COVID19 and the UK to Oz/NZ doctor pipeline :

The NHS is being handed the biggest opportunity for medical workforce management in years...and it's almost certainly going to squander it be without even noticing. THREAD/

The collapse of "direct to specialty/direct to registrar" pipeline of medical trainees in the UK is well documented. A few years ago over 75% of FY2s progressed directly to specialty training, now barely 20-30% do. Career breaks after core training have also mushroomed

Much of this is explained by two trends.
1) Docs taking time out after a natural break point (end of F2/CT2/CT3 etc) to go work in Oz or NZ
2) Docs taking time out as above, but to do locum work on home soil and use the proceeds to go travelling

COVID19 has decimated both trends. Even though Oz has an exemption for arriving docs many are reluctant to head to the other side of the world to work after the pandemic destroyed the notion of easy intercontinental travel for visits home. NZ remains a sealed fortress.

Locuming at home to save up cash for jetsetting far away seems pointless when international travel as we knew it has collapsed with an uncertain path to recovery.

Even though many/most of the "post foundation/core exodus" trainees return eventually the system has had to learn to cope without them. Some never return.
Now though, things are potentially different, at least temporarily.

Specialty training posts for the coming academic year have mostly been filled, but this still leaves a potentially sizeable pool of soon to be Ex-FY2/Ex-Core-trainee whose plans have gone up in smoke and aren't sure what they'll do next.

IF workforce planners in the NHS had the sense to seize the opportunity, and those controlling health service funding had vision, these docs could be enticed back into substantive NHS service.

Don't believe me? Look at @DrRobgalloway's work in Brighton ED & @DrLindaDykes in Bangor. Well designed non-training "clinical fellow" posts can earn a reputation and become competitive. Brighton ED has slashed locum spending, increased staffing, and staff morale simultaneously

There will be potentially be more candidates for such jobs willing to apply and sign on at the coming doctors changeover/new academic year, than has previously been the case for years.

It's a chance to reverse the vicious circle many departments and specialties find themselves in.
1) training is hard/rotas are awful
2) docs jump ship after foundation/core
3) staffing gets worse as there are fewer trainees, rota gaps, training gets worse
4) more docs jump ship

Now picture the opposite:
1) busy department recruits clinical fellows enticed by 6/12 months of location stability, non-clinical development time
2) staffing improves, morale improves
3) trainees have better experience, fellows get tempted by the specialty
4) locum spend falls

Now the downside, the NHS as a whole almost certainly won't seize this chance. The NHS has been poor at medical workforce planning and management for a generation and nothing during the pandemic has suggested that's going to change

This opportunity is unlikely to repeat. Hospitals outside the biggest cities in Oz/NZ have grown used to a pipeline of Brit/Irish docs filling posts that Aussies/Kiwis won't or can't. They won't give that up without a fight and northern hemisphere docs will head south eventually

So while I suspect the NHS as a whole will miss this opportunity due to a lack of strategic planning, that doesn't mean individual hospitals or departments can't seize the day. If your a high up in a department or trust, now's your chance!

Make the business case, redirect that locum spending, scrounge together every pound and penny you can find.

Not sure how to build a post juniors want? Imitation is the greatest form of flattery!

Steal ideas liberally from people who've succeeded at this before. @DrRobgalloway @DrLindaDykes @beans2er

Think outside the box. Maybe it's non clinical time, med ed time, funded PGCEs, taster days off the rota. It doesn't have to be rocket science, it just has to be interesting

12 month posts will give people who like the place a chance to stick around. 6 month posts will attract juniors who want stability now but want to hedge their bets for life after peak-COVID. Offer a mix of both to maximise recruitment.

Improving your department like this is like making more seedcorn for your specialty and your department tomorrow: good for now and good for later. Staying stuck in the vicious cycle is like eating the seedcorn: unsustainable.

This thread ended up longer than intended, but hope it's thought provoking.

DOI: I left F2 for a stint in NZ, then got back and eventually got hired into a locum post by a boss who was keen to have "old" hands back on the floor and in the specialty.

Addendum: Ireland is currently handling this issue in *precisely* the wrong way and letting medical unemployment spiral just as a chronically understaffed system could do with more docs. Hat-tip to @EllenNewman93 for raising awareness and helping inspiring the thread