Speed up medical school to solve Britain’s doctor shortage

Author: Lord Darzi of Denham

Published in The Times, Thursday February 23 2023 (Paywall)

Lord Darzi of Denham is director of the Institute of Global Health Innovation at Imperial College London and a member of the Times Health Commission.

Britain is short of doctors. On that point, there is wide agreement. With just three doctors for every 1,000 people, we have among the fewest in Europe, and far too few to support high-quality care for all.

The shortage generates eye-watering extra costs. Health trusts paid up to £5,200 for an agency doctor to cover a single shift last year. The NHS is in the absurd position of spending £3 billion annually on agency nurses and doctors to fill the gaps, more than its entire training budget.

The burden on the existing workforce is unsustainable. While medicine is still seen as an attractive career, there are growing reports of emotional and physical burnout, and complaints of low morale.

In the past the NHS has relied

on overseas recruitment but there is a global shortage of healthcare workers estimated by the World Health Organisation to reach 18 million by 2030. This approach is ethically dubious and increasingly untenable.

We should aspire to educate and train the world’s doctors rather than relying on other — often poorer — countries to train the doctors we need.

The NHS workforce plan is to call for a doubling of medical school places. Yet an increase on this scale in our current model will cost £2 billion. It takes six years andcosts £227,000 to produce a doctor, including at least a year’s training on the jobafter qualification before they can be registered for independent practice with theGeneral Medical Council.

While clinical practice operates at the limits of science, medical education andtraining has been stubbornly immune to innovation. There remains far too muchpointless rote learning in a model that has barely changed in the past century.

Now is the time for a fundamental rethink. The pandemic revealed a plethora of fresh opportunities for reform, from online classes to live streaming interactions with patients to simulators for surgery. Our systems should assess whether doctors-in-training are competent at caring for patients, rather than whether they have served their time.

The evidence shows that doctors can be trained more quickly than the five to six years it typically takes today. More than 20 universities in the US and Canada offer three-year courses, albeit for graduate entry. All the evaluations show the doctorsthat emerge from these courses are just as capable as their peers who have beenthrough longer programmes.

Though shorter overall, these programmes delivered broadly the same number of weeks training by eliminating the long summer vacation and incorporating other breaks. They thus demand more of students who must be of high ability, highly motivated and able to cope with the additional pressure.

Graduate-entry courses offered by 17 UK universities are already four years. But those pursuing medicine after completing a different undergraduate degree face a particular in justice, since they are unable to access loans for their tuition or living costs. We are in the absurd situation of forcing many of those who will be our future doctors to endure poverty while they learn and train.

Bold action is needed to reform the way we train doctors. Alongside the planned expansion of apprenticeship training, we must explore all options to shorten the length of medical degrees: increasing entry to existing four-year graduate programmes, offering new four-year programmes to school leavers, and introducing three-year degrees to experienced healthcare professionals with adequate credentials. Regulatory bodies, medical schools and the NHS have all expressed support for innovation.

Rethinking medical education and training will deliver great doctors more quickly, improving the quality of patient care and delivering a better professional experience. The wake of the pandemic is precisely the time for fundamental reform. We must have the courage to deliver it.