In the late 1990s UK medical schools produced nearly 5,000 graduates each year, considerably fewer than the NHS needed, writes Graham Winyard, a retired Postgraduate Dean. But in 1997, an expansion of medical school places began and the number of graduate doctors is set to rise to 7,000 in 2010, an increase of 40%.
The planners assumed that UK qualified doctors would replace those from overseas. But Government immigration policies have encouraged thousands of overseas doctors to compete for postgraduate training posts, and it is of course illegal for trusts and deaneries to discriminate on the basis of country of qualification when making appointments.
Expanding medical schools makes little sense if extra graduates cannot pursue a career in medicine, says Winyard.
UK trained doctors began to voice concerns about possible unemployment in 2005 and these concerns were dramatically realised this summer, when MTAS was introduced to select doctors for training posts.
While there were broadly sufficient posts to accommodate UK applicants, together with those from the rest of the European Economic Area, he argues, the inclusion of thousands of overseas doctors has transformed the prospects for all applicants and has made widespread failure to secure a proper training post inevitable.
The UK urgently needs policy coherence on immigration and medical training, he writes. The direct connection between policy on medical immigration and the likelihood of unemployment for UK medical graduates is inescapable.
The most obvious action, he says, would be to suspend the Highly Skilled Migrant Programme - a scheme allowing highly skilled people to migrate to the UK to seek work without a specific job offer - as it applies to doctors, and establish a two stage recruitment process similar to that used in other countries, whereby overseas applications are considered after those of domestic graduates.
The rights of overseas doctors already in the system must be safeguarded, but if decisive action is not taken the situation will be worse next year, he warns.
This muddle is in no one's best interests and needs open and honest discussion and clear leadership, however difficult that may be, he concludes.