Your Blog

MMC/ MTAS Disaster For Doctors

Posted by jameslacey on Monday, 05 March 2007 02:05:45

I am in the second year of my training as an SHO in Psychiatry, currently working for the St Mary's training rotation. I am passionate about my chosen discipline, and my ambition is to continue as a career psychiatrist. I did not choose Psychiatry on the basis of simply needing a position, or because it is perceived as unpopular, and therefore easier to get into, or to back-up more general training; I wish to specialise because it is my vocation.

I competed with other doctors for a place on the rotation, via application forms and interview process. Subsequent to my appointment, I successfully completed each 6 month post, leading up to the present. As part of my training, progress has been formally assessed at intervals, by each Consultant I have worked with. I have been judged overall as above average, and I give a direct quote from an example comment: "James has been an excellent trainee. He is very highly regarded by the team and myself."

In the normal turn of events, I would have approximately another year to go before completing my SHO training, subject to passing Parts 1 and 2 of the Membership exams for the Royal College of Psychiatry. I would then be free to apply for further, higher training as a Specialist Registrar, ultimately leading to becoming a Consultant.

In my recently completed post in Old Age Psychiatry, my Consultant and myself incorporated assessment techniques from the new system, beginning in August. This marks a change in approach to more structured, and continuous means of assessment; for example, a Consultant will directly observe a trainee doctor's interaction with a patient, and mark them using a pro-forma, downloadable from the Royal College website. I was found to be above the expected standard for my level of training.

In my background, I achieved an Intercalated BSc, extra to my MBBS medical degree; in support of that BSc, in reflection of my previous exam performance, I was awarded financial aid in the form of two scholarships. As part of that BSc, I gained valuable experience in laboratory-based research. All the above should enhance my employability.

Prior to embarking on specialisation, I worked for a year as a Foundation Year 2 SHO, in a pilot scheme for the new system now in place nation-wide. This position allowed me opportunity to demonstrate that I had gained "core competencies" of a junior doctor, which again, should make me more, not less employable in terms of the new system.

Previously, when time came to apply for another job, one had the option of applying to many individual hospitals within many different regions. Some prospective employers would ask for your own CV, others relied on application forms, though still allowing a high degree of self-expression in selling your self. If offered interview, then this was likely with the very people who would be your seniors in the work place.

With the introduction of MMC/ MTAS, I found myself obliged to essentially reapply for the type of position I had already secured, and done well in, for the last two years. Many raised fears about the impending change and new, untrialed application system; reassurances were made that these were unfounded. Now things look different.

Applying on-line, I was faced with a series of stock, confusing, polythematic questions, as a way of ‘proving' my suitability for (continued) training. The idea seems to be to look at the person specification for the level of training you are applying for, work out which key phrases and attitudes are expected from each question, and try to include them in your answers. Hopefully these are picked up when scored according to a tick-box protocol. The choice of places to work is now limited to a maximum of four, from broad geographical divisions of the country; once successful in interview, you will be able to list a preference for where you are ‘sent' within the region that wants you. Subsequently it has become clearer that past experience, extra achievements, degrees, good references, etc. are very much subsidiary in this new way of assessment; answers to the questions are key.

The process was plagued with glitches of numerous kinds; the crunch came when several Regions could not meet an extended deadline by which to finalise their shortlists for interview. The impersonal computer system informed me that so far I was unsuccessful in any application, but this was still subject to delayed announcements. Days after I had worked it out for myself, I was finally put out of my misery with a confirmation of emphatic rejection. Informing my Consultant referees, one said that they found it disappointing and surprising, agreeing that it was unfair, the other expressed amazement that I had not even been short listed. There is no opportunity for feed-back, support or appeal in this eventuality, from the faceless, mechanised MTAS.

This system is an unhappy mixture of rigid, State control, and pseudo-market forces with artificially increased ‘competition', in the sense that little provision has been made for doctors in the old system, versus newer doctors coming up through the ‘modernised' system. Arbitrarily, the new system will be loaded in their favour in the name of ‘fairness'. Behind this seems to be an almost ‘1984' turn of mind: a circular argument where the new system is defined as ‘improved' (because it is the new system), so those trained in it are, de facto, more desirable employees; it may also be cheaper in the short term.

Competitiveness only makes sense on a level playing field. It is alleged that somehow, a few applicants were able to acquire copies of the ‘secret' marking scheme for the assessment questions. Thus they had unfair advantage in being able to tailor their answers accordingly. Some have paid agencies to write their answers for them. I am aware of a colleague who had part of their application written by a more senior doctor. The unseemly rush to mark the underestimated number of applications, apparently leading to some not even being looked at, or being scored by non-medically trained individuals, builds the case for injustice.

An example of one of the application questions, (the emphasis is mine):

D1. Give a specific example of a time when you became aware that a clinical mistake had been made, either by you or someone else. How did you deal with this situation and how did your actions contribute to the outcome?

Apparently, though not clear from the question, a reply detailing your own mistake, as opposed to someone else's, received a higher mark. As it is a question about ‘probity', one is expected to realise that this is an opportunity to demonstrate your willingness and ability to learn from mistakes; detailing someone else's error is more suggestive of denial of blame. A politically correct mea-culpa might give you the edge. My own answer described a situation of shared culpability: perhaps a more explicit confession of my fallibility, despite my elitist professional status, would have been more acceptable?

Naturally, one can assume that those implementing these questions will be able to quote studies, the statistics of which endorse their efficacy in accurately and objectively discerning aptitudes deemed prerequisite in a doctor. Curious then, that such consistently reliable tools should lead to a situation where one person can be rejected across the board, but other individuals receive a range of ‘yes' or ‘no' answers to their applications.

Following the outcome of the current round of interviews in late April, there will be a second round of applications. It has already been made clear that by this stage, most full training posts, of up to six years duration will have been filled. Some remaining posts will be a new form of stand-alone, year long placements. These will count for training, but once you are out of the main system, it will be increasingly difficult to re-enter as time passes, as ‘new' doctors continue to progress in the hierarchy. I remember attending a seminar where a spokesperson for MTAS attempted to address this concern, by implying that posts in full training will always become available, due to the eventualities of illness or maternity leave.

As has always been the case, some posts will not be recognised for training, and are merely for service-provision. To remain employed, there may be no option but to accept such a post, but again there is now greater risk of resultant career stagnation. If made redundant second time around, I may have to offer my skills abroad, or with bitter regret, leave my medical career behind.

Public money has been lavished on my training as a doctor: in a sense there is a contract between myself and the State. I, and my family, invested much in this venture; I still have to complete repayment of my student loan. Now my primary means of fulfilling my social obligation, and satisfying my private debt, is in danger of removal by the same system that trained me. Does this breach my human rights?

The uproar that has resulted from MMC/ MTAS has so far been met with bland platitudes from the Authorities, thinly masking a pitiless indifference. The bleating protest of a profession over which this Government now has a near monopoly of power is unlikely to make much headway, I fear. What to expect, when it has consistently demonstrated shameless, craven venality in much wider arenas of control?

You could comment if you logged in | Read comments


 

Posted by hsarah on Monday, 05 March 2007 02:43:56

Patricia Hewitt should resign, not only for mismanaging the entire issue but for her lack of empathy and sheer determination to destroy entire medical training structure.

Posted by Allybee on Monday, 05 March 2007 09:20:16

My perspective is not as a doctor but as a taxpayer and (like all of us) potential patient. I am concerned to find that a generation of highly (and expensively) trained doctors will be "lost" - there will not be fewer of us patients in the future, we will not be less ill, and we will need just as many consultants.

I am also concerned that choices in these competitive fields are being made in an irrational manner. These are very technical jobs, and it is critical that employment decisions are made on the basis of academic achievement and relevant experience, and not on the ability to answer inane questions. James quotes a question on probity. I suspect that I (with no knowledge or aptitude for medicine) or indeed Harold Shipman could draft quite a good answer. It would not make us good doctors.

Please hold the government accountable on this issue - and help to get this resolved quickly so that we can have confidence in the quality of our future care.

Posted by paris on Monday, 05 March 2007 12:53:14

I am looking at this from a parent's point of View..Mr Cameron is selling the idea of family values..The sacrifces that my family have made to put my daughter through medical school is enormous, not just about money ,but mentally, supporting her through all the years of exams and the huge sacrifice whe has in her own life..even though she thinks this worthwhile. I hope Mr Cameron that your children do not have to go through a dilemma like this. Literally these doctors- the cream of our Society- are being aborted by this Government. How can you let this happen?. You cannot.;. This could be a huge vote winner for you. Please take this on full throttle

Posted by Fareed on Monday, 05 March 2007 14:13:39

Too much change is always bad. Recent NHS junior doctors employment fiasco is an excellent example. There has been all along a sense of dictatorialship in the way these huge and in most cases un necessary changes have been brought about. I do feel sorry for the junior doctor being made to suffer this situation created by other people's incompetency and no fault of thier own. Howver as a doctor I can assure you the worst long term sufferer will be the patients. NHS has a ot of problems, however one good thing about NHS was the doctors working in it were almost invariably very competent and highly skilled. A fact acknowledged world over for a long time. So why did we have to change a tried and tested system of training, recruitment, employment and also try to do all this in a matter of months. In doing so they have wronged the junior doctors but above all they have and are going to wrong patients. I think this has to stop, and hope you can help.

Posted by Poble on Monday, 05 March 2007 14:33:02

I'm not involved in a medical role but have a large number of friends & a husband who are. Over the last week or so I have had to sit by & watch a great number of very talented & hardworking doctors become victims of a crazy, ill managed & irresponsible system which could leave them without jobs.

I would urge the Conservative Party to take Tony Blair & Patricia Hewitt to task on this issue - they will win the support of tens of thousands of doctors & their families.

I would also urge those who are better informed about the processes to petition the Prime Minister using the online facility:

http://petitions.pm.gov.uk/

Good luck with your battle & please don't think that support for changing this doesn't lie outside of the NHS.


Posted by FlossieT on Monday, 05 March 2007 16:43:09

"About MMC" on the MMC website (http://www.mmc.nhs.uk) states:

"Streamlined training and explicit standards of assessed competence are also essential if doctors’ careers are to accommodate the pressures of a family and modern lifestyles."

and

"MMC... will promote fairness and equality of opportunity at all stages of a doctors’ career."

Can anyone explain how giving doctors little to no control over where they work can possibly accommodate the pressures of a family, or promote equality of opportunity? We have three small children, two in school and one in nursery. A training post at the furthest extremes of the two regions to which my husband has applied would be disastrous for us. Yet as I understand it, if you turn down a post you are offered, for whatever reason, you risk being blacklisted and unable to apply to future rounds.

Morale at the major teaching hospital where my husband is currently employed is at an all-time low (not least because, adding insult to injury, the hospital has so far failed to pay a significant number of junior doctors for most of February). Talented doctors, with first-class degrees, excellent track records and glowing references from their consultants, are facing the prospect of being jobless in August, owing to the poorly constructed and poorly managed application process.

With the NHS in its current state of crisis, the last thing it can afford is to drive away thousands of skilled staff who have been trained at the taxpayer's expense. The whole thing smacks of meeting budgetary targets by stealth - slimming down the number of posts to meet targets, with little regard for the ultimate impact on patient care. It may be "modern", but it's no "career" any more.

Posted by johanne on Monday, 05 March 2007 18:58:55

I am writing to express my concern at the cavalier attitude the current government has taken to the untenable situation many of us Doctors are finding ourselves in. We as a profession appreciate the need for change from time to time dealing with it constantly in our daily work. However this MTAS MMC recruitment system has proved disastrous on both a professional and personal level for so many of our clearly unvalued junior staff. We feel let down by our union, employers and senior colleagues and frustrated that no one seems to care.

My husband was one of the ST3 applicants who attended for interview (having flown form northern Ireland) at West Midlands today to be told the interview was cancelled and there are no plans to reshortlist or reinterview at present. He has spent countless hours filling in the application form which is not in any way relevant to the job and comprising a "portfolio" of evidence of his extensive 4 year post graduate experience to be kicked in the teeth again by the government. Not to mention the vast sums of money that we have both invested in our careers in terms of paying for professional courses, postgraduate degrees, conferences and research. Have the government forgotten that Drs are human beings with wives and families and bills to pay. So many Drs are married to other Drs (because we spend soooo much time in work we rarely meet anyone non medical!) and the current system potentially will cause enforced separation of many families. I for example have a training number in Northern Ireland deanery.

We are working considerably more hours than administrative staff have quoted on paper and getting paid a sum inappropriate to the amount of responsibility and time we spend working. IF you get paid at all - many trusts make it a habit to pay the wrong salary, banding supplement or in fact nothing at all on a regular basis. The NHS has survived on the goodwill of junior medical staff for many years - this has run out - and as a result patient care will become jeopardised more than it already is.

Little has actually been discussed with us as a group and these changes have been forced in rapidly at massive cost to the as yet unaware tax payer. I personally feel that the only way to make the government appreciate us as a profession vital to the survival of the NHS is to work to rule or take industrial action. I am not alone, as "negotiation" clearly is getting us nowhere and we have mortgages to pay and families to feed.

Posted by DrKJA on Monday, 05 March 2007 20:15:11

July 7, I was a Trauma SHO in a central London Hospital.

A bomb goes off. Then another and another.

People start coming in with horrific injuries like no other that I have seen before. The next 14 hours were the most intense and traumatic that I have ever experienced. However, I stepped up to the mark and attempted to treat some of the hundreds of patients, to the best of my ability.

In a time when people were shocked by the events that had taken place, a unity emerged and people offered to help in any way possible. Many were turned away as they did not have the skills required to assist, however on that day I was proud to be a doctor. It was a moment when I had the skills to make a real difference and I believe I did. The government, rightly so, praised the emergency services, for the job it had performed.

Today the same goverment has introduced a new training programme, as we all know. This programme told me last week that I could no longer train in trauma and orthopedics. The same doctor who was praised by the goverment has now been told that he is not good enough to work in this country as a trauma and orthopaedic surgeon.

How do I feel? Devastated and empty.

Mr Blair stated that the healthcare profession needs to accept that unemployment may be a common occurance over the next few years. Well Mr Blair, I tell you, I will not accept this and another nation will be the benefactor of the product of your taxpayer's investment.

I applaud the action of remedyUK: it is an organisation that the profession has been crying out for, for many years.

Mr Cameron I urge you to look into this issue, however as like many of my collegues, I believe it is probably too little too late. If you supported us I would vote Conservative, however I think in two years time, the choice I will need to make is whether to vote Democrat or Republican.

Yours Sincerely

Dr KJA


 

Comment edited by DrKJA on Monday, 05 March 2007 20:15:31

Posted by olivia on Monday, 05 March 2007 21:17:07

I am a doctor, still in training, but as a specialist registrar I am spared from this current horrendous fiasco as I am allowed to complete my training on the old system. I only hope the government will be held to account when my talented junior colleagues leave this country in droves to practise elsewhere, or leave medicine altogether. What a waste of money and talent.

Posted by laurie on Monday, 05 March 2007 22:05:55

I have every sympathy for your plight - as the mother (and mother-in-law) of three doctors currently applying through MMC it is incredibly difficult to understand the way in which this matter is being ignored by both the media and politicians. The labour party in particular seems to have been complicit in encouraging this apalling state of affairs, where some of the most able and hard-working young people of a generation are seeing all their aspirations of a career in their chosen speciality dashed by idiotic (and malicious?) bureaucracy.

Andrew Lansley seems to be familiar with the http://Doctors.net website - could I encourage him to have a closer look at the number of heartbreaking contributions from junior doctors posted there. If the destruction of the N.H.S. is of the least importance to the Conservative party then surely the potential redundancy of such a large part of its medical workforce is worth paying attention to. I know for a fact that many of those caught up in this farce are seriously considering either leaving the profession or the country. We cannot afford such shameful waste.

Posted by Splatfly on Monday, 05 March 2007 23:24:54

Isn't David Answering three of these very important questions this Wednesday?
It would have been polite to have researched how this site works and then wait for David to answer before everyone spams the site with repeated questions and votes.

I understand this is a very important issue, and I give my sympathies to those affected, but a little bit of respect to the other uses of the site, who have their own question, isn't too much to ask.

Three questions on the same issue just gets you ONE answer.

Posted by MarkieMark on Tuesday, 06 March 2007 00:18:28

Doctors' training system 'a shambles' and "disastrously wrong", Both comments from the The Daily Telegraph! Not to mention the appaling waste of money as outlined again in The Daily Telegraph some £250,000 to train a junior doctor, so down the drain along with many young men and womans hopes and dreams, not to mention skills and hours put in to secure a future in a job in the NHS. Anyone left in the position of not securing an interview at the first round left to beg for scraps in the next? Surely this is grossly unfair? Doctors not being selected for thier skills, aptitude dedicaion and commitment over those who simply waffled vaguley and gained 'wooley' points to secure said interviews, is this the way other employers would serve to appoint the right applicants for the job? What an utter Fiasco!

Posted by Beverly on Tuesday, 06 March 2007 08:36:26

Patricia Hewitt should resign. She and her department are not fit to run the NHS.

Posted by HelenM on Tuesday, 06 March 2007 11:17:21

I hope that the rest of the deaneries have the courage and integrity to follow suit.

And no, I'm not a doctor, nor do I have any vested interest in this (other than the obvious proviso that the quality of healthcare staff in this country should be of interest to everyone). I have only been made aware of this issue by a friend who is affected by MTAS/MMC... and that does worry me. Surely an issue of this potential magnitude should be something that any effective opposition should use to have the government under real pressure?

All I hear from Gordon Brown is that the exorbitant amount of tax I have to pay goes towards "schools and hospital, schools and hospitals". This rather implies that that's not the case.

So Labour are drastically undermining healthcare provision in this country... don't you think that this is an issue you should have something to say about?

Regards
Helen

Posted by FShearer on Tuesday, 06 March 2007 11:19:11

I also am an SHO who has been affected by the shambles brought upon the NHS. I cannot believe the government has been allowed to introduce a system which ignores references, experience and assessment and appoints future consultants almost solely on the basis of the answers to seven random questions. Surely the ability to waffle is not the quality you would look for in someone about to perform open heart surgery. I urge you to bring this crisis to the forefront by bringing it up at PM question time. If this is not halted now the NHS faces an immense crisis come august. In addition the country will lose several thousand highly qualified doctors who have been trained at the tax payers expense.

Don't miss these