Medicine is an incredibly oversubscribed subject. There are currently three times as many applicants to medical school than there are places available, and each year many well-qualified candidates do not succeed in securing a place. This gap will only increase, as we could see up to a million students applying for higher education by 2030 resulting in more young people wishing to join the medical workforce and greater disappointment when they do not receive an offer. Despite this demand, the UK has never produced enough doctors to be self-sufficient. Even before the pandemic there were increasing concerns about the workforce’s ability to meet the nation’s growing health needs. Post-Covid, these issues are now exacerbated by a stretched health service – we now have backlogs of patients requiring elective care alongside exhausted health professionals who are burned out from working non-stop since the beginning of the pandemic. When this backlog of patients is seen in the context of an ageing population with increasing comorbidities, it becomes clear that a comprehensive and radical rethink of workforce planning and medical school expansion is now urgently required. The demand from all sides is undeniably there.
The argument for the global exchange of medical knowledge is self-evident – the training and employment of doctors and other healthcare workers from different nations is important for the UK’s growth and health research. However, it has also long been acknowledged that a dependency on international medical graduates, often from low- and middle-income countries, is neither sustainable nor appropriate.
The Journey to a Million therefore presents a once in a generation opportunity to tackle these issues. The exact needs of the UK population and the NHS are difficult to predict, but the Medical Schools Council’s (MSC) proposal is that the number of medical students should be increased by 5,000 making a total of 14,500 graduating per year. This total would address NHS staffing needs while also allowing space for a reasonable amount of overseas recruitment, as medicine is a global profession and input of doctors trained overseas is invaluable to the NHS. There are, however, major challenges to such an expansion.
The Medical Schools Council firmly believes that the medical profession should genuinely reflect the society that it seeks to serve – the argument for which is self-evident. In order to make the study of medicine more widely accessible and available, an expansion should include a broader range of entry routes and course delivery options to ensure the broadest possible criteria for selection. A more diverse recruitment of students will, obviously, in turn lead to a more diverse workforce.
Medical schools have, for a while now, been paying closer attention to enrolling students from a wider range of backgrounds – there is, for instance, a course in Scotland that uses online learning and part time education to support healthcare professionals wishing to become doctors. Gateway, foundation and access courses can substantially diversify the pool of potential applicants, and an expansion will provide medical schools with the opportunity to further develop these unconventional entry routes. Other innovative ways into medicine such as apprenticeships, part-time education and conversion courses for healthcare professionals with relevant backgrounds are also in discussion.
Similarly, medical schools have been making a concerted effort to attract and recruit students from disadvantaged backgrounds through initiatives such as ‘widening participation programmes.’ These initiatives look at criteria such as socio-economic background, school performance, time spent in care, free school meals etc. An expansion will give medical schools the opportunity to maintain and increase widening participation, and, if done properly, will have enormous benefits for ‘under-doctored’ areas, which tend to coincide with relative social deprivation.
A UKMED study found that; ‘The majority of doctors prefer to train at postgraduate foundation schools that are reasonably close to the family home. Those who attended state-funded schools, from non-white ethnic groups and/or from lower socio-economic groups were significantly more likely to choose foundation schools nearer their parental home.’iii
Placing medical schools in areas of deprivation and selecting students from that area could mean a majority of graduates remains in the region as well as improving the local health economy. UKMED’s findings also suggest that a significant number, particularly widening participation students, may also wish to return to train near their family homes. Where there are under-doctored areas where it is not possible to create a new medical school, this could be addressed by concerted efforts by medical schools to undertake outreach in these locations.
These are just some of the challenges, considerations and possible means of fostering medical school expansion which the Journey to a Million can facilitate. The task is complex but if we focus on collaboration rather than competition and take a strategic approach to addressing barriers to growth, then we will be in a greater position to achieve a sustainable medical workforce. The potential benefits to the country are huge; the NHS is better supported with a larger workforce potentially leading to less burn out for its staff, patients with better access to care and improved health outcomes and bright applicants from across all sectors of our society have greater opportunities to begin a career in medicine.
Chief Executive, Medical Schools Council (MSC)
Dr Katie Petty-Saphon is Chief Executive of the Medical Schools Council, which brings together the heads of UK medical schools to shape the future of medical education. Katie also oversees the associated membership organisations: the Dental Schools Council, the Veterinary Schools Council, the Pharmacy Schools Council, the University Hospital Association and the Association of Dental Hospitals.