Dr John Crippen
Absolutely horrendous.
Doc, I was in the hospital today, and I've never seen my seniors (SHOs, FY2s, SpRs, etc) look so demoralised or apathetic.
I felt so sorry for all of them.
I would like to echo the plea from Dr C. for doctors to share a little information about what is going on, for the non clinical amongst us. A wider audience means more support and hopefully some of it may fall on ears which have some influence.
I have just watched this evening's edition of Panorama, and am shocked at the violence which takes place in Hospitals to NHS staff. After reading David Copperfield's blog and book ("Wasting police Time") about the daily life of a policeman, I am NOT shocked that NHS policies of "Zero Tolerance" are a mockery, only 2% of attacks in hospitals are prosecuted and most of them getting only derisory punishments. I also read Mr Chalk, the blog of a comprehensive schoolteacher, and his book "It's your time you're wasting" - I am so depressed as to what has happened to this country of ours and how it has all come about almost without being noticed. Now is the time to shout it out from the rooftops and let people KNOW just what is going on, so yes, please do tell us what is happening - we need to know, you need our support.
Thank You, and best wishes all
Steve
I was at clinic today and saw one of the SHOs, lovely guy, he was sitting waiting for news. He did say that "big things are happening in the NHS today" when I pointed out he hadn't signed the script form. Then I asked if he was under MMC and it all became clear. I hope he gets a post as he was bloody marvellous today.
The absolute lack of any communication from MTAS / MMC all day despite the system lurching between complete meltdown and spewing complete nonsense is unforgivable. All day young doctors (myself included) have been terrified about the future.
Now many careers which have been progressing well for several years - with real dedication to the profession and our patients - have been dashed on the rocks, by an unfair, unvalidated and rushed system.
Our doctors deserve better
More importantly, the patients of this country deserve better.
Tony Blair and his NHS ministers should be ashamed. A Black Day indeed.
Is it unfair that doctors be spread by region and specialty? In most walks of life the way to obtain your "dream job" is by being the top applicant. If you don't get the job, don't begrudge the person who did- they probably deserve it more than you. Not all astronauts get to stand on the moon.
Sure,
I have a medical degree from london, a "golden london SHO rotation" disctinctions throughout medical school, 100% in my medical and surgical finals (i joke you not), all my postgrad exams, posters, papers in progress, a pan-london audit etc etc
And I have sat in front of the computer all day - waiting to see whether this incompetent system has granted me a future in medicine.
I'm still waiting.
All day the website had been plagued with problems, doctors rushing from one computer terminal to the other trying to pretend their looking at blood results when in fact they are looking for a glimmer of hope that they still have a career, or job in the NHS come August.
Do you want to hear the biggest joke. In 2009 the EWTD says doctors have to reduce their hours. A year ago official figures predicted hospitals wouldnt have enough doctors. When they make 6000 of us unemployed this summer and we all pack up our lives and move to america or australia - within a year they will be "flying in SHOs" from abroad to meet the staffing crisis. For a huge price no doubt.
Not very smart.
And now I will continue to stare into my computer screen to see if a dedicated intelligent doctor has to "sign on" in August.
Well done Blair.
Well done Patricia Hewitt.
How are you going to spin this one to the patients?????
It is a disgrace to treat humans like we have been treated. It is tragic to see careers and lives being destroyed by just looking at a computer screen. The whole thing reminds me of an execution that has gone badly wrong: they have to put us back to the electric chair and electrocute us again and again until we are finally dead...
Dr Flexible - it's got absolutely nothing to do with being "the top applicant". Are you a doctor? THIS. IS. A . LOTTERY.
Thank you, John, for the plug.
Please, PLEASE, everyone, help us out. Submit your stories, talk to the press, get your voice heard everywhere and anywhere. This is shit. If you don't give a toss about us then think about the patients. They are not getting the best care right now because the only thing on all of our minds is "is my life going to be destroyed or not?" I'm afraid we're not infallible and are incapable of being completely selfless. How would you feel if your whole world was about to be destroyed, regardless of some outsider's view of the "fairness" of it all.
This is horrible. Horrible horrible horrible.
I have to say that my junior staff like most others seem completely at sea with this system. I was in the position owf writing a "structured reference" for the best trainee I have ever had-fantastic academic credentials and a superb combination of clinical skills and empathy with patients. She does not know whether she will have a job. This is insane, and although I expect it will all "come out in the wash" I think it is totally unacceptable to treat people in the way that they have been. I sincerely hope all those high quality doctors who have decided to work in Australia or New Zealand remember to take their polling cards with them to tell the Government what they think of it.
I love my job. My patients tell me I'm a good doctor. I have done the correct training, attended all the right courses and worked really hard to make sure patients get the best they can from me.
Today a message on a computer screen told me that my career in this country is basically over.
I will not be staying in this country. I intend to move to another where I will be allowed to do the job I love.
The thing that most upsets me is that the public are losing some fantastic doctors - and they don't even have a say in it.
MTAS and MMC - all part of a shambolic, farcical and unjust implementation of a selection system for doctors in the NHS that will ultimately seal the downfall of this health system. Today has been a harrowing day for all junior doctors who's careers, livelihoods and aspirations are dependent on a system that is not only unreliable, but fatally flawed in many respects.
I have never seen or heard so many doctors so unhappy, demoralised and uncertain about their futures. More than half of the doctors I know are contemplating leaving either the NHS to work abroad, or even medicine completely.
I just CANNOT comprehend why anyone would think that using IT boffins and management bureaucrats to selectively employ doctors was a good idea.
Come August 2007, when a predicted mass exodus of talented, dilligent and conscientous NHS doctors leave the UK for either Australia, NZ, Canada or the US, I hope the British public will forgive us for jumping ship - in many cases, it will have been the case of being pushed, rather than jumping.
Surely MTAS breaches several caveats of employment law, not to mention racial discrimination laws (as recently upheld by the courts of law), and also age discrimination laws.
Being limited to only 4 job applications nationwide hardly represents a fair and competitive market policy. The lack of communication with junior doctors with regards to the MTAS selection system reeks of a hashed and rushed job.
With so many junior doctors carrying the burden of student debts accumulated over a long period of university training, will Tony Blair's government be willing to underwrite these debts for those doctors that effectively have their jobs taken away from them?
Well, I didn't go to the right medical school nor have a number of papers to be proud of. I do have a number of rejected papers, instead. It did take me a horrible amount of effort and endurance to get to where I am now. I did feel I was good at what I do (for now and until August). I am appreciated by patients, peers, staff and bosses. I don't know what to say, I'm thoroughly devastated.
It's very easy to speak of career change and emigration. I've been there, and it's terribly tough. I wanted not to have to go through it all again but it seems I have no choice.
I wonder how many people will show up to work tomorrow with a hangover. Or not show up at all.
I don't understand, I've missed something important.
The impression I'm picking up is that junior doctors can make 4 applications for hospital positions, and that if you try for 4 very popular positions that have about 50 applicants each then you'll have to be lucky to get offered one of them.
But is there really that much of a discrepancy between the number of junior doctors, and the number of vacancies?
And does it really result in redundancy? Can't you carry on in the job you've been doing for another year and try again next time?
Sorry if all this has already been answered.
My partner is an SHO.
From all I gather from her colleagues, her consultants, she is extraordinarily talented at her job.
I personally know she’s passionate beyond words about her job.
I know too that as she spent days agonizing over her application she was able to tick more boxes than most – her passion and professionalism over the years having ensured she’s participated in her profession way beyond the call of duty. Publications, teaching, audits and so much more.
I’ve admired this passion since day one.
Her focus as she’s readied herself for work each morning, the zest in her voice if we talk during the day. The dedication as she has worked through each day or long weekends on call and then still come home each evening and revised studiously for her exams – in her own time and at her own expense.
For the last couple of weeks, I’ve watched her change.
She’s still risen each morning for work.
Still come home each evening and studied.
Yet she has paled and the worry has become nigh palpable.
Why?
For the simple reason that atop of working day to day, trying so conscientiously to save lives, atop of revising each evening – let alone the normal strains of life (relationship, social life, etc etc) she’s had to complete a re-application for a career she has already dedicated almost a decade of her precious life and multiple thousands of pounds to.
Last week the pressure really kicked in.
The shortlist was due on Saturday.
Monday, Tuesday…. As the shortlist release date crept agonizingly closer, so too did she become more fragile.
We own our home.
Bought in the belief that her career was safe, true. Centuries old and trusted.
I, myself, on an income I admit is too small to save us if she is not shortlisted.
Late news.
The shortlist would not be out until Monday.
Today.
We lived an agonizing weekend.
Worse, we had discovered some shocking facts about quite how the applications were being vetted.
Those involved in the vetting process themselves, outraged.
It had become clear that there was truly no fairness, no real discernment in the process.
People have said it before and I reiterate it – it really is a lottery.
Last night, pale and anxious, she tried to sleep.
I tried to sleep.
The night ticked by, our heartbeats drowning out the slow seconds.
This morning, we beat the dawn chorus of birds.
The laptop on, the website checked.
As anticipated by us (why the hell not by the IT Techs??), the website crashed.
As feared, a second delay – the shortlist still not finalized.
I watched her this morning as she sat, hands visibly shaking and her pallor literally grey as she waited for news.
Tears overcame her at one point as silently both our stomachs knotted and cold dread filled our lives.
So our day passed.
Comments read on DNUK – emotive comments of anger and anguish, frustration and terror.
Please do not dismiss this emotiveness but consider the following.
These doctors, so calm in the face of lives fading, so calm in pulling lives back from oblivion – what does it tell us about them – about MTAS – if they are reduced to such blatant raw emotion?
Something has gone horribly horribly wrong.
Tonight we sit, as it nears midnight, no closer to knowing our futures than we did when we shared the dawn with the birds this morning.
Tonight we sit, both knowing that hospitals are already dangerously understaffed and patients – people like you and I, there but for the grace of God – are right here and now losing their lives needlessly.
Tonight we sit helpless.
The horrible irony being that with all she is, this situation should never be.
She should be part of a team, inspired and energized, proud and focused, saving lives with competence and trust.
Fortunately enough my Missus has an interview. Interestingly nobody has been told what salary ST3s will be paid.
Can anybody else think of another job or profession where you would have to apply without knowing your prospective salary?
The Goverment can only get away with this nonsense because they are the only game in town.
I've told a couple of people this already but I'll repeat it here.
I'm in the fortunate position of having 3 interviews from 4 applications. And I feel terrible. I mean, I feel pleased that I have hope of a future career, and I know that I deserve my chance, but there are a LOT of juniors out there who deserve the same chance and have not had it. They may never. And that is a tragedy.
I feel selfish saying that I deserve my interviews. I'm not a selfish person, but I do deserve them, I know I do.
I didn't get them because I deserve them however, I go them because I was lucky in the MTAS lottery.
I know it's down to luck because of the stroke of irony in my application. I'd been contacted by a Prof from one of my deaneries prior to shortlisting. The Prof was interested in my research and wanted to slot me into their academic programme. In any other industry that'd be called headhunting. But not in MTAS. Oh no. Because the deanery who wanted me badly enough to try to headhunt me was the only deanery who rejected me from the system.
It's a lottery. No other possible explanation.
Big hugs all round, and I wish I could offer more, I really, really, do.
"Can anybody else think of another job or profession where you would have to apply without knowing your prospective salary?"
Porn Star
GW aka Mrs SHP:
I seriously hope you're in journalism or some such business, because that post was beautiful. Words can't express how I feel about the subject matter, but you certainly have a gift for writing heartfelt prose.
Dr C - can you post a link so I can email you direct?
I was not picked out of the hat for a job in gastro. Now it seems my career is in ruins.
If you would like I will post you my CV, my MTAS application and the only communications that I have had from MTAS/MMC.
I wonder whether you would like to "peer review" my application and feel free to publish anything from my CV or application that had been suitably anonymised or (if allowed) MTAS "communication."
Dr Sniper
HP - at the risk of turning this into a putrid love-in, Mrs SHP was just saying how pleased she was for you that you'd done so well in the lottery.
As am I.
Funny how we build oddly strong bonds and affections for people we have never met.
Dr C - can you post a link so I can email you direct?
I was not picked out of the hat for a job in gastro. Now it seems my career is in ruins.
If you would like I will post you my CV, my MTAS application and the only communications that I have had from MTAS/MMC.
I wonder whether you would like to "peer review" my application and feel free to publish anything from my CV or application that had been suitably anonymised or (if allowed) MTAS "communication."
Dr Sniper
Dr Sniper |
+++++++
by all means.
click on email at the bottom of the post.
John
I've always thought the internet provided a medium for Cartesian separation of body and soul, and one might therefore consider that personalities are more effectively perceived online than in real life.
[putridness over]
Mary - you are right in that we are allowed to apply for only 4 positions, according to whatever level of expertise and experience we are deemed by MMC to be at. If we don't get a Specialist Training (ST) position in August, the chances of obtaining one next year has been described by the people in the know as "extremely slim". There will still be jobs termed Fixed Term Specialist Training Appointments (FTSTA), but these are essentially service jobs with little prospect of career progression.
What a lot of junior trainees are angry about is the lack of options and lack of fair opportunity to show what we can do and to further our careers in specialties that we are enthusiastic in. What the government wants has done is to take away the options, and to force people into taking up specialties that they have no interest in - what a waste of potential talent. You wouldn't dream of asking a budding heart surgeon to take up training in psychiatry just because there were empty spaces in psychiatry would you? (an extreme example to be fair, but you get my drift).
On top of that, the whole application process has been painfully confusing and an utter waste of resources. There has been an utter lack of communication with juniors, and a complete absence of support from government agencies.
We really need to get more doctors on this site to explain what has happened to them to the public - most people read the papers and just see things written about greedy doctors, lecherous and murderous doctors. When have we ever read anything about how good a doctor was? It's rare because in our profession, we took an oath to be conscientous and diligent towards patients and we don't seek active approval and compliments in the process - because of this we are sometimes not vocal enough in our opposition of potential damaging change. It's time we voiced our concerns with the future of medical training in this country.
docs like the patients need some free market economics and a move away from a monopoly state funded provider, its the only way to free them up
Ouch at the MMC thing and unsurprise at delays and technical problems.
To speak up for IT techs, they probably knew the system would fall over too but were told by their management that there was no money to pay for extra hosting for a 'one off' large hits event or that they were exaggerating the severity of problems. Or that there was no money so hard shit.
Not that makes anything any better for any of you. I hope something is done to change this stupid and evidently unfair system.
Ouch at the MMC thing and unsurprise at delays and technical problems.
To speak up for IT techs, they probably knew the system would fall over too but were told by their management that there was no money to pay for extra hosting for a 'one off' large hits event or that they were exaggerating the severity of problems. Or that there was no money so hard shit.
Not that makes anything any better for any of you. I hope something is done to change this stupid and evidently unfair system.
This remedyuk march:
march 17 is st pat's day- the doctors would get lost in the shuffle.
choose an alternative day and have the theme song "what becomes of the broken hearted"
I am heartbroken on behalf of the doctors - people at the cream of their A'levels and university studies - being treated in the cavalier way.
When I was at this stage, I had a husband (with job in one area), plus a child (with pending school). I simply could not have borne the uncertainty of location, let alone of career. Had I not got a job in my region, I would have simply resigned medicine and gotten a sensible, lucrative, day-only career elsewhere - a fine waste of a half-a-£mill education and 6+ years of my life, but better than having a complete breakdown.
I cannot believe this is happening...
Even those who have been offered interviews are being forced to choose between them, as different deaneries are running interviews for the same specialty at the same level at the same time on the same day, and so far refusing to compromise.
So for anyone who actually has 2 or more interviews, you can basically half that figure. They are being forced to choose between overlapping interviews.
This new system has turned all of the old indicators of what makes a 'good candidate' on their head. It doesn't matter any more which university you went to, what class your degree was, where or with whom you have been trained, how hard you worked, how much you impressed your senior colleagues, whether you actually care for your patients, how much love and effort you put into your work, how easy you are to get on with, whether you are a good learner, whether you have any spark, personality or ambition and so and so on.
All that matters now is your ability to bullshit the answer (in 150 words) to questions such as:
"Mistakes can and do happen in medical practice. Describe a specific example where the outcome of action you took in response to a clinical mistake/error (made by you or someone else) caused you to reassess how you subsequently dealt with similar situations. What action did you take at the time and how has your practice now changed?"
Read it carefully. What is it asking? How are you going to condense the answer into 150 words?
A good answer to this question is worth more points towards getting an interview than having spent 3/4 years completing a PhD in one of the world's leading universities, studying the speciality to which you have applied.
Who would you prefer to have treating you? A good bullshitter or a highly trained doctor who may well know as much about your disease than anyone in the world?
Anyone, sufficiently coached, can answer the above question perfectly. You don't need any medical experience, the scenario doesn't even have to be real. Who the hell could ever check?
What makes this even more galling is that the 'mark schemes' for questions such as the one above have been leaked to a chosen number of candidates in advance of the application deadline. They, but none else, knew that the question above could only score full marks if the mistake described was your own, not someone elses. Read the question again. Did it say describe your mistake? Or did say 'yours or someone elses'?
Add to this the completely shambolic manner in which the applications were scored. Website crashes, supposedly anonymous applications with names visible, an online system reverting to old fashioned paper print-outs, non-trained assessors dragged in at the last minute to shift through forms, consultants scoring hundreds of forms in the final hours before the shortlisting deadline, deadlines missed, people hanging in limbo, 'final data check in progress', people officially advised to apply for the wrong training level, people for the whom the right training level doesn't exist and available posts being a fraction of those in previous years.
In my speciality, in the hospital I work at the moment (Oxford), 100 people applied for 3 jobs. There were 8 available in "London, Kent, Surrey and Sussex", 1 in Bristol (60 applicants), 2 in Leeds, 2 in Newcastle. If you are prepared to take a job 'somewhere in Scotland' there were another 9 or so. Choose 4 of the above & good luck.
Currently we don't know whether there will be a similar number of jobs next year, or whether most of them will be ring-fenced for people who came in at a lower level this year. 'They' simply haven't told us. In reality this is because they haven't decided.
Training programmes in English speaking countries worldwide are about to be bombarded with very highly qualified medical graduates. Not wanting to go too far from home, I am seriously thinking about which European language I need to start learning while I'm doing my PhD over the next 2/3 years.
The best student from my comprehensive school in north Liverpool, 5 grade As at A-level, Cambridge undergraduate degree and medical training, raced through post-grad exams in minumum possible time, universally esteemed by my consultants, a bit quiet and serious but mostly get on with the nurses, research done, papers in, prizes won, courses attended, PhD in Oxford. Currently being trained by the country's (if not the world's) experts in the field I want to work. I know my patients like me and I like them. Dr Crippen would be impressed with my communication skills & empathy (I think, but very hard to prove in 150 words).
Today I realised that this country doesn't want or need me anymore.
I haven't got all that stuff. But what I've got is genuine ability to be a bloody good doctor. I've got something that carried me from A-levels to medical school to a competitive house job to an extremely competitive psychiatric rotation, and at every step I have been praised for having done a bloody good job.
The area in which I want to work has still not published its results, but I have lost hope anyway. It just feels like too much. Reading Dan's post has reduced me to tears. Again.
It's not fair, it's just not fair.
Yes, it's self-pity, but I don't care. I'm 26, and quite possibly on the scrap-heap.
Dan- best post on the subject so far. Stay strong man.
As a US physician in residency, I have to say that I find this mind-boggling. The US and Canada have already solved the problem of coordinating those at a certain level of training with the posts to which they would like to be attached; it's called the National Resident Matching Program, and apart from a very few mistakes, it works. Every year. Without fail. Why on earth would the NHS re-implement, from scratch, such a program rather than just buying it from the NRMP? Why limit the applications to four? WHY?
I'm glad I don't have to face it.
One of my friends has been luckier than Dan above and has been shortlisted for two posts (in the same specialty). One in Birmingham, and one in the north of the country. The Northern interview was on two days in March, but the second day was already full by the time he was able to log on to MTAS. Birmingam's interview for his specialty, unfortunately coincides with the first day. There is no way he can get to this big northern town from Birmingham in time. The Northern hospital won't even give him a time slot at the end of the day to make it possible for him to appear in their interview by some miracle on the roads or the railways.
He has been told that it is bad luck, but he will have to choose one interview out of the two. This is the pathetic situation after years of planning.
As an American physician 'listening in' I am somewhat puzzled by the details of MTAS/MMC. Would someone be kind enough to enlighten me on a few points?
The general course of training here in the States is undergraduate 'pre-med' for four years (usually to age 22 or 23), followed by four years of medical school (including two years of mostly classroom work, one year of mostly hospital work rotating in the 'major' specialties--Surgery, Medicine, and perhaps Psych, OB-Gyn, etc.--and one year of 'electives', which function as an introduction to, and preliminary job interviews for specialty training (called residencies). Graduation from medical school is usually at age 26 or 27. This seems to be the age of SHP above, but he seems to be several years out of medical school. Can you tell me how the process works in the UK?
In the States we have a process call 'The Match' at the end of medical school that seems similar to what you are undergoing. In the Fall of the fourth year (the 'electives' year) medical students interview for training programs in their chosen specialties. They enter their preference list online, as do the training programs, and are matched in March for training starting in July. It is a stressful time. Usually all the students in each school get together on 'Match Day' and everyone gets their envelopes. There are a lot of cheers and tears, but everyone is encouraged to share the experience. Students on hospital rotations are almost always given the day off.
A percentage (maybe 10%) of students do not match, and are notified the night before. They are assisted by the school staff on Match Day to call all the training positions that are unfilled and there is a great scramble (by both the students and the weaker training programs) to fill positions by the end of the day. Many students find themselves going to a strange city, in a less desirable program/specialty.
From my perspective, the MTAS/MMC process is similar, although there seem to be differences in the States that make it a bit more humane. First, there is no limit to the number of training positions a student can list; it is a matter of time and money to visit the programs. High level programs will limit the number of interviews, but an aggressive student can usually find someone to call somebody at most programs and slip in a special interview as a long-shot. People have been known to list several different specialties and just depend on luck to determine their training.
Second, there is a lot of support from the staff, both administrative and clinical. People who do not match know the day before and have help finding a position. Everyone else knows they got something on their list, even though it might be down near the bottom. Getting everyone together and making a party of it also prevents the private anguish I see here.
Third, there seems to be more opportunity to return to the Match the next year or later.
Fourth, there are always more positions than stuents, although there are specialties that are highly desired and filled quickly. Someone who doesn't match can always find another specialty, or just take one additional year of hospital training (here called an internship), and therafter go practice as a general practitioner.
Fifth, after training for four to seven years (or one for GPs), the resident physician looks for a practice, which is usually private, and can be anywhere one chooses. If someone wants it enough, they can move to a city with no job in hand, 'hang up a shingle' and start their own practice from scratch. My guess is that it is this ultimate freedom to choose (or lack therof) that drives the angst in the UK. Is this correct?
This may sound cruel, but what the hell. Ignoring the inherent unfairness of the system, if there is such a massive oversupply of candidates compared with available places then why not just halve the pay and double the number of posts? Also, I am confused about what you are expected to do. Is there some dead end work-horse position they are expecting doctors to take up at a reduced rate of pay?
IMHO the best way to fix situations like this would be to make undergraduates pay the full cost of tuition (with a goverment subsidised loan) and let the market decide where doctors are hired from. If the situation is as I understadn it from these posts then the taxpayer is being badly short changed (although through no fault of the junior doctors obviously).
My fiance & I are both SHOs. If we don't get jobs in the careers we want, then we're shipping off to Australia to join our mates who are already there.
So sad - the system here in the states is different, as described by a previous commenter, and seems more humane. This sounds like such a huge waste of training, and an example of bureaucracy run amuck! Hard to know how it can be fixed now....tho I wager that in a few months when all of the juniors have disappeared to other places or professions, the shortage of docs will become apparent...too late to help either the patients OR the docs!
"Can you tell me how the process works in the UK?"
A would-be doctor specialises in their last two years in high school in three or four science subjects. Then they go to university for five or sometimes six years. Then they are doctors, but have many more exams to take in their chosen speciality.
"This may sound cruel, but what the hell."
What the hell? It bothers me because it may impact on my future care. When I read what SHP writes, I want to cry. There are people who need help they cannot get because of unfilled psychiatric posts, yet someone who really cares about her job may be driven overseaso or out of medicine. This is no way to match candidates to posts.
Would we allocate anyone else to jobs this way?
Well, like many others I didnt get shortlisted for any interviews either...seems the already demoralised docs are due to have their lives ruined yet again...only in this stupid career do we get TOLD where to apply to, and forced into doing things we don't want to do...maybe its time to organise a proper effort, perhaps a march or demo to Downing street( that is if anyone ever has enough time off!!)
Anyways, I think at the end of the day it will be their loss...all that training they forked out for our med school will go down the drain when we all run off to places where we are appreciated...(and AUS and NZ are laughing...readymade docs at no cost). Good luck to everyone in the coming weeks, interviews or not 
I have been spared the trauma of today, as I am applying to General Practice, and this has a slightly different route of access via MTAS(although unfortunately seems no less perilous!) so I am spared my judgement day until the 5th March, but have watched as many fantastic Doctors wait in suspense all day, and many are still waiting now.
The matching process is nothing more than a lottery, with some of the most amazing and well respected Doctors that I have worked with today coming totally unstuck - more fool them for believing that having dedicated their lives to building an impressive career serving the NHS, that the NHS would appreciate their input and reward them with job security perhaps?!
I hope that it does "work itself out" as many are assuming that it will, but the fact remains that if you want your Doctors to work hard and excel, you need to reward that by giving the most hard working and talented Doctors the best jobs, otherwise they will find a healthcare system elsewhere in the world that does value them, or worse still, will resign themselves to fate and stop putting so much energy and enthusiasm into their work.
This is not about the thought of failing to achieve a higer salary, this is about families being uprooted, couples torn apart, and hard working and caring individuals getting no official recognition for the efforts they make, often above and beyond the call of duty.
It really is a sad day for the NHS and the UK today, and the government should be ashamed.
please try and email the bbc and other media groups with the information....try the feedback page, if enough people write then perhaps something will be raised on a national level...
you can post suggestionhs to the bbc website on this link :
http://news.bbc.co.uk/newswatch/...600/
4032695.stm
at least you guys have jobs to go to (albeit dead-end). many nurses and physio's are totally screwed.
sorry for multiple comments...
you can email channel4 news on
news@channel4.com
and the various "times" newspaper links are ont his page :-
http://www.timesonline.co.uk/tol...ces/contact_us/
I don't know about getting in touch with "those that have any power"...
I have previously written (last year) to Sir Liam Donaldson about the whole fiasco and got a very long winded letter in return which was essentially a fob-off (they even mis-spelled my name, ultimate slap in the face). Its actually worth writing to him en masse i suppose but I doubt that would do much. (I have the address should anyone want it) Think the bottom line is that medics as a whole tend to be apathetic partly due to the nature of the work and workload and general low mood....if anything is ever going to change for the better we need to stick together and stand up for our rights (its not as if we are a burden to society- and we deserve much more!)
IMHO the best way to fix situations like this would be to make undergraduates pay the full cost of tuition (with a goverment subsidised loan) and let the market decide where doctors are hired from. If the situation is as I understadn it from these posts then the taxpayer is being badly short changed (although through no fault of the junior doctors obviously).
Tim
+++++
Excellent Tim. A loan of about £250,000 to train as a doctor.
That will certainly solve all the problems of over supply of doctors.
John
Thankfully my sister saw the writing on the wall & decided not to wait around for this nightmare. She will be starting a 3 year rotation in Australia in 2 weeks. My commiseration's with all those affected & I am happy to highlight this stupidity.
--------------------------------
John
Would it be worth co-ordinating something now?
Am pinching these comments.
It's an appalling state of affairs. God bless any of the doctors who have been put through this, or are still being put through this.
It's no way to run anything, never mind something as important as the NHS.
What is so appalling? Is it that the jobs are not fairly contested or is it that there is not a perfect job for everybody? Demographic realities decide how many doctors of each type are needed, and where. It is necessary to shoehorn the doctors into these positions because they can't distribute themselves evenly.
@SteveC
Pending a doctor answering you:-
First, there is no limit to the number of training positions a student can list. Although it is not clear from the posts here, there is actually a second round to this process, in early May. It looks to me as though the reason for the silly interview clash problems is that everyone is required to work to a very tight timetable, since unfilled posts have to be readvertised in the second round, after the first round interviews. I don't know whether the limit of 4 applies to the second round or not. Presumably it applied to the first round because of the tight timetable.
Second, there is a lot of support from the staff, both administrative and clinical. Presumably that will get better in future years (this is the very first time the new system has been used).
Third, there seems to be more opportunity to return to the Match the next year or later. I don't think anyone really know how this will work out. The new system seems to be designed to "force" or "encourage" doctors to accept training positions in unpopular specialties and/or unpopular areas of the country. Your description of the US system makes it sound as though that is already an accepted part of how it works.
Fourth, there are always more positions than stuents, although there are specialties that are highly desired and filled quickly. Someone who doesn't match can always find another specialty, or just take one additional year of hospital training (here called an internship), and therafter go practice as a general practitioner. This is really the crunch point. The new system is being introduced at the same time as an "oversupply" of doctors compared with the number of funded posts, caused by an increase in training places some years back and the financial problems of the NHS now. Look at the numbers of posts mentioned in a comment above.
Fifth, after training for four to seven years (or one for GPs), the resident physician looks for a practice, which is usually private, and can be anywhere one chooses. If someone wants it enough, they can move to a city with no job in hand, 'hang up a shingle' and start their own practice from scratch. My guess is that it is this ultimate freedom to choose (or lack therof) that drives the angst in the UK. Is this correct? I'll leave the doctors to comment, but since the vast majority of doctors in the UK are employed by the state, it is difficult to imagine that freedom separately from all the other changes that would have to happen to make it possible.
Look, it might help if someone somewhere told the "public" what the hell is actually happening. I have read numberous posts on this and have managed to work out the following:
(a) young doctors, new system
(b) possibly involving some randomness, specialism-wise and geography-wise
(c) bad computer system causing delay and, therefore, stress
(d) erm... that's it.
It sounds horrific. But this is being badly communicated to people on the outside. If you want the sympathy you so obviously deserve, it might help if someone could actually lay it out what the hell is actually going on, how it is different to what happens in other professions and why that is bad.
Good luck all of you.
Dr C - I have tried to send you an email - I assume that you mean the small mail symbol at the bottom of the post. If so, it will only let me email you if I know your address. I assume that little symbol is an email a mate your NHS blog doc post, rather than an email to you.
I seem to be a little dense here am a touch tired was pulling double plus shifts to pay for flights for interviews! What am i missing? I would like to send you an email with attachments (word and PDF). Help me Dr C.
I was going to send you the info for you to use as you saw fit. Not for a pat on the back, there there old chap type thing. Currently, that role is being filled by work and beer.
Dr Sniper
Sniper, send him a message from here with your details. He can then get in touch via one of his (I hope) anonymous webmail accounts.
Dr Sniper, I can't work out what he meant either (the little mail symbol if of course meant to allow you to email the post to someone else, not to email the blogger). Since he specifically invited you to email him, I don't suppose he will mind if I tell you
drcrippen AT nhsblogdoc DOT wanadoo.co.uk
making the obvious corrections to turn this back into a valid address from my spam-avoiding version.
Thanks to potentilla and Katherine for some explanation. I hadn't realized that this was the first year of the process. It doesn't excuse the IT and scheduling problems, lack of communication, and general bureaucratic stupidity, but every first run is problematic and these physicians have just been caught in the grinder. You can piss and moan, or you can suck it up and do your best. If you are a doctor trying to save people caught in a hurricane, tornado, or earthquake, are you going to complain about the lack of sterile wipes, or make do with whatever you can?
You can't fix the system for this year. But you can band together for emotional support, help each other as best you can, and put together a plan of publicity, political pressure, etc., so that next year's class won't getted sucked into the same maelstrom. As a side benefit, you may get the system changed enough so that your class gets a second chance, since that would make sense, but if you focus only on your own cause, not next year's class and the public health as a whole, you will get less support.
If you don't get a second chance, its tough luck and your life is changed, but NOT ruined. It doesn't even begin to compare with surviving the Blitz, or the Christmas tsunami, or growing up in much of Africa, etc. You have a good mind and training. Life requires priorities. Pick what is most important to you (specialty, location, medical career, etc.) and go for it. In today's world everything changes in a few years anyway, and you will almost certainly find new avenues to pursue. Since finishing medical school, I have had seven different 'careers' (resident in training, private hospital practice, academic faculty, clinical research, research administration, business consultant, and now entrepreneur).
What did those of you who applied for ST positions in general practice think of the exam on Saturday?
I've heard rumours that the EMQ paper (which was widely regarded as straightforward by F2s through to post-membership SHOs) is a test of minimum competence and therefore doesn't count towards short-listing - has anyone heard differently?
I am still trying to make sense of it all and am finding it hard to accept that I may be rejected on the basis of a computer marked 'professional dilemma' paper which contained too many questions for the allocated time and can only be described as bizarre. An example question went something like this:
You are in clinic when a patient suddenly bursts into tears. Rank the following actions in the order you would do them:
(1) Give the patient a tissue and ask what's wrong; (2) wait a while then ask what's wrong; (3) hold the patients hand, wait a while then ask what's wrong; (4) wait a while waiting for her to tell you what's wrong; and I think there was one other option which I can't quite remember but you get the general idea...
The number of applicants for general practice far outweighs the number of training positions and to exclude a large number of potentially very good candidates on the basis of such an exam beggars belief. We are NOT in management or indeed, the FBI (where the revision websites inform me this type of exam is used as a recruitment tool), we are doctors for heavens sake.
I don't understand why it has become so untrendy to actually assess and credit candidates on what really counts: clinical ability and communicating effectively with patients. Isn't this especially important in the recruitment process for general practice? As we all know we live in an increasingly litigious society where GPs are amongst the most vulnerable doctors in the NHS - needing to rely significantly on clinical acumen without the luxury of immediate test results or assessments from colleagues in other specialities. I accept there is a vague assessment of the above in the selection centre/interview stage but you have to be lucky (not good) enough to make it through that ridiculous exam first.
Guess it's one more example of dumbing down...good luck to everyone waiting for GP interviews - I hope it's less of a fiasco than the events of yesterday.
Dr Sniper, I can't work out what he meant either (the little mail symbol if of course meant to allow you to email the post to someone else, not to email the blogger). Since he specifically invited you to email him, I don't suppose he will mind if I tell you
drcrippen AT nhsblogdoc DOT wanadoo.co.uk
making the obvious corrections to turn this back into a valid address from my spam-avoiding version.
potentilla
Thats fine
ButI am slightly puzzled. the email address is at the bottom of each comment I post and on the profile.
John
"ButI am slightly puzzled. the email address is at the bottom of each comment I post and on the profile.
John
Dr John Crippen | Homepage | 27.02.07 - 4:10 pm | #"
All I see is that "Homepage" links to nhsblogdoc.blogspot.com and "#" links to the comment itself. Likewise I see no email address on your Blogger profile.
Perhaps they are hidden because I am not logged in, or something is configured as not publicly viewable.
Katherine wrote that it might help if someone clarified, for the public, just what the complaints are about MTAS. I’m not a doctor either, but I am married to one and I have been with him every step of the way (we have matching ulcers…) so here are the major issues as I/we see them:
1. Lack of transparency. This whole MMC/MTAS was thrown together like an omelette in a cheap café, without proper consultation or aforethought, and no one seemed to be willing or able to give proper answers to doctors about basic questions such as “which level should I apply to?”, “which specific competencies are required at each level?”, “how EXACTLY can one demonstrate achievement of those competencies if one has not been through the foundation program?”, “what do each of the levels pay???”, “what are the short-listing committees actually looking for?” and the list goes on… Only very generic answers have been given to any of these questions, usually with a referral to another website ‘for more information’ but then of course that other website (deaneries, colleges, etc.) doesn’t have a clue either. Or if they do, they are unwilling to take the time to answer doctors’ concerns. One deanery even had the gall to refer doctors to ‘the medical press’ for more information! Which leads to the next issue:
2. Lack of respect. In this whole process it has been made very clear that the least important person in the NHS is the doctor. All of this was thrown together at the last minute, not leaving doctors enough time to prepare themselves for the application deadline. That’s the doctors’ problem. Doctors have to prove they have what it takes. How? That’s the doctors’ problem. Doctors have to submit their applications on time, no exceptions, but deaneries can submit their shortlists as and when they like. Oh, will that cause doctors some distress? Too bad – that’s the doctors’ problem. And (this is my personal favourite) if you aren’t short-listed in the first round, you are not entitled to any feedback until AFTER the second round is complete. So you go into the second round blind – no idea what (if anything) you did ‘wrong’ and no chance to try and do better. Oh and if you weren’t even long-listed (i.e. if you were under/over qualified for the level at which you applied) you won’t find that out either.
3. Lack of jobs. My husband applied for ST2 in orthopaedics. At his level there were around 15 jobs in all of Oxfordshire, Hertfordshire and Buckinghamshire (combined). There must have been hundreds of applicants. What happened to all of those SHO posts in all of the hospitals in those regions? I know they have been spread over ST1-5, but I still think hospitals will be sorely understaffed. Especially since…
4. Lack of planning. Deaneries are conducting interviews for the same specialties on the same day. So doctors lucky enough to be offered more than one interview are often being forced to choose between them. (Actually this is the only thing that offers me a glimmer of hope – surely there will be a fair number of posts available in the second round if only ½ the short-listed doctors turn up to any given interview?) And they seem to have overlooked the fact that they may not be the doctors’ first choice, so even after interviewing, they could wind up with an empty post. In other words, I think their shortlists are too short. Also, has anyone else noticed the irony in the fact that while MMC is slashing the number of training jobs for junior doctors, the NHS wants to start doing evening surgeries? Who are they going to get to staff those once all the ‘surplus’ doctors have fled the country? They will of course turn to locum doctors, who cost the taxpayer more but who are not rewarded with training opportunities. The workhorses. Another example of lack of planning is the repeated crashing of the website. They apparently did not anticipate that 30,000 doctors would submit their applications shortly before the deadline, so the website crashed. They were ‘good’ enough to extend the deadline in order to give people a chance to submit, but apparently did not learn their lesson. So when those same 30,000 logged on to see the short-list results, it crashed again. Imagine the agonizing wait, which was extended because the deaneries couldn’t get their acts together, you’ve been awake all night, watching the minutes tick by, then finally the hour arrives, 9am Monday morning, and then… blank screen, error message. (Did I mention the ulcers?)
5. Lack of substance in the application. The short-listing was based on answers to essay questions of 150 words max. Even though applicants had to enter their whole career histories into the online application, these were not seen by the short-listing committees. Is there any other profession where your education and work experience are not taken into account? Is there any other profession where it is more important??!!
There’s more, much more, but to be honest I’m so fed up of thinking about this that I’m going to stop here and let others fill in the blanks. Like so many other doctors, my husband did everything right and so far 3 out of his 4 choices have not chosen him. I guess the 4th will let us know in their own sweet time. Meanwhile we are looking at our options. Leave the country or leave medicine? Seems to be the theme of the week. Or wait it out, work as a locum and hope that things improve? Perhaps I’m too jaded, but I think if the government ignored public opinion on Iraq, on congestion charging, on road charging, then I doubt they’ll do any different on this. In fact our overriding concern is ‘do we want to raise our son in a country where his voice doesn’t matter’? He is 11 months old, started walking this weekend and we should be celebrating that and planning his 1st birthday party, instead of sitting here in a cold sweat wondering what the hell we’re going to do, where will we live and how can we give him the kind of life we have imagined for him? Will he be MTAS’s real victim?
Apologies
When I changed to "new improved" blogger, my email address did not go over.
I have corrected that (I think!!!)
JOhn
My partner is currently an SHO, fortunately with one interview. So the rest of our lives rest on half an hour in March.....that might sound over dramatic but it's true. I am not an angry person but I'm furious about this system that's completely screwing over people who have had to work their arses off night and day for years to get where they are now. I can't bear the thought of my partner having to change career when he has spent so many years in hard slog getting to where he is now. I'm a teacher and more flexible so I guess we're the lucky ones.
My heart truly goes out to all you doctors and partners of doctors out there, especially if you have kids that will be affected by all this.
Its just a shame doctors aren't generally the sort of people who would go on strike. Perhaps that would show them how much they've screwed people's lives up?!!
The irony is MTAS is a system whereby people have been asked to apply for jobs they are ALREADY in, and now they are being told they are not even good enough to interview for the job they have been doing for 6mnths,
The NHS is about to lose it's most experienced clinicians. The public need to know. this is bad bad news for them. this is bad news for everyone.
My support and thoughts are with my friends who are getting screwed over by MMC and MTAS, and they are all and should continue to be bloody good doctors.
Whoever is responsible for this catastrophe whould be named and shamed and sacked.
Why aren't doctors prepared to go on strike? I was all for it in '99 when the new contract was a glimmer on the horizon, still think we missed our shot. I still am for a strike now.
Don't even mention the BMA.
I suppose if you don't have a job, going on strike isn't an option. If the government decides it only needs x-number orthopaedic surgeons, why should it train more?
Asa third year student, we were on the wards today when the SHO opened her mail to discover that interview for her specialty were scheduled for the same day in the Yorkshire and West of Scotland areas. Its not a large specialty (Rheumatology) so this seems a little weird.
Neither is allowed to change it's dates due to a protocol, and due to the strange interview process, described as being rather like an OSCE where you rotate round interviewers so you all get the same questions. So the chances of a morning interview in Leeds, a 200 mile drive and an afternoon interview in Glasgow seem remote. She said she was not the only SHO in this situation.
Interview dates were published after the SHO's had ranked their choices, thus they did not know which interview dates would conflict.
It's crazy........
Doctors should go on strike, now.
Doctors should go on strike, now.
Nope. That would instantly lose you all public sympathy which would in turn put you at the mercy of the government.
This is not me being unsympathetic, it is just an appraisal of the realpolitik of the situation.
The comments in here just make me sick, I'm a 5th year student awaiting my programme choices later next month and all I get from here and my hospital is that everyone is screwed over regardless. Until recently I was unaware that ST applications used pretty much the same pathetic insulting application questionnaire which is subjectively marked by a local deanery(i.e no consistency)and given out without any indication of the marking scheme.
I hope the laws of probability help and that other students choose posts that I dont like but if I get screwed with multiple posts in dire positions and/or choices then I'm considering leaving the profession altogether. Luckily I have something to fall back on but it will be a struggle to manage my debts.
People's comments before are right. This needs more attention. Perhaps we should start an e-petition at http://petitions.pm.gov.uk/ calling for MMC/MTAS to be scrapped/heavily modified because it is fundamentally flawed and WRONG in its scope as people before have mentioned.
I would start it myself but I have recieved fire for those involved in the system for complaining locally and who still have precedent over me these last few months, I was called unprofessional for complaining about the system, so much for free speech!
I'm sure if someone started a link and spread it to DNUK forum then many doctors would sign it from which a % could be asserted. Hopefully this would also incur some press attention.
what do people think?
Oh Honestly, stop whingeing, job insecurity is the NORM in the private sector. Imagine if this litany of whining was posted by Pub owners or car salesmen. "Oh no my mortgage - my pension - my 150,000 a year for a normal working week -devotion to selling the best new car deal - all on the line" Clear off to Australia the lot of yer and don't come back!
I'm sure they'll be happy to clear off to Australia, mutley.
Just pray you don't get sick in the meantime.
The government is trying to remedy the doctor distribution (by specialty and region) crisis, but the doctors feel this tramples on their childhood dreams. Get real guys and lose the entitlement syndrome. The taxpayer decides who goes where and if you don't like it, find another government to scrounge off. Just do it, don't keep threatening it.
I feel that the only thing to do under the circumstances is to go on strike. We could continue to carry on the emergency work as before, making sure that the sickest of the patients does not suffer. Did someone say something about the loss of sympathy? We can only lose something we had in the first place.
All I know is that if I treated my patients with the same amount of empathy as we are being treated at the moment, we would rightfully be struck off by the GMC in no time at all.
Mutley the dog
Piss off you insecure small-penised twat.
If you can't see that spending £250K per newly-trained doctor and then having that wasted with the doc going to US, Aus etc is crazy, then you're even stupider than I think.
Wait til you get ill you fucking little bastard, then you'll whinge, like the ill-informed coward you are. These doctors are on £25-35K by the way for a 50-60 hr week. Ignorant twat.
Dear MR Your Wrong
So following your logic if we spend £500 000 training doctors then we have to let them rip us of even more to keep them.
I trained myself at what I do and create now more wealth for the country than the average doctor. So can I have a refund on the £250,000 that the tax payer has never invested in me?
If you were promissing to pay it all back with interest then robbing the countries poor tax payers even more would not seem so imoral.
Start living in the real world and stop threatening people with their own lives to fetherbed your own selfish ones.
I trained myself at what I do and create now more wealth for the country than the average doctor.
*****************
I wonder how many GPs and cardiologists and everyone in between have worked on high powered business execs who have lived to make a lot more money for their shareholders.
That is a silly comparison. Doctors are not there to create wealth but to create conditions in which a population is healthy so they can go on and make money and work at jobs and keep the economy turning. Public health care (socialized medicine) was supposed to allow that everyone had a generally accepted level of health care available to them in order that the economy could benefit. I honestly do not know how successful it has been, but I do know that the only doctors who ammass/create great wealth are usually the ones who end up on Orac's Friday Dose of Woo.
Whatever- just whatever.
I have a good idear why dont we just deport all you lot for threatening terrorism. Then we could just get some cheaper doctors from some starving 3rd world country to take your place. After all they dont nead doctors do they?
If you dont like what you are getting paid its quite simple. Do what every other normal person does, that is, those that cant threaten other peoples lives without getting arrested, and leave the job. Its not rocket science, go and work somewhere else. Then they will pay you more or replace you or people will die. Its not your problem, thats the governments.
However DOCTORS AND NURSES going on strike on mass is imoral beyond belief. Thats worse then BLACKMAIL. I am sure there are at least some people in the medical "profession" that understand why this is imoral. Unfortunately not many of them seem to have a PC.
The taxpayer will pay for your training as long as you go into the specialty he chooses (I say he because males pay the most tax). If you can't get into your desired specialty the pay for the training yourself, or otherwise, find a new career.
anonymous
The comparison is more then good because it is people like me that PAY YOUR WAGES. GET it you Marxist. I know none of you people understand simple economics your just doctors after all. But please dont be so arragant to sugest that anything I do is in anyway less important than what you do. You dont even know what it is I do.
However someone must think it is very important otherwise I wouldn't make any profit and you would have no wages at all.
Thanks to Potentilla and Moonlights - I will get on to it tonight.
Incidentally, Aviator you are a bit of a tool aren't you now? Childhood dreams? What I wanted to be, for example, a gastroenterologists as a child? Most kids want to be "a doctor, when I grow up." You discover your speciality as you go along in your medical training. You plum, different specialities have different requirements. A neurosurgeon with a tremor is not much use, neither is a physician with no people skills. It used to be that as you progressed through your career your obvious suitability for a speciality revealed itself, now you are expected to make a fantastic whatever you are told to be.
The care that you will be offered is now going to be given to you by someone who really does not want to do that job – and you not only seem happy with that but are encouraging the remaining docs to bugger off, when we are short already. Hope you enjoy your illnesses in future. Who is going to try and make you better?
Dr Sniper
Anonymous 3;55
So again we see the logic of the elitist "professional". "Because I save lives I am so special that quite frankly gods got nothing on me."
How about the plumber who claims that without him making sure your water supply is working you would DIE. Or the guy who delivers your food to the supermarket. Or the guy that built the house that shelters you. You would be dead without these people so why are you so much more important then them?
What they get paid is determined by the market. Doctors wages in Britian are not. This is a political matter. the NHS is a socialist throwback well past is sell by date.
Doctors earn more in countries that work in the free market. Instead of striking Doctors should be asking very politely to put an end to the NHS once and for all. Sell of the hospitals and just give the poor the cash when they are ill. Before doctors become complicit in murder.
Please remember you might be doctors but you still shit and piss and your going to die in the end just like everyone else. You are not special people just very lucky ones. That do a highly trained job that you mess up just as much as everyone else messes up theirs.
Dear Gary
I am not a doctor. I am not a socialist. I am not British.
No matter what kind of economic system you have put in place to pay doctors, there are weaknesses in the system - in socialized medicine countries, you have politicians and taxpayers hashing out who will get what. Some people lose.
In "free" economies where the doctor is a business man you have insurance companies who decide who lives and dies.
Either way, you have a middleman who serves to limit access to treatments OR facilitate access, depending on a bunch of factors. Money and location are two big ones.
But please do not hold up the insurance company model as more fair. You would be an idiot to do so, as story after story out of the USA would contradict your version of Utopia.
As well, you moron, doctors practice as PROFESSIONALS. They have codes and ethics that are peculiar to their PROFESSION. Most doctors are also of the mind that they SERVE those who they deal with- they don't suck them dry for a buck or a thousand. They actually are providing a human service to another human being.
BTW Most plumbers connected to the water supply are civic employees, and practice under strict civic codes made by evil business hating governments.
I have nothing else to say other than you are an idiot. A ranting, persnickity, "socialist under every bed" type of dude.
I hope that you never live to regret your hatred of doctors. Does it get foisted on teachers as well? They are civil servants who I am sure are deserving of your rage. (For the normal people here, sarcasm was intended)
Who else do you hate?
And honestly I don't give a f*&k what you do or how much you make. But if you want, we can play the "mine is bigger than yours" game . I am sure it will be fun.
Anonymous 3:55
Actually, you ought to rant at teachers- you spell very badly. How's your blood pressure???
(Not a swipe at teachers---- a swipe at a mad crazy person who is obviously blaming everyone else for his mistakes, shortcomings and station in life!!!!!!!!!!)
"Mutley the dog
Piss off you insecure small-penised twat."
Glad you're not examining me you would be in for a big surprise!
"If you can't see that spending £250K per newly-trained doctor and then having that wasted with the doc going to US, Aus etc is crazy, then you're even stupider than I think."
So lets place restriction orders on them, and they could all become medical orderlies!
"Wait til you get ill you fucking little bastard, then you'll whinge, like the ill-informed coward you are."
Because there will be no doctors? Or maybe because there is not a surfeit of them? You seem obsessed with size -why? - also I might be wrong, but I don't think Im a coward.
"These doctors are on £25-35K by the way for a 50-60 hr week. Ignorant twat."
You'd have to work 120 - 140 hours a week to earn 30 -35k on the minimum wage - and whilst these docs have a career ahead of them some one working 20 hours a day 7 days a week faces career progression to - oh -certain death. That'd be lots of people who drive things you know - things full of people - life and death etc.
But of course they didn't get a 250,000 education courtesy of the taxpayer.
The comparison is more then good because it is people like me that PAY YOUR WAGES. GET it you Marxist. I know none of you people understand simple economics your just doctors after all.
Yes, we are JUST doctors. As said in the Gerry Robinson program, we have more degrees that you have GCSEs (or are you one of those morons who failed basic English GCSE?)
hey dickhead, enough of the bashing, you don't know what the doctors are going through - doctors are central to maintaining a good health service. It's a public service which you'll use.
"However DOCTORS AND NURSES going on strike on mass is imoral beyond belief. Thats worse then BLACKMAIL. "
Why? everybody has freewill, we do what we bloody want you moron. if you don't like it go elsewhere.
Dr Sniper: So doctors should choose their specialty unhindered and also where they practice- no restrictions. And the taxpayer must fund these extravagances.
How do I explain perspective to someone with no sense of proportion? I may be a "tool" and even a "plum", but you strike me as a "zero". Good luck with that.
MMC relies on a 'divide and rule' mindset that can be applied to almost any group.
Create a system that has 'winners' and 'losers'. No matter how catastrophic that loss might be providing there are enough 'winners' the instinct to compete will overide the instinct to protest - a protest, of course, would require organisation and consensus, both very difficult in my experience.
Look at working conditions for many of our nurses, and the well documented problems on the wards, but as a profession we have been unable to bring about effective change.
And then there are the targets - many Trusts seem to operate in a climate of fear these days, cooking the books, or introducing daft short term measues that waste time and money.
I must admit, up until fairly recently, I did not appreciate how vindictive MMC was for each applicant - and I'm still not sure if it is driven politically or by the medical heirarchy.
The main options as I see them are;
* Industrial action, unlikely though, given the
working culture amongst docs/nurses.
* Non-compliance by medical leaders, again
unlikely according to many recent
commentators.
* Non-compliance amongst candidates [see
divide and rule paradigm].
Why should we not choose the speciality appropriate to our skill sets?
We have, most of us, already worked all over the country most often not in locations we would choose to work. But I really don't expect you to understand that. Now we don't even get that choice.
If you want a doctor to try and sort out whatever illness you have, most sane people would hope that the doctor would be interested in that speciality rather than having been forced to work in that speciality with no hope of onward career progression. If you want that lack of interest from your doctor, congratulations, you will suffer.
As to you being a tax payer, con-fucking-gratulations, so is every medical professional in the UK. Because you pay our wages you get to tell us what we do with our lives and where we have to work. You could say that we pay our own wages as well; do you do that with your (assumed) private sector job?
As to getting some perspective, tell you what, How about I fuck around with your life and then you try not to complain. Of course I have some bias. Idiot.
Really A&ECN, that's not worthy of your normal calm and reasonable posts.
MMC is nothing to do with "divide and rule" and it's not "vindictive". Competition for jobs arises naturally. Even if you had a 100% perfect crystal ball to know how many cardiologists you would need or be prepared to pay for in Manchester in six years' time, that would still mean disappointing some would-be cardiologists, wouldn't it?
It's a ham-fisted attempt to solve the problem of not being able to recruit (say) dermatologists in Penzance (and I apologise to any d's in P who think this example is unfair). In fact, I suspect it was originally an attempt to adopt the US system as described above. I don't know who "reinserted" the interview bit which the US doesn't have - any halfway competent administrator could have pointed out that the timetable as proposed was bound to end in tears. Add silly recruitment criteria and bad IT - result, misery and stress, especially when introduced in a year when the crystal ball produced a seriously wrong result.
Chaos, not conspiracy. The only conspiracy involved is in trying to ensure that the taxpayer money spent on medical education actually provided some d's in P at the end.
(PS not wanting to get into the exchange of ill-spelt civilities above, but you have to wonder about a doctor classifying someone as a small-penised twat. Even I know more anatomy than that).
Thanks Potentilla,
Maybe palpable anxiety from medical colleagues is contagious - remember numerous specialties spend considerable time in A&E - I hear those affected talking about MMC most days.
I admit straight out that I am no authority on it but I do know that NONE of the docs ever seem to anything positive to say about MMC - either at junior or senior level.
It's a fair point to highlight concerns about getting enough docs into less popular specialties [and in less popular locations - although I understand Penzance is rather nice] but as I understand it MMC will probably create more problems than it will solve.
The problems as I see them include;
* Docs with specific talents not being able to
pursue their preferred specialty due to
draconian selection procedures - we can't write
this off as prima-donna syndrome, it's a really
important aspect of career development in my
opinion.
* Disaffected medics shoehorned into jobs they
don't really want.
* Docs opting out of the NHS [choosing to work
abroad or in other sectors].
Surely, endless tampering with NHS processes is proving to be both costly and counterproductive.
Hewitt virtually admitted that we have come full circle when it comes to the internal NHS market or whatever other the name it will be called these days.
And what really gets to me is that there seems to be no long term or settled strategy, at least in the sense that the grunts on the shop floor know which direction we are meant to be pulling in.
Too often changes feel like a knee jerk reaction, and poorly thought out to boot.
For example, once the 4hr A&E target is quietly dropped, we will return to the bad old days of too many patients competing in a volatile environment where there are too few resources.
Perhaps my post was a bit OTT but as I say there is an unpleasant atmosphere hanging over our young docs and I just don't understand why they are being treated so shabbily.
As you know I always welcome alternative points of view but this time there seems to be very little support for MMC once we exclude those expressed by the free marketeers.
‘Why should we not choose the speciality appropriate to our skill sets?’
Of course doctors should be allowed to choose the speciality in which they are most interested, surely that’s a no-brainer? This is to the benefit of both doctor and patient – when I need to see a hospital doctor, I want to see one who specialises in my particular complaint because a) he’ll know more about it and b) he’ll be more interested in it (and, hopefully, me!).
‘We have, most of us, already worked all over the country most often not in locations we would choose to work.’
However, I think also to demand the right to work in a chosen area of the country is pushing your luck a bit. Very few of us have this luxury and if you really, really want a particular job you have to be prepared to move to get it. This, sadly, is the real world as most of us know it, involving a series of compromises between career, family, lifestyle, etc.
Though none of this excuses the completely outrageous way your careers are being administered.
I join as a member of the public not an NHS employee but I can't believe how this god-forsaken government has managed to make such a horlicks of the NHS. Broon has taken loads of extra money from us beleagured taxpayers (NI tax) only to waste it by handing most of it to his and tony's cronies (I wonder if garypowell is one of them?) through PFI. What a con on such an enormous scale.
Last summer it was the newly graduated physios and nurses, 90% of whom couldn't get a job, now its the doctors.
How I ever imagined that the NHS was safe in NuLab's hands is beyond me.
I am astonished and extremely disappointed with the vitriol aimed at doctors by some here. Have you actually listened to what is going on or have you just leapt to the conclusion that the doctors are just whinging?
If you actually find out what is happening, then you might see that what is worrying people particularly about the MMC is not that there is competition for jobs or that they might not be able to get the specialisation that they want (although I'm sure that is individually worrying), but that the system is entirely unfair and unfit for purpose.
It seems, from what I can see, to offer neither transparency for the doctors, nor good results and employees for the NHS/taxpayers.
When an ENTIRE profession is outraged by something, with no one having a good word to say about it, chances are then there is actually something broken, don't you think?
Dear Rob - I am happy to work elsewhere in the country and with my wife's support I will even uproot my young family to do it. We (docs) used to do it all the time. I lived in Surrey yet worked in Cornwall, Hereford, Sussex and so on. Now I/we cannot get jobs anywhere close to home, or at all. To relocate thousands of miles for a job you don’t want and have no aptitude for seems a little, well, pointless.
It is not quite the same as the private sector – in the NHS you cannot shift employer if the area does not work out. I understand it is not that easy in private sector land either - but the option is there.
For the next year I have no job, with no prospect of meaningful progression to the career speciality that I have been working for over the last 5+ years. Then next year I am even less likely to get a post as I have only being doing "making time" jobs. Hence, the death of my career.
It is difficult to write this and not get emotional, but I genuinely don’t know what to do with my training now. There is no where to put it to good use (and pay the mortgage). My father suggested “working for free to show willing.” There is no box for that on MTAS and claiming the dole seems very, very wrong given that there is need for me to do what I do, just no way to do it and advance my career.
By saying advance my career, I don’t mean that I aim all of my effort at climbing the ladder for better pay etc, but becoming a better and more experienced doctor.
There are always other options; go to the private sector world (not hospitals), work on a cruise ship and so on. They might not be what you planned, they are certainly a waste of a good budding “insert speciality here” doctor.
The old saw that life does not often work out the way you planned is true. But up until very recently, I could say that my career was defined by ongoing acquisition of knowledge and your care as a patient, when I gave it to you, would only get better.
There is no reason to acquire knowledge for a job in which you have no enthusiasm. The idealism that carried you into medicine does dry up in the harsh cancerous glare of reality. That idealism will not mean that, stuck in your dead end job, you will seek to improve. Think Wally from the comic strip Dilbert.
Dr Sniper
Rob, I should add that in moving around the country before I was building my career. So that I could get a good training rotation, anywhere.
Dr Sniper
there seems to be very little support for MMC once we exclude those expressed by the free marketeers
No free marketeers would support MMC, since it is an examle of rigid socialist-type centralised planning. The fact that it produces some of the dis-benefits popularly associated with the free market does not mean it is actually anything to do with the free market. The free market might produce just as many people ultimately disappointed in their career expectations, but they would have a lot more ability to influence their career outcomes, and chances to try a second time (or indeed fifteenth time) if the first time didn't produce what they wanted, and so on.
I can see why working with all the poor people currently affected colours your views of the politics of the whole thing. But really, I don't think you can claim that it was imposed on the medical profession - see here, for example.
The immediate problem is exceptionally poor implementation - very NuLab.
Dr Sniper, I don't mean to be facile and I know "go-to-Australia" has become a cliche, but have you, in fact, considered it? I worked there for three years (in Sydney) and would have been happy to spend the rest of my life there had things worked out differently (I had a temporary residence permit and permanent residence would not be available to someone with metastatic cancer). I certainly didn't realise what a great place it can be until after I went there, despite having an Australian-owned employer in the UK for some years.
I think I would be inclined to start the process quickly though, to get in ahead of the possible crowds in late May. After all, you wouldn't have to go through with it.
I thought you might like to know that I have just fired off an email to the Department of Health, copying in a number of news organisations (you never know your luck) and my local MP. Full text follows:
Dear Ms Hewitt
I am appalled that a Labour secretary of state for health has presided over the introduction of a scheme as arbitrary, cold-hearted and short-sighted as the euphamistically named Modernising Medical Careers initiative.
My partner is an SHO working for an NHS Trust. Neither she nor any of her peers have so far been shortlisted for an interview in any speciality within any deanery. Save for the slim chance of securing an interview after the second round of applications, this has effectively put an end to their medical careers.
I wonder if you can begin to imagine the anguish that this state of affairs is causing countless thousands of families up and down the country. Even those lucky doctors who have secured interviews face the upheaval of moving home, finding new schools for their children and leaving behind support networks of family and friends if their applications are successful.
You need to be aware that through your actions you have single-handedly been responsible for the haemorrhaging of thousands of Labour votes.
Why was there no consultation process before these changes were so swiftly imposed?
Why was better provision not made for the many doctors who fall into the gap between the old and the new systems?
How can you justify the inevitable brain drain that will follow as doctors emigrate to countries where they can continue their training?
How can you defend the lack of patient access to properly trained doctors that will be the inevitable consequence of this reform?
In the coming months there will be a wave of protest against these changes and the general public will slowly become aware of the true extent of the debacle over which you have presided. Your response to Liam Halligan on Channel 4's 'Dispatches' programme on Monday evening was so self-serving as to be repugnant. The "absolute insult to NHS staff" is your disingenuous refusal to accept that both you and your government have failed the NHS.
Yours etc
I encourage everyone else who is angry to write to the Deaprtment of Health and their MP - this is surely the best way of making your concerns known.
Dr Sniper, believe me you have my deepest sympathy for the bloody shambles you’ve been caught up in. Although not in the medical profession myself, three of my children’s dearly beloved godparents are doctors, so I do have some awareness of the situation, which is nothing short of a disgrace.
I absolutely support your right to specialise in the area you want to and to be able to pursue a career in that speciality.
I was merely addressing the specific point that some doctors seem to think they should have the right to determine where they want to work as well and that, I feel, is a little unrealistic. I, and the rest of the population, have to go to where the job I want is located or accept a job I don’t want to do quite as much but which is more convenient for me/better for my family etc etc. I’m not convinced that doctors are a special case in this aspect. But of course you shouldn’t have to re-locate AND do a job you don’t want.
Hope something works out for you.
Nice letter Dan
Interesting that Ms Hewitt is my MP.
When applying to see her at her weekly surgery i was asked and subsequently informed appointments would not be made with NHS staff(i am a surgeon).
.... with over 5 years postgraduate experience and my surgical RC membership....and no MTAS interview.
angry surg
Hewitt refuses to make appointments with constituency members on the basis of who they are employed by?
Unconstitutional!
Anyone want to lay a bet that she'll still be in her job come the summer? I'm offering odds of 100 to 1...
MAKE YOUR VOICES HEARD PEOPLE
MARCH IN LONDON NEXT MONTH
WRITE TO YOUR MP AND THE PRESS
It really is appalling. I'm exploring
another approach at present...
According to the MMC's website MTAS will provide "a clear and open process for recruitment" http://www.mmc.nhs.uk/pages/med1. Yet the scoring of MTAS
applicants is not an open process, MTAS forms are currently scored using
confidential marking guidance.
The department of health is currently considering a freedom of information act (2000) request for this information under section 36 to which the public interest test applies.
I believe that there is a strong case for a truly open application system and that it is in the public interest to have one. In any case I think that the matter warrents proper consideration and so bring it to your attention here.
For what it's worth.
Reading all of this has just broken the camel's back. It's finnaly convinced me not to apply for medicine. Shame.
Well done NHS, you win.
Mutley the Dog
Enough said. No need to argue with a tool with a shrunken head.
As I said, piss off. Back to your polyester suited grunt-job pushing paper, or whatever non-valuable waste of time task you do. Find another forum to serve your Daily Mail-style sense of outrage, illogical reactionary outbursts.
And your cock is small. Your ex-girlfriend has been circulating pictures of it under the headline "micropenis".
Dr. Crippen, I'm puzzled by all this, looking at it from the outside.
From the perspective of this side of the pond. In the USA.....
You graduate medical school, assume satisfactory performance.
You take medical licensure exams, in my day it was called the National Board, now I think it's USMLE, which I think is US Medical Licensure Examination.
You decide what part of medicine you want to enter, medicine, surgery, pediatrics, etc.
You apply to the residencies. There's a matching program, the training programs rank their choice of candidates, the students rank their choice of programs, they try to match everyone in that system.
Assume you're happy with your match. You take some sort of postgraduate training. Some people do general internships, or at least they used to be called internships. Some go straight into specialty postgraduate training.
If there are candidates and spaces available after the Match, programs with empty spaces can negotiate with candidates who did not match.
Assuming satisfactory performance, you graduate the program, you get to sit for the specialty board exam.
Getting a job, practice opening, you're on your own. Set up your own practice, negotiate with hospitals or established practices, etc.
Or at least that's how it looks to me. It's been a while, so some of the subtleties I may have forgotten or misunderstood.
Where's the problem in your version of this, where these docs are without a job?
Dr Crippen is advised that the system is weighted so that the “new” doctors are not disadvantaged by their lack of experience. Think that one over.
++++++++++++++++++++++++++++++++++++
ah you mean 'new' doctors are cheaper.
I try to stay calm and concentrate on getting through medschool but every day I see more of this bullshit. I see apparently good doctors like SHP and our gastroenterologist 'Dr Smith' being shafted by an application and assessment process that finds out how well you can squeeze buzzwords into a computerised form rather than if you are any good as a doctor. What the fuck incentive is there to finish medical school if I'm going to find myself being left unemployed by a computer algorithm in a few years? I came into medicine with clear ideas about what I want to do and where, but under MMC I'll be lucky to get a job at all, let alone have a say in what I do and where I go to do it.
Potentilla, as you know competition for posts amongst junior docs is not new, but the arbitary selection process is.
I looked at the MMC link - fine words indeed, but honestly I think most of us would actually prefer it if the core elements of training and clinical practice was left alone for a little while.
In my mind the processes of becoming a doctor, nurse or other health professional [see scientist's comments on recent 'liar liar 'thread] involves learning x-amount of theory.
We are then cut loose in the clinical area with seniors keeping an eye on us [with varying levels of supervision and support, admittedly].
Eventually, we specialise - to a greater or lesser extent - and, hopefully, after many years in our specialty we learn a bit more, including how imperfect our understanding might be a lot of the time.
I don't hear docs are complaining about the competition, just the unfairness and randomness of the selection process, and if this approach was to be universally applied to other groups of workers I'm sure they'd be just as pissed off.
Now all of this [MMC] might be worth it if we are merely dragging a bunch of recaltriant whingers to the promised land, but I really dont think that's the case here.
And surely the acid test for MMC will be its ability to deliver new all-seeing, all-curing docs who are twice as happy and work for half the price.
But it wont, we'll still get exactly the same proportion of ordinary Joe's, semi-autistic geniuses, sociopaths, charmers, martyers, risk takers, and wanna-be stand up comedians.
In other words MMC is just another blatant exercise in pointless NHS upheaval without any tangible benefits for patients.
Arf:
I have relatives also practicising in the states and your residency matching program is indeed a good thing (similar to what our matching system in medical schools is for 1st year jobs after graduation).
After your 1st year (pre-registration) you are on your own. Jobs used to come up at different levels, in different geographical areas throughout the year. If you were unsuccessfull one month, you knew there would be a similar job somewhere else the following month.
The new system only allows a two week window to find a training job in the entire year - Wait till next year if you cant get in is the message.
It is also restrictive in that only a maximum of 4 choices are allowed in total (it further limits this by area and speciality in a very silly way)
Basically if the US system were adopted it may well make sense but the government are using a very retrictive system and not have not put in any transition arrangements for doctors in the "old system"
A case in point - the winner of the gold medal in my year of the postgraduate surgical exams has not been shortlisted at all. (sadly i wasn't the winner!!)
Re: Dr Peter Smith who wants to be a gastroenterologist.
Should the government be forced to train more gastroenterologists than it thinks it needs because PSmith wants it really, really bad. The slots available may have been filled by more talented applicants. Just an idea. My heart still goes out to the doctor but there is a stigma of sour grapes to all of this.
Re: Dr Peter Smith who wants to be a gastroenterologist.
Should the government be forced to train more gastroenterologists than it thinks it needs because PSmith wants it really, really bad. The slots available may have been filled by more talented applicants. Just an idea. My heart still goes out to the doctor but there is a stigma of sour grapes to all of this.
concerned
+++
Hmmm
Not really fair. He is 5 years down the road of higher professional training. That is all going to be wasted not.
He will have no difficult getting employment abroad, and we will lose him, and the investment we have already made in his training.
He is human. He is disappointed and pissed off, as I would be. And he does not even have an explanation.
And he may not have a job. At all.
It's crazy
John
Dr C, I've emailed you my responses to the above questions. I was offered 4 interviews.
Just to point out - I'm the same age as Peter Smith and applying at the same level but in a different specialty.
If they choose the candidates based solely upon those dopey questions, I agree it's crazy. Surely they look into grades.
The positive for Mr Smith is that he can get a job abroad. That's more than many people can claim. I wish him all the best.
I still think the person who pays for the training has the right to place constraints on certain courses, locations however. This is not unreasonable.
There are two problems here - is that right?
The first problem is that there are rather fewer available training posts than qualified applicants. This needn't be a particular problem if the expectation was that doctors would hang around being SHOs until they got a training post, but that appears to not be the case.
The second problem is that MTAS is a pile of crap. It does not usefully identify the best candidates for a post. This wouldn't be a complete disaster if there were enough training posts to go around - in that case, everyone that was expecting to move up would be able to move somewhere, even if it wasn't exactly what he wanted.
On this last point, there have been a lot of posts from doctors along the lines of "you wouldn't force a budding heart surgeon to go and train as a psychiatrist just because there was a spare slot".
Obviously that would be absurd, but it would be equally absurd to employ 50,000 heart surgeons and no psychiatrists. The number of jobs available at each level of seniority in each speciality must, in an NHS, be set by the relative need for those occupations. It makes no sense for the NHS to train surgeons it doesn't need rather than psychiatrists that it does. You can hardly offer the depressed man a triple bypass to cheer him up. (This is an example. I make no statement about the actual relative need for cardiac surgeons and psychiatrists in the NHS.)
MTAS appears to be a capricious and cruel way of selecting candidates for training posts, but with or without it, wouldn't the numbers work out the same? There would still be the same number of posts available.
Dr C, I don't mean to sound unkind but I think Peter Smith's excerpts are evidence that poorly answered questions don't score marks.
I didn't have any secret answer schemes, but I worked out for myself that I was required to be honest about my mistakes and reflect upon them. Peter Smith appears to be in denial of having ever made a mistake.
Also, it was made perfectly clear on the guidance instructions that specific examples were required to illustrate points. I do not believe Peter Smith has done this effectively.