NHS workforce

DAUK supports this expansion, and recognises the importance of investing in the next generation of the NHS workforce. However, this positive development comes against a backdrop of growing concern. Without robust, forward-thinking workforce planning, many of these students risk entering a healthcare system already buckling under immense strain. For the third consecutive year, almost 700 final-year medical students were allocated ‘placeholder’ roles through the UK Foundation Programme. This recurring issue represents a serious structural failure in how we allocate and support our new doctors.

Bottlenecks

The challenges extend well beyond the Foundation Programme. Specialty training remains heavily bottlenecked, with thousands of junior doctors each year unable to progress due to a shortage of training posts and a lack of a consistent, strategic workforce strategy. Many are left disillusioned – forced to delay their careers, seek alternative routes, or even consider leaving the NHS entirely. The NHS cannot afford to continue losing talented and committed future doctors.

Urgent reform

Urgent reform is needed: transparent workforce planning, expanded training capacity, and meaningful investment in career progression for junior doctors. We are frustrated that this is the current reality of our profession. But to every new student starting this September: we stand with you, we thank you for your commitment, and we remain hopeful that the profession you inherit will be in a better place than it is today. Medicine is and always will be an incredibly rewarding career. We hope that – with the right reforms – it will be a sustainable and fulfilling one for you and for generations to come.

Our student committee members are all volunteers and speak about issues facing frontline doctors in their own time. Please support our work by joining DAUK or donating to our our GoFundMe.

Trish Suji:

It is daunting to imagine how much higher the competition ratios will reach by the time of my cohort’s applications. We have all heard from doctors on placement that have not got into training. Instead, they have found a job in Australia or one of the few junior fellow jobs in the UK. The same is true on Instagram or X – all over the country. I am in my final year, and barely a week after final results were released, discussion of the next worry began; unemployment after Foundation Year 2 (FY2).

Speciality training

I am aware that competition ratios are not always what they seem as many candidates apply for multiple specialities. However, the scoring matrices for training with high cut-offs are a difficult, and sometimes expensive, goal to reach by FY2. Many foundation doctors and core training doctors on placement have urged my friends and I to start working towards goals that will win points in applications, as early as the third year. This has also meant that having just sat finals, some of my peers immediately began discussion on post-grad exams for points.

Bottlenecks

There is an element of fear that needs to be addressed. I think informal talks by the royal colleges on speciality applications aimed at clinical/ final year medical students in the UK to explain the competition ratios would be a good idea. This would allow us to ask questions about becoming a competitive candidate and how to plan and what to do if we don’t get into training. The royal colleges would also hear more final year voices on the national feeling of their future in medicine. For now I am going to do my best at becoming a competitive candidate. But, I will also try to find out more on the next steps if I am not successful first time around.

Alyx Douglas:

The increasing competition for speciality training posts in the UK is leaving many doctors without a clear career path, forcing them into jobs they never intended to pursue, or out of work altogether. New medical graduates face immense pressure knowing that, just two years after qualifying, our future could be determined by a system that lacks sufficient training opportunities.

Relocation

Many specialities require relocation, but financial, personal, or visa-related constraints make this unfeasible for some, effectively shutting them out of their chosen careers. As a result, a growing number of UK-trained doctors are moving overseas, uprooting their entire lives just to escape a system that fails to support them. Countries like Australia and Canada offer better pay, working conditions, and structured training pathways, making emigration an increasingly attractive option. This only worsens the NHS workforce crisis, as more doctors leave while shortages persist.

Sense of dread

As medical students, we enter the profession with a sense of dread, fearing that after years of hard work, we may find ourselves in limbo — unable to secure training in our chosen field or forced into roles that don’t align with our passion. Without urgent reforms — such as increasing training posts, improving regional flexibility, and addressing workforce planning failures — the NHS will continue losing dedicated doctors to burnout, disillusionment, or emigration.

Anish Malik:

Receiving a letter of acceptance to medical school is not only a proud moment for prospective medical students, but also for their parents and family. The pride of the parents stems from the efforts of their child to get in, the prestige associated with the profession, and the knowledge that their child will have a secure and prosperous future. However, this does not seem to be the case anymore. Now, after five years of medical school and two years of foundation doctor training, the future of every doctor applying to speciality training has become uncertain.

Training places

While many specialities are crying out for more specialists to improve their service, impossibly, the doctors applying to train in these areas are being rejected, with training places remaining stagnant. The supply of doctors can be available to meet the demand for services, but it is not as they are not being allowed to train. The cohort of doctors applying to speciality training is larger than the number of training places available. As a final year medical student, who will be in this position in two years’ time, it does not inspire the hopeful future which was once promised. Instead it introduces questions of uncertainty. Many of my peers are planning a life outside of medicine past FY2.

Secure future

Others plan to continue their medical journey abroad despite the money the UK has spent on their training. These two avenues now provide more of a secure and prosperous future than being a doctor in the UK. The remainder of my colleagues will compete with international graduates to tackle the current system, but with unknowns about their future careers.

Maya Machesney:

Reaching speciality training is a feat in itself. Medical students are forced to rely on a random ballot-generated ranking to decide their fate, facing the uncertainty of being sent anywhere across the country. This can mean being separated from family, friends, and the support systems we’ve built, becoming junior doctors far from home, at a time when stability matters most.

Medical training

With so much uncertainty and personal sacrifice embedded into medical training, one thing must remain non-negotiable: the right to pursue our chosen career path. And yet, even this is being steadily undermined. Despite growing and urgent demand for doctors across many specialities, increasing numbers of junior doctors are being left without training posts, or are forced to consider leaving the UK altogether to achieve their aspirations. From the early years of medical school, we are encouraged to plan meticulously for our futures. But we are building up portfolios for specialities we have no guarantee of securing.

Competition

This culture of constant competition only fuels anxiety, especially when there is no guarantee efforts will lead to the roles some have spent years preparing for. We have all invested so much in this profession – emotionally, financially, and personally. We need evidence that our faith in the system has not been misplaced. It is time our dedication and commitment is reflected back in a fairer, more supportive system.

Meaningful reform

The DAUK medical student committee is calling for urgent and meaningful reform:

• Immediate expansion of speciality training posts in line with workforce demand and future NHS needs.
• National standardisation of portfolio requirements across specialities, to ensure fairness and clarity.
• Protect career progression for doctors taking time out of training.
• A published, accountable roadmap for workforce reform, showing how the Government and NHS bodies will meet current and future demand.

Please support our work by contributing to our crowd funder or by becoming a member.

Student protests

Students have expressed fear of being penalised for engaging in activism, with one participant explaining: “I always felt that, as a medical student, partaking in activism was going against the standards that we are expected to adhere to.” Some students have voiced concerns that their involvement in political activism may be seen as ‘unprofessional’, and there is growing anxiety over professional consequences. One student said: “My medical school would consider it unprofessional. They have said doctors should be apolitical.” Another student expressed fear about potential retaliation from the General Medical Council (GMC), citing the suspension of doctors involved in climate action groups such as Just Stop Oil. The overarching sentiment among students is that their right to protest is not adequately protected.

Right to protest

As one student noted: “The university has not gone out of its way to ensure our rights to protest are protected.” As activism in the UK increasingly faces criminalisation, medical students feel their voices are being silenced. One student shared their anxiety about the potential impact on their future career: “Protest is being increasingly criminalised in the UK and we are a highly regulated profession (GMC).” Another reflected on the fear of prejudice from university staff, stating: “The stigma and prejudice staff of the medical school will hold against me and may use to influence results when sitting exams.” A particularly concerning comment came from a student who said that ‘on pro-Palestine marches, people were being threatened with expulsion’.

Solidarity

The Doctors’ Association UK (DAUK) stands in solidarity with medical students, advocating for the protection of their right to protest and express their political beliefs without fear of professional retribution. The ability to stand for justice, human rights, and humanitarian causes is integral to the ethos of medicine, and it is imperative the medical profession supports its students in doing so. Medical schools must provide clear guidance on how students can appropriately express their political and social views without risking professional repercussions. With increasing instances of humanitarian events and global unrest, medical schools should take a proactive stance on educating their students on how to advocate for causes important to them, while ensuring their professional standards on protest are relevant and fit for the modern day. Please support our work by contributing to our crowd funder or by becoming a member.

Picture credit: Markus Spiske on Unsplash

Hottest year on record

It’s official. 2024 was officially the hottest year on record, breaching for the first time the 1.5C threshold set by the Paris Climate Agreement. Stable weather patterns we have taken for granted for millennia are breaking down before our eyes and we are seeing the effects of this in the UK and globally. Last year gave us widespread flooding in north and south Wales, Manchester, Shrewsbury, Worcester, Loughborough, West Sussex, the Isle of Wight, Dorset, Newcastle, Surrey, Oxfordshire. Just about every region in the UK experienced severe flooding and storms.

Climate change

The increased severity of weather is human-caused climate change through the burning of fossil fuels. And this is just the beginning. We will experience stronger storms and worse flooding in the years to come. The Californian wildfires demonstrate the strength of the natural forces around us and the futility of our actions when faced with the impacts of climate change. During 2024, wildfires in Greece, Portugal, Turkey, Brazil, New Zealand, and other countries caused immense damage. For many people, they brought the climate crisis even closer to home. What we have previously viewed as ‘normal weather’ is rapidly disappearing.

Rising temperatures

And as we continue to emit more carbon from fossil fuels than we absorb, global temperatures will continue to rise. Catastrophic weather events will increase in frequency and intensity. They will affect our food production, our public services and our health. 2025 can be the year the UK shifts the dial on climate change action. In addition to the Government’s Net Zero commitments, we must go further and faster to secure a liveable future. Legislatively, we must pass the Climate and Nature Bill, to lock into law a commitment to restore nature by 2030. Nature is our greatest ally in reducing carbon emissions. We must help it to help us all. The second reading of the bill is on 24 January and we urge everyone to contact their MPs to ask them to attend.

Public health

Furthermore, we need a public health awareness campaign on the climate crisis. The UK public needs to know why we have to take stronger and more urgent climate action, in the same spirit as highlighting the importance of wearing masks in the pandemic. We urge the Government to work with healthcare professionals to make this happen. Our Health, Our Planet is already having an impact in raising this awareness. We welcome discussions with national and devolved governments on the use and amplification of the resource to raise awareness to everyone what climate change means for our health, and what we must do to secure a safe and liveable future for all. Please support our work by becoming a member or donating to our Go Fund Me.

DAUK’s Dr Ellen Welch and Dr Katie Sanderson write in the BMJ.

For months now, it has been the norm in primary care to speak with patients calling to discuss their new coughs and fevers, and to be greeted with surprise and often outrage when a covid test and household isolation are suggested. “I know it’s not covid” or “I always get a cough at this time of year” are the commonest protestations, alongside the belief that an intact sense of smell invalidates all the other symptoms. After the well-rehearsed debate is over, what follows is typically an unconvincing agreement to follow the government advice, which inspires zero confidence that this will actually happen.

Meanwhile, on the wards, a similar narrative occurs while checking that the relatives of covid-19 patients are isolating. The response is often simply: “I can’t isolate”, with financial hardship acknowledged as the main influence. While we are sympathetic to this situation, there remains a profound lack of understanding about this disease, despite its omnipresence in our lives. The many patients dying of covid-19 in hospital invariably all ask: “How did this happen to me?”

The general public cannot be criticised for these misperceptions, since the guidance from the government throughout this pandemic has been confusing, ambiguous, and inconsistent, often changing at the last minute. The lack of financial support for those needing to self isolate has left some people unable to follow the guidance for fear of financial hardship or ruin. Instead of following the lead of countries like Australia, who isolated and tested anyone presenting with any upper respiratory symptoms (including rhinorrhoea and pharyngitis ), here in the UK clinicians have been forced to have daily disputes with patients about the nature of their cough, while ignoring patients who present with snotty noses and sore throats as these symptoms somehow aren’t included as covid-19 in the UK.

Read the full article here: https://blogs.bmj.com/bmj/2021/02/05/we-urgently-need-to-double-down-on-the-basics-if-we-are-to-find-a-way-out-of-lockdown/

Starting medical school in 2008 felt like a dream. I can’t say that it was a lifelong dream though. You see, I didn’t grow up wanting to be a doctor. Trudging through the pits of depression, anxiety, and agoraphobia through law school led me to medicine. Back then, my interests faced inwards. However, confronting myself emotionally made me realise that service is important. Medicine is how I chose to live out that value.

While the first and second year of medical school was a blast in every way, the third year whiplashed me into a stormy path to learn some hard lessons. I had a car accident. Worse yet, I sustained a spinal cord injury and quadriplegia.

Despite all this, I still love life. I’m grateful for everything that I have. This includes some of the intricacies that such an injury bestows on life. 

I was in New York during a December. Coming from Australia’s hot summer, this was a chilly change. Thanks to the condition that changes the body’s response to thermoregulation, I wandered around shivering in New York looking like a well-wrapped ninja stopping occasionally for hot water. These are things that few people realise about a spinal cord injury. Not even I understood what was to come when I woke up on an intensive care bed in 2010. Apart from the very dramatic changes physiologically, life suddenly changed socially as well. We lost money, friends, and family. My own family, which was once a warm fortress of safety, fell apart. What was left was mum and me. I often felt physically and figuratively naked.

Being a patient was tough. I watched medical students do ward rounds on me, addressing me clinically. I rarely felt like a person. There were harsh doctors. There were encouraging doctors. There was a loss of autonomy and empowerment. For months, I didn’t even choose when I showered or ate.

In that hospital was a nurse who was oddly particular about cleaning the male patients’ privates. While one was chilling out in the ward waiting for the day’s therapies, you would often hear this nurse’s booming voice rolling down the corridor. If you were unlucky enough to remain in their path, the inevitable question came. “Have you cleaned your little man today?”, they would say. Regardless of the answer, you would be dragged off to the bed to have the little man cleaned.

With an unusually clean little man, five years went by. I slowly put life back together and plotted the never-ending dream of coming back to medicine. Some said that I shouldn’t do it. Some of my best friends talked about the challenges that would lie ahead and encouraged me to pursue another path. They wanted me to avoid the pain.

This was a time that I remembered the very thing I understood during that time in law school. When we come to the end of our life, no one else will be accountable for the choices we made. If I didn’t give medicine a try, I would regret it forever.

My mum and I, with the support of a forward thinking medical school, came back in 2015. I started life again in Gold Coast, Australia with nothing. We had a couple of bags, a broken wheelchair and some borrowed furniture. I spent weeks in the medical school’s clinical skills lab with a supportive general practitioner, school staff, and a simulated patient learning how to do a physical examination again. This time, I had to think laterally about achieving the same clinical outcome through different physical means.

I figured out how to do most things. I put my head down in a way that I never have before. The injury has forced me to focus my head more. I passed exams and started proving that this can be done. Perceptions however, were still adversarial.

I became privy to a disturbing email circulated on 14 October 2015. In the email, an academic stated that they had developed national inherent requirements for medical students. The academic, who knew me, wrote, “we should refer to them if we are making any difficult decisions about candidates’ suitability to enter or remain in the MD.  They do not bind us to exclude anybody but it is hoped that they will provide some legal protection where we do have to make the difficult decision that a candidate’s disability cannot reasonably be accommodated to enable them to study medicine.” Reading these words was nauseating. By this point, I’d gone through many clinical rotations successfully. Why was there suddenly policy that allowed schools to prevent people like me from study medicine?

I read through these inherent requirements. They prescribed physical qualities that would surely exclude me from going through medical school. Fortunately, I wasn’t affected by and graduated in 2016.

Then, another challenge came. In our state, domestic graduates are guaranteed internships. I also had a contract with the Health Authority that bound me to work for them for five years after graduating. Nonetheless, my application was removed from the pool to be “considered separately in a bespoke process”. As the opaque process dragged on, I asked more questions. At one point, I was told that I wouldn’t be starting work with my colleagues and was offered free psychological support instead of a job. After going through the rigours of a spinal cord injury and depression previously, psychological support was not what I wanted. I wanted to work.

I had a lot of supporters in the community, doctors, media and politicians. Emergency physicians in our department even offered to give up some of their salary to fund my position. Thanks to everyone, I was offered a job at the twelfth hour and I started work in 2017.

I have loved every minute of this job. It’s everything that I imagined it to be. And more. The challenges medicine places on a person allows one to experience parts of humanity that would otherwise be inaccessible. I have not only grown as a person, but have come to appreciate people even more.

They have been more than one tired nightshift in the emergency department where I have shared journeys with patients going through life changing events. Medicine happens. We all have the technical skills. My most memorable moments on the job have been the difference just a cup of tea and a chat has made.

The challenges didn’t stop with the internship though. I once started a conversation with a radiologist about pursuing a career in the specialty. Their first reaction was, “I have so many concerns about this. Can you even type?” Later, in response to my questions about the roadblocks roadblocks they kept putting my way, I got a call one day. They said, “You cannot work in our department with a spinal cord injury. If anyone asks, you can’t tell them that I said this. You have to tell them that it is the position of our whole department that you are not wanted.”

Lucky for me, there were many more radiologists that were willing to fight for what’s right. Right now, I work in Australia’s busiest emergency department surrounded by a supportive team that I call family. I even met my beautiful fiancé there.

I am heartened that we are now changing policies about medical students with disabilities in Australia. We are developing professional standards to include a variety of people in this profession.

 I like to think that having a wide variety of perspectives benefits our patients. After all, shouldn’t our lived experiences go towards caring for our patients better? The arguments for including a diverse group of people in the practice of medicine are many and obvious.

Most importantly, what we do as doctors has an effect on the rest of the community. We have always had the privilege of being thought leaders. The work that has been done on doctors with disabilities have had widespread repercussions for employment and education broadly. For our profession, leading the way is a must.

Dr. Dinesh Palipana OAM, LLB, MD

Doctors with Disabilities Australia

Griffith University