know about economics as a profession, and know your example's flawed.
I don't see McDonalds telling their brand new burger flippers which city they have to work in
I don't see doctors working for McDonalds' pay.... but I'll drop the sarcasm right there and try to explain (one of) my point(s). A waitress (e.g.) is indeed likely to be able to take her skills to any city or remain within the city of her choice, albeit if her workplace closes, it closes, and albeit she may not in fact be qualified for all waitressing jobs and if she is, may not be acceptable to all employers of waitresses. A neurophysiologist (e.g.) is far less likely to be able to work as a neurophysiologist in any city, and that was so before MTAS (because there are comparatively few posts in neurophysiology). A monopoly employer can perhaps exacerbate that but might, just might, ameliorate it (what's the free market for neurophysiologists like ?).
To be more abstract, if there are n jobs and n plus one qualified applicants, someone's going to lose out. If the n jobs are divided among 10 cities and more than n/10 applicants want to work in city one, someone's going to lose out. MMC/MTAS (I haven't re-read all this so have decided to lump them together, a little infelicously) exacerbated this problem by chopping the number of jobs suddenly (I think that was done suddenly?) and by imposing a) a badly flawed selection system and b) a limit on applications. And I understand junior doctors' anger. But to suggest that all other jobs allow people to live where they want to while furthering their career is simply crazy. And it detracts from the strong case against MTAS.
I hope my point's clear now...
(If the n jobs are divided equally among ten cities...)
id have thought medics have one of the better jobs for allowing freedom to live anywhere, id love to be able to carry out my role on a scottish island or similar
"I don't get your point though. Where else does a monopoly employer have the power to practically force people to move to continue their career?"
Try being in one of the many specialist admin roles associated with local bus companies...if you lose your local job you truly do have to be prepared to travel the country...
And the employers know it...and boy do they use that at wage award time...
Many people do not believe that doctors can be unemployed. This is a major falling down and a major common delusion.
Roll on August 1st.
I for one am leaving permanently the medical profession to be poor. I shall never be accused of being rich again.
I don't see doctors working for McDonalds' pay...
Did you not see the article that compared an SHO's pay and conditions to a mid-level McD's manager's? Suffice to say, it was interesting.
I do see where you're coming from now, but I would put one more point in - in your first few years of being a doctor (and who knows after that) you must take the job that you're given. AIUI, in other jobs, even highly qualified ones, you can leave and then re-enter the training pathway. So if I was offered dermatology on the isle of Skye I could say 'no thanks' work for McDonald's for a year and reapply. This is now no longer an option.
Trusts are offering FY1 jobs to SHO 4 doctors! Money to match of course! Some are promising year long FY1 employment to those SHOs who do not secure posts in round 2
Did you not see the article that compared an SHO's pay and conditions to a mid-level McD's manager's?
that was just a mean snipe, renal, as I signalled; also, though, you talked specifically about McD's burger flippers, and they're the basis for my remarks.
in your first few years of being a doctor (and who knows after that) you must take the job that you're given.
I accept that. I don't want to suggest being a medic, particularly under MMC/MTAS, is the exactly same as being (name the other occupation of your choice), simply that various 'in no other occupation would X happen' points have been misconceived. I can see why they were made, MTAS must have been hell for many doctors, others have ended up either without a training post at all or without one in their specialism of choice; and despite all I've said, I do sympathise massively, as the doctors concerned had been led to expect better, and the government changed the rules in the middle of the game. But I can imagine many people reading junior doctors' complaints with a certain anger, given the demands of their career paths (demands that are not unjust). (I think that's all I've got to say!)
Yes. MTAS is a complete balls-up, and I say that as the other half of someone who is fighting their way through it, but the outrage has not always contained total clarity about why medicine is special.
For a parallel example, take a person who does a science PhD and thinks they would like to make a career in research, e.g. as a University lecturer.
At the point of finishing a PhD the person has been studying for 6 yrs - same no. of years as a junior doc finishing the (old) house officer yr post-degree and getting full registration.
Typically the person with a PhD would next need at least two 3-yr stints as a postdoctoral researcher (often involving moves to different countries, and almost certainly different parts of the UK if they stay here) before they have a realistic chance of being short-listed for lecturer jobs. So by this stage they would be in their early 30s. Often people being appointed as (probationary) lecturers where I work have done significantly more than this six years of what one could almost call "advanced training"
But... quite a number who reach this stage, by now 12-15 years after starting their first degree, will NOT get a faculty job in science at University, or a scientific job in industry. Some stay as jobbing scientists on short contracts. Many more leave to go into alternative careers such as medical writing, IT, teaching, etc etc.
Even the one-in-ten or so that make it from PhD to an academic post will typically be on three or four year "probation". If they don't demonstrate an ability to raise research funds within those years they will be booted out back into the job pool, and typically out of science, perhaps in their mid 30s, possibly facing re-training for some new career. Have known it happen to more than one good person.
And finally, the person who makes it through this rather Darwinian selection is, at age 35-40, still a lecturer earning 30-40K. To achieve the same sort of status a consultant has in the NHS they would have to get promoted, in competition, two or three times more to be a Professor.
Anyway, the point of the example is not that scientists have it tough - there are many compensations, not least being able to follow your curiosity - but that doctors are not totally unique in terms of the total no. of years of experience and training that are required to turn out a "fully finished professional". Other careers do the same, and sometimes with less rewards and more "wastage". Some other careers, like law and finance, pay better but also demand an awful lot of semi-slavery and 80 hr wks.
In the end, you make your choice and you have to live with it.
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