Why UK doctors need to work abroad
The lack of training in the modern NHS has made working abroad an absolute necessity for UK doctors, says Lucy Mackillop
Introduction Top
Introduction
Too busy for teaching
Losing the love for...
Training in Australia
cellent learning and training
Conclusion
Time abroad has long been part of many junior doctors' CVs, particularly immediately after doing junior house jobs. Traditionally, the year is spent making just enough money to enjoy a sunny climate and recover from the rigours of the house officer year. However, I propose that spending time abroad at a later stage in your career is actually a necessity. It's vital in order to make up for the lack of training in today's NHS.
Too busy for teaching 
Top
Introduction
Too busy for teaching
Losing the love for...
Training in Australia
Excellent learning and training
Conclusion
Few people would disagree that clinical experience in the United Kingdom is exceptional—not least because of the long hours and heavy patient load. In my view this trend is set to continue and is reflected in the membership exam becoming more a test of general clinical skills and management rather than knowledge and evidence based medicine. Most specialist training programmes include regular teaching events, but the registrars are too busy to attend. More and more of our time is spent in service provision. The result is that our training is shifting away from academic pursuit.
Losing the love for medicine Top
Introduction
Too busy for teaching
Losing the love for...
Training in Australia
Excellent learning and training
Conclusion
Like many of my friends, I passed the exam for membership of the Royal College of Physicians (MRCP) reasonably quickly. I found myself MRCP positive with six months left to do as a senior house officer (SHO) before I could apply for a national training number (NTN). I was tired and fed up. I had had enough of putting venflons in at 3 am, enough of writing up warfarin and clerking elective angiograms, and enough of mindless jobs and no focus on training. I looked above me and saw harassed, exhausted registrars. I looked sideways and saw exhausted, bored SHOs. I had lost the love of medicine and I wanted to run far away.
Training in Australia Top
Introduction
Too busy for teaching
Losing the love for...
Training in Australia
Excellent learning and training
Conclusion
I chose Australia, and specifically Sydney, because I had been there during my elective and had fond memories of it. I had little direction when I started looking and applied indiscriminately for jobs advertised in the international section of
BMJ Careers. Amazingly, replies and even some offers started coming back via email. I then did my homework and focused my applications. Essentially, there are lots of jobs in Sydney, and the further you go outside the main city, the more jobs that are available. Rural or district hospitals are just like those in the United Kingdom—they are busy and there are lots of jobs available. I wanted to be central as my husband was looking for jobs in central Sydney, and, importantly, I wanted a teaching hospital job that would add to my training.
Luckily, one of my bosses in England put me in touch with a nephrology consultant at St George Hospital, Sydney, and I applied for the nephrology training programme (akin to an NTN in nephrology). I was accepted and opted to take a one year job in the first instance, to give me flexibility if things didn't work out. My good fortune in nephrology was not solely down to a good curriculum vitae—Australia needs nephrology trainees. The specialty has a reputation for long hours and little private practice, and for this reason has taken a nosedive in popularity.
Further information
The upside to this lack of new trainees is that the consultants in the Sydney area, and more specifically in the southeastern health service, are at pains to make nephrology attractive and have set up a fantastic training programme.
Excellent learning and training Top
Introduction
Too busy for teaching
Losing the love for...
Training in Australia
Excellent learning and training
Conclusion
I have now been in Sydney for six months and I have learnt more in the past six months than in the previous three years as an SHO. Admittedly, some of it is to do with being a registrar—seeing referrals and doing more clinics. In addition, the hours are great and I don't do nights. I am not exhausted all the time. The clinics are less busy, leaving me time to sort out patients properly and see them much more regularly to follow their progress. I have three monthly regional meetings, which are well organised and bleep-free. They are held outside the hospital and usually include dinner. We have the usual weekly departmental meetings, and because I am much less busy with a smaller inpatient list, I can go to all these meetings and enjoy them for what they are—a learning and training experience.
It is important to note that if you are considering staying in Australia you will have to take the equivalent of the MRCP exam—the fellowship of the Royal Australian College of Physicians (FRACP). MRCP does not qualify you for any exemptions. However, if like me you are treating this time as added valuable experience either before or during your specialist training, no further exams are necessary.
Conclusion Top
Introduction
Too busy for teaching
Losing the love for...
Training in Australia
Excellent learning and training
Conclusion
There is little doubt that gaining good clinical experience is important and easily achievable in the United Kingdom, not least by virtue of necessity—the see one, do one, teach one, mentality. However, because of the clinical workload and overall exhaustion the academic side of things, for me at least, can get lost. I now have time and, more importantly, the enthusiasm to read journals and do that Medline search on a subject I saw in clinic. I have got the love back. This is why working abroad is a necessity for UK doctors to meet our educational needs and remind us why we trained in this profession.
Lucy Mackillop, nephrology registrar</STRONG>
St George Hospital, Sydney, NSW, Australia lucymackillop@hotmail.com
Linear Mode
