Double Vision: Doubling Medicine Places and the Implications for Chemistry

The Policy Exchange thinktank recently released a report called “Double Vision” on the need and route for doubling the number of UK medicine graduates.

What implications might this have for Chemistry, which is typically a required A Level for entry to Medicine for English school-leavers?

Publisher and Provenance

Thinktanks are organisations which put together policy proposals, and often drive the form of government policy. Policy Exchange is a right-wing thinktank founded by (among others) Conservative MP Michael Gove in 2002. It is funded unusually opaquely (the “Who Funds You?” exercise gave it an E grade, the lowest available) yet despite this seems to have had considerable influence in the recent history of the Tory party. As an organisation, Policy Exchange is worth taking seriously, but it is also worth being appropriately-critical of their agenda when its financiers are impossible to identify.

The two authors are professional policy experts. Iain Mansfield has considerable experience of the UK education system, through both the Civil Service and roles as Political Advisor to ministers. He’s a big name in HE policy. Sean Phillips is someone I have not encountered before. He presents his expertise as being in Health and Social Care policy, but I am unable to judge his standing in the field because I am ignorant of this area.

The Case for Doubling Graduate Numbers in Medicine

There are currently around 7,500 medicine graduates every year. The number of UCAS applicants for Medicine in 2022 was nearly 30,000, a ratio of roughly 4 applicants per available place. Doubling graduate medic numbers to 15,000 is presented as a stated policy goal of the Labour party, but also as broadly aligned with standing Tory policy. Three arguments for this goal are articulated: future healthcare demand, increasing international competition for medics, and the need for a strong regional supply of medics in under-served areas of the UK.

The report is broad in scope, and much of it doesn’t relate to Chemistry at all (e.g. changes to the placement training of Medicine students). My focus will centre on the bits which do.

Context: Chemistry as a Passport to Medicine

Chemistry is normally a required subject for Medicine. Though not completely universal, the standard way to get into a medicine degree for an English school-leaver is to take three A Levels with one being Chemistry.

Taking the subject is not enough: medicine applicants also need to get a high grade in Chemistry. The high competition for places means that conditional offers are set high. One anecdote in the report is that when Kent lowered its A Level offer to AAB all the successful applicants got at least AAA anyway. Some of this high performance may relate to the survivorship effects of other selection tools, such as minimum performance on the BMAT test.

So if the number of Medicine places doubled, what are the problems for Chemistry?

Problem 1: Schools

If you double the number of medicine places, the context of Chemistry A Level - the traditional passport to Medicine - will be affected significantly. In 2019 only 17,000 pupils got an A or higher in A Level Chemistry. If 15,000 Medicine places were available (rather than the 7,500 currently), 17,000 wouldn’t leave a lot of change.

It seems possible that more people would take Chemistry at A Level if there were more Medicine places. This could be a good thing for the discipline, but it would also place higher demand on a secondary teacher workforce which is already being asked to do too much.

This might be an opportunity for negotiation, both individually and collectively. Good Chemistry teachers would presumably be in higher demand, and the political case for improving the structures of recruitment and retention of Chemistry teachers becomes much stronger in this context.

Longer-term, it might also be that expanding the number of places provokes Universities into creative responses such as non-Chemistry pathways into Medicine. If other passports into Medicine were created (one STEM subject plus work experience and a good BMAT score?), this might in principle weaken the prestige of Chemistry as a secondary-school subject.

Problem 2: University Chemistry Departments

If there are 15,000 Medicine places and 17,000 people with an A or higher in A Level Chemistry, who will do a Chemistry degree?

Of course, these numbers may not stay static when Medicine widens its access. If more people took Chemistry A Level, more people would get A grades. If more people entered Medicine from routes which didn’t require Chemistry, the need for A Level Chemists to fill the 15,000 places would be reduced. It might also be that people taking Chemistry A Level with the intention of doing medicine decide that actually they’d prefer to do Chemistry at University.

But the central problem remains: Chemistry departments would experience significantly stiffer competition for strong school-leavers. This threat seems very serious to me; even if it didn’t lead to departmental closures (my guess: it would), we might expect to see substantial changes in the profile of applicants to degrees. 

Conclusions

Perhaps the doubling of places won’t happen, and thinking about a still-hypothetical scenario is a waste of time. But there seems to be cross-party consensus on increasing the number of medicine places at University, and even if 15,000 places is too ambitious it might be that 10,000 or 12,000 isn’t.

I believe the proposal is worth taking seriously, and that its implications for our profession are worth considering carefully. There are real risks here if a double demand hits an unprepared system: imagine every school Chemistry teacher suddenly taking twice as many A Level classes!

But there are real opportunities, too. Here is an influential thinktank excited about the role Chemistry plays in the training of a critical workforce. Here is a chance to bang the drum for rigorous academic training in the arrangement and rearrangement of atoms. Here is a way we can help the country stay healthy.

Chemistry as a discipline will need governmental support to make this happen, and we should be ambitious about asking for the resources required to execute such a crucial piece of national policy.