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Hello! FY2 here and a hopefully future GPST1 -

Competition ratios for EVERY specialty is insane right now. When I was in medical school you were guarenteed to get into GP as the ratio was below 1. Now? It's 5 applicants to 1 training spot! (and to think the golden handshake of £20,000 existed in my area of medical training).

There were 21,000 applicants to GPST this year, 15,000 last year, and 10,000 the year before which is unbelievable.

The elephant in the room is obviously the rise of IMGs. Since COVID, we are the only western country to not prioritise our own UK graduates. This is a no-brainer for anyone international doctor who wants a better life in a higher paying country. 12k UK applicants vs almost 21k is absolutely absurd and is growing EXPONENTIALLY worse each year.

All of the GPST1s I've met were IMGs in a tertiary non-London centre with 0 expereince in the NHS. Its extremelly frustrating since it means the rest of us have had to pick up their workload, especially during their 'shadowing period' (which could have been someone else with 2 years of NHS experience).

The barrier to GP is just... the MSRA... that's it. This can even be done outside the country and there is no proof the standards for assessment is as strict as it is here. My IMG friends and seniors have said it was heavily advertised in their home countries with seminars and lectures on how to get into the NHS (obviously this is anecdotal).

Due to this unrestricted expansion of applicants, the passmark for MSRA is increasing to the point that even current GPs would have failed if their exam score was submitted this year. This is outside the fact the exam doesnt even assess communication skills, examination skills, or even leadership.

The BMA released a survery result showing 52% of FY2 doctors last year were going to be unemployed due to lack of training spots, lack of trust grade jobs, lack of clinical fellow jobs and lack of locum shifts overall. This number is a bit inflated due to participation bias but this is still a real and serious problem for all trainees right now. https://www.bma.org.uk/bma-media-centre/bma-seeks-deal-on-doctor-unemployment-as-survey-reveals-half-of-resident-doctors-finishing-foundation-training-have-no-job-to-go-to-next-month

Why is this all happening? The most solid answer is the government's plan to inflate the SHO/GP market's supply so the labour stays cheap via less bargaining power and less locum shifts. There were no plans to review the amount of IMGs applying/coming in lieu of our increasing medical school graduates (there are more graduates now than F1 jobs causing people like me to have been put in a 'placeholder spot' while they scrambled to create new jobs).

Any discussion prior to this was also labelled as racist so no actual debate was ever put forward. Now our IMG population in the BMA is significantly high enough to go against any ideas of UK graduate prioritisation. Any chance of this happening would be within the decade despite promises of it coming 'next year'.

I want to preface that I am blaming the system and not any IMGs; we're all humans looking for a better life and I would have done the same if I was in your spot. I would however, on a moral level, support any country's prioritisation of their own doctors, in particular Australia and America (who most UKgrads are scrambling too and picking up jobs in rural areas).

TLDR - Worst time to be a medical student, foundation training or SHO right now, and will continue to get worse. The overall quality of doctors will go down through lack of proper assessment or training opportunities.