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Medical Unemployment


Posted by Dr No on 30 December 2010

moon.jpgThe Daily Hail may constantly portray doctors, especially GPs, as lazy golfing fat-cats, and no doubt more than are few are, but there are other corners in the medical universe that are not so cosy, corners closer to the dark side of the moon than the sunny terrace of the nineteenth hole; and one of those corners is that of medical unemployment: doctors who are in a position to work, but for some reason cannot find work.

To those outside the profession, medical unemployment is inexplicable, bizarre, even disturbing and unsettling. Doctors are both committed and driven individuals, trained to the highest standards (at considerable tax-payers expense, some would add), with a ticket to work in a rewarding – both personally and financially – profession. And we are, so the story goes, always short of doctors. How, possibly, could medical unemployment be a reality?

The recent cruel farces in the shake up of medical training in the UK have shown how ideologically driven incompetents, including some in the highest ranks of the profession, can shatter the balance of recruitment, and cast, as flung pebbles on a beach, thousands of junior doctors into joblessness, their hopes in tatters, their dreams blown, a queasy mist of distant will-o'-the-wisp.

Despite the valiant attempts of Remedy UK, the perps of MMC and MTAS remain at large, and they and their wicked henchmen and women are set on wreaking, indeed are already wreaking, further havoc on the lives and careers of our junior doctors. Harder noses than Dr No cares to contemplate have openly questioned the propriety of providing training jobs for medical graduates: no graduate in other disciplines is guaranteed a job - so why should doctors be any different? An excellent riposte to this rhetorical nonsense can be read here.

This then is the hard face of official policy. Junior doctors are to be denied special pleading, and the aspirations of thousands callously shattered by a deliberate provision of an excess of applicants over places. In such a toxic climate, is it any wonder that nearly one in four Foundation Year doctors choose not to apply for further training? Of those who did apply, a similar proportion were not offered a place, and of those who were appointed, seven percent subsequently turned their offer down.

These are eye-watering figures – on a crude assessment they suggest over half (23% plus 22% plus 7% adds up to 52%) of these junior doctors are not in medical employment. And yet, dreadful as the plight of these junior doctors is - and Dr No does not in any way wish to diminish the direness of their position – junior doctors represent only a fraction (perhaps a quarter, depending on what denominator is used) of the profession, while those covered by Remedy UK’s recent report represent a very small proportion – perhaps 3-4% of the total profession (see footnote for an explanation of figures).

This begs the question of what about the rest of the profession. Are they all in jolly full-time employment? The GMC has almost a quarter of a million registered and licensed doctors on its books – and yet only under two thirds of them are accounted for in the NHS. Many of the unaccounted for will be in non-NHS work – Harley Streets big and small, Armed Forces, propping up Big Pharma, and all manner of other gainful employment. But the numbers are still large (at a guess 75,000 doctors) – and – and this is what intrigues Dr No – if unemployment is rife in the small groups of junior doctors we do know about, then maybe it is also rife amongst those we don’t know about.

Dr No certainly knows of two close medical friends who are currently involuntarily unemployed. He wonders whether there are many more unemployed doctors than we might expect. So he decided to have a look at the official figures to see how many doctors are on the dole – and got a shock – a vanishing small number - some 150 - of doctors are presently on the dole.

These numbers just don’t add up. Remedy UK and others quote thousands if not tens of thousands of unemployed doctors – and that is from only part of the workforce. Yet there are around only 150 (that is 0.066% of all registered and licensed doctors, compared to the current UK average unemployment rate of around 8%) on the dole.

Now, maybe the public perception is right after all (and Remedy UK, dear darlings that they are, have got it quite quite wrong) – and medical unemployment is virtually non-existent. But Dr No thinks it is otherwise; and the explanation very simple – doctors don’t like signing on. If that is the case, we simply have no idea how many doctors are unemployed. It could well be tens of thousands. If that is the case, it is a national disgrace.

Footnote: Medical workforce figures: 2009 numbers taken from here, which gives total numbers in NHS posts (132K FTE) and a breakdown by grade; however the GMC says it has over 226,000 doctors registered with a licence to practice – ie they presumably had some intention of doing some UK work at some point.

15 comments:

These are interesting discrepancies. At least a proportion of the F2s would be abroad, particularly in the Antipodes or in research, but a surprising number seem to be in non-medical careers. They would not show up on the dole if they are working as management consultants etc.

This is not always a bad thing, some of the happiest doctors that I know are those who have quit medicine for other careers. Neither is it a new thing, Graeme Gardner and David Owen both left medical careers for other opportunities in the 1970's.

There is no doubt a problem, but what is its nature? is it that MTAS has knackered training to the point that no-one wants it? or is it that Undergraduate selection is so poor that we are choosing Medical Students who are not really motivated for a career in medicine? I think it mostly the latter.

Undergraduate selection and MTAS have certainly got a lot to answer for, but this post is chiefly about hidden involuntary medical unemployment, be it direct (look for/apply but can't get a job) or constructive (don't apply because the prospect is just too awful).

Medical truants are interesting (in all sorts of ways - David Owen was known as Dr Death; Jonathon Miller famously got told to 'take a shufti' and not come back) and the list is long (try googling 'medical truants'). Dr No even has a 1983 reprint of Lord Moynihan's classic 1936 book on the subject. Even more interesting is the very use of the term truants, with its over-tones of bunking off; that somehow it is not quite the done thing (which of course spills over into the it costs a quarter of a mill to train a medic, how dare they do something else argument). But truants are a post for another day.

Dr No rather suspects the idea of hordes of juniors taking the magic bus to Oz is a comfort myth (in an imaginary out of sight, out of mind, they'll be able to look after themselves sort of way) for those who would prefer not to contemplate reality. Certainly the Australian immigration figures suggest the numbers are small. Last year (2008-9), the UK exported 370 GPs to Australia, and GPs were ranked number 5 (nurses came top) in the list of incoming occupations, with no other medical entry visible - ie any other group of incoming medics must have numbered less than 370. These numbers are small when ranked against thousands if not tens of thousands of juniors said to be unable to find work.

Similarly research is not exactly an easy ticket these days; and management consultancy doesn't seem to be snapping up medical recruits; and even entrepreneurial Shibby Robati famously got blown out of the Apprentice at an early stage...

...Dr No suspects that, far from doctors easily transferring into other professions, they actually find it very hard. And they don't sign on (that we do know). And here we have been considering only trainees - what about the far greater number of career grade doctors? Dr No can't help wondering if there aren't an awful lot of unseen, uncounted unemployed medics out there.

"or is it that Undergraduate selection is so poor that we are choosing Medical Students who are not really motivated for a career in medicine? I think it mostly the latter."

I think not Dr Phil. The admission tutors are still the same, name by name, and so is the criteria, but interviews have changed in some colleges from the usual 4 person panels to what now resemble OSCEs, meaning that in effect, it has actually now become harder to get into medicine. Only I don't know if would be students will still want a career that will lead them to a dead end and a huge mortgage like debt after all the hard work they put in!

Dr No's analysis is spot on too! Because I too wonder about those unemployed doctors who do not show up in the statistics?! I think that the shock of going from excellent with hopes and aspirations to totally unexpected and unexplained ruin and despair is why they do not show up on those stats! So, will medicine still attract the brightest in the future?

And it's all about the lack of jobs at all levels of training that's causing all this, and the new sub hopes ... and this new to medicine lack of respect as a direct result to!

I know a wonderful GP who used to visit our home in a professional capacity. As well as being kind and respectful to our residents, he extended the same courtesy to staff and did not regard us as the dross of society and therefore gained our immediate respect.

Following a family tragedy, he decided (as we never know what tomorrow might bring) to fulfil his dream of travelling the world while he was still young enough to enjoy it. He withdrew from his partnership, safe in the knowledge that upon his return he could rejoin the practice on a salaried basis.

His travels took him far and wide; he visited distant friends; applied for work visas and took temporary work outside of medicine, doing things that previously had just been a dream.

After three years, refreshed and rejuvinated, his bad memories far behind him - he returned to England, looking forward to returning to one of the great true loves of his life - medicine. Realising that he need a returner placement as the world of medical admin had changed greatly - he went through the application process only to be turned down.

This good GP has an unblemished record - yet his career in medicine is over. His only thoughts as to the reason for this are that in the past he would not go with the flow if he thought something was not right. He was not prepared to be part of the establishment if it meant abandoning his ideals. He was and is a man of principle.

But, after reading your above comment, is it possible he was regarded as a truant?

I have not seen him for some time and do not know whether he would have signed on. I only know that when I saw him last - he was a broken man, finding it impossible to come to terms with the knowledge that his profession had abandoned him. It is a tragedy for him and a tragedy for medicine.

It is not fair and it is not right.

Please keep highlighting this injustice Dr No. I too now wonder if there aren't an awful lot of unseen, uncounted, unemployed medics out there.

Anna

Anna - The question of whether your GP was a truant is a complex one. Those of harsh mind will say he was - he 'bunked off' for three years - and so got what was coming to him. Others, Dr No included, will say truancy has to include an element of bunking off when we had a duty to be in a particular place at a particular time. Whether a grown man who has already done many years of medical work ought to stay in post, even when he knows he needs - or even just would benefit from - a sabbatical, is another matter altogether.

That said, the shameful treatment of your GP is not an isolated case. Dr No knows of a now ex-GP who suffered almost identical disgraceful treatment.

If between us we know of two cases, one can only wonder how many other similar cases there are out there.

I think poor undergraduate selection is a problem. Competition rates are not the only issue, as there is a big difference between wanting to be a doctor, and being suitable. I don't think that competition rates are worse than 1970's when i started out, with 4000 places per year, compared to the 8000 or so now.

The old system was fairly blatently discriminatory, with British graduates taking the jobs with prospects, and the jobs with little future going to doctors from the commonwealth, who would either become staff grades or return home after a few years. Part of the purpose of MTAS was fairly explicit, to force British doctors to take up these less desireable posts in Cinderella specialities in less well considered parts of the country.

If you search for a staff grade job in most specialities on NHS Jobs you will find plenty of vacancies. Similarly GP out of hours services only seem to be able to function by importing dodgy Germans such as Dr Ubani. Clearly British doctors do not want these jobs, preferring unemployment. It seems that MTAS failed in this too. It seems working Saturday night in casualty in Fulchester is not popular.

So we either need to find a way through either pay or conditions to make it popular, or accept medical unemployment in the Southeast and vacant posts in the dodgiest bits of the country. Getting rid of national pay scales and allowing a free market would be one option, with lower salaries in London and higher ones elsewhere. Call these incentive payments if you are a socialist, but I call it the free Market.

One of the problems associated with the predominant intake of women doctors into medicine nowadays, is their lack of mobility if they have a family to look after. Most families will not tolerate a mother and father living miles apart and only meeting up at weekends when not on call. The cost of keeping two homes going while paying back two huge student loans would be prohibitive. I think as a consequence of this we will overall not have enough doctors, but this will be patched up often using other health care professionals trained in a few specific medical competencies. Sometimes this will work well but in other circumstances it will not. Sometimes it will be downright dangerous.

It will be interesting also to see how the female medical workforce with domestic commitments responds to revalidation when it comes along particularly if they take a career break.

WD and Dr Boots - my reply to your comments grew over-long, and has developed a life of its own here.

I found this a fascinating article, but would consider that there are more jobs available in the medical profession than in many others at this time. However, it is shocking to hear of doctors being treated as you described, Anna.

My husband trained for 20 years and became a surgeon, he went off on fellowships as there were no jobs for his speciality, he returned to the uk to one of the top hospitals and had a rolling 6 month contract suddenly after 2 years of this he was dropped for political reasons (ie: someone who could bring in more money) We then went to other countries looking for work but most other countries take their own born and trained first! within the next month he will be unemployed in a foreign country where he has only been allowed to assist!
I am a sister of nursing and am going to have to go back to the UK and beg for work! We sold everything we had to go for jobs in other countries and the UK, and are now left with nothing Personally I am appalled by the way the UK government treats their medical staff. Some medical people will not go on the dole but spend every penny they have trying to cope, it is soul destroying watching doctors with english phrase books in their pockets trying to understand the patients when the uk born and trained cannot get jobs in their own country!

I am actively seeking work and have been unemployed for 5
Years. I'm a British graduate and highly qualified and meet essential criteria
But due to personal reasons I had to resign from a consults t
Job to raise my young family alone. I've struggled
And done bits and pieces to avoid signing on. There has been
No help for me. No one wants to offer me a job becuase Of the break and I
Cannot re write history. It's what life dealt me and being
There for my kids is what I needed to do.
I'm in my forties and considered past it.

Have a look at the unemployed number of doctors in the U.S as well pls. Countries now a days reward whores for passing out their sex tapes while doctors are in the gutter with monster size medical school debt to go with it. Everyday the system screws us in more and more and we can do nothing about it. Those who secure residencies don't want to look back at those left behind the gate so no one talks about the hell that we go through... Then they wonder why depression rates are high, people are going postal, suicide rate is up?.. vile govt. and vile corporations we all know who is running the show.. question is how much longer people of reason are willing to stay quiet and tolerate all the BS. If this doesn't get published of course I wouldn't be surprised.. many thanks back at ya I just needed a vent.

Today everywhere youth unemployment is seen which making youth angry and do wrong things. Reading about medical unemployment is really shocking students work hard for so many years to become to doctor and what if after that they are not getting the opportunities, its a big shame according to the society in which we live. Today's youth future is being so insecure.

I am finding it difficult to believe that medical unemployment is possible. The government should find something to solve this issue.
more here
I hope that we will not have to see the days when doctors seek out for jobs of a laborer.

The reason there are so many British unemployed surgeons is because the government brought an influx of foreign doctors into the uk, now at every interview you are interviewed by mainly foreign consultants and managers who in turn put their friends into the role of our consultants this is why most British surgeons jump ship and have to go abroad for work!
Because they have no choice!
Fact
I know one British qualified surgeon who has to locus around the uk re- doing the mistakes of the foreign guys ! I am not saying that the foreign guys are all bad, not for one minute but why is it only in the uk that we treat our own so abominably when in every country I have been too they help there own first!
My husband and myself are both qualified and we both finish our locus work in December, we have no idea what will happen to us after this!
Shame on you British government !


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