In the past, a system existed for when unexpected circumstances arose, with trainees from one part of the country being able to apply to relocate to another part without losing out on training time.
This was mainly because of marriage, family circumstances or childcare issues. I can’t be alone in thinking that this system is now so hopelessly broken that it needs to be either reformed or abolished altogether – another example of the Tragedy of the Commons corrupting every aspect of systems in which goodwill and fairness used to play a key role in allowing a little of something good to be shared amongst those who truly needed it.
If current trends continue, the situation in a few short years will be as follows: the first new, ST1 trainees hitting a deanery will all have applied for transfers to the South East of England, as every single successful applicant for the highly competitive ophthalmic training scheme (competition ratio 1850:1) will have been an Oxbridge-educated, PhD-positive Londoner whose furthest foray out of the capital (other than a gap year building schools in Bolivia for the children of artisanal, peripatetic postcard artists) was Bristol. Bristol itself is dangerously rustic and entirely unsuitable for settling down in permanently. Wales is, well, Wales! Yuck!
When Wales had its own interview process, the application was onerous – as were all the applications for all the deaneries – and ever so subtly different, such that only people who specifically wanted to apply to a place bothered to fully complete it. As a result, we had a selective bunch of applicants each year with some sort of connection with the country and who wanted to stick around and practice ophthalmology after completing training, out of whom we picked the best ones. The people who applied to work here tended to be from here, had connections here and therefore didn’t apply to London, Oxford or any other such area.
Then a national (well, supernational, as in effect as it is the whole of the UK) selection came in and suddenly it was much more difficult for the typical recruit from a Welsh hospital to get their foot in the door. They were told, “Ophthalmology might not be for you.” The competition was just too great. We had some truly phenomenal people come here to train who went on to lead phenomenal lives after completing their training, though not in Wales – important people working at the top of the tree in various places in England, and perhaps for the first time a not insignificant smattering had some sort of Welsh connection now. They were being wonderful, just not being wonderful in Wales. But they were completing training here at least.
Then people started coming here and leaving after a few years. They, too, were phenomenal and excellent and great. And they also went on to be all of those things in England. Now the requests for transfer are in from the very beginning, and perhaps a third of new recruits have already applied by the time August is complete.
I recall an incident where the training programme director (TPD) and a few trainees went out during congress in Birmingham and one of the trainees expressed frank surprise and not a little disgust that she’d ended up in Wales, where she’d never been before. It didn’t help that her drunk cardiologist boyfriend, who also showed up for some reason, took it upon himself to make fun of the TPD for his choice of wearing socks with open-toed sandals, and was generally a bit weird toward us all.
Meanwhile, Swansea University graduates are finding it increasingly difficult to get onto the training ladder, mainly as the bottom eight rungs now seem to be missing. For those of you saying, “Ahh, but ST1s can’t apply for inter-deanery transfer” – while from a legalistic perspective that is true, from an actual, practical perspective they reapply for training elsewhere and if they succeed, they can transfer out without losing training time, and if they fail, they still have their training number in Wales. It’s a win-win for them.
I am fairly confident I would not be able to make it into ophthalmology if I applied today. I don’t have a PhD, I have no OBE, and I don’t know every single facet of the Declaration of Helsinki. I don’t think I could even get into training if I applied now. I just wouldn’t have the points. I don’t think I am a particularly bad ophthalmologist (though others would probably disagree) but I admit I am not among the academic superstars of today. Does ophthalmology need more high-ranking super-point scoring Übermensch though? Or just more jobbing joes who can do the work without necessarily being up for writing a new Cochrane review every year after giving another keynote speech at ARVO?
Is it moral to game the system? Are the trainees of today who apply, ranking everywhere but never intending to stay for long in most, decent human beings putting others before themselves? Of course not. They never were. They are human. Society needs rules otherwise shared resources are wasted, hence why pure capitalism and bare market forces never work; human nature is just not good enough. Throughout history, this very human defect was checked by strict rules enforced from above that limited unfair behaviour.
Do we need to break up national recruitment? Do we need some massive discouragement (beyond an old-fashioned British raised eyebrow, which used to work well in the past and now works not at all), such as having to pay the deanery they are leaving a sum for having trained them? Being unable to apply again unless they give up their training number entirely? Should both the TPD and Head of Schools (HoS) be allowed to beat trainees wishing to apply for interdeanery transfers with sticks for 60 seconds before signing their form?
All I know is that if this isn’t fixed, our profession on this island will end up with overeducated Southern Englanders filling every job everywhere, but all continuously vying to get back to their civilisation while everyone else is locked out.
