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  • Another tabloid victory

    by Rumbold
    19th September, 2009 at 1:44 pm    

    As a result of changes in immigration laws, Britain is now facing a 5% shortage in junior doctors:

    “In some cases, hospital departments had to rely on just six junior medics to do the job of ten. The shortage started after recent changes to the immigration system which prevent people from outside the EU from coming to train as doctors in Britain.

    Now the BMA fears the it has got worse this year as a result of a new European Working Time Directive, introduced in August, which prevents the UK’s 60,000 trainee doctors from working more than 48 hours a week.”

    Thanks to the tabloids and the EU, we now don’t have enough people to heal the sick. The incompetence is striking.

                  Post to del.icio.us

    Filed in: Current affairs

    27 Comments below   |  

    Reactions: Twitter, blogs
    1. pickles

      New blog post: Another tabloid victory http://www.pickledpolitics.com/archives/5938

    2. Debate around the web « The press, the media and regulation policy

      [...] Pickled politics says that a shortage of junior doctors is partly due to tabloid newspapers: “Thanks to the tabloids and the EU, we now don’t have enough people to heal the sick. The incompetence is striking. [...]

    1. David Jones — on 19th September, 2009 at 1:58 pm  

      Tabloids had what to do with this?

      Incidentally, as the article says, ‘International recruitment is still possible where there are no EU candidates for the post’

    2. douglas clark — on 19th September, 2009 at 3:16 pm  


      Whilst I love the EU and it is fashionable to hate it, what does that story have to do with the EU at all? I’d have thought, not a lot.

    3. MaidMarian — on 19th September, 2009 at 4:38 pm  

      Sorry Rumbold. The medical profession is a master of shroud-waving and I have a feeling you’ve been taken in.

      The changes to the immigration system date from 2006 - hardly new. In effect, doctors in approved training posts did not need a work permit before that date. If you read the Tooke Report which reviewed the disastrous changes to medical recruitment in 2007 you will see that there were (at that time) 32,000 applicants for 17,000 posts. Hardly a shortage that justifies a blanket exemption from immigration law.

      Indeed, in late 2006 Indian newspapers published several articles about unemployment amongst immigrant doctors.

      More than that senior doctors and consultants benefit from the new points-based immigration system. In addition, reforms in 2003 also expaneded eligiblity for overseas doctors to apply to be credentialled to practice in the UK.

      What the medical profession does not want to face upto is that (in some, not all specialites) the NHS is wildly over-producing specialists. And be in no doubt, the medical profession will defend to the death the categorisation into sheep and goats that is those in approved training and those in staff/associate specialist grades. The abolition of the old ‘SHO’ grade is something that doctors, three years on, have still not worked out of their system.

      What the BMA wants is for doctors to be able to choose thier specialty with little heed for the reality that the NHS is overproducing in many areas.

      As to the working time dorective - well, I am not convinced that there is a case for doctors being sleep-deprived on shift. I will leave you to form your own view.

      There is a real need to have a discussion about the numbers and direction of medical training - but the BMA are not the body to lead it.

    4. Trofim — on 19th September, 2009 at 5:12 pm  

      “… we now don’t have enough people to heal the sick”.

      Not wholly accurate. We have 61+ million people, in the United Kingdom, including umpteen million unemployed people, but we have not, and are not, TRAINING enough people to heal the sick.

    5. Shatterface — on 19th September, 2009 at 5:17 pm  

      What’s unacceptable about the EU ensuring junior doctors get enough sleep to do their job properly? They take life and death decisions - training shouldn’t be a feat of human endurance.

      Maybe the EU should back off airline pilots as well, I mean they’re only flying a plane.

      You’re normally more sensible than this.

    6. Tory — on 19th September, 2009 at 6:28 pm  

      Depends on the quality of the individual doctors i guess. There were a couple up the Glasgow the likes of which we can do without.

    7. MaidMarian — on 19th September, 2009 at 6:38 pm  

      Trofim (4) - UK medical schools are throwing out medical degree trained students at a rate unheard of in the past. In the 2007 reforms, there was a great expansion of training posts with little heed for workforce planning.

      The ugly truth is that we are wildly overtraining in some specialties and have not planned the workforce properly in others. None of that though makes a blanket exemption from immigration law, as Rumbold suggests, a good idea.

      Some specialties are popular. Largely the ones that can be ‘sold’ in private practice such as cardiology. Some are popular because the workforce planning has been better. There is not a lot of consistency. When the BMA get it that not every doctor can have their first choice of specialty we will be closer to solving this.

    8. Rumbold — on 19th September, 2009 at 7:31 pm  

      To deal with the EU question first. I don’t have a problem with doctors working normal hours. However, what the law failed to allow for was the time doctors ‘on call’, but often doesn’t involve work. Failure to deal with this issue has worsened the problem. Junior doctors are also receiving pay cuts as they will now have to pay for accomodation on site, whereas before it was free.

    9. Rumbold — on 19th September, 2009 at 7:37 pm  


      I did wonder about that as I remember hearing that there was a massive over-supply of doctors a few years ago. Forgive my ignorance but what does specialisation have to do with a lack of junior doctors? As I understand it junior doctors can’t specialise in their first two years. I hope you are right though and that the BMA are just being devious.

      David Jones:

      Like with child protection, the tabloids wail against things and then are shcoked wihen the inevitable happens (like social workers seizing children, etc.).

    10. douglas clark — on 19th September, 2009 at 7:47 pm  


      I know you have an undeniable hatred of the EU, what with it being a bit better than the UK Parliament and that. However, the failure of the UK Parliament to address the issue of reasonable working hours suggests it isn’t worth any respect. It is, frankly, stoked up with Lords and Ladies who see even Doctors as slaves.

      You, sir, are on the wrong side of this discussion.

      We ought to let anyone that is qualified come here if they want to. And we ought to fund their places of learning too…

    11. Rumbold — on 19th September, 2009 at 7:51 pm  


      I am a EU-sceptic, that is true, and I do think it is deplorable that doctors were working such long hours. But it doesn’t follow that the EU were right.

    12. Rumbold — on 19th September, 2009 at 7:55 pm  

      It was a rushed piece, and not my best work.

    13. douglas clark — on 19th September, 2009 at 8:05 pm  


      Thanks to the tabloids and the EU, we now don’t have enough people to heal the sick. The incompetence is striking.

      Well, in what way did the EU stand in the way? If you merely mean the European Working Time Directive (EWDT), then that is nonsense. Employ more junior doctors. On the minimal conditions that the EWTD specifies, why don’t you?

      People are entitled to respect, I think, and not to harm, which the EWDT rectifies.

    14. douglas clark — on 19th September, 2009 at 8:12 pm  

      Rumbold @ 12,

      Well, I have been known to get my arse and my elbow mistaken. And you have stood up for me, despite that. So, just delete 13 or whatever.

      You will never be anything other than a chum.

    15. MaidMarian — on 19th September, 2009 at 11:00 pm  

      Rumbold (9) - Thank you for your reply.

      ‘I did wonder about that as I remember hearing that there was a massive over-supply of doctors a few years ago.’

      Was and still is. One of the reasons why Indian doctors have a tradition of coming to the UK/US is that India has for a very long time had an enormous problem with overproduction of doctors to the extent it distorts world supply. Often European/US qualifications are one of the few ways to progress in the Indian medical system.

      The BMA simply sees an oversupply of doctors as being more members for them.

      ‘Forgive my ignorance but what does specialisation have to do with a lack of junior doctors? As I understand it junior doctors can’t specialise in their first two years.’

      Doctors complete their degree and a 2 year Foundation training course and then enter ‘core training.’ This is in a broad area of practice (not a specific specialty) e.g. medicine, anaesthetics, surgery etc. Core is for 2 or 3 years. On completion of core training they then enter specialty training, related to their core training, which is training to a CCT (Certificate of Completion of Training). Pathology does not have a core element and doctors enter training from foundation.

      Some specialties have few problems filling specialty training posts and overproduce CCTs. Some specialties can not fill up - partly due to to having too many training posts. Diabetes would be an example.

      The complaints stem from in the past there being something called ‘SHO’ posts which were replaced with core training. These SHOs were posts that did not lead to the CCT and were a loose pool of junior doctors. My view is that the changes were both good and bad. The net effect has been that doctors DO specialise earier. The medical profession is bitching 3 years on and has signally failed to get to grips with a more structured career path. My view is that this is again good and bad. Some have got used to and worked with the new structures. Others have just cried to the BMA and press.

      In any case, the NHS’ workforce planning has not been good, hence it is so patchy. The lack of junior doctors is becaues some specialties are just not attractive.

      What the new system has done is leave fewer doctors hanging around to take up locum posts which has caused problems. This is especially true as more junior doctors than before are taking time out of training to do research, career breaks etc.

      ‘I hope you are right though and that the BMA are just being devious.’

      I leave the NHS training system (with a specialism in overseas doctors), after six years, on Friday. The BMA are pushing thier luck. What’s worse is that there are far stronger arguments to me made about junior doctor numbers.

      In any case, I can see no case for an exemption to work permits.

      On the EWTD - That argument has as much to do with pay as anything else. Nothing wrong with that per se of course, but this is shroud waving.

    16. Rumbold — on 20th September, 2009 at 12:32 pm  


      You too are a chum, and I didn’t take #13 personally. The problem is that the working time directive is essentially nothing but a paycut. Previously doctors got paid overtime for working more than a contracted number of hours. They will still work longer than 48 hours (how many doctors would leave a severely ill patient because it is 5:00pm?), but will not be able to put it down. Add to that the changes to accomodation rules which will now see doctors charged for staying in hospitals, and you have a situation where junior doctors will be working 60-70 hours a week for around £16,000 (a doctor last night explained it all to me).


      That’s interesting about Indians using Euorpean/British qualifications to progress. I suppose it makes sense as it helps you stand out, especially if you go somewhere like Cambridge.

      “What the new system has done is leave fewer doctors hanging around to take up locum posts which has caused problems. This is especially true as more junior doctors than before are taking time out of training to do research, career breaks etc.”

      Thank you for this. That really clears things up. I guess it is sometimes easy to defer to professionals.

    17. camilla - Rumbold — on 20th September, 2009 at 1:32 pm  


      could you please explain me Rumbold, how it always turns out - according to this site - that the influx of immigrants never has nothing to do with some negative things - crimes, terrorism, hate crime attack (when its muslim-on-non-muslim hate crime, of course)?

      but you managed to notice such a strong connection between changes in immigration laws and medical workers shortage? arethere many muslim juniordoctors?

      selective eyesight, indeed…

      come on, people move form their motherland to some other country not to bring good to this country, but to benefit from it. and if there is an opportunity to have allowance for the whole family - why work? what for?

    18. zak — on 20th September, 2009 at 2:48 pm  

      Rumbold, the counter argument about the “I would prefer being seen by a Doctor who hasn’t been working non stop for 3 days” is that because wards have little cover due to the EWTD..the Docs are overstretched and end up having far more work to do in little time. There training suffers and getting locums is a major problem. It’s worse in frontline services like A&E which are very dependant on locums.

      IMG (International Medical graduates) also don’t want to work in the UK anymore because of the lack of career progression..those who do are locuming so locum rates have shot up in hospital medicine.

    19. Rumbold — on 20th September, 2009 at 4:37 pm  


      I am not sure I understand what you are asking, but I shall try and answer. Some immigrants do commit crimes. As do those who have been born here. This is not in itself newsworthy. I do not know the percentage of doctors who are Muslims.


      What do you think you think should be done about it, in addition to the sort of reforms MaidMarian has suggested?

    20. zak — on 21st September, 2009 at 1:18 am  

      Rumbold: Very little..the NHS has a tendency to have knee jerk reactions to problems. The situation will only be looked at once care is compromised ( and the blame game will start)

      IMG’s should’nt be taken for granted either..the NHS’s reputation has taken a knocking over the last few years with many IMG’s preferring the US or australian system to staying in Britain. The opening up of visa’s to IMG’s historically has always been cyclical. But it wouldn’t surprise me if and when the system opens up again..that the response from overseas won’t be as big as the planners in the DOH would like..

    21. Rumbold — on 21st September, 2009 at 10:04 am  

      I suppose increasing competition will whittle down the incentive to work in Britain.

    22. MaidMarian — on 21st September, 2009 at 12:34 pm  

      zak - Yes, the NHS does knee-jerk terribly. The blanket work permit exemption was just such a knee-jerk. It was a Thatcherite way of getting doctors on the cheap rather than funding UK universities. The exemption was wrong as it was never sustainable. It is to the shame of Conservatives and Labour that it was allowed to go on to the extent where IMGs developed a sense of entitlement. The IMGs have not been ‘stabbed in the back.’ There were treated as a special case and circumstance no longer allows that treatment. There is no case for doctors to be seen as special.

      In classic New Labour style the reforms were right, the implementation was so bad it will take years to clear up.

      That said, I can’t agree with your other point. If the door is opened again, the Indians will come running. The BMA and IMG associations are kidding no one if they say otherwise. The Indian system of medical training in particular incentivises overseas training. The real discussion is with the Indians about their wild overproduction of medical graduates - but that is their business.

      The root answer to all this is to be far, far, far more prescriptive about what doctors can and can not do. The 2007 reforms introduced a mild amount of prescription and that led to nothing but grief.

    23. zak — on 22nd September, 2009 at 1:23 am  

      Maidmarian: I agree with some of your comments but i think we are writing from different perspectives. What you term as “a sense of entitlement” is more a point of system comparison..IMG’s will prefer a system which is streamlined and promises them a better future..anecdotally the impression i get from chats with many IMG’s who have left or are leaving is that the US and Australian system are better(in the sense of career progression, quality of life and long term settlement chances). So from my perspective there is also a false sense in the NHS that IMG’s will rush over the moment a switch is flicked.

      but even if you are right.. if the floodgates are opened Doctors may well flood in..the NHS won’t attract the cream of the crop. Other countries will benefit from Doctors with the ability to pioneer new treatments and research.

      A side point the Indian state healthcare system from my understanding doesn’t the actually recognise the British royal colleges examinations as equivalent to it’s fellowship exams. The Pakistani system is partially recognised..( a completed pak fellowship exam exempts a pakistani Doctor from part 1 of the MRCP and MRCS) but increasingly in Pakistan local specialists are preferred .

      I think people misjudge whats going on at their peril..locum agencies are struggling to fill posts up despite significantly better pay, ..I know of one case back in april where 4 non training SHO jobs were being advertised and only two people turned up (both got offered and both turned it down because they preferred locum pay over a non training job which had no prospects). Similarly i know ST doctors who have recently started who are frankly being appointed more out of desperation to fill the post then any real competence.

    24. MaidMarian — on 22nd September, 2009 at 6:08 pm  

      zak - I take the point, but the bottom line to my mind is that IMGs simply are not a special case as they were 20 years sgo. As I understand it, the australians are, like Britain in the 1980s using thier visa system to ‘create’ doctors and it will be interesting to see how they end up. But I remain convinced that opening the door to the NHS would result in a pile in.

      As to overseas and exams, you are making a fundamental error. MRCP and MRCS are not ‘final’ or credentialling exams. The RCP final exam is the SCE and the Surgeons have the Intercollegiate exam. Exemptions from parts of MRCP/CS don’t mean much. The situation varies massively from College to College.

      OK India: India does not have fellowships (Pakistan does and they are very good). India has a system where doctors train and obtain an MD. This is a junior-ish award and allows access to ‘Senior Resident’ and then ‘Assistant Professor’ grades as experience builds. There is also a Diploma of National Board exam, but this is seen as secondary to an MD. The problem is that one MD is very different to another. An MD from the Univeristy of Chandigarh or the All India Institute of Medical Sciences is a pretigious award that almost guarantees a lucrative ‘Professor/Consultant’ post in India. Of course, in a system that massively overprodcuces doctors, comptition for these MD course is ferocious and many good candidates don’t get in. These doctors have a choice - accept a second or third class (or worse) MD which closes doors. Or head overseas to seek good overseas awards like a UK CCT and College Membership or the Australasian Fellowship or the United States Board.

      This in turn disadvantages new graduates in those countries.

      Yes NHS ST3 are being appointed for the wrong reasons. But that is more to do with mismatched aspirations. Not everyone can have an NHS consultantship in cardiology post and a private practice too. What do you mean by a ‘non-training SHO’ job - ST2 CMT? SHOs were training posts. Do you mean staff-grade? If so those were always impossible to fill as anyone with sense took locum pay. MMC has not changed that.

    25. zak — on 22nd September, 2009 at 11:34 pm  

      Maidmarian: I take your points about how the training programme finishes but that final part doesn’t apply to IMG’s applying for jobs in their home countries.

      The Indian healthcare systems lack of capacity to absorb it;s own Doctors will probably correct itself with the growth of the private sector.

      Your point about disadvantaging local graduates is fair..not many systems would NOT look out for their own graduates ( it would be inconceivable if the situation was reversed for British Doctors to expect to be treated fairly in the Indian or Pakistani system)

      ..but it depends on what one is looking to achieve in their healthcare system..a system which is good for it’s graduates or a good system.

      I was referring to LAS/LAT posts.. the lack of locums is also hitting teaching sessions especially in busy departments.

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