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This week, the UK Foundation Programme Office (UKFPO) published their 9th annual F2 Career Destinations survey. This survey, which is compulsory for doctors towards the completion of their F2 year, includes a wealth of data around the career choices being made by the latest cohort of graduates from the Foundation Programme in the UK. The headline findings included the fact that yet again, there has been a significant drop in the number of F2s making the decision to progress straight into specialty training. The data provides some interesting insights, but also leaves just as many questions unanswered.
Only 37.7% of F2s went straight into specialty training in 2018 (see Figure 1). That’s down from 42.6% last year, and 71.3% in 2011. More and more F2s still don’t see Core or Specialty training as a desirable option straight away.
There is a gradual increase in F2s taking a career break from medicine (14.4% compared with 13.8% in 2017). The majority state an intention to do this for one year, and most intend to travel. Is this because of an accessible chance for a gap year after years of intense work through medical school and the Foundation Programme, or is it symptomatic of junior doctors desperately needing a break due to burnout?
Data from the survey shows that 55.6% of F2s continue in some form of clinical role in the NHS, and while this too has fallen, it has done so at a less significant rate than those progressing to specialty training (Figure 2). Service posts rather than training have been increasing in popularity, suggesting that there is something inherent in training itself that is the issue here.
The report, as in 2017, cites data from the GMC that indicates that 88-90% of those who completed F2 in 2012-2014 entered specialty training within 3 years, but today’s cohorts of F2s are different. This much is apparent from the significant reduction in those going into specialty training; the environment has changed. It’s therefore essential that longer term career intentions continue to be monitored, as there is a danger in assuming that these trends will continue.
These figures are stark. The causes for this are almost certainly multifactorial. This time immediately after F2 is the first natural break after several intense years of work at medical school and then as a newly-qualified doctor; it is an obvious time to be able to take a “gap” year, and the more people who do so, the more socially acceptable and less likely to damage your career it becomes.
Data from career pathways surveys from both the BMA and the GMC shows trainees citing burnout, as well as fatigue from training “hoops” and requirements, and a feeling of being on a continuous treadmill. Additionally, levels seem to peak at F2. This also likely is a huge driver towards needing some time away from formal training.
It isn’t all attributable to what happens in the Foundation Programme though; the number of new doctors indicating that their plan at the end of medical school was to go straight through is also falling (49.7% vs 52.8% in 2017). Is this because this gap after the Foundation Programme is becoming increasingly well known, and indeed, planned for, as a regular part of a junior doctor’s pathway through medicine? Or is it due to medical students seeing the reality of the pressures involved in working in the NHS at the moment, and therefore already anticipating that they will need a break after their first two years of work as a doctor?
In addition, service roles are often much more flexible and allow greater control over your life than training posts. It’s much easier to choose where you are working, both in terms of geography and type of posts. A significant number of trainees have also expressed the view to us that they have been able to access better training out of programme than in, with both time and opportunity to learn and undertake career development on their terms. With being a consultant looking less desirable, this extra time spent as a junior doctor no longer appears to be a problem.
What’s more, there is likely to be an increasing drive towards taking this “F3” year out to make yourself more competitive in specialty applications, as many colleagues who do so will use some of this time to undertake exams, courses, audits, QI projects and teaching, scoring extra points on applications.
Health Education England is currently leading a wholesale review of the Foundation Programme, which is due to the report in the spring, but the whole system needs to recognise and respond to the need for change, as the answers are likely to lie beyond just the Foundation Programme.
The BMA Junior Doctors’ Committee continues to engage in a review of the 2016 junior doctor contract in England, and work likewise goes on to improve the lives of junior doctors in Scotland, Wales and Northern Ireland. This data shows just how essential engagement here is.
Valuing staff is essential to help recruitment and retention across the NHS. 1500 extra doctors per year will be a welcome step, if jobs and training for them all is funded. Likewise, various flexibility initiatives that are in development should provide more autonomy over our working lives.
We would be interested to hear your thoughts on this data. The report can be found here, and there have been some lively debates on Twitter on the subject. Join in the conversation.
Sarah Hallett is JDC Deputy Chair and chair for Education and Training
I think a training like USA is better. Three years of residency and the person becomes a hospitalist making 10,000 usd a month. In the UK the pay is less and u spend years of your youth training with a miserable pay and no leisure.
Isn’t the elephant in the room here the massive pay gap between training posts and locum rates.
Joining a training programme puts you at higher risk of being bullied because the ARCP combined with national selection so you don't know your trainers allows a handful of consultants to do as they please with your career completely unchecked. You often have to move against your will to a random location, including your family, and if you ever leave the programme you cannot reapply to that programme ever. You are no more likely be consultant-ready at the end. You are better off not being in a training programne.
Training is like being a hamster on treadmill. One stage just leads to another without considerable break. In foundation yrs, trainees are allowed to take only 9 days off each placement and by the end of 2 yrs they just want a longer break to re-energise. loads of F2s at the end of foundation yr take one or two months off before starting a non training post. Making the starting date of CT training more flexible might solve problem?
I’m an FY5 (and will be taking an FY6) and have definitely had better training, have had control over my geographical location, have willingly undertaken exams/clinical governance (not just to tick a box) and had a better work/life balance outside of a traditional program despite being a full time clinical fellow for the last few years.
However, many people are ‘suspicious’ of me as I don’t have that “gmc recognised training program” behind my name and it can be a fight to be recognised as someone who does hold some valid clinical experience.
In reply to the FY5 who commented above, I am in a training programme and I think that the two tier training vs clinical fellow system is completely flawed. Apart from anything else, it invites division and bullying behaviours, I've seen excellent clinical fellows with bags of experience treated like dirt because of their second tier status. You quickly become "overqualified" to apply to almost all the training programmes by even a couple of years work as a clinical fellow or you are disqualified for 'inadequate career progression'. However, as you say, you are free from the arbitrary annual requirements to tick off so you don't get held back each year at ARCP. You also don't have to uproot your family and move to the other side of the country to prop up the service provision needs of a random hospital no one wants to work in!
Lack of control on personal life especially georgraphy in a time of your late 20’s for a low paid training job with no flexibility.
Oh and just to make you life more miserable, don't forget the managers prioritize the skillmix staff by making sure they have permanent jobs and paid training that is paid for from our tax dollars and they end of getting paid better than the doctors, who just get training program and locums....
I think this raises a very valid issue. I have a colleague who began at the same time as me in a staff grade post and me on a training programme. I have had to move house yearly and put up with sub standard training throughout my career, yet he has worked in a single hospital supported by a good consultant and is about to get his article 15. This feels a rather bitter pill to swallow.
Another factor that goes into the decisions is how much money you can earn as a locus F3. It’s certainly not the only reason, but it’s persuasive.
With the current work climate or trainees, I really don't know why anyone would want to go straight through to core or run through from foundation. Training rotas for some FY rotas don't give you enough time to get exams studied for with the time they deserve, and the hoop jumping for surgical portfolios is ridiculous and time consuming. You spend time concentrating on online portfolios and sign offs, which takes away precious time away from the real medicine; dealing with patients, theatre time, learning etc. You suddenly realise after two exhausting years that having a bit of a life is preferable and not usually detrimental to your training, so why not!
I have had a pre-Core surgical FY3 year and am currently in a post-CST year out. Best decisions I've made, paid a tonne of debt out, stress levels down, miles better portfolio and heaps more confidence in my clinical acumen prior to reg training.
Maybe if training was made more flexible, more educational and better paid, might deter people from locum FY3 years or clinical fellow posts with more autonomy. It's kind of sad really that training isn't what it should be..
I am at a point where I am failing to see how i can keep hoop jumping. 3 hours of one form for arcp. It actively took me away from patient care to no benefit to anyone. Right now getting out of training looks good
Surgical training in the UK is in terrible shape in my opinion. If you look at the way it is run now it is structurally designed to take high calibre people and set them up to fail or at least make their life as difficult as possible. When you fail to achieve something as a direct result of the training or behaviour of your trainers it is blamed on the trainee as if everything they did to get to where they are does not count. I've seen trainees at the end of their training who never do independent cases and therefore cannot even get locum consultant posts, truly excellent trainees who can't even pass mrcs A by ST3 due to being used for service provision, I've seen careers destroyed by blatant bullying. Trainers get a stream of free recruits and no consequence for bad training. If the situation is severe enough they may have the trainees taken away at some point but by then those people have had their career ruined. The trainers themselves have a different trainee all the time so can't get into an individual's training, as soon as they get to know their trainee that person is moved on to someone else. It is a mess, as said above you are now better off as a clinical fellow.
Call a spade a spade, BMA. It’s NOTHING to do with flexibility or need for gap years. There was a strike not so long ago, that was ignored by the health “secretary” at that time. A career “break” isn’t working in medicine elsewhere... that’s just taking a better paid job in the same career... in the southern hemisphere
I agree with pretty much all the points in the article:
- geographic flexibility
- flexibility in specialty
- ability to CV build
- ability to develop clinically without committing yourself to a specialty forever
I took three years out of training. I am now in my final year of GP training. My only desire of the current system is to be able to take some of my non-training-post experience and count it towards my current training. I think I would have been clinically sharper if I qualified a year ago - I didn’t need to do an extra year of hospital posts.