The truth about the Tik Tok doctors’ boasts: I work in the NHS… and this is why I feel so sorry for them, reveals PROF. ROB GALLOWAY

“Medfluencers” – that is, TikTok influencers who are doctors – are popping up on social media, glorifying the joys of locum work.

“Shift workers are paid at significantly higher rates than normal basic pay,” one person told her 55,000 followers; another that her hourly rate as an observer is “so vastly different from the normal hourly rate that it is insane.”

In addition to the junior doctors’ strikes, this questionable use of social media and stories about making small fortunes has helped change many people’s view of our junior doctors (who are now officially called ‘resident’ doctors).

But what few of them will know is that over the past twenty years the NHS has failed to tackle the key problem that is really driving young doctors out of healthcare.

There is no doubt that we need more doctors: it is estimated that we need to train an additional 3,000 to 6,000 doctors every year to meet the expected demand of an aging population.

However, NHS staffing policies, together with a total failure of leadership from organizations such as the Royal Colleges, the General Medical Council (GMC) and Health Education England, have sabotaged that.

Last month the GMC published its latest staff report. Hidden within the charts and tables detailing plans for the medical workforce is a glaring error. The increase in the number of eligible medical students has not been matched by the increase in the number of training programs – by the thousands.

When a doctor is newly qualified, they undergo two years of basic training – this includes six four-month jobs in different areas, to gain a breadth of experience and get them ready to start formal training programs to become the general practitioners and consultants to become what we need.

Only they don’t start those training programs. In 2022, only 22 percent of new doctors did what had to be done: trained after their basic job.

There are currently 11,757 physicians who have completed their basic training but have not undergone a training program. That’s literally thousands of highly qualified physicians who could treat our loved ones, and cut back on the amount hospitals spend on locums during their training to become specialists.

And the reason? There are not enough training places. So we have brilliantly trained British doctors who want to work in jobs that we want to fill, but there are no training jobs for them.

For example, there are more than nine applicants for every training job in psychiatry.

I have a friend who wants to be a psychiatrist: she’s a great doctor, but there are only two positions a year available for psychiatric training in Cornwall, where she lives.

So instead she – like so many others – works as an observer (in her case as an observer psychiatrist).

Sure, this is for a lot more money, but with little training to help her become a better, consulting psychiatrist. She is now considering accepting a job offer in New Zealand, where she will also receive that consultant-level training.

If she goes, it will not only cause upheaval in her family, but it will also be a terrible waste of the money the NHS has spent on training her as a doctor and giving her basic training.

Crucially, it will be a disaster for our patients who need her skills, now and in eight years’ time, when she could be a consultant.

The problem is that the formal training program numbers are not set by hospitals, but by the NHS. One solution hospitals are using is creating “non-training jobs.” But while these are often identical to formal training jobs, they cannot lead to the doctor becoming a consultant.

And because there are no formal training programs, many young doctors leave the country and take their skills, expertise and potential to countries like Australia and New Zealand. Meanwhile, we still need the patients to be treated, so waste millions on locums.

Some of the best trainee doctors we have are leaving the NHS and non-training jobs are being filled by non-British trained doctors – they now make up the majority of new doctors in the NHS.

All these changes are making our workforce increasingly less experienced, with 9 percent of doctors on the GMC register having been there for a year or less, compared to less than 6 percent less than a decade ago. This lack of experience affects the quality of care our patients receive.

And it threatens to get even worse. The number of medical students is increasing significantly, but there are no formal plans to expand training programs by an equivalent amount.

You couldn’t make it up. We risk spending millions on training brilliant new doctors who will provide great service to patients… in Australia.

For some specialties it is even worse: some doctors, such as anesthesiologists, must apply for basic training and then, after passing a series of exams, apply for senior training.

Strangely enough, the number of jobs for these two programs does not match, so after five years of training, they cannot complete the final step of becoming a consultant.

This recently happened to an entire cohort of anesthesiologists. Many of my friends left the NHS at this stage of their careers to move to (yes, you guessed it) Australia.

Between 2019 and 2023, the number of doctors training to become anesthesiologists fell by 6 percent.

If you’re wondering why there is such a backlog in surgeries, don’t blame the doctors and nurses for not working hard enough, but instead question the medical workforce decisions made by those at the top of the NHS.

Even worse is what happens to other doctors who have completed their post-doctoral training. We have fully qualified GPs who cannot get a job, despite the great need for them. They leave the NHS or return to locum duties as junior doctors.

That’s because much of the budget allocated to primary care practices cannot be spent on primary care physicians, but must be used for alternatives to physicians, such as Physician Associates (PAs).

At the same time, a narrative is being spread that there is a shortage of physicians – so we need to expand alternatives to physicians, such as PAs. As Good Health has long reported, there are real concerns that PAs are taking on more responsibility than they are qualified for – in some cases with tragic consequences.

Back to our doctors-in-training. There is an alternative to this fiasco: let hospitals implement their own training programs. I set up a plan to do this at my hospital twelve years ago, breaking convention.

We now have more than 75 of these doctors, who often combine clinical work with teaching and research. If only we were allowed to convert those jobs into training jobs, this would be the kind of scheme that could be replicated nationally.

Our doctors in training have been failed by those responsible for workforce planning and education, as have our patients and we, the taxpayers. We need to change how we do things; We can’t afford not to do that.

@drrobgalloway