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The NHS Doctor Unemployment Crisis: Why Are Thousands of Doctors Delivering Amazon Packages?

Introduction

You’ve probably seen the headlines: record waiting times in the NHS, a health service in crisis, and thousands of people struggling to get GP appointments. But what if I told you that thousands of doctors are now delivering Amazon packages or driving for Uber because they can’t secure jobs as doctors or GPs? Hi, I’m Dr. Emma Derma, a dermatology resident doctor working in the NHS, and I also coach and mentor other doctors to get into specialty training. Honestly, this is the worst I’ve ever seen it. So, how did we get here? Let’s dive in.

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The Scale of the Problem

The situation is dire. According to health education statistics, around 33,000 doctors applied for just 12,000 specialty training posts, leaving 20,000 doctors unemployed—meaning they won’t become consultants or GPs. This is a significant issue because the path to becoming a GP or consultant isn’t automatic. After graduating from medical school, doctors must navigate a competitive, multi-stage training process, reapplying and reinterviewing at each step.

For example, to become a dermatology consultant, a doctor graduates from medical school, completes foundation year training, and then applies for core medical training (2–3 years). After that, they must reapply and reinterview for dermatology specialty training. The process is similar for surgical routes. For specialties like GP, otolaryngology, or radiology, doctors apply for run-through training after foundation years, but these are also highly competitive. The competition ratio has skyrocketed. When I applied for core medical training in 2017, the ratio was 1.4:1; now, it’s 4:1. For psychiatry, it’s gone from 1.26:1 to 10:1—an alarming increase.

GPs are also struggling. A BMA report indicates that 56% of GPs want to work more hours but can’t find additional GP work, while 15% are completely jobless. Shockingly, 70% of these GPs report stress and anxiety due to unemployment and financial hardship.

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The Bottleneck in Specialty Training

One major cause of this unemployment crisis is the bottleneck in specialty training jobs. Between 2021 and 2023, the government increased medical school places to address pandemic needs. According to the GMC’s 2023 report, around 10,000 medical students were admitted, surpassing pre-pandemic levels from 2019. While this seemed like a positive move to address doctor shortages, the number of specialty training posts didn’t increase to match this influx. As a result, more graduates are now competing for a limited number of training positions, creating a narrowing bottleneck and intensifying competition.

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Competition from Other Healthcare Professionals

Doctors aren’t just competing against each other; they’re also up against other healthcare professionals, such as physician associates (PAs) and advanced nurse practitioners (ANPs). PAs typically hold a science degree, complete a two-year NHS internship, and then work under consultant supervision. ANPs are nurses who undergo additional training to take on advanced roles in specific specialties. (My apologies if I’ve oversimplified their training—please comment with details if you’re a PA or ANP.)

These roles are crucial for reducing NHS waiting lists and workloads, but they’re inadvertently taking opportunities traditionally held by junior doctors. Consultants used to train junior doctors for these roles, but now PAs and ANPs often fill them. Similarly, in GP clinics, PAs, ANPs, and even paramedics are seeing patients under GP supervision, reducing the need for fully qualified GPs. This shift is partly because PAs and ANPs are cheaper to train—costing significantly less than the £230,000 required to train a junior doctor—and their salaries are lower than those of GPs, making them attractive for cost-cutting measures.

The NHS Long-Term Workforce Plan exacerbates this issue, aiming to increase ANP roles by 6,300 per year and employ 10,000 PAs by 2031–2032. This further limits specialty training opportunities for doctors and GPs.

The Impact of International Medical Graduates

Another factor is the increased competition from international medical graduates (IMGs). Since a 2019 policy change, IMGs have equal access to specialty training posts as UK graduates. According to the GMC’s 2023 workforce report, UK graduates increased by 9% (from 169,000 to 185,000) between 2019 and 2023, while IMGs surged by 41% (from 90,000 to 130,000). This influx has intensified competition, particularly in specialties like GP training (10,000 IMG applicants vs. 4,000 UK graduates) and psychiatry (2,500 IMG applicants vs. 900 UK graduates). Health education statistics show that more IMGs are securing GP training posts than UK graduates, further reducing opportunities for UK doctors.

This also poses challenges for IMGs. Despite securing training posts, many face unemployment after completing training due to the saturated job market. IMGs often invest thousands in visas, PLAB exams, and relocation, making it critical to seek mentorship before pursuing work in the UK. My coaching agency (linked below) can connect you with mentors who’ve navigated this process.

The Struggle for Non-Training Roles

Some might assume doctors can take non-training roles, like clinical fellow positions, while waiting for specialty training. However, these roles are also becoming highly competitive as more unemployed doctors apply for them, further limiting options.

Proposed Solutions and the Role of the BMA

The British Medical Association (BMA), the doctors’ union, has proposed reverting to the 2019 system, where UK graduates had priority for specialty training posts to reduce competition. However, the government, not the BMA, makes policy decisions. The government weighs cost-benefit analyses, such as the lower cost of training IMGs or employing PAs and ANPs, and political factors like public sentiment on immigration. These considerations often take precedence over addressing doctor unemployment, which is a cynical but realistic perspective.

What Can Doctors Do?

For doctors facing unemployment and fierce competition, the situation is daunting. Competition ratios are at an all-time high, and securing a specialty training post requires a polished CV, a robust portfolio, and exceptional interview skills. This is why I founded Doctor Specialty Coaching—to help doctors navigate this challenging job market. If you’re struggling with your portfolio, CV, or interview preparation, check the link below to connect with a mentor tailored to your specialty. If your desired specialty isn’t listed, email us, and we’ll find the right mentor for you.

If you’ve faced rejection for specialty training or clinical fellow roles, I’ve created a video on handling rejection—check it out for practical advice.

Call to Action

I’d love to hear your insights on this crisis. How can we improve the situation? Have I missed any key factors contributing to doctor unemployment? Share your thoughts below. If you’re a doctor facing these challenges, don’t lose hope—resources and support are available to help you succeed in your specialty career.