Lottery is the word that springs to mind to describe the situation facing many junior doctors about to continue a journey concluding in the attainment of consultant status.
Lottery is the word that springs to mind to describe the situation facing many junior doctors about to continue a journey concluding in the attainment of consultant status.
The vehicle to take them from junior hospital posts to specialist positions has undergone a radical overhaul. It seemed ripe for change but the replacement model, due to come into operation at the beginning of August, shows signs of breaking down before it has even started the task intended. Consequently, many junior doctors who have signed up to the system might find themselves out of work just as they should be embarking on the next, critical stage in their career.
As of last night, some 1000 young doctors who had identified Scotland as the place where they most wanted to work were lacking a job offer in the country. For those whose preference is not matched up with a suitable post, the options include taking locum work, moving elsewhere or becoming unemployed. People are accustomed to taking their chances in the job market. There are no guarantees. But one of the reasons the situation facing junior doctors is intolerable is the fact that applications to study medicine are based on the requirements of the profession in the years to come. Effective workforce planning should ensure there are neither shortages nor surfeits of doctors.
Managing this aspect of the system, taking account of the number of applicants for undergraduate places and the number of likely vacancies ahead, enables universities to set school leavers high tariffs. How, then, can we find ourselves in a situation where, superficially, there appears to be a looming surfeit on a large scale? The shortage of consultants in certain specialisms (a reason cited for difficulties in meeting hospital treatment-time targets) demonstrates that there is no surfeit. There are several reasons why the new system has been found wanting to an unacceptable degree. As with other initiatives, too much change appears to have been attempted in too short a time frame. Applicants for specialist training posts in Scotland (many of them Scottish-domiciled and educated) have been put at a disadvantage because the country has been defined as a single region for the purposes of the UK model. The pot is so large that they could be offered a specialist place anywhere, which is far from ideal for junior doctors married with young families and mortgages (which is frequently the case).
A new, online applications system intended to match candidates with posts is discredited and has been abandoned. With the clock ticking down, the task has been undertaken manually. But it is far from certain that everyone who wants to train in Scotland, in the right specialisms in the right areas, will be able to do so. (It is, in fact, highly unlikely.) This could result in several unwelcome scenarios, the worst of which is probably junior doctors deciding to complete their training overseas because of avoidable uncertainties at home. This would be scandalous. It costs the taxpayer nearly £100,000 to put a student through medical school in teaching fees alone.
The investment is not made frivolously, but that is how it would seem if trainees were forced abroad. The poor health profile of Scots shows beyond doubt that the expertise is required here, now. We will not become healthier if we lack the experts to treat and advise us. A system that produces shortages yet raises the prospect of unemployment at the same time in the same profession is a failed system. Medicine is the caring profession. The training component of that system has been exposed as uncaring and incompetent. At what potential price?
