Covering Europe, you see a lot of old people behaving selfishly. (the vigour of youth, the guile of the old.) But young people can behave badly too; back in London, I met up with a number of junior doctors whom I had met earlier this year at their annual conference. My conclusion: Junior doctors in Britain are under pressure – and they have started acting mean. And they do not want to be quoted on this.
They are suffering unprecedented competition for junior doctors’ posts due to a number of factors. The launch of a number of programmes that bring doctors who have spent time off sue to illness, travel or having families back into the profession. The establishment of six medical schools in the last few years, churning out thousands of extra graduates. The creation of a new specialised health professional – the care practitioner, who can do some of the jobs doctors can do – anaesthesia, surgery, general medicine – but lack the doctor’s breadth of experience and judgment. They are also much cheaper and quicker to train and employ. Then, uniquely in 2007, a shorter foundation programme of two years introduced in 2005 whose graduates will emerge to compete directly with the first graduates from the earlier, three year programme.
Then there is competition both from EU doctors and from those further overseas, the overwhelming majority from India.
None of this has been balanced by an expansion in nearly as many doctors’ posts, despite the shortages demanding to be filled by the introduction of the European working directive and its shorter hours.
The average junior doctor’s position now has several hundred applicants for it. You don’t need to be an economist to see the irrationality of training doctors at £30,000 from A-levels through to graduation only to dump most of them on to the dole queue. Something had to give. It was the overseas, commonwealth doctors.
They have been coming for decades; unlike other international workers, who required work permits, graduate doctors from overseas could just apply, on the same basis as any British citizen, for any hospital job. The NHS needed them: their English language skills were excellent; their undergraduate training based on the British system. They in turn got excellent postgraduate training – the seven long years of twenties and early thirty-hood being so called house doctors, then specialist registrars, before graduating, subject to professional exams, to the desired goal, the acme of medicine – a consultant’s position. Then they would return to India where an NHS training was a badge of excellence enabling its benefactor to command huge private fees.
Under not so subtle pressure from the youth wing of the British Medical Association, the doctors’ trade union, the government stopped the work permit free regime in March and ruled that Indian doctors would only be able to fill a vacancy in a hospital only if it could be proved that the post could not be filled by a suitably qualified British or EU graduate.
While many Indian doctors in their late stage of postgraduate training, those in their first two years and those looking for work are in jeopardy: the first training posts are usually six month contracts and when these run out these doctors will, basically, have to go home, since it is extremely unlikely hospitals will be able to prove that hundreds of EU and British applicants ahead of the Indians in priority are unable to fulfil the junior posts’s requirement, which are classic first step the ladder menial tasks
No one keeps records but, of the 40,000 doctors of Indian origin working in the NHS, you cpould be talking of a few thousand vulnerable Indian junior doctors.
Dr Prasada Rao, chairman of the association and a general practitioner in Stoke-on-Trent, spoke for many when he said: “We are concerned that the UK is beginning to turn its back on the vital links that we have with the Commonwealth.”
Some British doctors expressed outrage at the decision: “It is basically a kick in the teeth,” said Dr Jim Stuart, clinical director of the Manchester Royal Infirmary’s A&E department.
For many, if not all, of the doctors who have just turned up from India and were looking for their first jobs, or have been here a short term in one or two short contracts and have no other job to go to, it marks a brutal end to a dream. On top of med school back in India, the investment of a fare to England, the fees for tests proving linguistic and professional competence, there is the cost of rent and lodging in the UK. The investment was accompanied by the hope of being able to earn back the costs; but every evening, the Shri Mahalakshmi Hindu temple in east London dispenses free food to indigent doctors from the Asian subcontinent.
Dr Rao told me from the BMA’s annual conference that there had been no change in the situation since March; and that several demands for concessions to be given a grace free period for unemployed doctors to find a job for two years had gone unheeded.
Looking at Indian junior doctors’ websites, there is a certain resentment about the EU, which is perceived as imposing these laws and whose doctors are thought of as being less well trained and compatible with the British system. But while EU doctors cannot be denied entry to the UK, there was no EU pressure to rescind the permits to Indian doctors. It was a British government decision, pushed by the BMA, and useful to blame on the EU. Still,. It’s yet another indication of how Britain is becoming more European.
They are suffering unprecedented competition for junior doctors’ posts due to a number of factors. The launch of a number of programmes that bring doctors who have spent time off sue to illness, travel or having families back into the profession. The establishment of six medical schools in the last few years, churning out thousands of extra graduates. The creation of a new specialised health professional – the care practitioner, who can do some of the jobs doctors can do – anaesthesia, surgery, general medicine – but lack the doctor’s breadth of experience and judgment. They are also much cheaper and quicker to train and employ. Then, uniquely in 2007, a shorter foundation programme of two years introduced in 2005 whose graduates will emerge to compete directly with the first graduates from the earlier, three year programme.
Then there is competition both from EU doctors and from those further overseas, the overwhelming majority from India.
None of this has been balanced by an expansion in nearly as many doctors’ posts, despite the shortages demanding to be filled by the introduction of the European working directive and its shorter hours.
The average junior doctor’s position now has several hundred applicants for it. You don’t need to be an economist to see the irrationality of training doctors at £30,000 from A-levels through to graduation only to dump most of them on to the dole queue. Something had to give. It was the overseas, commonwealth doctors.
They have been coming for decades; unlike other international workers, who required work permits, graduate doctors from overseas could just apply, on the same basis as any British citizen, for any hospital job. The NHS needed them: their English language skills were excellent; their undergraduate training based on the British system. They in turn got excellent postgraduate training – the seven long years of twenties and early thirty-hood being so called house doctors, then specialist registrars, before graduating, subject to professional exams, to the desired goal, the acme of medicine – a consultant’s position. Then they would return to India where an NHS training was a badge of excellence enabling its benefactor to command huge private fees.
Under not so subtle pressure from the youth wing of the British Medical Association, the doctors’ trade union, the government stopped the work permit free regime in March and ruled that Indian doctors would only be able to fill a vacancy in a hospital only if it could be proved that the post could not be filled by a suitably qualified British or EU graduate.
While many Indian doctors in their late stage of postgraduate training, those in their first two years and those looking for work are in jeopardy: the first training posts are usually six month contracts and when these run out these doctors will, basically, have to go home, since it is extremely unlikely hospitals will be able to prove that hundreds of EU and British applicants ahead of the Indians in priority are unable to fulfil the junior posts’s requirement, which are classic first step the ladder menial tasks
No one keeps records but, of the 40,000 doctors of Indian origin working in the NHS, you cpould be talking of a few thousand vulnerable Indian junior doctors.
Dr Prasada Rao, chairman of the association and a general practitioner in Stoke-on-Trent, spoke for many when he said: “We are concerned that the UK is beginning to turn its back on the vital links that we have with the Commonwealth.”
Some British doctors expressed outrage at the decision: “It is basically a kick in the teeth,” said Dr Jim Stuart, clinical director of the Manchester Royal Infirmary’s A&E department.
For many, if not all, of the doctors who have just turned up from India and were looking for their first jobs, or have been here a short term in one or two short contracts and have no other job to go to, it marks a brutal end to a dream. On top of med school back in India, the investment of a fare to England, the fees for tests proving linguistic and professional competence, there is the cost of rent and lodging in the UK. The investment was accompanied by the hope of being able to earn back the costs; but every evening, the Shri Mahalakshmi Hindu temple in east London dispenses free food to indigent doctors from the Asian subcontinent.
Dr Rao told me from the BMA’s annual conference that there had been no change in the situation since March; and that several demands for concessions to be given a grace free period for unemployed doctors to find a job for two years had gone unheeded.
Looking at Indian junior doctors’ websites, there is a certain resentment about the EU, which is perceived as imposing these laws and whose doctors are thought of as being less well trained and compatible with the British system. But while EU doctors cannot be denied entry to the UK, there was no EU pressure to rescind the permits to Indian doctors. It was a British government decision, pushed by the BMA, and useful to blame on the EU. Still,. It’s yet another indication of how Britain is becoming more European.
