What changes has MMC brought?

Drakethesnake

New Member
I'm a school leaver preparing for an interview and I'm just trying to get a better idea of the new conditions of MMC actually are.
I understand the old way was you applied for a speciality and would generally get it, apart from in very competetive ones. But I can't make sense of the new procedures from their website. Like if you apply for multiple specialities, if you are forced to accept a place you are offered or how much the competition has changed.
Can anyone help me out?
 

James

New Member
Main points:

(i) Medical schools are now producing more doctors than the NHS needs. So a reasonable, and growing percentage of graduates will have to emigrate or not practice as doctors.

(ii) There is currently an oversupply of trainees in some specialities like general surgery, ENT and Opthalmology. Because of this they are reducing the number of training posts for the future.

(iii) It is looking more likely that there will be a 2 teir system of doctors. The lucky few who get training posts and become consultants - and an increasing number stuck in non-training service provision jobs.

(iv) More & more specialities are introducing an exam in F1/2 year to rank candidates and 'cream off' the best.

(v) It is likely to remain that you have one chance to get into specialist training at the end of F2 year and if you mess up your screwed

(vi) With a shrinking number of training posts and increasing number of graduates competition will be fierce - and don't forget this isn't like being top of your class at school - every candidate will have a string of A's at A-level, passed all 5 years of medical school and a good number will have intercalated degrees and publications.

(vii) If you are lucky enough to get into a training post, the chances of it being in your speciality of choice, in the area you want to work is tiny.

(viii) Even if you get into a training post you will spend all your time doing pointless competency based assessments, doing hardly any on-calls (EWTD) and getting paid significantly less than all your friends who got good grades at school.

(ix) Perhaps the most frustrating thing will be the methods MMC uses to select candidates for training posts. Doctors are chosen on their ability to write politically correct mini-stories of patients they have seen - rather than being ranked on achievement or ability (two things medical educationalists lack in abundance).

If I was in your position I would give you one piece of advice - don't do it. Train as a nurse and become a noctor. It is much quicker, you earn more, you have little actual responsibility and as far as the media and public are concerned you can do no wrong.
 

yazoo

New Member
Main points:

(i) Medical schools are now producing more doctors than the NHS needs. So a reasonable, and growing percentage of graduates will have to emigrate or not practice as doctors.
I would agree this is true.

(ii) There is currently an oversupply of trainees in some specialities like general surgery, ENT and Opthalmology. Because of this they are reducing the number of training posts for the future.
Again, agree this is accurate. And historically has been a problem with a wider range of specs - O&G, cardiothoracics...

(iii) It is looking more likely that there will be a 2 teir system of doctors. The lucky few who get training posts and become consultants - and an increasing number stuck in non-training service provision jobs.
Again, I agree. But how relevant is this to the school leaver? The same can be said of most careers. You can be more or less successful. I agree it is a cultural shift, though. Most people expected a decent career from medicine. Now it may be more difficult. But the same can be said for other careers...

(iv) More & more specialities are introducing an exam in F1/2 year to rank candidates and 'cream off' the best.
This would depend on the role of the exam. Sure, to screen out those with no academic knowledge! But beyond a certain point, a range of qualities are required to make up the package that becomes the specialty Dr. There are still interviews that do assess some of these issues - see bleow.
(v) It is likely to remain that you have one chance to get into specialist training at the end of F2 year and if you mess up your screwed.
I disagree with this. Indeed, some of the interviewing schemes used last year - it was suggested that they were developed to favour non-Fy2s. Irrespective of this, I work with a number of individuals admitted to spec training from non-FY2 posts.

(vii) If you are lucky enough to get into a training post, the chances of it being in your speciality of choice, in the area you want to work is tiny.
However, if you are an excellent candidate you will suceed.

(viii) Even if you get into a training post you will spend all your time doing pointless competency based assessments, doing hardly any on-calls (EWTD) and getting paid significantly less than all your friends who got good grades at school.
Rubbish! I'm in one of those posts. I spend most of my time doing on-the-job training work and have do my assessments in my own time! I do a substantial number of on-calls, boosted hugely by locum work that I don't especially want! And it all depends on who your friends are as to what they do and how much they are paid...

(ix) Perhaps the most frustrating thing will be the methods MMC uses to select candidates for training posts. Doctors are chosen on their ability to write politically correct mini-stories of patients they have seen - rather than being ranked on achievement or ability (two things medical educationalists lack in abundance).
Sure. I agree. 1st round screening forms do this. But then the second interview stage is far more relevant. Plenty of consultants support the OSCE style approach of new interviews. Quite a lot of people who have actually been through this style of interview process (e.g. me several time last year) also think the interview style was quite tough and relevant!

If I was in your position I would give you one piece of advice - don't do it. Train as a nurse and become a noctor. It is much quicker, you earn more, you have little actual responsibility and as far as the media and public are concerned you can do no wrong.
Of course, it is worth considering if responsibility and job satisfaction are actually important to you before dismissing it medicine as a career option. I, personally, am glad I have changed career. But then I have something to compare it too...
 

James

New Member
I think it would be more helpful for the original poster if you actually wrote some of your own thoughts on the topic, rather than picking over my post like some sort of literary vulture.



I do disagree with you on two of your 'responces':

I disagree with this. Indeed, some of the interviewing schemes used last year - it was suggested that they were developed to favour non-Fy2s. Irrespective of this, I work with a number of individuals admitted to spec training from non-FY2 posts.


Rubbish! I'm in one of those posts. I spend most of my time doing on-the-job training work and have do my assessments in my own time! I do a substantial number of on-calls, boosted hugely by locum work that I don't especially want! And it all depends on who your friends are as to what they do and how much they are paid...
QUOTE]

Certainly when I applied through MMC strict limits were in place on the amount of experience you were allowed to have when applying for (ST1) training posts. This essentially limited applications to F2s and those with a little more experience only. Although in theory more experienced doctors can apply directly for more sernior traning posts (ST3 etc.) in reality the number of jobs available has been tiny/non-existent.

They are also 'tightning up' the rules on having an up-to-date e-portfolio which becomes more complicated and pointless every year. Those who went to Aus/Nz for a year are now finidng that they are excluded from applying to ST training posts as they don't have the most recent portfolio/competencies.

Over the on-calls - future med students (like the one who posted the original question) will be working in a completely different system to the one we work in. EWTD will be fully inforced, max 48hrs/week, with most of the on-call 'donkey work' (as in the stuff where you actually learn how to look after a patient) will be done by noctors.

I also disagree with your comments over the assessments. In my day (not that long ago!) i would finish my ward work as a houseman then go down to theater to practice central lines with the anaesthatist, or head off to the respiratory ward to put in a chest drain, or go down to MAU to do an LP. There were no stupid forms to fill in, it was simple and easy and you learned on the job. I know of current F2's/ST's who are spending three hours a day filling out the stupid forms.
 

Drakethesnake

New Member
I was expecting a very hostile response to this, because as far as I'm aware the scheme is a pile of s**te. Your responses have left no doubt that it is indeed a pile of crap.
But I disagree with both of you on one point. The NHS needs far more doctors, the demands being set on waiting lists, the overwhelming neccessity for more research to be done and ageing population all combined is causing much more demand for physicians. It's just that the NHS are so screwed they can't do it, so rely on the doctors to deal with it.
Thanks for the information, and giving me a better idea of what my future holds. I am still adiment on becoming a doctor though, even if I have to endure all that.
 

ben_

New Member
I was questioned on the MMC reforms in an interview recently - they asked whether the oversupply of doctors was a good or a bad thing. I told them it was a bad thing for the average medical student, to which they sharply responded "But is it good for patient care?" The answer which I gave - and which I believe to be the one they wanted to hear - is yes.

If there is more choice between medical graduates then you have another stage of selection for quality rather than simply employing everyone who made it through medical school. This sucks for doctors but in terms of providing the best patient care I think it is tough to fault.

(NB: This only holds true if the selection procedure does select for quality. Obviously, this is debatable)

So to the OP - don't make the mistake of looking at this purely from the doctor's point of view if you are asked this in interview
 

yazoo

New Member
I think it would be more helpful for the original poster if you actually wrote some of your own thoughts on the topic, rather than picking over my post like some sort of literary vulture.
Overall, I thought you gave a reasoanble appraisal and therefore I attempted affirm my own thoughts and disagree where appropriate (for me!). Hence I did indeed write my own thoughts, you simply provided a structure. So again we disagree. Quel suprise....

I do disagree with you on two of your 'responces':
why don't you simply point out the typo! Maybe you thought I wouldn't notice the undertone...


Certainly when I applied through MMC strict limits were in place on the amount of experience you were allowed to have when applying for (ST1) training posts. This essentially limited applications to F2s and those with a little more experience only. Although in theory more experienced doctors can apply directly for more sernior traning posts (ST3 etc.) in reality the number of jobs available has been tiny/non-existent
.

As I said above, I know who I work with. I guess the system is still suiting itself!

They are also 'tightning up' the rules on having an up-to-date e-portfolio which becomes more complicated and pointless every year. Those who went to Aus/Nz for a year are now finidng that they are excluded from applying to ST training posts as they don't have the most recent portfolio/competencies.
Again, know people who put time and effort into duplicating the foundation assessments. They got jobs if they were decent applicants - in my experience.

Over the on-calls - future med students (like the one who posted the original question) will be working in a completely different system to the one we work in. EWTD will be fully inforced, max 48hrs/week, with most of the on-call 'donkey work' (as in the stuff where you actually learn how to look after a patient) will be done by noctors.
Perhaps you are unaware that 1A has a high proportion of OOH on-call committment (rubbish shift-work pattern, I acknowledge). It is EWTD compliant but with a high proportion of anti-social hours (and therefore on-call). If you sit down and discuss this with people who worked the 100 hour weeks, they agree currently the intensity of work is now much greater. So direct hour comparisons are invalidated.


I know of current F2's/ST's who are spending three hours a day filling out the stupid forms.
The perhaps you should direct them to their educational supervisors. This is not necessary.

COI: I have just finished yet another very busy w/e on-call!
 

yazoo

New Member
I was questioned on the MMC reforms in an interview recently - they asked whether the oversupply of doctors was a good or a bad thing. I told them it was a bad thing for the average medical student, to which they sharply responded "But is it good for patient care?" The answer which I gave - and which I believe to be the one they wanted to hear - is yes.

If there is more choice between medical graduates then you have another stage of selection for quality rather than simply employing everyone who made it through medical school. This sucks for doctors but in terms of providing the best patient care I think it is tough to fault.

(NB: This only holds true if the selection procedure does select for quality. Obviously, this is debatable)

So to the OP - don't make the mistake of looking at this purely from the doctor's point of view if you are asked this in interview
I am sure this is the answer they expected. And I agree with the point that you made. However, quality patient care also relates to morale in the work place. It is quite stunning how much difference a great team morale makes to patient care when compared to units with the direct opposite. Having lots of disatisfied Drs is not good for patient care.

Another point which I feel is important is a disincentive for ambitous young people to apply for medicine. Medicine needs these people just as it needs the less ambitous work-horses with a genuine passion for patient care but no desire to change the world.
 

James

New Member
As I said above, I know who I work with. I guess the system is still suiting itself! Again, know people who put time and effort into duplicating the foundation assessments. They got jobs if they were decent applicants - in my experience.
Entry requirements

"Possession of Foundation Competence is essential for successful applicants to cope with and proceed successfully through GP Specialty training. It is crucial that this is evidence of current competence rather than historical evidence, as any competency must be sustained to be useful, and to act as a firm foundation for GP Specialty training. It is not sufficient to have achieved each competency once. Competencies must be achieved, maintained and demonstrated."

Read it carefully, they are limiting places to F2 graduates as no-one else will have 'current' foundation competences. This is relevent to next year and future years (ie. for the original poster), I don't see how the doctors you currently work with, and how they recruited last year have a bearing on this point.



Perhaps you are unaware that 1A has a high proportion of OOH on-call committment (rubbish shift-work pattern, I acknowledge). It is EWTD compliant but with a high proportion of anti-social hours (and therefore on-call). If you sit down and discuss this with people who worked the 100 hour weeks, they agree currently the intensity of work is now much greater. So direct hour comparisons are invalidated.
As someone who used to work a 120 hour 1:4 on-call week for my surgical house jobs, and currently both works and works with doctors on a 'modern' rota I really don't think I need to sit down and 'discuss' this point with someone else.

Your point about intensity of work will of course vary across jobs, but in my experince it is simply wrong. When I did housejobs there were no phlebotomists or noctors, you did your own bloods, venflons, drug re-writes, warfarins, fluids for every patient. If I needed a platelet or blood transfusion out-of-hours I needed to go down to the lab, defrost the platelets myself then start the drip myself. I used to have to make up and give the first dose for any IV antibiotic in the hospital when on-call. I needed to do my own ECG's. My SHO would sit in the mess and refuse to help with anything other than the most dire medical emergency. The medical registrar was on-call from home and never came in overnight. Need I go on....

I don't get your point about a 1A rota. You are working a maximum of 48hrs per week (on average). Most jobs in the pre-MMC system were 2A or band 3 (mine were).
 

yazoo

New Member
Entry requirements

"Possession of Foundation Competence is essential for successful applicants to cope with and proceed successfully through GP Specialty training. It is crucial that this is evidence of current competence rather than historical evidence, as any competency must be sustained to be useful, and to act as a firm foundation for GP Specialty training. It is not sufficient to have achieved each competency once. Competencies must be achieved, maintained and demonstrated."

Read it carefully, they are limiting places to F2 graduates as no-one else will have 'current' foundation competences. This is relevent to next year and future years (ie. for the original poster), I don't see how the doctors you currently work with, and how they recruited last year have a bearing on this point.
If only you had taken your own advice... If you scroll down just a few paragraphs from the website section that you quote you will find a section titled: “Demonstrating Achievement of Foundation Competency”. This clearly states alternative methods of achieving competencies to the foundation route.
As someone who used to work a 120 hour 1:4 on-call week for my surgical house jobs, and currently both works and works with doctors on a 'modern' rota I really don't think I need to sit down and 'discuss' this point with someone else.
One would have hoped there was no scope for debate, but I do wish to point out to people reading this forum that just because you are a reg your advice is not necessarily 100% correct. I cite the point above, or the issue of people spending 3 hours a day filling in forms as 2 examples (I note you didn’t reply to my point in relation to that – but then even common sense would dictate that is not what should be required).

Your point about intensity of work will of course vary across jobs, but in my experince it is simply wrong. When I did housejobs there were no phlebotomists or noctors, you did your own bloods, venflons, drug re-writes, warfarins, fluids for every patient. If I needed a platelet or blood transfusion out-of-hours I needed to go down to the lab, defrost the platelets myself then start the drip myself. I used to have to make up and give the first dose for any IV antibiotic in the hospital when on-call. I needed to do my own ECG's. My SHO would sit in the mess and refuse to help with anything other than the most dire medical emergency. The medical registrar was on-call from home and never came in overnight. Need I go on....

I don't get your point about a 1A rota. You are working a maximum of 48hrs per week (on average). Most jobs in the pre-MMC system were 2A or band 3 (mine were).
Quel dommage!

As you say, you don’t grasp the bit about on-call and the 1A rota. One can work a 1A and a 2A and still do the same amount of on-call. I know as I have worked 1A and 2A rotas. (For others reading, this works as there are compensatory days off mid-week to make the post EWTD compliant (I would cite the BMA website link to the junior Drs handbook for evidence, but you need to be a member to access it.) So you do the same out of hours commitment, which is mainly where you learn to be more independent as a junior or middle grade Dr.

When I did housejobs there were no phlebotomists or noctors, you did your own bloods, venflons, drug re-writes, warfarins, fluids for every patient. If I needed a platelet or blood transfusion out-of-hours I needed to go down to the lab, defrost the platelets myself then start the drip myself. I used to have to make up and give the first dose for any IV antibiotic in the hospital when on-call. I needed to do my own ECG's. My SHO would sit in the mess and refuse to help with anything other than the most dire medical emergency. The medical registrar was on-call from home and never came in overnight. Need I go on....

Personally, having had jobs where I acted as my own phlebotomist, and I can see some benefits to juniors doing repetitive tasks, but they aren’t necessarily benefits that relate to training, more to patient care. The junior Dr still has to interpret the ECG and act on it, take the difficult bloods etc etc.

I agree that job intensity varies. But an FY2 doing an A&E or acute medicine job will know that you work when you are there - frequently 13 hours with no break if it’s busy (and it generally is with rotas running short all over the country). Yes, you eat and drink, but while working (e.g. while writing a Kardex for a new admission, or writing in the notes). If you speak to people who have worked 120 hour jobs they will tell you didn’t work every hour of your 120 hours a week. Maybe James won’t agree that he slept for the odd hour during his 120, but speak to other people who did. I can’t answer this personally, but speak to the current consultants – they will tell you how it was…

Clearly, people worked longer hours in the past. I am not debating that. I believe what I actually said was: "direct hour comparisons are invalidated".

So to quote James:

Need I go on....

Incidentally, I have no intention of doing so unless James comes back with a reply which I think is wrong…
 

alex MD

New Member
But I disagree with both of you on one point. The NHS needs far more doctors, the demands being set on waiting lists, the overwhelming neccessity for more research to be done and ageing population all combined is causing much more demand for physicians. It's just that the NHS are so screwed they can't do it, so rely on the doctors to deal with it.
Disagree with you there, the NHS doesn't need far more doctors. The immense waiting lists are due to the sheer number of patients requiring procedures. If, like you suggest, more doctors are needed, than surely more hospitals need to be built for these doctors to work there and hence reduce the waiting lists by carrying out more procedures. I could be wrong, but I don't think the huge waiting lists are due to a shortage of doctors.
 

ben_

New Member
I am sure this is the answer they expected. And I agree with the point that you made. However, quality patient care also relates to morale in the work place. It is quite stunning how much difference a great team morale makes to patient care when compared to units with the direct opposite. Having lots of disatisfied Drs is not good for patient care.
I agree with this, but I think the overall benefit of selection probably outweighs the negative effects of stress and worry over not getting selected. This can't really be proved either way, though.

Another point which I feel is important is a disincentive for ambitous young people to apply for medicine. Medicine needs these people just as it needs the less ambitous work-horses with a genuine passion for patient care but no desire to change the world.
Of course - but I'm not sure how selection post-foundation would discourage the ambitious.
 

ben_

New Member
Disagree with you there, the NHS doesn't need far more doctors. The immense waiting lists are due to the sheer number of patients requiring procedures. If, like you suggest, more doctors are needed, than surely more hospitals need to be built for these doctors to work there and hence reduce the waiting lists by carrying out more procedures. I could be wrong, but I don't think the huge waiting lists are due to a shortage of doctors.
The huge waiting lists are due to a historic problem with the NHS and socialized healthcare in general - namely, a finite supply (of professionals and resources) is expected to match effectively infinite demand (for medical treatment).

Cost can't play a factor in reducing demand because we don't charge at the point of delivery. Absent this limiting factor, demand will continue to grow with both the population and their expectation of what the health service will do for them. We've seen a local example of this recently with the cancer drugs issue.

The NHS will never have enough resources because there is no constraint for demand on its services. Without reform, waiting lists are here to stay.
 

yazoo

New Member
I agree with this, but I think the overall benefit of selection probably outweighs the negative effects of stress and worry over not getting selected. This can't really be proved either way, though.
It's not the stress and worry of not getting selected, it's the disillushionment of ending up in a staff-grade job, possibly in a less popular specialty that you don't especially want to work in. And not having any promotion prospects. This then acts as a deterrent to

vvvvvv

but I'm not sure how selection post-foundation would discourage the ambitious.
 
It's not the stress and worry of not getting selected, it's the disillushionment of ending up in a staff-grade job, possibly in a less popular specialty that you don't especially want to work in. And not having any promotion prospects. This then acts as a deterrent to

vvvvvv
And this is what Tooke tried to address in his report by talking about the need to destigmatise staff grade careers. In theory, there is no reason that staff grades should have "no promotion prospects". Indeed, a proportion of people gear their career towards the "Associate Specialist" route and then make it to consultants. So there is scope for someone who steers his career properly. The main problem is that it relies mainly on two things:

1 - Local trusts/employers making an effort to create proper jobs with prospects (and not slave jobs to address short term targets)
2 - Good consultant who pay an interest into the development of their staff.

Both are rare. So the government's strategy on the whole seems right, but it is the way that it is applied by the trusts which is wrong. Hence why you all disagree. You are in fact all right but the problem needs to be seen from different perspectives.

It is also fair to say that there are many trainees who fancy themselves as future consultants but in reality don;t have what it takes to make it. I am sure you have all met some. Surely this is an argument for not having an automatic entitlement to a senior post.
 
The huge waiting lists are due to a historic problem with the NHS and socialized healthcare in general - namely, a finite supply (of professionals and resources) is expected to match effectively infinite demand (for medical treatment).

.
Obviously true, but there are also other factors which the govnt has tried to address (and I do stress "tried" because we won't really know for a long time whether this is positive or not". For example:

1 - Some consultants do not have an incentive to clear waiting lists. Keeping cararact surgical lists with high waiting lists made it easy to justify the need for a private practice. You get paid the same for working harder on the NHS, so you might as well get more money by doing it privately. This has been addressed by introducing the private sector into the equation to reduce waiting lists.

2 - Part of the problem was that the majority of waiting lists related to simple cases which always got deferred or postponed because theatres were clogged up by overrunning complex cases or emergencies. So one solution was to isolate the easier cases in separate hospitals (sometimes private) to just get them done without interference.

Again, both make sense on paper, but then they create other issues, like: if we ensure numbers are done, can we really ensure quality too?
 

chris5656

New Member
It is also fair to say that there are many trainees who fancy themselves as future consultants but in reality don;t have what it takes to make it. I am sure you have all met some. Surely this is an argument for not having an automatic entitlement to a senior post.
It think this is an important point. Without wanting to moan and back stab too much, there are some people at my med school who i wouldnt want coming anywhere near me if i was ill (yes, i know they/we are a long way away from being consultants, but still....). There are plenty of good, competent people here too, but there were also plenty of competent people on my last course (economics) and they are not promised a 90K consultant position after so many years working.

What needs to change is the perception that going to medical school will guarantee you 120 hr weeks as a jnr but the reward of a consultant position. It seems like medicine is heading towards becoming more like other profesional careers - normal working hours, and career progression for those who deserve it.
 
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