The real cost of core training
BMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i2051 (Published 05 May 2016) Cite this as: BMJ 2016;353:i2051
- Tomos Richards, year 1 specialist trainee1,
- Lucy Collins, starting GP specialty training in August,
- Edward Schwarz, starting GP specialty training in August
- edward.schwarz{at}doctors.org.uk
Abstract
Junior doctors may buy points on their CV in a bid to be the best candidates, say Tomos Richards, Lucy Collins, and Edward Schwarz
With growing uncertainty around their contracts in England, junior doctors throughout the UK are considering their career options within the NHS. In the first six weeks of 2016, the General Medical Council reported that more than 1110 applications for a certificate of current professional statement, which enables holders to work abroad, had already been made.1 The number of applications to specialty training are expected to fall this year, with financial burden being cited as important contributing factor.
Doctors have come to expect that they will incur considerable costs during specialty training from exams, courses, and attending conferences. We outline below the measurable costs for completing the first two years of specialty training using set training requirements and person specifications.
Exams
Exams represent important steps in training and are vital to ensure core knowledge reaches the expected standard. The cost of these exams, however, is alarmingly high. Trainees may have to sit difficult exams many times and spend additional money on revision aids and courses, easily doubling the minimum cost of around £1500.
Courses
Courses allow intensive training on specific topics of interest. They are increasingly being incorporated into core training as mandatory elements. The UK Resuscitation Council clearly outlines its charges on its website. For example, an advanced life support course costs £50 (based on £28 per candidate and £22 for the manual); however, providers’ charges are considerably more and vary between hospitals (£350-£460). Although courses are compulsory, the cost is shouldered by the trainee and may well exceed the annual study budget.
Cost of mandatory training
The cost of completing the mandatory requirements for core training or specialty training years 1 and 2 in run-through posts is high and differs widely (see table): £1704 for obstetrics and gynaecology compared with £3928 for core surgery. These costs do not include General Medical Council fees or medicolegal protection and assume you pass the exams first time.
Buying your CV—conferences and presentations
In addition to the minimum requirements to complete their core training, trainees must also strive to stand out from the crowd and make their portfolio competitive for application to higher specialty training. As selection for these training numbers is objective, application points (such as desirable criteria) may essentially be bought through additional courses and presentations at conferences. To achieve higher scores, projects and audits need to be presented at conferences nationally or internationally. The cost of conferences varies (from £60 to over £750), and many will have a low threshold of acceptance to ensure a high number of delegates attend and pay the registration fees.
Considerable additional costs are incurred, including travel and accommodation. There is a danger that conference organisers may exploit trainees’ eagerness to build their CV to generate revenue and thus accept lower quality abstracts. This devalues the educational component to the conferences and disadvantages those who are unable to afford to attend.
The intense pressure on trainees to compete may result in the content of their CV becoming more important than the course attended or the poster presented.
Conclusion
Exams, courses, and clinical governance are key to continuing professional development. The costs of achieving mandatory requirements are rising, and for some they will impact on their future career choice. Trainees quickly use up their training budget as these requirements increase. There is also a risk that good quality research is overlooked when conference organisers accept submissions on the basis of ability to pay, rather than on the quality of the proposal. Colleges should evaluate essential criteria in job advertisements and the funding in place, to ensure high quality applicants are not discouraged by costs or outdone by inferior trainees who have simply bought more points on their CV.
Cost of core training by specialty