Dr Jake Adams / Emergency Medicine / Cornwall, UK
Emergency medicine trainee, Adventure Medic editor, and taking-time-out enthusiast Dr Jake Adams takes us through his experience of stepping off the treadmill. From ad-hoc locuming to unusual clinical fellowships, he provides a comprehensive guide for anyone considering taking an ‘FY3’ year in the UK.
After five or six years of university and two years of foundation training, it is unsurprising that many junior doctors take time out of training. A break from the hoop-jumping, the relentless rota, or a voyage of self-discovery: there are countless reasons why people choose this route. Whatever the reason, taking a break is a fantastic way to regain autonomy and headspace, and capitalise on the ever-growing opportunities available both inside and outside of medicine.
The number of doctors taking an ‘FY3’ year has risen steadily from 17% in 2010 to 65% in 2019. Few seem to regret their time out and 93% return to training within five years, hopefully refreshed, recharged, and re-enthused. My own time out was not only fun but also allowed me to return to a career that I had chosen, rather than one that I had fallen into at 17 years old.
It is very easy to take time out, simply don’t apply for a training programme. The more difficult task is planning your time. When thinking about beginning something, it is often helpful to start at the end. As the British Medical Association puts it, ‘Will you be better equipped at the end of your time out than at the beginning?’. It is not difficult to answer this with a resounding yes: many doctors return to training with more experience, better qualified, and, hopefully, reinvigorated. This article provides a starting point for those planning their time out, from exciting opportunities to much less exciting practicalities.
The Case for Remaining in the UK
If the yearly GMC survey is to be believed, many FY2s will spend their year applying for visas, planning either temporary or permanent ventures into the Southern Hemisphere. For more information on packing up your stethoscope and your sun cream, Adventure Medic has guides on moving to Australia and New Zealand. The benefits of remaining in the UK, however, are plentiful. For most, it will mean no immigration bureaucracy or complicated medical council paperwork, a process that is not just painstaking but also extremely expensive. Working in the UK will also appeal to the climate-conscious, and allows many to remain close to their support networks. In addition to this, there are now a huge number of more ‘unconventional’ work options within the UK, with many NHS trusts recognising the value of specialised junior fellow years. Trusts are also increasingly keen to sweeten these deals: many employers now offer adventure-friendly options such as funded qualifications, out-of-hospital experience, and annualised contracts.
- Indemnity – Doctors must always have legal cover that is appropriate to their stage and responsibilities. Make sure you update your provider regarding any changes to your address or job. See our guide to expedition indemnity here.
- NHS Pension, National Insurance, and Student Loan – for those working for staff bank or in a contracted post, these will continue to be automatically debited from your pay cheque. Otherwise, it is the employee’s responsibility to ensure that these are paid (if applicable) and you may need to submit your own tax returns. With student loan repayments in particular, you must arrange to continue your repayments if you are working abroad. Remember also, that all doctors are eligible to claim tax back on employment expenses, including college fees, GMC fees, and exam fees.
- CV – It is a good idea to have an up-to-date CV ready to go and this can make all the difference when opportunities pop up unexpectedly. CV writing is a difficult skill and it is worth spending some time ensuring that yours is concise, error-free, and tailored to the opportunities you are applying for.
UK Employment Options
It is remarkably easy to forget that there is a whole world of work outside of clinical medicine. Those deciding to venture into a different field undoubtedly bring back a wide range of skills and experience. Doctors choosing this path should plan carefully regarding their GMC status (details below). The other option is to continue to work within medicine. In this case, there are two main choices. The first choice is whether to work abroad or in the UK. The second choice is whether to take a contracted post or to work as a locum, be that via an internal bank or an agency.
Loving that Locum Life – Staff Banks v.s. Locum Agencies
For those wanting to maximise their earnings, locuming is very attractive. Pay varies in a supply-demand fashion across different trusts. The BMA suggests £70-80 per hour as a standard rate, but as a rough guide £40 per hour is common. Working as a locum usually pays more and offers autonomy over shifts, ensuring maximal flexibility. That said, extra pay comes with extra risks. Locum doctors are not entitled to annual leave, sick leave, study leave, or a study budget. There is also no guarantee of work, and work that is advertised may be last-minute cover for unsociable shifts.
For some, the familiarity of colleagues and systems makes working via their hospital staff bank an attractive option. Employers will usually give priority to doctors on their staff bank as it costs them less than agency fees. The other, potentially more lucrative, option is to use an agency. This can result in quicker turnarounds for payment, and sometimes a higher wage. Agency work usually requires more movement between trusts and departments, so for those with a dread of changeovers it may not be ideal. With both options, it is important to keep track of hours worked, agreed rates, and what has, or has not, been paid. Mistakes happen and if you, the employee, do not spot them, then in all likelihood, no one will. It is also worth remembering that after 12 weeks of work with the same employer, locum workers are entitled to the same benefits as other employees, including receiving ‘rolled-up holiday pay’.
For She’s a Clinical Fellow
Clinical fellow roles have exploded in both availability and popularity over the last few years. They are a great choice for hospitals, as they are cheaper than paying locums, but also for doctors as they often come with extra opportunities. Clinical fellow jobs have many advantages; they offer the stability of rostered shifts, a guaranteed and predictable pay cheque, annual and sick leave, and the consistency of working within a set team or specialty. Typically, fellow jobs are six or twelve months long, allowing flexibility to combine work and travel. They offer valuable opportunities to try out specialties and gain experience that will pay dividends come interview. There are also many themed fellow jobs, with opportunities including expedition medicine, global health, trauma, and pre-hospital medicine. A common model is for employers to offer 80% clinical time with 20% time allocated to a specialist interest, decided by the trainee. These are ever-evolving and will only become more plentiful as trusts face more competition for employees.
Apply and Defer
Depending on the specialty, and who is leading recruitment, it can be possible to defer the start date of a training programme by six months. This could be the perfect option for doctors who know what training job they want to do but want a short break before starting.
LAT but not Least
An alternative to clinical fellow posts is taking a Locum Appointment for Training (LAT) job. While seemingly very similar to a clinical fellow role, they are recognised for training so the time in these posts can ‘count’ towards training if you want it to. These posts are an excellent option for doctors who know what their final specialty will be, but don’t want a training number yet. LAT jobs allow more choice in location, and offer a degree of ‘try-before-you-buy’ for training programmes.
Expedition Medicine from the UK
The world of expedition medicine can seem like a difficult area to break into. However, there are many ways to gain experience and get your foot in the door. Taking time out after FY2 offers a great platform to branch out into the expedition world. What’s more, these experiences will all count towards appraisals and offer something different to showcase at interviews. The UK makes for an excellent base for this. A useful place to start is by looking into courses and qualifications that align with your areas of interest. A list of courses including diplomas, masters, and short-course options can be found here.
There are many courses on offer from a variety of different providers. Adventure Medic is full of course reviews to help guide future participants and has a helpful calendar too. Courses can be expensive, but provide a good grounding in expedition medicine, usually with training in the field. Expect to have a tiring but fun experience, make some great new contacts, and become more credible as a prospective expedition doctor.
Diplomas are a highly useful way to spend all the new free time that time out of training provides. There are many options, with courses in expedition medicine, disaster medicine, and global health medicine proving very popular. It is worth noting that some clinical fellow jobs will contribute to diploma costs. As the expedition medicine field gets more competitive, formal qualifications will be increasingly important to make applicants stand out.
Charity Expeditions, Sports and Event Medicine
Charities offer a worthwhile and interesting introduction to expedition medicine. The general advice is to email organisations and see if they are hiring – another reason to have an updated CV. There are a wide range of options, many of which require a financial contribution.
Event medicine and sports medicine also offer an excellent way to build out-of-hospital experience. As well as networking opportunities, these jobs offer exposure to challenges such as pre-planning, resource management, and real-time medical problems – experience that is very transferable to expedition work. Again, there are many different companies, both local and national, that offer event medical cover. The best way to get involved is to contact sports teams directly or find a doctor who is already involved and ask them.
Volunteering for NGOs and humanitarian causes is a meaningful way of gaining out-of-hospital experience. Though most placements will not be in the UK, many doctors both in and out of training find these placements eye-opening and purposeful. There are a plethora of charities and organisations that will be keen for new enthusiasm and energy. Prospective volunteers should ensure they know what their duties will be, what support, both personally and clinically, will be available, and check that their indemnity is valid. The BMA has a very useful guide here.
Returning to Training
- It’s worth noting that the proudly earned certificate awarded for passing foundation training, the FACD 5.2, is only valid for three years. If foundation graduates are out of training for longer than this, a consultant who has supervised them for at least three months must fill in a Certificate of Readiness to Enter Specialty Training(CREST) form found here.
- Keep up to date with your intended specialty’s application matrix. Some programmes mark candidates down if they have too much out-of-training experience in certain fields.
- Be prepared to justify any gaps in training and employment. Most employers and interviewers will look favourably on career breaks; they are something different to talk about and can make candidates stand out. Whether it be for courses, qualifications, personal development, or looking after your mental health, the reason will rarely matter as long as you are prepared for these questions.
- Many specialties can offer a return to work period, although it might not be offered automatically. This provides greater support and supervision to help trainees return to clinical work if they’ve been away for more than three months.
There are three options to choose from with more detailed information available here:
- Continue to hold a full licence to practise. Doctors must continue to pay their GMC fees and are advised to organise a yearly appraisal. For those who will work in the UK, this is the right option.
- Give up your licence to practise but continue to be registered with the GMC. This allows doctors to continue to practise medicine abroad, but not work within the UK. This is a good option for those working abroad for an extended period, or those choosing to take a complete career break. Doctors continue to pay a reduced annual fee to the GMC, and the GMC will issue a certificate of good standing to other medical regulators. It can take some time to regain your licence to practise and doctors should anticipate this when returning to UK medical practice.
- Give up GMC registration. This is also known as voluntary erasure. Think carefully about this as it is intended for those who don’t ever want to practise medicine in the UK again.
The GMC recommends an annual appraisal for every doctor with a licence to practise. This is an annual meeting between a doctor and a colleague who has been trained as an appraiser. Those working within a hospital should be allocated an appraiser by their department. Locum agencies usually organise appraisals internally as part of their service, but it is worth clarifying this.
Appraisals are a process of facilitated self-review supported by information gathered from the doctor’s full scope of work. Aprasiees are expected to reflect on their practice, identify learning needs, and demonstrate that they are fit to practise. In reality, following the requirements of FY2 should be a reasonable blueprint to pass an appraisal. Some trusts will share access to an e-portfolio, otherwise it might mean a return to paper forms. All of the information is available here but it is useful to consider the following areas when preparing for an appraisal:
- Personal Development Plan (PDP) – setting up a PDP with a couple of achievable points makes the appraiser’s job easy.
- Continued Professional Development (CPD) – RCEM for example, suggests getting 50 CPD points per year which equates to an hour a week of podcast listening or journal reading. Exams, courses, and conferences all count too. Different specialties will offer different advice, but the important thing is to keep a record of your learning.
- Logbook – In some specialties, keeping a logbook is essential. There are a variety of ways to facilitate this with many choosing apps or online platforms for ease of use.
- Reflections – It is important to show evidence of your reflective practice, particularly with regards to any significant adverse events, complaints, or near-misses that may have occurred.
Your Own Adventures
Sometimes the best expedition experience is an independently organised personal adventure. Planning a big trip offers plenty of life lessons, and just because it was technically a holiday doesn’t make it any less valuable to talk about at interviews. The UK can be easy to overlook when searching for adventure but offers a plethora of outdoor opportunities in an amazingly varied landscape. Whichever path you choose, taking time out is a great chance to reconnect with friends, hobbies, and general life. It emphasises the perks of working as a medic, demonstrating just how flexible, varied, and rewarding medicine can be. However you decide to spend your time out, have a wonderful time.