New allocation system for foundation training leaves doctors demoralised before they’ve even started work

Earlier this month, I was among the first cohort of medical students to be assigned their foundation training post by the preference informed allocation system, which gives each applicant a random, computer generated ranking.1 Although the UK Foundation Programme Office (UKFPO) has maintained that this system has been introduced to make allocation “as fair as possible,”2 the powerlessness felt by incoming trainees who’ve been given a post far away from their families, friends, and partners has engendered a palpable sense of injustice among many. More than that, the introduction of random allocation seems to foreshadow a future career in an impersonal and indifferent institution, which disregards the wellbeing of its workforce.

In June 2023, the UKFPO announced—with less than six months’ notice—that their “score based” system was to be replaced by a random ranking system.3 For current final year students, who were led to believe that they could influence where they were sent for further training by performing well in exams, this meant that their academic efforts were suddenly replaced with the equivalent of a raffle.

Students’ total lack of control over how they are ranked has manifested with very real consequences. Within an hour of our allocations being published, I heard of a friend who—having worked hard for six years in the hope of being placed close to their long term partner—has been allocated to their 12th choice (out of 18), more than 100 miles away from their significant other. Another friend has been assigned to Northern Ireland, their 14th choice, with nearly 500 miles and a sea between them and any semblance of a support system. A brief scroll through social media shows more unfortunate stories of dashed hopes and despair.

These disappointed students are grappling with the stark reality of being more isolated from their friends and family, and risk becoming disillusioned with a career that they haven’t even begun yet. Medical students in the UK are already in a peculiar position: they are academically gifted and hardworking, they would be welcomed by companies who would better compensate them for their work, and they accept far less pay than their equivalent colleagues abroad. Now they don’t even have the means to influence where they work and live. Both of my unlucky friends are seriously considering withdrawing from foundation training to be closer to their partners. Can the NHS afford to lose more doctors this way?

In my case, I have been lucky. I applied to relatively non-competitive deaneries and have been allocated to my first choice. I should be happy with the results, but there are too many sources of disquiet for me to be content with the new system. One is the sense of injustice that I feel for many of my peers. On 7 March, they were able to dream of working and living in a place that they would have chosen. By the next day, they had to re-plan their entire lives. One benefit of the score based system was that at least students could have some idea about their chances of being allocated to certain deaneries and plan accordingly. Now any possibility of predicting where you’re likely to be moving has gone.