Posts Tagged ‘Recruitment’

Facing up to a recruitment crisis in Scotland

By Caroline Whymark - 2nd October 2013 9:35 am

I wonder how the provision of a trained doctor service in anaesthesia can be maintained in Scotland.

To begin with, our training posts numbers are below that required to replace those expected to retire. On top of this, it is proving more and more difficult to recruit doctors to the posts we have. When we do succeed, it is hard for them to progress in our specialty along the default timeline and, worryingly, it seems less and less likely that they will stay and work here having gained their CCT.

The first point is being addressed by the Scottish government and we should have an additional 10 CT1 posts to recruit to next round. This is less than the 14 that were calculated to be required, based on the previous five years of attrition at this level. There has always been an attrition rate of 25% at this (or SHO) level of training. This was due to trainees deciding that the specialty was not for them or failing to pass the primary exam.

These factors may increase further post MMC as trainees need to apply to a programme straight from foundation training (without sampling extended periods in other specialties) and due to the increased logistical difficulty in passing the Primary FRCA exam.

The rigid timetabling of examinations by the college, and national recruitment to specialty training are not synchronised to one another. While each process has its deeply embedded and sound reasoning for when it takes place, the fact remains that it is very difficult to do both these things together, at the expected time. Our core trainees are now required to have  passed all parts of the primary examination by month 18 of a two-year training programme to be eligible to apply for the ensuing ST3 post commencing that August.

This is by no means easy. Passing said exam within the full two years was often difficult, taking more than one attempt for many. Now, passing the last part in May is too late and leaves trainees unable to apply to ST3 the same year (however, should they fail at that sitting, a six month extension to training ensues allowing time to pass and apply to ST3 for the following February).

So while we can recruit to CT1, it does not mean we fill our ST3 posts. We still have gaps in Scotland despite clearing systems, LAT appointments and additional February recruitment. Of those who do take up ST3 posts the majority will take longer than the basic five years to complete the training programme.

Maternity leave, sick leave, repeating a year, doing research, going out of programme, inter deanery transfers out of region are not new phenomena, but additionally we see an increasing proportion of trainees training LTFT  (and doing so earlier in their career s); we also see intensive care medicine training adding at least one year onto training time(possibly more for non-anaesthetists) and we seem to be supporting an ever increasing number of ‘doctors in all sorts of difficulty’ which impacts upon their ability to work and train as required to progress at the required rate.

Thus it seems training is now a journey to be enjoyed at a leisurely meandering pace rather than as getting to a destination, arrived at via the shortest, fastest route. Prolongation of training leads to a reduction in the annual production of CCT holders compared to that projected when these people were recruited at CT1 level.

But why rush to get a CCT in anaesthesia in Scotland? Consultant posts are advertised with 9:1 DCC to SPA contracts with no guarantee of this division being revised (although this has occurred in some Health Boards). This has created a real ‘us’ (new guys) and ‘them’ (established consultants) feeling. Further, there are resident on calls and weekend shifts built into most new and replacement posts.

With uncertainty around posts and no time for professional development we have seen many trainees leave Scotland post CCT following MMC. We now wait with baited breath to see how many return in due course.

While undesirable, 9:1 contracts threaten our ability to train and the quality of training for which anaesthesia is renowned. New consultants have no time to be educational supervisors, to take on teaching, to help with exam preparation, to complete workplace based assessments with trainees. These activities all take time out of theatre and the goodwill is all but gone.

As time passes and departmental workforces consist of proportionately more and more new consultants, I fear high quality training and intensive input to our trainees will be lost. When word gets out we will see fewer and fewer foundation doctors being attracted to our specialty and recruitment to core training will become harder and a ‘cycle of doom’ will be perpetuated.

Does anyone have any solutions?

“Professions must be open to all backgrounds”

BBC Health - 30th May 2012 9:07 am

Professions such as law, journalism and medicine must do more to widen their intake, David Cameron’s social mobility adviser will say.

Ex-Labour minister Alan Milburn calls for a “bigger drive” to open careers to young people from poorer backgrounds.

In a report out later Mr Milburn says internship schemes are a “lottery” and no profession has “cracked” widening recruitment.

Economic difficulties meant the issue risked being “sidelined”, he will say.

This came amid concerns that entrants to the professions were coming from an increasingly narrow social group. The report being published today suggests much work is needed to increase young working-class people’s access to the professions.

Medicine lacked a “sense of the sort of galvanised effort” to improve access to young people from different backgrounds, the report will say.

Read more in BBC Health.

Former minister says Army A&E plan “worrying”

BBC Health - 20th January 2012 7:18 pm

A proposal to bring in Army medics to cover a shortage of doctors is “deeply worrying”, MP Yvette Cooper says.

The A&E unit in Pontefract, run by Mid Yorkshire Hospitals NHS Trust, has been closed overnight since 1 November.

Ms Cooper, shadow home secretary and MP for Pontefract and Castleford, was backed by Hemsworth MP Jon Trickett, who said the trust should “get a grip”.

The trust said the unit would reopen fully as soon as enough doctors could be recruited to staff it safely.

Read more at BBC Health.

No guarantee of jobs for UK medical graduates

By Francesca Robinson - 14th November 2011 11:25 am

It may not be possible to guarantee all future UK medical school graduates a place on the foundation programme, two new reports are warning.

A surge in applications from Sudan and Pakistan last year resulted in the 2011 foundation programme being oversubscribed, creating for the first time a surplus of demand for places.

There were 7,257 eligible applications for 7,073 places and as a result 184 applicants were placed on a reserve list. These applicants were all eventually offered a place after some students withdrew either for failing finals or for other personal reasons.

The 2012 programme has again been oversubscribed this year and although the UK Foundation Programme Office (UKFPO) is confident that all eligible applicants will eventually all be allocated jobs, there is increasing concern about the future.

Pressure on foundation programme jobs is coming from an unpredictable number of applications from both EU medical students and non-EU students eligible to work in the UK. In addition following an expansion of medical school places increasing numbers of doctors will be graduating in future years.

A recent GMC report on the state of medical education in the UK warns that the prospect of the foundation programme being oversubscribed in future years is an area of potential concern. It says: “Students who enter medical school have legitimate expectation that if they pass their examinations and graduate they should have the opportunity to qualify as a doctor.”

It calls on the Department of Health to expand the number of foundation programme places in order to fulfil this “moral obligation”.

A second report by the Medical Schools Council into steps being taken to improve the selection process for the foundation programme, also warns that it is “likely” in future that the number of posts will continue to exceed the number of applicants.

Unless the application process is made more robust ensuring the “best” candidates are selected it warns there could be legal challenges from unsuccessful applicants.

Proposed measures to toughen up the application process include the introduction of situational judgement tests replacing the current ‘white space’ questions, a prescribing skills exam and an educational performance measure to more accurately reflect performance at medical school.

Dr Ben Molyneaux, deputy chair of the BMA’s Junior Doctors Committee, said they were extremely concerned about the pressure on foundation programme places and  were actively working with the Medical Programme Board and the UKFPO to find long term solutions.

“One of our concerns has been that over the last five years the government has consistently reduced the number of foundation posts available. There used to be a headroom of 5-6% more posts than trainees but in the last few years that has been reduced to 2%.  Unfortunately in austerity times it is unlikely the Department of Health will want to increase the number of posts.”

He said he was optimistic that the changes to the foundation programme application process would ensure more UK graduates would win FY1 jobs in competition with foreign applicants because they would have a better understanding of how the NHS works. He said there had also been discussions about incorporating the FY1 and FY2 years into the undergraduate curriculum although the jury was still out on this idea.

Marion Matheson, co-chair of the BMA’s Medical Students Committee, said it would be a personal disaster if a medical graduate was not able to get an NHS job. “The BMA has made it clear on numerous occasions that the government and the UKFPO have a responsibility to ensure that all UK graduates receive a foundation post when they leave medical school so that they are able to achieve full GMC registration,” she said.

A UKFPO spokesman said: “We are in ongoing discussions with the four UK Health Departments regarding contingency plans for future over subscription.”

A DH spokesperson said: “To date all eligible applicants to the Foundation Programme have secured a place. We will, of course, be monitoring the situation for future years.”

Job plan holds key to better work-life balance

By Mike Broad - 5th June 2011 10:52 pm

Striking a better work-life balance through the job planning process is essential to reducing the stress of O&G consultants and improving the attractiveness of the specialty, a royal college report says.

Getting a Life says the key to a work-life balance is the job plan, and the strength of the job plan is greater where responsibilities can be discussed and agreed on an individual, team and department basis.

The lack of work-life balance for doctors in O&G has affected the specialty’s ability to recruit and retain staff. The increasing requirement for consultant presence on the labour ward, and to be resident on-call, has been particularly damaging and the report calls for improved local planning to improve the situation.

The RCOG says on-call time must be followed by appropriate time off for rest and recovery.

The report says the role of the clinical director is crucial with service demands increasing and changing and more training, preparation and support for this role is required.

Job planning must also recognise other responsibilities such as teaching, clinical governance, professional development, it says.

Mr Richard Warren, RCOG honorary secretary, said: “The demands of O&G mean that conscientious doctors do find themselves working harder when they have little energy and this may result in an unhealthy spiral of guilt and disillusionment.

“Apart from having a potentially damaging affect on the doctor’s life, there is also an impact on patient care and we must find ways to support our doctors so that they are healthy and continue to provide excellent care.”

Read the full report.

New code sets out recruiters’ responsibilities

By Dr Ayesha Rahim, former deputy chair of the BMA's junior doctors committee - 16th February 2011 1:41 pm

Does this conversation sound familiar?

Mum: “How’s your training going?”

Me: “I’m starting a new job next week.”

Mum: “Where’s that, then?”

Me: “Well, I’m not exactly sure.”

Mum: “Are they giving you a pay rise?”

Me: “I don’t know yet.”

Mum: “Dear me. Well, can you come home for dinner next Saturday?”

Me: “I’ll have to get back to you, as I haven’t had my rota yet.”

Mum: “You don’t know very much, do you dear?”

Recruiters have got away with vague job adverts and woolly offers for far too long. It is not just an inconvenience. The lack of proper information can lead to a huge amount of stress and anxiety - try arranging childcare when you don’t know in what hospital you will be working or details of your rota.

In 2008, the BMA decided to challenge the Employment Agency Standards Inspectorate, an organisation that regulates employment agencies, to find out whether deaneries were employment agencies in the eyes of the law. If they were, deaneries would have to supply all these basic details about their jobs before we actually start.

The EASI confirmed that postgraduate medical deaneries are employment agencies. Great news, we thought, but sadly in May 2009, the Department of Business and Skills moved to exempt junior doctors from the protections of the employment agency regulations.

But the issue did not go away. The BMA responded strongly to this consultation stating that deaneries should not be exempted. As a result of this response we managed to kick-start talks on the development of a code of practice to nail down the basic level of information required for junior doctors when applying for training programmes.

This code of practice has now been published. It currently applies to postgraduate medical recruitment in England and Wales only. Negotiations are ongoing in Scotland and Northern Ireland. The code sets out the responsibilities of recruiting organisations, telling them what information should be included at each stage of the process, from job adverts through to offers of employment.

The code of practice should put an end to junior doctors being kept in the dark when moving jobs. But given the winding road we have gone down to get what are pretty basic rights, it is worth reading the code of practice yourself, should you receive a hazily-written job offer in the future.

Of course, if you actually didn’t want to go round to your Mum’s for dinner, you’ve just lost your best excuse.

Read the code of practice.

Medical students run risk of unemployment

By Francesca Robinson - 30th November 2010 11:31 am

Two per cent of final year medical students will not receive a place on a 2011 Foundation Programme when places are allocated in December.

The UK Foundation Programme Office (UKFPO) has confirmed that the programme starting in August next year is oversubscribed following an unprecedented surge of 1,600 extra applications.

Applications will now be ranked in score order and the 7,073 top scoring students will be placed on a primary list to be allocated places on 8 December.

The surplus 184 applicants will be placed on a reserve list and are likely to be allocated a place by next summer and probably by March.

Based on previous years figures around 400 applicants are expected to withdraw between allocation of places in December and the start of the Foundation Programme in August. Last year about 200 applicants failed their final exams and others withdrew for personal reasons such as to go travelling or start a family.

Professor Derek Gallen, UKFPO national director, said: “I am confident that all eligible applicants will be placed by next summer. Although we are pleased that nearly 98% of students will be allocated during December, we appreciate that this is a time of uncertainty for those who will not know what foundation school they are going to for another few months.”

Applicants on the reserve list will have a dedicated contact person in their medical school to provide them with support and advice.

The BMA said it would be closely monitoring the UKFPO’s contingency plan. It is unacceptable for any UK medical graduate to be in a position where they might not be able to start a job as a junior doctor after medical school,” said Karin Purshouse, chair of the BMA’s medical students committee.

“The UKFPO have given the BMA assurances that their contingency plan will mean that no medical graduate is left without a post by August. However, the UKFPO must take all necessary steps to ensure that their contingency plan works effectively,” she said.

Dr Shree Datta, co-chair of the BMA’s junior doctors committee, added: “It is important, given this year’s problems that we begin immediate work to examine how we can prevent any repeat next year. Given the financial investment to train a doctor, ministers and the UKFPO have a responsibility to make sure that there is no repeat of these issues in the future.”

Read more about the contingency plan and how the reserve list allocations will work.

Selecting doctors on an uneven playing field

By Lucy Stephenson, medical student, and Terence Stephenson, former medical school dean, president of the Royal College of Paediatrics and Child Health - 4th November 2010 9:46 am

Figures from the UK Universities and Colleges Admissions Service (UCAS) show that, from 2002 to 2008, medical students were between 4.5 and 7.2 times (depending on the year) as likely to come from the wealthier socioeconomic groups 1 to 3 as from groups 4 to 7. Selection to a medical course should not depend on the applicants’ financial status. However, with “grade inflation” at A’level, choosing between applicants often involves other criteria that may depend on ability to pay. The selection process for many medical courses may favour applicants who undertake activities outside those paid for by the state education system, and some such activities are a mandatory requirement, the authors write on bmj.com.

The hidden, upfront cost of a medical school application may include the following (2008-9 prices). Many medical schools require applicants to sit the UK Clinical Aptitude Test (UKCAT) or the Biomedical Admissions Test (BMAT) in addition to A’level examinations. These cost £60 and £32.10 respectively.

The cost of travel to the test centre is borne by the applicant. UKCAT tests are held at driving test centres, and no one should have to travel more than 40 miles (64 km). Most students who can afford to will buy books to prepare for these tests; and as the format of BMAT and UKCAT is different, this may require two sets of books - roughly £20.

Although not obligatory, most students who can afford to also travel to attend a “Medlink” or similar residential course (£200 to £300) to familiarise themselves with the medical career and the complex application process and to have interview coaching and guidance on completing their personal statement on the UCAS form. Then there’s the cost of attending, say, six open days as far afield as Exeter and Edinburgh is down to the applicant. With only four UCAS choices for medical schools and intense competition for places, many sixth formers will attend six different open days to try to determine their best chance of success and what to say at interview.

If lucky enough to be offered an interview, the student must pay to attend. Most other degree courses in the UK do not require personal attendance at interview, and there is little evidence that a 20 minute interview at age 17 bears much relation to the ability to practise as a qualified doctor six years later. Sometimes candidates are offered interview at short notice, which precludes cheap advance fares. Depending on the students’ declarations, they may be asked to attend separately for one or more medical assessments.

If the applicant is offered a place, the cost of vaccinations essential to commencing the course (such as hepatitis B) is £32.50 per injection, and three injections are necessary (£97.50 total). Some but not all schools cover the cost of this.

Adding all these costs together comes to £1609.60.

Whether an applicant is offered a place can be influenced by many non-academic factors cited in the written UCAS form and at interview. For example, weekly flute lessons at £25 a lesson from age 8 to 18 to obtain grade 8 standard, plus the cost of the flute and eight external examinations, costs more than £12,000. Charitable or paramedical work experience is often sought, and work overseas with less advantaged groups is also impressive. It all has costs attached.

In addition to the greater opportunity that professional parents have to arrange appropriate work experience, and the lesser aversion to debt among wealthier families (medical students finish the course with average debts of £35 000), the costs described here may further disadvantage young people from poorer backgrounds in the process of selection for medical school.

This is a summary of an article on bmj.com.

Legal challenge over juniors’ employment rights

By Francesca Robinson - 30th December 2009 1:24 pm

A legal challenge has been issued to the government over decisions it has made which deprive junior doctors of key labour protection rights.

Lawyers employed by the campaign group Remedy are questioning the propriety of a consultation carried out earlier this year on whether to exempt deaneries from employment agency legislation.

Remedy has opposed the move because it claims that it deprives juniors of key employment protection rights.

Abuses include failing to inform junior doctors seeking work through deaneries of which rotation jobs they will be assigned to when they apply; being forced to ’stick or twist’ on jobs; and not knowing where they will be two weeks before a job starts.

Remedy’s lawyers have sent a legal ‘letter before action’ to Lord Mandelson, the business secretary, in a bid to persuade him to withdraw his decision and to start the consultation process again.

They have highlighted the way the Department for BIS justified the exemption on “potential consequences” and “evidence” - the details of which were not revealed.  

They argue that the consultation came to the conclusion that the only group who could be affected by the proposed changes to the law would be the deaneries themselves. They also point out that there was no consideration of the impact this action would have on the doctor.

Remedy’s head of policy Richard Marks said: “In the short term this legal action will delay any changes which will be to the benefit of those currently going through the system. But our long-term aim is to campaign for better and fairer controls of the ways that deaneries conduct recruitment.

 “We want to see the levels of protection for doctors increased, not reduced. The distant promise of a code of conduct with very uncertain powers is simply not good enough.”

In return for exempting deaneries from employment legislation the Department for BIS has proposed establishing a code of conduct to govern future recruitment and training arrangements for junior doctors.

 But Dr Shree Datta, chair of the BMA’s junior doctors’ committee said they were concerned about how much teeth the code would have and whether it would be enforceable. 

“We will await with interest the progress that Remedy make on this issue. Meanwhile were are putting pressure on deaneries to make sure they are aware of the feeling among junior doctors on this issue,” she said.

A Department for Business spokesperson said: “I can confirm that we have received a letter from Remedy and are in the process of considering it.”

Read a blog on the issue.

Encouragement will widen professional access

By Liz Denny, medical student in Liverpool and the BMA's lead on accessibility - 18th December 2009 1:34 pm

There will be many of you who will approach yet another report about equality and widening access to medicine in the same way that I approach the Peter Andre and Katie Price circus.

I don’t understand it, I don’t care about it and frankly I wouldn’t be that fussed if a gigantic foot dropped down on top of it.

I sympathise with this reaction as in recent months we have been deluged with reports, pronouncements and initiatives on this topic, not least from Alan Milburn’s summer report on widening access to the professions. Unfortunately much of this has been wrapped in the overbearing language of political correctness which makes you want to pull your hair out.

But, buried beneath this mountain of political spin lies a couple of serious points. It is true, as the BMA’s new report into the make up of medical school demonstrates, that as a profession we have an appalling track record of recruiting students from low income backgrounds.

Just one in seven medical students comes from this group, despite the government pouring £392 million into widening participation schemes in recent years. The glut of spending has resulted in an increase from the lowest groups of just 1.7% since 2003. Not exactly time for the party hats and the cava.

I imagine though that many of you again would have been left unmoved by this last paragraph, possibly because you suspect that what is coming next is a call for positive discrimination. Certainly our report suggests this view is filtering through to students, with a rising rate of applicants refusing to answer questions about their social status, possibly due to a fear they could end up being penalised if they are judged to be too wealthy.

Well, this isn’t what the BMA or I believe in. Positive discrimination is as unfair as it sounds - there is nothing positive about discriminating against anyone.

What instead needs to happen is for us to remove the barriers holding back low income students. Many of these lie at school level, well before application forms are even filled in.

Pupils from low income areas receive worse grades than their counterparts in more affluent districts and, perhaps linked to this fact, many automatically think a career in medicine isn’t for them. Another issue may lie in the career advice students get, as there is evidence of an inconsistency in the quality of these services.

Certainly, in my own experience, I didn’t feel I got much encouragement to go for medicine despite my grades. There of course other barriers, not least the increasing cost of a medical degree which all politicians appear to have genetic pre-disposition to ignore - despite medical students now facing a £37,000 debt bill after graduation.

To tackle these problems we don’t need phony positive discrimination schemes. We need to look at the school system and how it interacts with medical schools, especially in terms of career advice services. We need no more increases in tuition fees and someone in Whitehall to wake up to the debt problem that threatens to bury the ambitions of thousands of students with the brains but not the wallet to get into medical school. And we also need a proactive set of mentoring schemes - an area the BMA is looking to work on - aimed at raising the sights of children so that they believe a career in medicine is within their reach.

Tackling the under representation of low income students is therefore not a flag to be raised in the cause of political correctness. It is about something more real, more practical and more important - making sure we get the best talent into our hospitals and that everyone gets the chance to fulfil their potential.