Unemployment after FY2
Dear Friend,
Greetings from San Francisco this week. I promise this is my final holiday of the summer—still making the most of that post-IMT sense of freedom.
Over the past few days, it’s been heart-warming to see so many LinkedIn posts from newly graduated doctors starting their first days on the wards. Many FY1s have just completed their first year in practice and are now rotating into new teams and specialties.
But one LinkedIn post in particular stopped me in my tracks. It was written by a resident doctor who had just finished FY2—and it was a stark reminder of the state the NHS finds itself in. Here’s what they wrote:
*”I’m unemployed.
I never thought I’d write these words.I’d say I have the best job in the world—but I don’t have one. When you’re next frustrated you can’t see a GP (family doctor) or the waiting list is years long, please don’t blame doctors. Chances are, we have friends or family on that list, too. We want to help—but we’re unemployed.”*
Alarming Unemployment After FY2
This story isn’t an isolated case. According to a recent BMA survey, more than half of FY2 doctors have no job lined up for next month.
Of the 4,401 doctors surveyed, 1,062 were in FY2. 52% of them reported having no substantive post or regular locum work from next month. Across all respondents, the figure was still striking—34% said they had no work lined up.
Not Enough Training Places
One of the main drivers of this crisis is that training posts have not expanded in line with the significant increase in medical school places. While we are producing more medical graduates—who are guaranteed two years of work through the Foundation Programme—there simply aren’t enough jobs for them beyond FY2.
The result? Hyper-competitive specialty training applications. This year, the overall competition ratio for specialty training was 4.68 applicants per vacancy (4.68:1). In some specialties, the figures were staggering—112.13 applicants for a single post (Medical Specialty Recruitment, NHS England).
Even non-training “clinical fellow” posts are now fiercely contested. I recently saw a Clinical Teaching Fellow role with just 7 vacancies attract over 1,300 applications—a ratio of 185.71 applicants per post (185.71:1).
Competition from IMGs
I’ve written before about the impact of International Medical Graduates (IMGs) on job competition. This is nobody’s fault—it’s simply the reality of a global medical workforce—but it does mean that UK graduates are now competing with even more highly qualified doctors from around the world.
For certain specialties, such as GP and psychiatry, shortlisting is based solely on an exam score, with no interview stage. This means that, theoretically, doctors can secure a training post without having ever worked a single day in the NHS.
What This Means
For many doctors finishing FY2, the options are bleak:
Pick up irregular locum shifts here and there
Relocate far from home to find substantive work
Emigrate to countries offering better job security and pay
Leave the profession altogether
I personally know colleagues who have chosen each of these paths.
The toll on wellbeing is significant. Rates of psychiatric morbidity—including anxiety, depression, burnout, and stress—among UK doctors range from 17% to 52%, compared with 21% in the general UK population (BJPsych Bulletin, 2017). Poor mental health is a major factor driving doctors abroad in search of careers where they feel valued and where caring for others does not come at the cost of their own wellbeing.
Summary
Normally, I end my newsletters with a positive action point or some advice. This time, the only silver lining I can see is that the BMA has recognised the problem and has formally raised it with the government as part of ongoing disputes. However, to date, there has been no substantial progress.
Let’s hope the coming years bring real change—otherwise, we may see even more UK-trained doctors packing their bags for Australia and New Zealand.
Drug of the week
Acetaminophen
This is the American name for paracetamol.
It is a non-opioid analgesic and antipyretic agent used to treat fever and mild to moderate pain.
Paracetamol appears to exert its effects through two mechanisms: the inhibition of cyclooxygenase (COX) and actions of its metabolite N-arachidonoylphenolamine (AM404).
Paracetamol is close to classical nonsteroidal anti-inflammatory drugs (NSAIDs) that act by inhibiting COX-1 and COX-2 enzymes and especially similar to selective COX-2 inhibitors.
Paracetamol inhibits prostaglandin synthesis by reducing the active form of COX-1 and COX-2 enzymes.
AM404 is a weak agonist of cannabinoid receptors CB1 and CB2, an inhibitor of endocannabinoid transporter, and a potent activator of TRPV1 receptor.
A Brain Teaser
A 34-year-old man with schizophrenia is detained under Section 2 of the Mental Health Act (MHA) for assessment. He has been assessed as having capacity and refuses antipsychotic medication, stating that it conflicts with his personal beliefs. However, over the past 24 hours, he has become increasingly agitated, pacing the ward, shouting at staff, and refusing food and fluids.
What is the most appropriate course of action?
A: Administer antipsychotics under the Mental Capacity Act
B: Administer antipsychotics under the Mental Health Act
C: Discharge the patient as he has capacity and refuses treatment
D: Seek a second opinion to override the patient’s refusal
E: Treat the patient under common law as an emergency
Answers
The answer is B
Administer antipsychotic treatment under the Mental Health Act (MHA) is correct because patients detained under Section 2 of the MHA can be treated for a mental disorder — even if they have capacity — if treatment is deemed immediately necessary to prevent deterioration or harm. In this case, the patient is refusing medication, and his condition is worsening, with behavioural signs that pose a risk to himself or others. The MHA takes precedence over the MCA in such cases. It is essential to document the clinical rationale and ensure that treatment decisions are regularly reviewed.
Administer antipsychotic treatment under the Mental Capacity Act (MCA) is incorrect because the MCA applies only to individuals who lack capacity. Since the patient has capacity and is detained under the MHA, treatment decisions must follow the MHA framework. The MCA cannot be used to override capacitous refusal in detained patients.
Discharge the patient as he has capacity and refuses treatment is incorrect because the presence of capacity does not prevent treatment under the MHA when the patient is detained. The law allows treatment to proceed in order to prevent deterioration, and discharging the patient would place him at further risk.
Seek a second opinion to override the patient’s refusal is incorrect because a Second Opinion Appointed Doctor (SOAD) is only required after three months of continuous treatment under Section 3, not Section 2. However, seeking an informal second clinical opinion may still be good practice if there are concerns or disagreements.
Treat the patient under common law due to an emergency is incorrect because the common law is used only when there is no applicable statutory framework available. Since the patient is already detained under the MHA, which provides a legal basis for treatment, there is no need to invoke common law in this scenario.
