Shortage of senior house officer (SHO) posts - An interim report of a survey undertaken by the BMA in July 2005
28 July 2005
Key findings
- Over a third of respondents to the survey (37.7 per cent, 104/276) had not been offered a post to start in August 2005.
- 14 per cent (24/173) of respondents who had been offered a post were not happy with the post they had been offered.
- 87 per cent (239/276) of respondents expressed concern about the availability of training posts within medicine.
- 58 per cent of respondents (159/276) stated that they would consider moving abroad to continue training if they were unable to find an accredited training post in the UK
- 32 per cent of respondents (89/276) stated that they would consider leaving medicine as a career if they were unable to find an accredited training post in the UK
- The majority of respondents aspire to work in a senior clinical post in the UK
In early 2005, the BMA junior doctors committee began to receive anecdotal reports that current PRHOs were struggling to find SHO posts to allow them to continue their training from August 2005.
By June 2005 it had become evident that a significant number of Pre-registration house officers (PRHOs) were experiencing difficulties in finding suitable posts.
In order to determine the extent of the problem and to allow action to be taken to support this group of junior doctors in securing appropriate employment in the training grades a survey of PRHOs was undertaken.
Methods
On the 16 June 2005 an e-mail (Appendix I below) was sent to all PRHOs and SHOs with a valid e-mail address who had registered with the BMA website. It was not possible to separately identify PRHOs, however recipients of the e-mail were asked to pass it on to colleagues who had not been contacted directly.
Recipients were asked to complete a short questionnaire on the BMA website (Appendix II). It is acknowledged and accepted that due to the methods used to contact respondents, the statistical significance of the results could be diminished.
However, the use of electronic media allowed a larger body of potential respondents to be contacted within the tight timeframe available. At September 2004 there were 5,322 PRHOs working in the UK.
On the 22 July 2005 responses were exported into the statistical programme SPSS for analysis. Duplicate entries were identified and removed from the data set as were responses from non PRHO doctors. A total of 276 valid responses remained. These were analysed and the results are presented below. These results represent the interim findings and a further analysis will be carried out and reported in due course.
Results
Over a third of respondents to the survey (37.7 per cent, 104/276) had not been offered a post to start in August 2005.
Of those respondents who had been offered a post for August 2005, the majority (68 per cent, 117/172) had been offered SHO posts and a further 22 per cent (38/172) had been offered a post on an F2 pilot training programme.
Of those however, 10 per cent (17/172) had been offered a post that was not accredited for training purposes Doctors who are continuing training following their PRHO year can only do this in an SHO post or an F2 pilot programme, trust grade posts or other posts e.g. locum posts are not accredited for training purposes. Table 1 below, provides a summary of the data.
Table 1 - What type of post have you been offered?
 | | Frequency | Percent | Valid Percent |
Valid | SHO post | 117 | 68.0 | 68.2 |
| F2 pilot training post/programme | 38 | 22.1 | 22.1 |
| Trust grade post | 5 | 2.9 | 2.9 |
| Not applicable | 1 | 0.6 | 0.6 |
| Other | 11 | 6.4 | 6.4 |
| Total | 172 | 100 | 100 |
Missing | | 0 | 0 | |
Total | | 172 | 100.0 | |
14 per cent (24/172) of respondents who had been offered a post were not happy with the post they had been offered.
The reasons given by respondents who were not happy were varied. Some were unhappy that the post they had been offered was not accredited for training; others reported that the post they had been offered was of shorter duration than they had wanted; some respondents noted that their post was in a different region or in a different area of medicine than they would have hoped for.
Why are you not happy with the post you have been offered - comments
“The lack of training certification despite being identical in all other aspects to training SHO posts in this hospital.”
"I had wanted to have a secure training post. In the event I was only offered a one year post”
“I do not feel that it offers any exposure to any career path I have an interest in.”
Respondents who had yet to find a post for August 2005 were asked why they thought they had been unsuccessful (Table 2). Over half (53/104) responded that they were unable to find a post in the region they want to work, and 22 per cent (23/104) were unable to find a training post in any region or in any area of medicine.
Table 2 - Why do you not have a post for August 2005?
| Frequency | Percent | Valid Percent | Cumulative Percent | |
| I am unable to find a training post in the region I want to work | 53 | 51.0 | 51.0 | 51.0 |
| I am unable to find a training post in the area of medicine I want to work | 13 | 12.5 | 12.5 | 63.5 |
| I am unable to find a training post in any region or area of medicine I want to work | 23 | 22.1 | 22.1 | 85.5 |
| Other | 15 | 14.4 | 14.4 | 100.0 |
| Total | 104 | 100.0 | 100.0 | |
Respondents were also given the opportunity to provide further details about their experiences and the barriers that they perceive are preventing them from finding a post. A selection of comments are below.
Why do you not have a post for August 2005 - comments
“I feel that many of the posts have been taken up by the FY2 and I do not wish to take an FY2 job and feel that I am losing out”
“I keep getting told that unfortunately there were candidates with more experience.”
“I have made a considerable amount of applications without even being short listed. I have now totally lost my confidence and am feeling very concerned as to how I am ever going to get back to work.”
“I am very concerned about the very real possibility of not finding work in August. I have spent 6 years at University”
“I am particularly finding it difficult to find a surgical SHO job and the jobs currently being offered are only for 6 months or a year”
“Due to the large number of applications that still require an extensive application form there is a limit to the number of applications that can be completed at the end of the working day.”
As would be expected, respondents who have yet to find a post for August 2005 have, in general, submitted more applications than their colleagues who have already found posts, some respondents having submitted as many as 200 applications. 51 per cent (49/96) of respondents who did not have posts at the time of responding to the survey had submitted more than 20 applications compared to only 16 per cent (23/144) of those who have secured posts.
Table 3 - How many applications for accredited training post have you submitted
| | All respondents | Offered post for August 2005 | No post for August 2005 | |||
| | Frequency | Valid Percent | Frequency | Valid Percent | Frequency | Valid Percent |
Valid | less than 20 | 167 | 69.9 | 121 | 84.0 | 47 | 48.9 |
| Between 20 and 40 | 42 | 17.6 | 16 | 11.1 | 26 | 27.1 |
| Between 40 and 60 | 12 | 5 | 4.0 | 2.8 | 8 | 8.3 |
| Between 60 and 80 | 7 | 2.9 | 1 | 0.7 | 6 | 6.3 |
| more than 100 | 11 | 4.6 | 2 | 1.4 | 9 | 9.4 |
| Total | 239 | 100.00 | 144 | 100.00 | 96 | 100.00 |
Missing | | 37 | | 28 | | 8 | |
Total | | 276 | | 172 | | 104 | |
Chart 1 – Number of applications submitted, offered post vs. no post
87 per cent (239/276) of all respondents and 96 per cent (100/104) of respondents who have yet to find a post for August 2005 expressed concern about the availability of training posts within medicine. A number of themes were apparent in the comments made by respondents:
- There is concern about the seemingly large increase in the number of non standard/trust grade posts appearing;
- There is concern that the introduction of the foundation programmes is putting this cohort of doctors at a disadvantage, most have not participated in F1 programmes and are nervous about embarking on ‘pilot F2 programmes’;
- SHO posts are increasingly for six months or a year and PRHOs applying for these posts are often in competition with doctors who have more experience having already completed 1-2 years at SHO level.
Table 4 - Are you concerned about the availability of accredited training posts within medicine
| | All respondents | | Offered post for August 2005 | | No post for August 2005 | |
| | Frequency | Valid Percent | Frequency | Valid Percent | Frequency | Valid Percent |
Valid | Yes | 239 | 86.6 | 139 | 80.8 | 100 | 96.2 |
| No | 37 | 13.4 | 33 | 19.2 | 4 | 3.8 |
| Total | 276 | 100.0 | 172 | 100.0 | 104 | 100.0 |
Missing | | 0 | | 0 | | 0 | |
Total | | 276 | | 172 | | 104 | |
“Although I have been lucky to find a post I wanted I have seen others struggling and I feel as the F2 programmes become more developed those of us who are in the last few years of the old system are going to struggle as the SHO posts disappear.”
“Am I going to be unemployed?”
“BMJ careers is littered with trust grade or "junior clinical fellow" posts - many many more than accredited posts.”
“Clearly there are not enough jobs for local graduates so why on earth conduct PLAB examinations!”
“Every UK graduate PRHO doctor deserves a training post - It’s why we're here doing it!”
“High level of competition and few posts with added problems due to highly experienced foreign graduates being selected for training rotations”
“I am desperate for work and can't find it. I believe I am a capable doctor who may be forced to locum. What kind of a system leaves good doctors without a job?”
“Have not been short listed for a single post and I have met all the criteria having a first class BSc and completed ALS and completed PRHO in a good teaching hospital”
“It has become very apparent that there is severe lack of SHO posts available for newly qualified house officers looking for jobs in Aug 05.”
“Many of my friends have been offered trust posts and out of panic have taken them and subsequently had to turn down further interviews for training posts.”
All respondents were asked what action they would consider if they were unable to find an accredited training post in the future. 58 per cent of respondents (159/276) stated that they would consider moving abroad to continue training and 32 per cent of respondents (89/276) stated that they would consider leaving medicine as a career. Many respondents commented that they would work in a locum capacity until a suitable post became available.
Table 5- If in the future you are unable to find an accredited post in order to continue training would you consider
n=276
| Frequency* | Percentage of all respondents (n) |
| Working in the UK in a non training grade post | 137 | 50% |
| Changing specialty | 85 | 31% |
| Moving to a different region | 148 | 54% |
| Moving abroad to continue training | 159 | 58% |
| Leaving medicine | 89 | 32% |
| Other (please specify) | 26 | 9% |
| Total | 644 | |
| Missing | 1 | |
| Total | 645 | |
Comments different courses of action respondents would consider if unable to find an accredited training post
“I am considering leaving medicine if every 6 months I have this same problem and the stress that goes along with it”
“I think leaving medicine would be the hardest thing for me to do but I have found the last few months very distressing.”
“I would be tempted to work in academia or medical journalism.”
“It seems like you can't be choosy on region in order to get a training post which means if you have ties in a particular area you have to put your job first and
perhaps move.”
“Work for locum agency until something came up”
“Take time off”
Finally respondents were asked about their long term career goal. The majority of respondents (68.5 per cent, 189/276) plan to work in the UK as a consultant, 20 per cent (56/276) of respondents want to work in general practice in the UK and 6 per cent (16/276) plan to work overseas.
Table 6 - What are your long term career goals?
| | All respondents | Offered post for August 2005 | No post for August 2005 | |||
| | Frequency | Valid Percent | Frequency | Valid Percent | Frequency | Valid Percent |
Valid | Work in UK as a consultant | 189 | 68.5 | 114 | 66.3 | 75 | 72.1 |
| Work in UK as a GP | 56 | 20.3 | 39 | 22.7 | 17 | 16.3 |
| Work as a doctor overseas | 16 | 5.8 | 10 | 5.8 | 6 | 5.8 |
| Other (please specify) | 15 | 5.4 | 9 | 5.2 | 6 | 5.8 |
| Total | 276 | 100.0 | 172 | 100.0 | 104 | 100.0 |
Missing | | 0 | | 0 | | 0 | |
Total | | 276 | | 172 | | 104 | |
Discussion
The result above clearly show that there is a shortage of accredited training posts for doctors coming to the end of their PRHO year.
In recent years there has been a steady expansion in the number of medical school places in the UK, the impact of this on the number of newly qualified doctors in the workforce is only now starting to be felt, this increase comes at a time when the number of overseas qualified doctors in the UK at SHO level continues to increase 5,430 in 2002, 6,771 in 2003, 8,460 in 2004.
Department of Health; Hospital, Public Health Medicine and Community Health Services Medical and Dental staff in England: 1994-2004
and huge changes to the structure of medical training in the UK are being introduced. From the evidence presented above it is apparent that the number of training accredited SHO level posts has not been expanded sufficiently.
In response to the e-mail sent to PRHOs and SHOs, a number of SHOs responded stating that although they are currently in SHO posts, they are unable to find further SHO posts to continue their training.
Although the vast majority of respondents aspire to work in senior clinical positions in the UK, comments made by respondents to the survey demonstrate that there is a very real danger that large numbers of doctors will leave medicine to either train and work overseas or to pursue other careers. These doctors are very concerned about the lack of available training posts and the constant stress they are placed under as they are forced to apply for scarce training posts each year.
Appendix 1 - text of email sent to PRHOs and SHOs with a valid email address
From: mailings@info.bma.org.uk [mailto:mailings@info.bma.org.uk]
Sent: 16 June 2005 13:18
To:
Subject: BMA survey - PRHO training posts (Our ref: )
Dear Dr …………..
The Junior Doctors Committee is concerned that there is a very real possibility that a number of PRHOs may be having difficulty finding accredited SHO posts beginning in August 2005. We are already aware that some junior doctors do not have posts to go to or are having to settle for non-training trust grade posts.
We want to find out the extent of the problem and support all junior doctors in securing appropriate employment in the training grades; to do this we need help from you and your PRHO colleagues.
We are asking all PRHOs to click on the link to the BMA website below to complete a short questionnaire that will let us know about the current employment opportunities for junior doctors today. If you can cascade this questionnaire through to your colleagues please do so. Your views on this matter will help inform our action on this issue.
Go to the questionnaire at: https://www.bma.org.uk/gsurvey.nsf/DoQuest?OpenForm&q=SMAY-6DDKPN&mode=a
You will need to login. If you have forgotten your web user name and password you can check it here https://registration.bma.org.uk/uvar.nsf/passr?OpenForm
For employment advice and information members can call askBMA on 0870 60 60 828 or email askBMA@bma.org.uk
Please use the following link to login to the BMA website and unsubscribe from future mailings: http://www.bma.org.uk/unsubscribe
Appendix 2 - Shortage of SHO posts questionnaire
1. Are you a PRHO?
Yes
Please go to question 2
No
End of questionnaire
2. Have you been offered a post to start in August 2005?
Yes
Please go to question 3
No
Please go to question 5
3. What type of post have you been offered?
- SHO post (accredited for training)
- F2 pilot training post or programme
- Locum post
- Trust grade* post
- Other
4. Are you happy with the post you have been offered?
Yes
No
If no, why not?
Please go to question 7
5. Why do you not have a post for August 2005?
I am unable to find a training post in the region I want to work
I am unable to find a training post in the area of medicine I want to pursue
I am unable to find a training post in any region or in any area of medicine
Other (please specify) ____________________________
Please go to question 7
6. How many applications for accredited training posts have you submitted?
7. Are you concerned about the availability of accredited training posts within medicine?
Yes
No
Please explain:
8. If, in the future, you are unable to find an accredited post in order to continue training would you consider:
Please tick all that apply:
- Working in the UK in a non training grade post?
- Changing specialty
- Moving to a different region
- Moving abroad to continue training
- Leaving medicine
- Other (please specify) ____________________________
9. What are your long term career goals?
- Work in the UK as a consultant
- Work in the UK as a GP
- Work outside medicine
- Work as a doctor overseas
- Other (please specify) ____________________________