Senior House Officer job crisis


October 2005

Advice to juniors looking for SHO posts
  • keep applying for jobs and don’t give up
  • talk to your consultant/mentor and/or dean about your situation
  • talk to your regional specialty training adviser
  • be flexible - be prepared to take a job in another location and/or another specialty in the short term
  • be realistic - competition in some specialties is intense - if you need to adjust your long term career aspirations - seek careers advice
  • contact locum agencies
  • apply for trust grade posts as a last resort - JDC does not approve of service grade posts that are not accredited for training and may have disadvantageous contracts that do not adhere to national terms and conditions of service. However, if all else fails trust grade posts can offer useful experience and are sometimes SHO-equivalent but have not been able to secure training approval because of a lack of deanery funding
  • help us with our campaign - write a letter or send an email highlighting your personal situation and/or volunteer with our press office to be a case study for the national press.
See below for sources of help and further information. You can also read answers to frequently asked questions about the SHO job crisis here.

Background to the problem
The competition for jobs at PRHO and SHO level has increased significantly and suddenly over the past few months with an average of over 200 applicants for each SHO post, and some posts attracting over 1,000 applicants. For further information please read Important information for overseas medical graduates . Information issued on behalf of the Academy of Medical Royal Colleges based on a Royal College of Physicians survey on current competition for junior hospital posts (December 2004).

Why is this happening?
The reasons for this increased competition include the following:
  • Since 1999 the number of medical schools and medical school places has expanded to address the general shortage of doctors in the NHS. However, the number of junior doctor posts has not been increased to accommodate the increased number of graduates.
  • There is a deficit in deanery funding which means that deaneries cannot afford to give educational approval to many of the new trust grade posts that trusts have created to meet local demand and to meet targets for EWTD-compliance.
  • A number of SHO posts have been subsumed into foundation year 2 posts. (One year, as opposed to six month, posts at this level reduce further the number of available stand alone SHO posts.)
  • There has been a large increase in applications from international medical graduates who have been given unrealistic expectations of gaining training posts in the UK fostered by international recruitment campaigns and an increase in places available for the GMC’s Professional and Linguistic Assessment Board examinations. These doctors face unemployment, prolonged financial and emotional hardship, exploitation and discrimination, with little hope of eventual employment or training benefits. Increased competition for posts also increases the chances of discrimination in application shortlisting processes.
We are concerned that this problem may be exacerbated during the transition period between the current system and the implementation of Modernising Medical Careers while SHO posts are phased out and new specialist training programmes are formulated. SHOs who have not been able to secure a specialist training post under the current system by August 2007 will find themselves in competition with those emerging from the F2 training programme for entry into the new specialist training programmes, and there may then be no training posts available for those who are unsuccessful.

No plans have been outlined to allow for this to be factored into the supply planning timescales and we believe this will affect 5 to 10,000 SHOs from August 2007 each year during the transition. If solutions are not found urgently and the transition problem is not carefully managed but left to market forces, then the bottleneck will simply be moved from training to service posts and MMC will have failed to improve SHO training.

What is the BMA doing?
The Junior Doctors Committee conducted an emergency email survey of PRHOs in July. The results show that a third of respondents did not have a post to go to on 3 August 2005. The report also reveals that 14% of those respondents who did have a job starting in August were not happy with the post offered; 58% would consider moving abroad to continue training if training posts are not available and 32% would consider leaving medicine altogether. The BMA has since undertaken a formal survey of junior doctors which has confirmed the problem, a link to which is found at the bottom of this page.

The Department of Health has been quoted as saying that there has been no reduction in SHO posts. However, JDC has found a decrease of 50% in the number of SHO posts advertised in BMJ Careers in May 2005 compared with those advertised in May 2002.

Armed with this information the BMA is continuing to put pressure on ministers and Department of Health officials to find urgent and lasting solutions to this crisis. Solutions that we are keen to discuss with the Department of Health include the following:
  • The cycles of ‘famine’ and ‘feast’ in the number of doctors which through poor manpower planning occur over and over again in the UK must be stopped for the good of all doctors and patients.
  • While JDC understands that allowing unlimited training opportunities in itself is not the solution to this problem; in the short term it is essential to increase the number of doctors passing through higher specialist training to allow the expansion of the numbers of consultants and GPs that deliver service and patient care.
  • There needs to be an end to the reliance on service provision at SHO level. It should be seriously questioned how much of the ‘service’ delivery the NHS relies on from SHOs is really patient-centred. We are keen to work constructively with the Department of Health around the idea of other groups of staff taking away inappropriate workload from junior doctors, and ensuring that initiatives such as Connecting for Health reduce wasted time while at the same time ensuring that crucial training elements are not undermined, to help alleviate this reliance.
  • There needs to be an increase in deanery funding to allow suitable trust grade posts to be accredited for training purposes.
  • An international foundation programme with a single-point of entry application process needs to be established for international medical graduates. JDC has developed a proposal along these lines.
JDC is currently awaiting a response to a letter sent to the Secretary of State for Health on at the end of September 2005.

Sources of help and further information
Help the BMA help you Follow the political wizard on the BMA website and e-mail your MP.

Careers information Help for BMA members
askBMA — 0870 60 60 828 or email askbma@bma.org.uk
BMA counselling and ‘Doctors for doctors’ — for help, counselling and personal support call 08459 200169 and ask to speak to a doctor adviser.
Local support services.

BMA members whose gross professional income is not expected to exceed £29,532 may be able to claim a salary-linked concession on their BMA membership fee. Members not expecting to earn in excess of £8,156 may also be able to claim the 'temporarily retired' concession; and members receiving state benefit for more than six months may have their whole year's subscription refunded. Please email membership@bma.org.uk for further details.

Further information
- SHO job crisis, BMA survey results
- BMA press release
- Discussion paper on international foundation posts

© British Medical Association 2008

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