For the first time ever, the ‘best’ new doctors won’t necessarily come to London. When I tell people that newly qualified doctors are being randomly allocated to hospitals across the UK, not based on merit or an interview, but on a random computer based system, they think I must be mad.
But in fact it’s true as this year the first cohort of junior doctors are randomly scattered across the country – and no one seems to know about it. For context, newly-graduated doctors spend the first two years of their medical career in the ‘Foundation Programme’ training programme and were previously allocated according to a ‘rank’ calculated from an examination called the Situational Judgement Test, their academic achievements and how well they had done in medical school.
Now these doctors are being allocated to the training programme through a new system called the Preference Informed Allocation (PIA) system, which gives all applicants a computer-generated rank that is completely randomised. The change was introduced after critics felt the old system ‘drove disruptive competitive behaviour in medical students’, with the planned new system being ‘fairer and reducing stress’ for applicants.
READ MORE: ‘I’m a junior doctor at a busy London hospital – seeing patients waiting in agony is relentless’
Still medical students can’t help feeling that they have still been betrayed, and patients are unsure where it leaves them. One anonymous London medical student, who has consistently excelled during medical school, told MyLondon they had to move 300 miles away to Northern Ireland, their 15th choice.
He said: “I was extremely disappointed, I worked very hard knowing that this would give me the best chance at [staying in London] with my long-term partner, and now instead a randomised algorithm has determined we do long-distance for years. I am angry at the lack of control I have been given over my own future.”
While figures released show 75 per cent of medical students got their first preference, fewer received their second or below options; for instance 2.6 per cent fewer medical students were allocated their top five choice this year. Others feel this system has promoted mediocrity, with no rewards for excelling in their clinical studies at medical school.
One medical student commented: “I’ve been crying for hours – I have a first class BSc, finished top decile in my medical school and I am currently doing a masters in Law. All for what? What was the point of anything?”
However the debate has not yet reached the public sphere, who largely remain unaware of the changes. Most importantly for Londoners, the system raises questions for its implications on the capital, which has historically been the most competitive area in the UK for newly-qualified doctors.
‘Students are more likely to put places other than London as their top choice’
One anonymous medical student said: “The system disincentives people applying to competitive areas like London. If you put somewhere competitive as your first choice, you have a much higher chance of getting somewhere you really don’t want to – that’s why medical students are likely to put places other than London as their top choice under this new system.”
He feels the previous points-based system was a more accurate reflection of doctors’ competence and the new system will move the most ‘competent’ foundation doctors out of oversubscribed areas like London and distribute them across the UK. Another medical student wrote in the British Medical Journal: “The PIA system could potentially benefit undersubscribed areas, resulting in a more equitable distribution of medical trainees across the UK, addressing regional healthcare disparities.”
Another anonymous medical student said: “Some would say sending high-ranking medical students to struggling hospitals is a good thing but ultimately these problems are caused by chronic underfunding, not good or bad doctors. Denying good quality training to doctors can only compromise patient care in the long run.”
One Londoner, Eamon Defret, 38, was surprised when told about the system and was concerned about effects on London patients. He said: “it is good to be open-minded but naturally I agree that the best should be coming to London, it is a major hub, and that doctors should choose to be here if they want to.”
Final allocations to jobs will be done in the next few months, and newly qualified medical students will start their jobs on the first Wednesday of August 2024. The effects of the change in system, and what this means for healthcare workforce and for patients, remains to be seen.
The Department of Health and Social Care was contacted for comment but did not respond by the time of publication.
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