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After many young doctors failed to get NHS jobs this summer, Edward Byrne argues that training posts should go to UK graduates. But Edwin Borman believes restricting access would damage the profession
For decades the United Kingdom has recruited overseas doctors to supplement its workforce. In more recent times, the number of doctors needed has increased as a result of an ageing population, labour intensive new technologies, and shortening of working hours. Recognising these factors, the UK greatly increased medical student places. In a few years there will be many thousands of additional medical graduates annually, and for the first time the UK will be able to meet its medical workforce needs largely through its own graduates. This large increase in medical student numbers creates an increased need for foundation programme places for new graduates and eventually for training places in the specialties if new graduates are to be effectively employed in the workforce.
Most medical disciplines require many years of postgraduate training for full certification, and graduation from medical school is at about the halfway point of a young doctor's training path. Little can be done with a medical degree without completion of both the requirements for GMC registration and a period of post-registration training leading to full registration as a family doctor or specialist. Medical student training times are longer than for most other university courses, requiring five or six years of undergraduate training or a basic degree followed by a four year graduate entry course. Young people invest a great deal of time and hard work in completing their primary degree. The financial costs to the individual and to society are considerable.
Some other professional degrees—notably a law degree— provide useful skills for work outside the primary discipline, but this is less so with medicine, where the integrated training is useful only in medical practice or research and to a limited extent in industry. A strong case can be made that society has a moral obligation to ensure that young people who successfully complete a demanding primary medical course have the opportunity to complete their training and enter medical practice.
The European Union treaty requires a free flow of medical professionals across the continent and increasing numbers of non-UK graduates are now applying for both foundation training and further postgraduate training. Many hundreds of non-UK graduates applied for a foundation training place in 2007-8, and this number is likely to increase. The increasing number of UK graduates in the next few years make it likely that most foundation positions will be required for UK graduates to meet the requirements of GMC registration. Language barriers limit the ability of many UK graduates to obtain adequate early postgraduate training in non-English speaking countries. This situation may improve if language skills in general increase, but a lot of work is needed in this area.
There are clear advantages for doctors in early postgraduate training being supported by the health system they have started to gain some familiarity with as students. The more a student is in need of special mentorship and support, the more relevant a period of further training in the UK may be to assisting them gain the expertise for independent practice.
We live in a global world, and free exchange of expertise is clearly desirable. This and a need for global movement later in medical training needs to be balanced against the likelihood that the training needs of UK graduates will place increasing demands on local training positions as the increase in graduate numbers filters through into family medicine and specialist training programmes. One possible solution would be to encourage a period of work in other countries towards the end of specialty or family medicine training and to encourage the development of bilateral exchange programmes. Creative programmes should be developed with postgraduate deanery, trust, and, where appropriate, university support to ensure that international training opportunities continue to be available both for UK graduates and international graduates, but such programmes should be aligned in scale with overall capacity at each stage of postgraduate training.
Fully trained family doctors and medical specialists are capable, language skills allowing, of working anywhere in the European Union or indeed internationally. Full mobility should be encouraged at the end of specialist training. If in future the UK has a transient excess of fully trained young doctors, they will be able to make a considerable input to health in other countries. If, instead, substantial numbers of medical graduates are not able to complete their training it would be a considerable waste of both personal and national investment.
Medical training in the UK is among the best in the world at both an undergraduate and postgraduate level. It is appropriate that a country with the wealth and stature of the United Kingdom cover its medical workforce needs without drawing doctors from less well advantaged countries in Europe or elsewhere. If the UK can contribute a relatively small number of fully trained medical doctors to work in other countries that would be a useful contribution to international health. A failure to provide training opportunities for the great majority of UK graduates and enable them to enter practice would represent a waste of human potential and a failure of care for young doctors.
Competing interests: EB completed his undergraduate training in Australia and benefited enormously from the opportunity to do further training in the NHS a quarter of a century ago.