Modernising Medical Careers and Junior Doctors
by Simon Creer
THOUSANDS of junior doctors this summer found themselves caught up in a drama which left over 10,000 of them without training posts and forced many to emigrate to find work. Sir John Tooke, who is leading the independent inquiry into the Medical Application Training Service (MTAS), has labelled the fiasco, “a deeply damaging episode for British medicine.”
MTAS was rolled out in January by Modernising Medical Careers (MMC) to avoid many doctors being forced into cul-de-sac jobs that left them with little or no training opportunities. The system went live and received over 30,000 applications for approximately 18,500 jobs. There was no contingency for this over-subscription.
The idea had been to create a fast track to consultant positions through 4 year “run-through” posts. However, in his report, which was released in October, Sir Tooke said that MMC risks creating a new “lost tribe” of doctors effectively excluded from future training.
At the forefront of protests against MMC and the new application system was a group called RemedyUK. A non-partisan voice for doctors, they organised a protest march in London and took their case to court.
Speaking after a “week of hell” working as a surgeon, the press coordinator for RemedyUK, Mr Matt Jameson-Evans, was tired but happy to talk about the plight of trainees. He highlights, “What happened this year was due to massive expansion of UK medical schools.” The figures speak for themselves in 98/99 3,700 doctors graduated. Medical schools are now recruiting around 7,500 students. The NHS he believes is heading dealing with “an impending time-bomb of over supply.”
Mr Jameson-Evans says, “We are only at the beginning of this massive bulge.” The problem of over subscription is serious enough but as he points out, “The biggest inequity of MMC was that while the bulge was kicking off they chose to bring in an inherently flawed application system.” He is concerned that there are many doctors locked into run-through posts after a discredited application system.”
As a result of the flawed MTAS process the report says, “There is mounting evidence that doctors who in prior selection processes would have been regarded as first class candidates were not being short-listed.”
As an emergency stop-gap, to find employment for many of these doctors, a new post was created called a Fixed Term Specialist Training Appointment or an FTSTA. These positions are only one year long and count for nothing towards any further training. Some senior physicians have spoken of these posts as dead-end jobs. It’s easy to see them as cul-de-sacs. A re-branding of the very problem the MMC set out to solve.
Dr Thompson*, a Yorkshire-based medic, working in an FTSTA this year agrees with Tooke and Jameson-Evans saying, “There are people in jobs that probably aren’t as good as people out of them.” He says, “I know people that took jobs they didn’t want so they had jobs for four years.” He also tells me, “I know registrars taking training posts that are massively over-qualified but taking them for security.”
As a young man with mortgage repayments to make, Dr Thompson believes that MTAS treated doctors as numbers rather than people. He says, “I’ve been lucky in that I’ve got a job,” but goes on to say that he will have to reapply next year with no guarantees of finding a training post or run-through position.
“No one at MTAS,” he admits, “knew anything to tell you about job security.” He was not alone as the newest lost tribe began to roam through a wilderness of uncertainty. Many who were caught up in the problems that had less home commitments, and could afford to, are now working abroad.
Dr Thompson wonders why any of these doctors would want to come back to a training system that shows little sign of improvement.
Dr David Rees is one such émigré. Having been let down by MMC and MTAS he and his girlfriend moved to Manly in Sydney, Australia. He admits that while his life in Australia is “pretty cruisy” things are not all sun and sand. “It’s a bit of a dead year for me,” He says, “For me applying next year no one will know I’d done an extra year.” Dr Rees’ experience in the UK before he left is like many other medics. “I just wasn’t hearing about the jobs” he tells me over an international phone-line.
The Tooke report indicates one of the major flaws in the system was communication and David’s story is an example of this. He says, “It took ages to get anything back for how well I had done.” All he sought was some kind of confirmation. “I wanted to know what my chances were,” he tells me, “I was worried I’d be left with nothing.”
His decision to move to the other side of the world is not permanent and he is categorical that he “Will be trying to come back.” Unfortunately this may not be as easy as it was to leave. Mr Jameson-Evans and RemedyUK are not confident it will be any easier in the future for FTSTA doctors or physicians who have travelled abroad to find their way back into the system.
RemedyUK are concerned about a “splintering” of groups within the new lost tribe. Factions of doctors are now languishing in FTSTAs, or working abroad. But in addition to this there are, “old guys in the wilderness and new guys coming out of their foundation year.”
As the bulge of graduates continues, “The decisions the top brass are making,” he says, “are who is going to take the hit over this. Do they want to open things up for the more qualified or do they want to open it up for juniors?” No one appears to have an answer to these questions. Mr Jameson-Evans says, “I don’t think there is an obvious way back in.”
The Tooke report entitled “Aspiring to Excellence” outlines many of these problems and a summary introduction points out that, “There is a policy vacuum regarding the potential massive increase in trainee numbers.” The report goes on to say, “There is inadequate provision for the many experienced and talented SHOs (Senior House Officers) already in the system.
The aspiration of the report comes in its recommendations for the future. “The principles underpinning postgraduate medical education,” it says, “should be redefined and reasserted.”
Professor Ian Gilmore, the President of the Royal College of Physicians says, “Overall we are very supportive of the report’s aims.” The College’s official press statement goes further by saying, “we particularly welcome Sir John’s support for helping junior doctors caught up in this sorry episode.”
Most agree the last twelve months have been a deplorable experience for the medical profession and that things have to change. Dr Thompson says he is, “Waiting to see what happens. It has to be better. It can’t be worse.
Mr Jameson-Evans believes, “They have set in motion events that have taken on their own momentum. I don’t think there is a possible positive outcome.” This he thinks is plain and simply “a case-book of how not to reform” and has “systematically bruised” the next generation of medical specialists.
* Dr Thompson is not his real name. He asked that he remain anonymous for fear that speaking out may impede his job prospects.
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