Advice to juniors looking for SHO posts
keep applying for jobs and dont 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
write a letter or send an email highlighting your personal situation and/or volunteer with BMA press office to be a case study for the national press.
See below for sources of help and further information.
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 .
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 GMCs 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 (please see survey results attached as appendix I). The BMA is undertaking a further, more formal survey of junior doctors over the following few weeks.
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 (please see appendix II attached).
JDC is currently awaiting a response to a letter sent to the Secretary of State for Health on 26 July 2005. In the meantime, we understand that the Conference of Postgraduate Medical Deans has been charged with the task of investigating the extent of this problem: The Department of Health is taking this very seriously and is trying to estimate the size of the problem. The deans are involved in discussions with the clinical tutors up and down the country to see how many PRHOs are in this position and to see whether any special action would be appropriate.
Sources of help and further information
Help the BMA help you
If you would be willing to take part in publicity on this issue contact our press office on: sharman@bma.org.uk
Write to or email your MP http://www.writetothem.com/ or http://www.locata.co.uk/commons/
Please take a minute to complete and return our survey when it reaches your door mat over the next few weeks.
Careers information
BMJ Careers Advice Zone http://www.bmjcareersadvicezone.synergynewmedia.co.uk .
BMJCareers www.bmjcareers.com
BMA careers information http://www.bma.org.uk/ap.nsf/Content/Hubcareersadvicefordoctors
Your postgraduate deanery should provide advice along with information about specialty training opportunities and contact details for training programmes http://www.copmed.org.uk for deanery links.
Medical royal college websites http://www.aomrc.org.uk/pages/links.htm
Help
askBMA 0870 60 60 828 or 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
http://www.bma.org.uk/ap.nsf/Content/Hubdoctorsfordoctorslocalservices
Further information
SHO job crisis, BMA survey results
http://www.bma.org.uk/ap.nsf/Content/SHOposts
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 .
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 GMCs 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 (please see survey results attached as appendix I). The BMA is undertaking a further, more formal survey of junior doctors over the following few weeks.
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 (please see appendix II attached).
JDC is currently awaiting a response to a letter sent to the Secretary of State for Health on 26 July 2005. In the meantime, we understand that the Conference of Postgraduate Medical Deans has been charged with the task of investigating the extent of this problem: The Department of Health is taking this very seriously and is trying to estimate the size of the problem. The deans are involved in discussions with the clinical tutors up and down the country to see how many PRHOs are in this position and to see whether any special action would be appropriate.
Sources of help and further information
Help the BMA help you
If you would be willing to take part in publicity on this issue contact our press office on: sharman@bma.org.uk
Write to or email your MP http://www.writetothem.com/ or http://www.locata.co.uk/commons/
Please take a minute to complete and return our survey when it reaches your door mat over the next few weeks.
Careers information
BMJ Careers Advice Zone http://www.bmjcareersadvicezone.synergynewmedia.co.uk .
BMJCareers www.bmjcareers.com
BMA careers information http://www.bma.org.uk/ap.nsf/Content/Hubcareersadvicefordoctors
Your postgraduate deanery should provide advice along with information about specialty training opportunities and contact details for training programmes http://www.copmed.org.uk for deanery links.
Medical royal college websites http://www.aomrc.org.uk/pages/links.htm
Help
askBMA 0870 60 60 828 or 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
http://www.bma.org.uk/ap.nsf/Content/Hubdoctorsfordoctorslocalservices
Further information
SHO job crisis, BMA survey results
http://www.bma.org.uk/ap.nsf/Content/SHOposts
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