It’s allocation day for junior doctor jobs. Soon-to-be medical graduates across the UK find out what deanery they will work in upon finishing university. While it should be an exciting time for Britain’s future medics, recent changes to the system have sparked outrage as students hoping to work close to friends and family find out they have been sent halfway across the country instead.
Criticism has long been directed at the way in which foundation programme jobs have been dished out. Foundation years 1 and 2 provide compulsory training to graduating doctors, completion of which leaves one a fully registered medic and able to progress further into training. You might expect a medical student to become increasingly excited about their vocation as they near the end of their degree – but an increasingly randomised, UK-wide allocation system has, for many, dulled that enthusiasm.
Once upon a time, medical graduates were able to apply directly to hospitals – often sites where they had gained clinical experience and made professional contacts during medical school – through an informal process sometimes requiring an interview for more competitive roles. Then the system changed to a points-based ranking system, where a complex algorithm was used to rank every final-year student in the UK in order of academic prowess.
During this method, exam results and performance in the now-scrapped Situational Judgement Test (SJT) were analysed to provide an overall score. This was then taken into account when students ranked their workplace preferences, starting with deaneries – England is split into several while Scotland, Northern Ireland and Wales are classed each as one – before receiving their first allocation. The process continues, with students being further allocated to groups within deaneries (e.g. West of Scotland) and then to specific jobs in hospitals.
This was by no means a perfect process. In the year I graduated, the lowest-ranked 800 people were placed on a ‘reserve’ list and were effectively jobless until everyone else had been allocated – despite the NHS facing a workforce crisis and a shortage of doctors in both general practice and hospitals. These people were not failing the degree – in fact, they had progressed to the final year of medical school, with some already having sat and passed their finals.
Now, however, the process has become even stranger. Since 2024, instead of academic grades guiding the process, the SJT has been binned and students are randomly allocated a rank which in turn determines which job they get. ‘The system before wasn’t great,’ a penultimate-year medical student training in London tells me, ‘but now there’s no incentive to aim for anything above a pass in your exams.’ She goes on: ‘I’d like to stay close to where I grew up, but it doesn’t really matter how I rank my choices now – we could get sent anywhere.’
That realisation has led to a feeling of nihilism among current medical students. At universities that offer a six-year degree (which includes an intercalated Bachelor of Science) as compulsory, there is a growing trend of medics opting to leave after achieving their BSc in fourth year. Instead of completing their medical degree, they will pursue jobs in health policy, management or healthcare-related tech startups. There is increasing frustration at the lack of reward work in modern medicine offers – with gruelling hours on understaffed wards and pressure from seniors to fill ever-frequent rota gaps leaving medics feeling disillusioned. Couple that with being sent miles away from a partner, family and friends – with few extenuating circumstances for reallocation – and a sizeable number of the high-achieving cohort are considering abandoning the career altogether.
Today students have taken to X (formerly Twitter) to voice their upset at being sent across the UK, with one ‘heartbroken’ medic slamming the rules changing halfway through their study. ‘When I applied to medical school, the deal was that if you do well then you reap the benefits for your foundation programme,’ they wrote. ‘Changing it over halfway through was unbelievably cruel.’ Another student, who has so far got her first choice of deanery, remains glum about the process, noting: ‘With my grades, I could previously have been pretty sure about getting a good job. Despite the publication of the competition ratios for each area, you have no idea what your rank is. Even if you were to “tactically” rank jobs, you’ve got nothing objective to go off to guide you.’
It’s baffling that the UK Foundation Programme has chosen to run things this way. The NHS is facing a shortage of doctors across all specialties. There are almost 16 per cent fewer fully qualified GPs in the UK, relative to population, than other developed countries – while there has been a decrease in the number of full-time equivalent family doctors. Hospital wards, meanwhile, are overrun, A&E wait times are unacceptably high, and waiting lists remain in the hundreds of thousands.
To stop this worsening – and indeed, if there is to be any reversal of these trends – more doctors are needed in the system. This requires a focus on both recruitment and retention. Medicine is already suffering from a loss of doctors to countries like New Zealand and Australia on completion of FY2. The system must better serve its future doctors if we are to avoid a fresh exodus of graduates.
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