The Sky Is Falling
I'm writing this again as Seamonkey crashed, so unfortunately it's not as good as the original, which I couldn't save ; ;
Set The Scene
==============
10-15 years ago the Government decided that as we were short of doctors in the UK, it would advertise abroad. This was successful, and many international graduates came, especially from places like India and Pakistan. At the same time, they planned to increase the numbers of medical school intakes, and build new medical schools for the future.
Over 5 years ago, it was realised that the UK was quickly becoming saturated. Instead of applying the brakes slowly, the Government continued recruiting at break neck speed. Suddenly in 2006, having had multiple reports in 2005 of UK graduates being unemployed and finding it hard to even get a locum post (it was in the news in case you missed it >.>), they carried out their patented emergency stop (as they do with all policies, especially those connected to the NHS), and suddenly essentially "banned" those with the wrong type of visa - a not so insignificant population of junior doctors who spent a lot of money and effort to get here and uprooted their families to do it, and have spent many years propping up the NHS, only to find themselves out on the doorstep suddenly.
Unfortunately, this only caused more problems as by now more medical school existed, and more medical students were being pumped out than ever before. Even though the international influx had subsided to an extent, the recent introduction of EU laws that allowed EU trained doctors to work in the UK more than made up for it, so we were back to square 1.....too many doctors.
At this time, expansion of Consultant posts was frozen, as there was barely enough money (some say not even that) to support those already there, let alone new ones. This meant that Registrar posts were frozen as well and more and more doctors were left at the Senior House Officer (SHO) position, milling around from post to post until a Registrar National Training Number (NTN) opened up.
NHS debts were also piling up over this time. Some of the blame has gone on the pay of Consultants and GP's (a very small minority of GP's actually earn as much as the newspapers say, and that's because they own their own practices and do more than just GP'ing - ie: they earn it), but this is the Governments' fault. They negotiated pay contracts with these 2 groups, and through their ignorance and denial of reality, bypassed the fact that a lot of work gets done in the NHS through goodwill of doctors staying late to finish clinics...etc... When payment for all these efforts finally began to take place, the Government suddenly realised (too late again of course) what a monumental cock-up they had made...resulting in an estimated extra £500 MILLION being spent paying for these services.
Also adding to debts was the fact that medical students each take £250,000 (remember this number, because this is what will have been wasted if a UK graduate ends up leaving the UK because they can't get a job) to train over 5 years. By increasing the number of doctors being trained in the UK (and paying for medical schools to be built and hiring staff...etc...), a lot more money was spent too...
Bring On The Clowns
=====================
Over the last 5 years, the Government, spurred on by recent medical scandals (Shipman, Bristol Heart Scandal....etc....etc....), and their own lack of sense and general ability to "fix" everything by going completely the other way (also totally inappropriate, but they conveniently ignore this part because it's "their" choice), devised a new system to train junior doctors to Consultant, called Modernising Medical Careers (MMC). However, in typical civil servant fashion, they did not think things through, and much of the planning was superficial. This became more and more apparent as the deadline for implementing MMC loomed (2007), and still little information was available. What little there was changed from deanery to deanery, and noone could separate fact from fiction.
In preparation for MMC, all SHO contracts that extended beyond August 2007 were cancelled, so anyone who had been on a 2-3 year rotation was screwed after all the work they did to secure the rotation in the first place. These people had to apply for ST posts too.
Mangling Medical Careers / Massive Medical Cull
===============================================
The Medical Training Application Service (MTAS) went live late 2006 (around October). It was a while before personal specifications were released on the MMC website for each new grade (number ST1 upwards) of each Speciality Training (ST) Programme. Unfortunately, no info on job numbers was given, and so juniors had to wait another 1-2 months before this was seen fit to be released (ie: almost less than a month before the applications began), which meant that no planning could be carried out as to where to apply based on the number of posts.
Applications were submitted on 05/02/07 and already problems had appeared. Some candidates had been unable to send in their application (this was all online) as servers had problems. Some referees sent incomplete/wrong references for their juniors. The application form essentially consisted of around 14 "fluffy" questions that had to be answered in 150 words or less. An example: "Describe a time when you have had to explain a complex term or procedure to someone. What were the main challenges and the strategies you used?". This meant that candidates were no longer able to send in beautifully crafted CV's that had been honed over many weeks/months/years, but instead were resigned to an ugly white box format that did not allow the opportunity to give a personal statement or show any other achievements beyond the little that was requested.
Applications
===============
These allowed a candidate 4 applications:
1) 2 locations in 2 specialities.
2) 1 location in 4 specialities.
3) 4 locations in 1 speciality.
With no previous statistics, noone knew what was going to be more popular, so essentially people just guessed, or used other personal reasons to pick essentially random places.
Shortlisting
=============
How was this done? Well, some of us still wonder that. This was a highly guarded secret pretty much up until applications were sent it, though it has since transpired that this was because noone knew what the hell was going on, even the people making the decisions. It turns out there was a wishy-washy set of marking criteria used, and it also turns out that this was leaked to some candidates before applications were submitted, thus giving these candidates an unfair advantage - something that this "perfect online system" was supposed to have prevented.
As for how people were shortlisted after these criteria were followed, we don't know, as it hasn't been publically acknowledged, nor likely will ever be. (ie: 100 candidates have the same top score after marking with the wishy-washy criteria, yet only 30 can be interviewed. how do you select when the application forms don't give any other information to go on?)
However, the result was that around the UK on 28th Feb, thousands of junior doctors were left gobsmacked, as the ineptitude of MTAS really became apparent. Many highly qualified candidates were left without an interview. Some were given multiple interviews. Some were given interviews in specialities they hadn't even applied for! The deaneries were (as expected based on previous MMC deadline dates) late in giving final reports of shortlistings, so some people had to wait almost a week before finding out whether they could have an interview or not.
At this point, the medical profession erupted. Unfortunately, this mostly consisted of juniors with little senior or Royal College support (the majority of which supported MMC blindly having become Governmental lapdogs). Eventually under pressure, the Government reluctantly agreed to review applications and decide if people had been unfairly not shortlisted. This has meant more work for everyone involved in shortlisting as they now have to call back even more candidates.
Interviews
============
These have been messy. To start, with the huge numbers of SHO's and Foundation Year 2 (FY2) doctors (Foundation Years 1 and 2 have already been brought into replace the old style Pre-Registration House Officer and first year SHO years) going for interview, arranging departmental cover around the country has been catastrophic, with some departments being left dangerously understaffed (the Government said this wouldn't be a problem, and once again they've been proven wrong).
Interviews themselves have been variable, with some places being extremely hardcore (F2 doctors getting grilled, having to critically appriase research papers...etc...), and others being more bizarre....(sugical interviewees being asked to make origami paper cranes).
The deadline for results is 19th March, but with all the new interviews that are taking place as a result of the Governmental "inquiry" into "MTAS/MMC flaws", this is probably going to be pushed back, so that Round 2 (assuming any jobs are left) will take place later....
Jobs
======
The whole point of the new MMC scheme is that the bottleneck is brought down to post-FY level, so juniors are forced to decide earlier what they want to specialise in, rather than the old system of bouncing round the SHO grade from speciality to speciality until they decide. On top of this, the number of jobs has been streamlined to match the number of current Consultant posts, so that only "needed" doctors are trained. These posts are Speciality Training (ST) posts. The Government have also introduced Fixed Term Speciality Training Appointments (FTSTA's), with the aim of maintaining service provision with these 1 year posts that do not count for official training. What some people don't realise (though as time goes on, more and more people have become clued in, so this number is dropping) is that:
1) In order to advance from an FTSTA to a ST post, someone needs to leave that ST post to free it up, and everyone who is suitable (ie: by experience and person spec) can apply for it, so there will be a lot of competition, probably even more than there is now.
2) FTSTA's are rumoured to possibly be phased out in a few years to some extent, with the minority left becoming new equivalents to Trust (SHO level) and Staff (Registrar level) Grade jobs, albeit most likely with a new title.
3) Essentially if you do not get a ST post now, your career is destroyed in this country. If you are unsuccessful in applying to a speciality, you will not be allowed to apply for it again, and you will be offered an alternative speciality post (or more likely an alternative FTSTA).
At last count, it looks like approximately 8,000 doctors will be left without a job come August 2007. This is assuming all jobs are filled (i'm sure this will happen as somewhere there is always someone willing to do what you're not). These people are most likely either going to Australia, New Zealand, or Canada, as they are all recruiting at the moment. The rest will go to other countries, or leave Medicine for good for a job in the city, or even unemployment. Some of these will be people unsuccessful in Rounds 1 and/or 2, and some will be those who are not interested in taking the random FTSTA offered by the Government in order to ensure "Services are provided".
Responses
============
The number of doctors that became sick on 28th February when shortlisting results of Round 1 were first released was unprecedented. Many broke down crying on wards, some were sent home. 3 have since committed suicide. This is the biggest crisis to hit junior doctors since the inception of the NHS.
Over 10,000 doctors marched on London in March to show their displeasure at the incompetent handling of their careers.
Some of the media has been sympathetic and have runs pieces on the whole mess, or just shown snapshots (BBC, Channel 4, The Telegraph, The Guardian).
The Government, headed by Patricia Hewitt and Lord Hunt, still deny the magnitude of all this, and refuse to stop the MMC juggernaut, or even overhaul it properly. To the date of this blog, only the miniscule inquiry so far has occurred.
Personally
============
I've had 1 Ophthalmology ST1 interview in Newcastle (Northern Deanery), which involved 4 stations of 10 mins:
1) Clinical Scenarios:
a) A untreatably blind patient comes into your clinic. What do you do?
b) A patient in for pre-assessment for her cataract operation is found to have severe heart failure.
2) Ophthalmic (yes, not normal surgical) suturing - 3 interrupted sutures with instrument ties (we'll ignore the fact that FY2's are not officially allowed to go on Royal College of Ophthalmology Microsurgical Skills Courses and learn such techniques properly).
3) Standard interview grilling.
4) Communications skills - Tell an patient (actress) that she cannot have the cataract operation she's waited months for and come in for today because the operating scope is broken, there is no spare, and it cannot be fixed today.
I am not interested in anything bar ophthalmology (eye surgery). I have experienced other specialities, and while some hold passing interest, I cannot see myself doing anything else for the rest of my career. This means I will not accept a token FTSTA in Gynaecology or Orthopaedics when the Governement want to get the not-so-popular posts filled. Unfortunately, this means my options are limited to emigration - essentially permenantly, as once the new system is in swing, it'll be nigh on impossible to come in again - or quitting medicine. Unsurprisingly, having devoted 9 years to the profession (and countless years in school aiming for my shot at it) and my love of helping people, the thought of having to walk away from it all makes me nauseous. Yet, reality beckons, and there are times when one has to make a hard choice in order to survive. Hopefully it won't come to that, but we'll see....Where would I go if I did quit? Well, that's a good question, and is something medics are not advised well about. Generally medics in this category either end up in pharmaceuticals, medical journalism, (medical) law, medical education, or finance (of some kind). I have no idea which of these would suit me, and I hope I don't have to find out.
Other Related Links
====================
These are other blogs covering this
http://murderingmycareer.blogspot.com/index.html
http://aphrabehn.wordpress.com/
http://thejuniordoctor.blogspot.com/index.html
http://nhsblogdoc.blogspot.com/
http://ferretfancier.blogspot.com/index.html
Another view of MTAS/MMC
http://aphrabehn.wordpress.com/2007/03/09/a-patients-guide-to-modernising-medical-careers-and-mtas-part-1/
Set The Scene
==============
10-15 years ago the Government decided that as we were short of doctors in the UK, it would advertise abroad. This was successful, and many international graduates came, especially from places like India and Pakistan. At the same time, they planned to increase the numbers of medical school intakes, and build new medical schools for the future.
Over 5 years ago, it was realised that the UK was quickly becoming saturated. Instead of applying the brakes slowly, the Government continued recruiting at break neck speed. Suddenly in 2006, having had multiple reports in 2005 of UK graduates being unemployed and finding it hard to even get a locum post (it was in the news in case you missed it >.>), they carried out their patented emergency stop (as they do with all policies, especially those connected to the NHS), and suddenly essentially "banned" those with the wrong type of visa - a not so insignificant population of junior doctors who spent a lot of money and effort to get here and uprooted their families to do it, and have spent many years propping up the NHS, only to find themselves out on the doorstep suddenly.
Unfortunately, this only caused more problems as by now more medical school existed, and more medical students were being pumped out than ever before. Even though the international influx had subsided to an extent, the recent introduction of EU laws that allowed EU trained doctors to work in the UK more than made up for it, so we were back to square 1.....too many doctors.
At this time, expansion of Consultant posts was frozen, as there was barely enough money (some say not even that) to support those already there, let alone new ones. This meant that Registrar posts were frozen as well and more and more doctors were left at the Senior House Officer (SHO) position, milling around from post to post until a Registrar National Training Number (NTN) opened up.
NHS debts were also piling up over this time. Some of the blame has gone on the pay of Consultants and GP's (a very small minority of GP's actually earn as much as the newspapers say, and that's because they own their own practices and do more than just GP'ing - ie: they earn it), but this is the Governments' fault. They negotiated pay contracts with these 2 groups, and through their ignorance and denial of reality, bypassed the fact that a lot of work gets done in the NHS through goodwill of doctors staying late to finish clinics...etc... When payment for all these efforts finally began to take place, the Government suddenly realised (too late again of course) what a monumental cock-up they had made...resulting in an estimated extra £500 MILLION being spent paying for these services.
Also adding to debts was the fact that medical students each take £250,000 (remember this number, because this is what will have been wasted if a UK graduate ends up leaving the UK because they can't get a job) to train over 5 years. By increasing the number of doctors being trained in the UK (and paying for medical schools to be built and hiring staff...etc...), a lot more money was spent too...
Bring On The Clowns
=====================
Over the last 5 years, the Government, spurred on by recent medical scandals (Shipman, Bristol Heart Scandal....etc....etc....), and their own lack of sense and general ability to "fix" everything by going completely the other way (also totally inappropriate, but they conveniently ignore this part because it's "their" choice), devised a new system to train junior doctors to Consultant, called Modernising Medical Careers (MMC). However, in typical civil servant fashion, they did not think things through, and much of the planning was superficial. This became more and more apparent as the deadline for implementing MMC loomed (2007), and still little information was available. What little there was changed from deanery to deanery, and noone could separate fact from fiction.
In preparation for MMC, all SHO contracts that extended beyond August 2007 were cancelled, so anyone who had been on a 2-3 year rotation was screwed after all the work they did to secure the rotation in the first place. These people had to apply for ST posts too.
Mangling Medical Careers / Massive Medical Cull
===============================================
The Medical Training Application Service (MTAS) went live late 2006 (around October). It was a while before personal specifications were released on the MMC website for each new grade (number ST1 upwards) of each Speciality Training (ST) Programme. Unfortunately, no info on job numbers was given, and so juniors had to wait another 1-2 months before this was seen fit to be released (ie: almost less than a month before the applications began), which meant that no planning could be carried out as to where to apply based on the number of posts.
Applications were submitted on 05/02/07 and already problems had appeared. Some candidates had been unable to send in their application (this was all online) as servers had problems. Some referees sent incomplete/wrong references for their juniors. The application form essentially consisted of around 14 "fluffy" questions that had to be answered in 150 words or less. An example: "Describe a time when you have had to explain a complex term or procedure to someone. What were the main challenges and the strategies you used?". This meant that candidates were no longer able to send in beautifully crafted CV's that had been honed over many weeks/months/years, but instead were resigned to an ugly white box format that did not allow the opportunity to give a personal statement or show any other achievements beyond the little that was requested.
Applications
===============
These allowed a candidate 4 applications:
1) 2 locations in 2 specialities.
2) 1 location in 4 specialities.
3) 4 locations in 1 speciality.
With no previous statistics, noone knew what was going to be more popular, so essentially people just guessed, or used other personal reasons to pick essentially random places.
Shortlisting
=============
How was this done? Well, some of us still wonder that. This was a highly guarded secret pretty much up until applications were sent it, though it has since transpired that this was because noone knew what the hell was going on, even the people making the decisions. It turns out there was a wishy-washy set of marking criteria used, and it also turns out that this was leaked to some candidates before applications were submitted, thus giving these candidates an unfair advantage - something that this "perfect online system" was supposed to have prevented.
As for how people were shortlisted after these criteria were followed, we don't know, as it hasn't been publically acknowledged, nor likely will ever be. (ie: 100 candidates have the same top score after marking with the wishy-washy criteria, yet only 30 can be interviewed. how do you select when the application forms don't give any other information to go on?)
However, the result was that around the UK on 28th Feb, thousands of junior doctors were left gobsmacked, as the ineptitude of MTAS really became apparent. Many highly qualified candidates were left without an interview. Some were given multiple interviews. Some were given interviews in specialities they hadn't even applied for! The deaneries were (as expected based on previous MMC deadline dates) late in giving final reports of shortlistings, so some people had to wait almost a week before finding out whether they could have an interview or not.
At this point, the medical profession erupted. Unfortunately, this mostly consisted of juniors with little senior or Royal College support (the majority of which supported MMC blindly having become Governmental lapdogs). Eventually under pressure, the Government reluctantly agreed to review applications and decide if people had been unfairly not shortlisted. This has meant more work for everyone involved in shortlisting as they now have to call back even more candidates.
Interviews
============
These have been messy. To start, with the huge numbers of SHO's and Foundation Year 2 (FY2) doctors (Foundation Years 1 and 2 have already been brought into replace the old style Pre-Registration House Officer and first year SHO years) going for interview, arranging departmental cover around the country has been catastrophic, with some departments being left dangerously understaffed (the Government said this wouldn't be a problem, and once again they've been proven wrong).
Interviews themselves have been variable, with some places being extremely hardcore (F2 doctors getting grilled, having to critically appriase research papers...etc...), and others being more bizarre....(sugical interviewees being asked to make origami paper cranes).
The deadline for results is 19th March, but with all the new interviews that are taking place as a result of the Governmental "inquiry" into "MTAS/MMC flaws", this is probably going to be pushed back, so that Round 2 (assuming any jobs are left) will take place later....
Jobs
======
The whole point of the new MMC scheme is that the bottleneck is brought down to post-FY level, so juniors are forced to decide earlier what they want to specialise in, rather than the old system of bouncing round the SHO grade from speciality to speciality until they decide. On top of this, the number of jobs has been streamlined to match the number of current Consultant posts, so that only "needed" doctors are trained. These posts are Speciality Training (ST) posts. The Government have also introduced Fixed Term Speciality Training Appointments (FTSTA's), with the aim of maintaining service provision with these 1 year posts that do not count for official training. What some people don't realise (though as time goes on, more and more people have become clued in, so this number is dropping) is that:
1) In order to advance from an FTSTA to a ST post, someone needs to leave that ST post to free it up, and everyone who is suitable (ie: by experience and person spec) can apply for it, so there will be a lot of competition, probably even more than there is now.
2) FTSTA's are rumoured to possibly be phased out in a few years to some extent, with the minority left becoming new equivalents to Trust (SHO level) and Staff (Registrar level) Grade jobs, albeit most likely with a new title.
3) Essentially if you do not get a ST post now, your career is destroyed in this country. If you are unsuccessful in applying to a speciality, you will not be allowed to apply for it again, and you will be offered an alternative speciality post (or more likely an alternative FTSTA).
At last count, it looks like approximately 8,000 doctors will be left without a job come August 2007. This is assuming all jobs are filled (i'm sure this will happen as somewhere there is always someone willing to do what you're not). These people are most likely either going to Australia, New Zealand, or Canada, as they are all recruiting at the moment. The rest will go to other countries, or leave Medicine for good for a job in the city, or even unemployment. Some of these will be people unsuccessful in Rounds 1 and/or 2, and some will be those who are not interested in taking the random FTSTA offered by the Government in order to ensure "Services are provided".
Responses
============
The number of doctors that became sick on 28th February when shortlisting results of Round 1 were first released was unprecedented. Many broke down crying on wards, some were sent home. 3 have since committed suicide. This is the biggest crisis to hit junior doctors since the inception of the NHS.
Over 10,000 doctors marched on London in March to show their displeasure at the incompetent handling of their careers.
Some of the media has been sympathetic and have runs pieces on the whole mess, or just shown snapshots (BBC, Channel 4, The Telegraph, The Guardian).
The Government, headed by Patricia Hewitt and Lord Hunt, still deny the magnitude of all this, and refuse to stop the MMC juggernaut, or even overhaul it properly. To the date of this blog, only the miniscule inquiry so far has occurred.
Personally
============
I've had 1 Ophthalmology ST1 interview in Newcastle (Northern Deanery), which involved 4 stations of 10 mins:
1) Clinical Scenarios:
a) A untreatably blind patient comes into your clinic. What do you do?
b) A patient in for pre-assessment for her cataract operation is found to have severe heart failure.
2) Ophthalmic (yes, not normal surgical) suturing - 3 interrupted sutures with instrument ties (we'll ignore the fact that FY2's are not officially allowed to go on Royal College of Ophthalmology Microsurgical Skills Courses and learn such techniques properly).
3) Standard interview grilling.
4) Communications skills - Tell an patient (actress) that she cannot have the cataract operation she's waited months for and come in for today because the operating scope is broken, there is no spare, and it cannot be fixed today.
I am not interested in anything bar ophthalmology (eye surgery). I have experienced other specialities, and while some hold passing interest, I cannot see myself doing anything else for the rest of my career. This means I will not accept a token FTSTA in Gynaecology or Orthopaedics when the Governement want to get the not-so-popular posts filled. Unfortunately, this means my options are limited to emigration - essentially permenantly, as once the new system is in swing, it'll be nigh on impossible to come in again - or quitting medicine. Unsurprisingly, having devoted 9 years to the profession (and countless years in school aiming for my shot at it) and my love of helping people, the thought of having to walk away from it all makes me nauseous. Yet, reality beckons, and there are times when one has to make a hard choice in order to survive. Hopefully it won't come to that, but we'll see....Where would I go if I did quit? Well, that's a good question, and is something medics are not advised well about. Generally medics in this category either end up in pharmaceuticals, medical journalism, (medical) law, medical education, or finance (of some kind). I have no idea which of these would suit me, and I hope I don't have to find out.
Other Related Links
====================
These are other blogs covering this
http://murderingmycareer.blogspot.com/index.html
http://aphrabehn.wordpress.com/
http://thejuniordoctor.blogspot.com/index.html
http://nhsblogdoc.blogspot.com/
http://ferretfancier.blogspot.com/index.html
Another view of MTAS/MMC
http://aphrabehn.wordpress.com/2007/03/09/a-patients-guide-to-modernising-medical-careers-and-mtas-part-1/
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