New allocation method is going to create worse doctors, according to medical students
A NUMBER of future doctors in Wales feel let down by a new computer-generated ranking system which allocates them an area of the UK to start their careers as junior doctors.
After graduating from university, doctors must complete two years of foundation training as part of the UK Foundation Programme.
This year the UKFPO changed the way it allocates placements to final-year medical students from a merit system to a Preference Informed Allocation method, which uses computer-generated list based on how students rank their choice of teaching centre.
In the previous system, future doctors across the country were rewarded for good grades, published academic papers, and whether they had done other degrees and qualifications.
Several medical students are disappointed with the new system which they say could impact their career prospects and the quality of patient care. Some say the change reduces the incentive to work hard at university, and that being forced to move away from their support networks could affect doctors’ mental health.
“If people do come to areas where they are unmotivated to work because they don’t want to be there, it could end up backfiring,” said medical student, Caradog Davies, 24, from Carmarthenshire.
Another medical student, Pranav Kalra, 26, said under the new system “there’s no real incentive to work really hard”.
And 26-year-old Lydia Fice agreed saying: “It changes the outlook of medicine – they are going to create worse doctors who just aim to pass.”
A spokesperson for the UKFPO said the new system was introduced because of concerns expressed by students and medical schools about the burden of the previous method of ranking applicants, including the national Situational Judgment Test which has now been scrapped.
Reduced quality of care and worse career prospects
Caradog Davies studied at Cardiff University and wanted to stay nearby to be close to his partner. Instead, under the new system he has been allocated to work in the Hywel Dda health board in west Wales.
Mr Davies said the new system could improve health equality throughout the UK by spreading talented medical students around. But it could also have a negative effect on the quality of care given to patients if they are given a specialism they to no intend to pursue.
“If people do come to areas where they are unmotivated to work because they don’t want to be there, it could end up backfiring,” he said.
“It will impact my future profession quite significantly”
Caradog Davies, medical student
“I am going to be randomly allocated to potentially a specialty that I have no interest in, that I have no passion to work within.
“Not only will that reduce the quality of care that I’ll deliver – hopefully not, I will try my best – but it will impact my future profession quite significantly.”
“[Different] hospitals do have a reputation for training and progressing your profession. When it comes to applying for certain jobs, I was in a position previously where I could have done the training for any job I wanted.”
But Mr Davies, who wants to be an anaesthetist, said he could now be limited by what specialties are available in at Hywel Dda.
He said future employers “will look at our CVs and ask: ‘why have you not done any specific training’?”
The spokesperson for the UKFPO said: “All foundation applicants allocated to Wales will be offered a two-year programme. These programmes are well established and offer a range of experiences and opportunities.”
Mr Davies said being away from support networks for a long period could have a detrimental effect on his mental health.
“It feels unjust. It’s a bit of a kick in the teeth.”
Caradog Davies, medical student
“I think if you have worked hard at university and have achieved a higher grade, you should be allowed to choose where you want to train. It feels unjust. It’s a bit of a kick in the teeth.”
Disappointed student considers leaving the UK
Pranav Kalra, 26, from Australia, has just finished his postgraduate medical degree at Swansea University.
Mr Kalra wanted to go to London and so put it as his top choice in the PIA ranking system.
“I would be more inclined to stay longer if I was somewhere I chose.”
Pranav Kalra, medical student
Instead, he was allocated Northern Ireland – his 18th and last choice.
He said: “Never did I think I would get my last choice.”
He is now likely to leave the NHS and the UK entirely and move home to Australia.
He said: “I am going to go to Northern Ireland for a year and then I am going to go back to Oz.
“The temptation is too great to go back to Oz having been put in Northern Ireland – so far from everyone I know, all my friends. I would be more inclined to stay longer if I was somewhere I chose.”
The old system for Mr Kalra, a mature student with previous degrees to his name, was a “big draw” in his choice to study in the UK and work in the NHS.
He said: “When I first got into Swansea, the system was obviously very different. We were also told that you get extra points for previous degrees and papers you publish. So, I had all that under my belt.
“I had an offer from Ireland, so I was weighing up coming to the UK or Ireland.
“I worked pretty hard to be where I am and then to be told ‘We are scrapping this whole system, your marks don’t matter, it’s all going to be up to this computer-generated system’ was just quite tough to take.”
He appealed but was not successful.
“There are elements of the system that are good – it takes away a bit of the pressure.
“[In the old system] all the top students would end up going to the best hospitals and it was creating a bit of disparity.”
No, however, he believes: “There’s no real incentive to work really hard.”
The British Medical Assocation Wales said the incentive to work hard had not changed because passing all university assessments was essential for graduation and medical practice.
Moving away from friends and family
Lydia Fice, 26, from Surrey, also studied the postgraduate medical degree at Swansea University.
Her first choice was the Severn area which includes Bristol to be close to her partner.
However, she was given her sixth choice of West Midlands South, which includes Hereford, Worcester, Warwickshire.
Under the old system, she would have likely been allocated her top choice: “I was in the top decile at uni up until now and that would have made a big difference.
“It just seems a bit unfair that I have been done over now, that it is random and that I only knew in my third year at uni that this was going to be changed. If they are going to make a change, it should be set out in first year, so you know what is to come.”
“It changes the outlook of medicine – they are going to create worse doctors who just aim to pass.”
Lydia Fice, medical student
Ms Fice said she would not have worked any less hard, but she said: “It changes the outlook of medicine – they are going to create worse doctors who just aim to pass.”
The BMA Wales said the new system could “potentially decrease student engagement in extracurricular activities like teaching, research, and leadership”.
Despite coming to terms with the allocation, Ms Fice admitted she was “quite shocked” when she heard that she was allocated West Midlands South.
“As doctors, the whole point of us is to help other people and they can’t even help us.”
Why did the system change and how will it affect Wales?
The BMA Wales said: “The new allocation system is designed to ensure that, provided there is enough applicants to the UK foundation programme, Wales will receive the appropriate number of doctors.”
There are 18 deaneries – areas – in the UK and medical students are told to rank all 18.
Wales is one deanery so doctors could be allocated anywhere from Rhyl or Pembrokeshire by the computer-generated random allocation system.
“If you didn’t get your first choice, you are a bit screwed”.
Lydia Fice, medical student.
Mr Davies believes fewer medical students might now apply to Wales and other large geographical deaneries because they will not be in as much control of where they end up compared to denser deaneries like London.
He said that due to different contracts, doctors in Wales are already “worked to the bone a lot more than you are in other countries in the UK” and to not be control of where you work and live makes matters worse.
This year 75% of 9,702 medical students got their first choice of deanery, up from 71% from last year.
But 92% got one of their top 5 deaneries, down from 95% last year.
This means there are 776 medical students allocated to an area of the UK that is not in their top five choices.
Mr Kalra said: “It’s just the top choice which has gone up. If you look at the overall trend, I am not even sure it has really changed. A few years ago, it was already up at 75%.”
Ms Fice said under the new system “if you didn’t get your first choice, you are a bit screwed”.
The BMA Wales said: “This is understandably unsettling for applicants, but there have been similar numbers of applicants receiving their lower choices across both systems.
“There was a slight increase this year from last year in those getting first choice and a slight reduction in those getting next highest choices, but overall it is within a similar range, so the issue of students being placed in parts of the country they consider unsuitable is not new to PIA.
“This system is an improvement on the earlier system but is far from perfect. Engagement from the wider student body is encouraged to address these challenges collectively.”
The UKFPO said: “The delivery of the foundation programme, curriculum and location of posts in Wales have not changed.
“We continue to communicate directly with our future foundation doctors and look forward to welcoming them to Wales in the summer.”
