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THE SITUATION ON THE GROUND
some practical considerations
GME
in Pakistan GME in
THE UK GME in THE
USA
Most medical students and fresh
graduates will already know that the job situation in the UK is very dismal. A
visit to different online forums for overseas doctors looking for jobs in the UK
gives an extremely discouraging picture. In September 2004 the BBC aired a
Newsnight feature on the plight of overseas junior doctors. Some of the comments
made by the doctors interviewed are quoted here:
“I've not been able to get one single job. You feel so low about
yourself. You feel what on earth am I good for.”
“Filling time, unemployed orthopedic doctor, Satish Bhat spends most of
his days filling in forms. 250 job applications in the past six months. He's
left his wife and child in Kerala south
India, in
search of jobs and training with the NHS.”
“The perception in
India is that
there is a dire shortage of doctors in the
UK. I was
expecting to get a job at least a few months so far, there's no sign. I keep
meeting so many people day in and day out who are in the same boat as I am. They
are also here for months on end without any jobs. Without any hopes of a job.
Moving from place to place, and totally devastated, totally disillusioned.”
“It has been an ordeal here. I'm sure there are several doctors out there
who are going through the same nightmare. Who came here with high hopes, and who
have ended up being emotional wrecks, who've become so frustrated and
disillusioned with the system. I'm sure there are so many of them there.”
Keep in mind that when we talk
about the job situation in the UK, it refers mainly to the SHO-grade (in the new
system, it will be the FY2 and BST grades). Competition for the higher grades is
also very tough, but by the time an overseas doctor reaches a level of
qualification that allows him to compete for higher grades, he is already
somewhat secure financially. Resultantly, a difficult job situation for a more
senior doctor would not hurt as much. The hue and cry about the job situation is
coming from junior overseas doctors who come to the UK a year or two after
acquiring their medical degree. At present, it is generally accepted that a
doctor going to the UK looking for a junior post will have to endure at least 6
months of unemployment before landing his first job. However, there is no
telling how much time it will take for the doctor to find a job. The 6 month
figure is just an average generally agreed upon by doctors going there these
days. It could be more than that - or less.
Some people contend that the
job situation is not really as bad as is publicized and that most doctors who do
eventually find a job don’t make it a point to come back to the same forums
where they would previously complain about their joblessness. It is argued that
persistence pays off eventually, and land the determined doctor a job.
While this may be true, certain
points must be kept in mind. Firstly, finding a job might relieve the financial
stress that comes with unemployed living, but unless the job is a standard SHO/FY/BST
post, there is no guarantee that the job will impart good training. Trust grades
for example, are also considered jobs, but there are many trust grade jobs with
very poor training elements incorporated into them and in any case, even if
there were a training element, it would not be recognized. This is a significant
drawback considering the fact that most doctors go to the UK to seek further
training. Secondly, the interruption of a young doctor’s training by 6 months to
1 year so early in his career is bound to have some detrimental effect to his
competency as a doctor. The blunting of clinical skills over the time he is away
from his profession is a problem he will need to work hard to overcome once he
finds a job.
The simple fact is that there
is a case of supply outstripping demand. There are simply not enough jobs for
all the doctors who want one. The best approach an aspiring overseas doctor can
take when entering the arena is to be mentally prepared for the hardships that
lie ahead. If one comes to the UK thinking that things will go smoothly, then
the disappointment he’ll face when things don’t work out that way will be
devastating. As long as an overseas doctor anticipates that there will be
hardships and troubles to contend with, he’ll stand a much better chance at
enduring them when they do come along.
This was not the situation some
5-6 years back. Doctors who went to the UK as early back as the late 90s didn’t
have to face such a difficult job situation. Most got their first jobs in a few
weeks, if that long. However around the turn of the century, the NHS realized
that they were facing a shortage of doctors in the consultant-grade level, and
to remedy this shortage they actively advertised job opportunities in foreign
countries (like India) asking experienced doctors to seek employment in the
UK.
This initiative by the NHS created the impression that the UK had become a land
of opportunity for each and every type of doctor, regardless of his experience
and qualifications. Word spread in the medical communities of India and Pakistan
(the two largest contributors of overseas doctors in the NHS) that the UK was
the place to go. It was assumed erroneously that the NHS would have ample room
for junior doctors as it would for the more senior, consultant-level doctors.
Thus around the turn of the century, the exodus began, and it has been
increasing exponentially, causing the alarming level of unemployment that we see
today.
Currently, an overseas doctor
would spend the 3-4 years required to train for his membership examinations in
the SHO grade. When he attains his membership, he is faced with the following
options:
·
Return home (or
go to another country) to practice there.
·
Try to attain a
Type I SpR or FTTA post.
·
Work in Trust
grade or Staff grade posts.
According to the London
Deanery, 10% of overseas doctors leave the UK after they have completed their
membership qualification. Of those who choose to remain, 97% of them go into
Staff grade or Trust grade posts. Only 3% of them are able to get into Higher
Specialist Training in an SpR or FTTA capacity soon after their membership is
complete.
Currently, 86% of all Type I
SpR posts are reserved for UK-graduate doctors. Overseas doctors may not compete
for them. They have to contend amongst themselves for the remaining 14% of SpR
posts.
To quote a BMJCareers article
dated 17th August, 2002: “As anyone chasing a much sought after national
training number (NTN) will know only too well, obtaining a type 1 specialist
registrar (SpR) training post is arguably the most difficult and stressful
hurdle in clinical training in British hospitals.” This is the situation for
UK-graduated doctors back in 2002. The competition amongst overseas doctors is
even tougher, and promises to get even more so.
Perhaps this is the reason why
most overseas doctors continue to remain in the trust and staff grade posts
until they return to their own countries, or retire in the UK. In the NHS, 70%
of Staff grade and 62% of Associate Specialists are overseas doctors and most of
them will continue to remain in those grades as long as they remain with the NHS.
This has been a source of resentment amongst the overseas doctors community who
claim that they are being preventing from progressing within the NHS to higher
grades because of a bias against them.
For overseas doctors entering
the NHS these days, it is clear that the road to a consultant grade is a hard
one. Nothing is impossible of course, for the highly accomplished and driven
doctor. However for those who are unable to attain a very high level of
competitiveness, a realistic goal after membership is a staff grade post with a
good teaching and training environment, ensuring that the doctor continues to
learn and develop professionally, even if the increase in his expertise over
time is not recognized officially. In such a setting, he would evolve to become
a competent and professional doctor and that is a goal many would be satisfied
with in itself - be it recognized by a degree/diploma/certificate or not.
An overseas doctor coming to
the UK must have strong financial support. He will face the possibility of
anywhere from two to twelve months of unemployment and during this time he will
have to bear his living expenses. He is not allowed to work there (in a
non-medical capacity) so his only source of money will be his own savings (if
any) or that of his guardians. Therefore the average monthly living expenses for
people in such a position in the UK becomes an important issue: How much money
will the doctor spend as he looks for a job? There is no one answer to this as
the amount of money a person spends for his upkeep is affected by several
factors: e.g., where he is living in the UK (cities are more expensive than
towns); whether he is sharing the rent with someone else; his own spending
habits; whether he has brought a spouse or family with him, and of course the
length of time before he lands the first job.
On average, one can live
decently on 400-700 Pounds/month (with rent) in the UK. This cost can be more
than halved if one is living rent-free with family or friends. It is up to the
individual doctor to look at his financial resources and decide if he can make
the investment required to find a job in the UK.
If a doctor was unemployed for
6 months before getting the first job, he would have spent 4,200 Pounds before
getting the first job (using 700 Pounds/month as an average). An SHO gets paid
about 2,000 Pounds/month. The contract lasts for 6 months which means an earning
of 12,000 Pounds during the first job. If he decides to spend his money a little
more freely upon getting the job and increases it up to 900 Pounds/month he
would still be able to save 1,100 pounds every month during his first job. This
means that after completing his first job, he would have 6600 pounds in the
bank, easily enough to sustain him for another 6-7 months as he looks for the
next job. It is worth noting that the second job is much easier to obtain than
first one (because the doctor now has experience in the NHS), and it is unlikely
that his savings from the first job would be exhausted before he found the
second one.
This will change of course with
the introduction of the FY2/BST grades. The FY2 post is of one year’s duration
and during this time, the doctor can establish a very sound financial base for
himself. However it has to be kept in mind that obtaining the FY2 post may prove
to be more difficult than obtaining an SHO post is now. Furthermore, it is not
clear yet whether overseas doctors will be offered the full 2-3 year contracts
in the BST grades as opposed to 6-month or 1-year stand-alone contracts. Only
time will tell how overseas doctors will be treated in the BST grade.
In any case, from a financial
point of view, it is the first job which is the most difficult hurdle. At that
stage, the doctor has no NHS experience to put on his CV, no letters of
recommendation obtained from senior doctors he has worked for in the UK, and no
money. All this changes when he gets the first job. If he gets an FY2 post, it
will further strengthen his position as he’ll have competency-based assessments
to take him forward. If he works really hard during the first job to earn
himself good letters of recommendation, spends carefully to save his money, and
makes good contacts within the NHS, then the wait for the second job will be
shorter and much easier to endure than the first. | 
