It may be possible to train to be as a doctor through the apprenticeship route rather than through medical school. Health Education England (which is the part of the NHS that deals with education and training) has indicated it may be possible to become a doctor by the apprenticeship route starting from September 2023.

The plans have been controversial, with many doctors questioning whether this is an appropriate method of training to become a doctor and whether the schemes will give apprentices the required skills needed to work as a doctor.

Here are some of the key points we know so far from articles and blogs from HEE as well as some of our thoughts using the information we have so far.

• The training and standard of education will be the same as a traditional medical degree ✅

• Apprentices will gain a medical degree using the apprentice approach 🏆 By medical degree, we assume it will be the same Bachelor of Medicine, Bachelor of Surgery (MBBS MBChB etc.) or equivalent but this is currently not clarified. It has been indicated that completing the scheme will allow apprentices to register with the General Medical Council and then progress to foundation training.

• It has been indicated that some places may be reserved for graduate entry medicine, as well as school leavers. It may also be suitable for people who have been in work for some time already.

• There was initially 100 places for September 2022 entry, which was postponed - it is not known what the number of places are for 2023 entry.

• It is not currently known if international medical boards (such as those in Australia and Canada) will recognise the qualification. There are international standards for medical education, such as those of the World Federation of Medical Education (WFME), which the apprentice training will need to be compliant with 🙋🏻 This may limit your opportunity to work outside the UK, as well as perhaps tie you down to a career in the NHS.

• We have been here with something similar before. There was a qualification known as the LMSSA (Licentiate in Medicine and Surgery of the Society of Apothecaries) which was accepted by the GMC in order to practice medicine in the UK. There are doctors using this as their primary qualification in the UK but is no longer available as a method of GMC licensing and registration. It was used by overseas doctors as a way of equivalent experience to a medical degree.

• Apprentices will have to pass the Medical Licensing Assessment (UKMLA) as per other medical students to graduate as a doctor.

• At present, the traditional way to study medicine is to apply to a medical school. Medical schools in England and Wales charge the maximum tuition fee of £9,250 a year for home students, totalling £46,250 over the 5 years of undergraduate training. This excludes your day to day living expenses and rent, which can bring the total cost of studying medicine in England to over £100,000. This is prohibitive for many students and attracts interest payments which is a major distraction for students from poorer backgrounds.

• While Student Finance and NHS Bursaries offer loans, these can be limited and have eligibility criterion, and medical students often do not have time - and are often prohibited by the educational contract with their universities - to work part time alongside their studies. This is seen as a barrier to entry for students from poorer backgrounds.

• Apprentices will be able to earn a wage as they study 💷 Typically, for the national government apprentice scheme, this is the national minimum wage, which varies with your age. It ranges from £4.81 per hour to £9.50 per hour at the time of writing in July 2022. It is currently unknown what the salary for a medical doctor degree apprenticeship is.

• Traditional apprenticeships are open to ‘those over 16, living in England and in full time education’ although it has been indicated that this could also be an option for people currently working in the NHS to train as a doctor. It is unknown whether similar opportunities will exist in other parts of the UK. It is currently unknown if students from overseas can apply for a medical degree doctor apprenticeship. Your ability to work elsewhere during your apprenticeship might be restricted – this is normally for discussion between you and your employer.

• Entry requirements, in our view, will likely be very similar to those of a traditional medical degree, likely including A-level and GCSE requirements as well as the need to demonstrate relevant medicine work experience. You will need need to demonstrate you have the academic ability and resilience to go through a long training programme to become a doctor.

• In addition, traditional apprenticeships can start at any time of year, so it may be possible to start your training to become a doctor outside the normal UCAS application cycle, although the first batch of students is set for September 2023. It is possible there may be no UCAS application, with your application being made directly to the employer instead using a traditional curriculum vitae (CV). This may be an advantage for certain students. You may even be able to apply to student medicine though UCAS and as an apprentice - this is currently possible with some other apprentice degree programmes, giving your more choices than your 4 UCAS choices.

• It has been indicated that the apprentice will be employed by a healthcare provider organisation (which could be a hospital NHS trust). The healthcare provider organisation will also pay some of the costs of tuition. It is currently unknown what the tuition fee to the apprentice will be or if there will be any (apprenticeship schemes generally have no fees as it is expected you will ‘work’ for the employer who will then fund your training).

• Looking at the standards of the programme, it appears to be more clinical right from the start. However, you may be expected to work shifts, including nights, weekends and bank holidays right from the first day, which may affect the student experience and lifestyle. We currently have little detailed information on exams including finals, apart from the need to sit the UKMLA. This may well be dictated by the university that the programme is linked with.

• It has been indicated that the apprentice scheme is designed to make the profession more diverse 👩🏻‍🎓👨🏻‍🎓🏳️‍🌈 It is not known if there is any widening participation criterion or whether the scheme is open to all. The entry requirements are currently unknown, but we would expect them to be the equivalent as a traditional medical degree.

• There is no mention of UCAT or BMAT exams either, which is a major advantage 😀 Our view is that the medical schools use these exams to shortlist purely because of competition. We have had decades that medical schools admitted students purely on A-level results, UCAS statement and medical school interviews (and many in the past did not interview). However, you can expect to attend an interview for a medical doctor degree apprenticeship.

• We cover the topics assessed in medical school interview in our medical school interview course. It is likely apprentice interviews will cover similar topics. Come to our course and learn the knowledge and skills you need to get your place 🏆

• It is not sure how long it will take to become a doctor during the scheme. Traditional apprenticeships tend to be undertaken by an ‘employer’ who will likely expect some service provision (i.e. work) from you rather than full time study as you would at medical school. The standards for the degree programme indicate a period of funding for 60 months which is the same as a traditional 5-year medical degree. However, maximum funding from the government is currently capped at £27000 according to the Institute for Apprenticeships and Technical Education which to us seems inadequate. It can currently cost over £34000 per year to train a medical student, so there is a real concern the training as an apprentice will be inferior.

• In summary, the ability to obtain a medical degree and become a doctor without the debt of going to a medical school in England (which has some of the highest tuition fees in the EU and punitive interest rates on student debt) is a definite positive 😀 In addition, it may help those that have financial commitments and are not able to stop employment completely in order to study.

• However, the plans are opposed by some doctors groups, such as the Doctors Association UK (DAUK). The BMA has raised a concern there will be ‘two tiers’ of doctors and argued that there are better ways to remove some of the barriers for widening participation students. Other doctors say that the number of foundation year places (which are open to international medical graduates) should be more of a priority. There are also concerns the teaching could fall to consultants and general practitioners, who do not have the capacity.

• There are concerns over the ‘job specification’ and service commitment part of the apprenticeship. In the past, hospitals have used medical students as phlebotomists, porters and theatre assistants, which has a limit to its educational value.