Head to Head

Should UK medical students be guaranteed a job on leaving medical school? Yes

Authors: Oliver Ellis 

Publication date:  27 Apr 2011

Helen Macdonald ( [Link] ) believes that the NHS is not obliged to provide medical students with a job when they leave medical school, but Oliver Ellis argues that it makes financial sense to ensure that students are guaranteed a place

“Make £££s In Your Spare Time!!! Work From Home!!! Be Your Own Boss!!!”

It’s a common scam. The advertisement promises to teach you how to make loads of money stuffing envelopes in exchange for a “small fee.” You dutifully send off £500 for your training materials, but after that your new employer never seems to have any work available.[1]

Well, it’s your own silly fault for believing something with exclamation marks in it. But you might have been forgiven if the advertisement were on a glossy, government funded website ( [Link] ) and offered to train you as a doctor.

Cheerful indifference

In December it emerged that there were not enough foundation year 1 places for all the medical students who graduated last year.[2] Many have now been given a place, and it is looking like everyone will get a job this time around.[3] But the government body responsible for recruiting foundation year 1 doctors, the UK Foundation Programme Office (UKFPO), has said that, in the future, people graduating from medical school will not be guaranteed a job.[2]

The problem seems to be due to poor planning, misapplication of free market principles, and a cheerful indifference to the plight of students rather than out and out criminality. But the upshot is the same. A proportion of medical students may well be booted out with some nice letters surrounding their name and some great stories about “that time in the dissection room” but in masses of debt and not actually registered as a doctor.

And that is the crux of the issue. When you leave medical school you aren’t really a doctor. The foundation programme is a continuation of the medical course and needs to be completed for full registration with the General Medical Council. It’s a pretty rum deal for trainees to have the rug whipped from under their feet just one year before they complete their training simply because some bureaucrat can’t do decent workforce planning.

It has been argued that other professionals face similar issues; lawyers, for example, aren’t guaranteed a job when they qualify. But this is a red herring. Yes, the various stages of training to be a barrister or solicitor are unpleasant, expensive, and seem almost designed to keep the working classes out, but there’s no reason for this unpleasantness to be foisted on to medics as well.


The UKFPO is fairly unsympathetic. Aside from a bit of hand waving about the lack of jobs being the fault of foreigners in general and the European Union in particular, it protests that “workforce planning can be a tricky business.”[4]

It costs around £200 000 to train each medical student.[5] If the government fails to employ just 10 medical students a year it will be wasting £2m a year. You could certainly hire a lot of workforce planning experts for that.

Two million is pocket change to the NHS, though. The real impact here is a human one. In the light of massively increased tuition fees, an average medical student will be £70 000 in debt when they graduate,[6] far more than other students who studied, say, three years of medical science. You would hope that as a minimum the government would refund the difference to those who don’t get a job.

Deficiencies in workforce planning

Derek Gallen, national director of UKFPO, told Student BMJ that “patients should be assured that the doctors treating them have been selected through a competitive process.”[2]

In other words, to excuse its deficiencies in planning ahead UKFPO is positioning itself as yet another arbiter of fitness to practise. Suddenly it isn’t enough to be judged competent by a medical school and the General Medical Council, you have to be more fit to practise than the person sitting next to you. If you have the misfortune to be in an exceptionally talented batch of students that year—tough.

This is part of a wider pattern of the government messing around with the health service to suit its short term ends and ideological fixations—witness, for example, the alarming lack of specialty trainee 3 training posts in a number of deaneries, which may lead to many skilled trainees leaving medicine altogether.[7] The Department of Health said something similar in this case: “Competition helps to ensure that the best candidates progress in the field.”[7]

A career in tatters

This misplaced faith in competition seems rooted in a faith in the unshakeable supremacy of the markets, a policy that successive governments seem determined to foist on to all aspects of the NHS even when it is clearly inappropriate to do so.

So instead of a fulfilling vocation in public service, tomorrow’s doctors can look forward to a system where their numbers are whittled down as though in an episode of The Weakest Link, their walk of shame a career in tatters.

“Thanks for all your hard work. You leave with nothing. Goodbye.”


  1. Federal Trade Commission. Work-at-home schemes. Facts for consumers.   2010. [Link] .
  2. Zarsadias P. Not enough jobs. Student BMJ   2010;18:c6314. [Link] .
  3. Jaques H. Half of foundation applicants left out for 2011 have now been offered places. BMJ Careers  2 Apr 2011. [Link] .
  4. Moore C, Gallen D. Foundation programme oversubscription. BMJ Careers   1 Dec 2010. [Link] .
  5. Brown CA, Lilford RJ. Selecting medical students. BMJ  2008;336:786. [Link] .
  6. Mashta O. English medical students face £70 000 debt. Student BMJ   2010;18:c6926. [Link] .
  7. Oxtoby K. The new lost tribe. BMJ Careers   7 Oct 2010. [Link] .

Oliver Ellis editor, Student BMJ London, UK


Cite this as BMJ Careers ; doi: