Ellie Heath / Adventure Medic Editor
This article was updated in February 2020 and is now out of date. The updated version can be found here.
Yes, it’s that time of year again. With Core and Specialty Training applications looming, these few months can be fraught with difficult decisions for junior doctors facing the next stage of their medical career. Here, we proudly present Adventure Medic’s Guide to Taking Time Out From UK Training.
More and more UK doctors are opting to take time out of training in order to pursue medical and personal interests abroad. According to the GMC, the number of doctors requesting certificates of good standing (needed to register with an overseas medical council) has increased by 12% over the last five years, with 4,726 doctors applying in 2012. A 2010 study by a London Deanery found that almost a third of doctors completing FY2 did not enter Core or Specialty Training programmes straight away.
Here at Adventure Medic, we feel passionately about the personal and professional benefits to be gained by taking time out from medical training in the UK – whether your motivation is to broaden your clinical exposure, to experience developing world medicine, to resolve specialty or career indecision, to pursue personal interests, or even just to exercise some autonomy over your work and professional development. Not to mention the (very valid) reasons of travel and adventure for their own sakes.
The British Medical Association proposes that the key question to ask yourself is, ‘will you be better equipped at the end of your time out than at the beginning?’. If you’re organised and motivated, it’s very easy to ensure the answer to this question is a firm ‘yes’.
When to take time out?
Before Foundation / Unless there is an opportunity that will not wait, it’s not advisable to delay the move from medical school into Foundation Training. The support of your Medical School during the Foundation Programme application process is invaluable. The transition from student to FY1 is a steep and often daunting learning curve, and one best travelled with the support of your peers. In addition, whilst you have graduated with a medical degree, until you’ve completed your first year of the Foundation Programme, you are only registered in a provisional context by the GMC. In other words, you are not eligible to practice medicine independently or outside your place of supervised employment.
Between F1 and F2 / Some Foundation Schools will support time out between FY1 and FY2, or accredit an FY2 year abroad. If you are interested, it is best to make your enquiries early with your Foundation School Director, as there is considerable variation across schools. See the Foundation Programme Reference Guide for more information.
After FY2 / Probably the most popular time to head away is after completing FY2. At this stage, you have full registration with the GMC, a broad base of general medical skills and you are at a natural break in the job ladder. It’s also a time when many junior doctors experience doubt over choice of specialty (or even over choice of career), so the opportunity to experience medicine in a different context or continent can be invaluable.
After Core Training / For non run-through specialties such as Core Medical, Anaesthesia and Surgical, completion of the CT2 year is also a natural break in the system, and many doctors choose to divert at this point, with the advantage of another couple of years experience under their belt.
In Specialty Training / Most specialty training programmes (including GP) offer opportunity for Out Of Programme Experience (OOPE). Availability varies by Local Education and Training Board (LETB) and in some specialties OOPE is becoming more difficult to get due service provision pressures. Again, if you’re interested it is worth expressing interest early and enquiring of your Postgraduate Dean before you enrol on a particular programme. You may also have the opportunity to do a fellowship abroad in an area of special interest during your advanced specialty training.
Where to go?
It can seem daunting to know in which direction to go, given that there is a whole world outside. There are lots of wonderful opportunities, and part of the fun is designing your own unique adventure. After all, when else in medicine will you be the master of your own fate? In the meantime though, here is some basic information on some of the routes better travelled to get you started.
Australia / The Australian job market has tightened up somewhat in recent years as word of the glorious sunshine, pay and hours has filtered up to the beleaguered inhabitants of the Northern Hemisphere. However there are still some jobs to be had. You are eligible to apply if you are a UK citizen and UK graduate, but Australia has explicitly chosen to give priority to Australian and New Zealand candidates over us Brits. Jobs are advertised state by state and within states there are centralised online application websites. While the design, layout and deadlines vary from state to state, the basic process is the same all over the country. Typically, jobs are posted online from late June to early August. Interviews take place from late August to Mid-September and offers are made in early October. Jobs then start between mid-January and mid-February. A sensible approach is to choose the city or area that appeals and then get a list of all the hospitals in a 20-100 mile radius (depending on location). Call (rather than e-mail) each hospital and try and get through to the medical workforce unit. Follow up your call with an email and your CV. Don’t be discouraged and keep at it. It is also possible to get jobs through the year via ‘unofficial’ pathways, particularly between September and November as people start to resign posts and places free up before the end of the year.
New Zealand / You are eligible to apply to New Zealand if you are a UK citizen and a UK graduate. You can apply for a post as a House Surgeon or a Registrar. House Surgeons are roughly equivalent to FY2’s, but Kiwis may spend several extra years at that grade getting experience in a wide range of specialities. Registrars are equivalent to CT1/ST1 and upwards. As specialty training in New Zealand is typically five years rather than seven, you will be worked quite hard at Registrar level and given somewhat more responsibility. However, it is a great way to get experience. Sometimes UK doctors will start out as House Surgeons and then choose to join the Registrar rota once they have found their feet. Applications for New Zealand are usually in June, for an interview in July and an offer in August. House Surgeons then start at the end of November and Registrars in early December. Apply direct to hospitals via the RMO Office. After getting an offer, you can then apply for registration with the New Zealand Medical Council, get your visa and indemnity and finally book your flights. If you are going for longer than one year, you will require a medical for the visa, but that can also be done in New Zealand and your visa subsequently extended. Keep all the receipts, as the hospital will reimburse you.
Europe / Given that it is on our doorstep, surprisingly few doctors go to Europe. With freedom of movement in the EU, as a UK citizen and graduate you are eligible to work anywhere in Europe. However, language is often the singular limitation to crossing the Channel. While you may be eligible to work, you still have to meet the registration requirements of the individual country’s medical council. This can be tricky, particularly as many European countries have different medical models and specialty structures. You may also require your qualifications to be translated into another language, which can be expensive. Finally, in some European countries, there are actually quite high levels of medical unemployment, so finding a job may be difficult. However, for those with good language skills and a thirst for the Continent, don’t be put off. A good way to start is by contacting the various Anglo-European medical societies, via the websites listed in the Resources Section.
North America / Love red tape? Exams? Hard work? Then North America is for you. The BMA provides excellent online guides to working in the USA and Canada which are good places to start. Broadly, the issues are eligibility to work and visas, training requirements, exams and competing with homegrown candidates. For those looking for a short fix, research posts and some fellowships are a good way to spend time working in North American institutions, while avoiding the exams.
Developing World Work / Developing world work can be an immensely satisfying way to consolidate your medical skills and get some love back for being a doctor. Work can either be arranged yourself, or through an organisation or NGO. Different posts will have different professional requirements, and some ask for additional qualifications such as a tropical medicine diploma. Whatever the organisation’s requirements however, you have to satisfy yourself that you are the right person for the job. Consider whether other doctors of similar experience have gone before you, what supervision will be in place, and what the arrangements are regarding salary or expenses. You will likely have to register with the country’s medical council, which can take some time. The best advice for arranging a developing world placement is to start early and be persistent. Please visit our Resources Section for details of some charities and organisations who may be of interest.
Expedition Medicine / Expeditions are a particular passion of ours here at Adventure Medic HQ. In theory, any doctor with a license to practice (i.e. post- Foundation) can go on an expedition and many do. However, there are a number of ways to keep yourself right. First of all, make sure you are up to the job. Get a thorough understanding of the nature of the trip and the participants before accepting, and be honest about your own experience. Expedition docs are subject to the Bolam Test (Hunter vs. Hanley for Scots) – in other words, your actions will be judged against your peers. If you bill yourself as a ‘mountain medicine expert’, expect to be judged against other experts should the worst happen and you end up in court. For your first expedition, it may be good to go with one of the more well-known organisations, such as Raleigh International or Blue Ventures, as they are used to junior doctors. Whoever you go with, make sure that they are clear about the deal that they are offering. Do they include flights? Kit? Indemnity? Expenses in country? A salary/per diem? Be wary of operators who offer you ‘10% off’ off the cost of the trip if you are willing to act as doctor. Often, the cost of kit, indemnity and preparation time will be considerably more than the 10% and may detract from your enjoyment of the expedition. A good way to take the stress out of being an expedition doctor is to go on a course first. There are a number listed in our Resources Section. As well as teaching you some of the skills, courses are also great ways to make contacts in the expedition world. Good luck, and let us know how you get on!
Recruitment Agencies / Recruitment agencies can take a lot of the hassle out of arranging work abroad. However, be aware that they are a bit like budget airlines – they often take you somewhere near to where you want to go. Be very sure where you are being placed. Remember also that agencies make a lot of money for every doctor they place, so you are doing them a favour not the other way around. Drive a good bargain.
Adventure Medic talked to an eclectic bunch of medics who’ve successfully deviated from the straight and narrow at various points in their medical careers. Between them they’ve climbed Kilimanjaro, lived the dream in New Zealand, motorcycled across the African plains, and skied through Greenland. They hope to provide you with encouragement, ideas and inspiration. They’ve also provided us with a wealth of helpful tips including things to consider when taking time out and how to ensure you keep yourself right.
Graduated / Manchester, 2009
Time out / Two years after FY2
What did you do? I spent four months in a hospital in Sierra Leone, did a diving medicine job in Plymouth, worked in the Scottish Outer Hebrides, taught anatomy at Bristol University and worked on expeditions to Everest Base Camp, China, Morocco, Mt. Kilimanjaro and Fiji.
Best bits? Freedom – not being tied into a long contract, being able to try jobs just because I was interested in them, and having time for long expeditions and travelling. Also gaining experience with diseases like tetanus and Lassa Fever in Sierra Leone was incredible.
Any other adventures along the way? I did Postgraduate Certificates in Medical Education and Remote Healthcare, learnt to dive, met a lot of great people, learnt a little Creole….
Any regrets? Absolutely not
What are your plans now? I’ve started ACCS Acute Medicine training in London – my first choice of job and one I don’t think I would have got if I had applied during FY2 – the experience and qualifications I gained during my time out made my application stronger. I’m still managing to keep up my expedition medic work in annual leave, and have recently returned from a 10 day trip to Peru.
Graduated / Aberdeen, 2006
Time out / Two years after FY2
What did you do? I worked for ten months as an SHO in ED and Medicine in New Zealand. I was expedition medic on a three month trip to Borneo with Raleigh International and a ten week diving and conservation expedition with Coral Cay in Tobago. I also did a four month LAT post in Emergency Medicine in the UK to earn pennies.
Best bits? Working in a country that understands the concept of work-life balance (NZ)! Easy access to lots of great outdoor activities and lots of like-minded people. Working as medic on expeditions was great experience both professionally and personally.
Any other adventures along the way? Lots of running, surfing, canoeing, mountain biking, camping etc. I travelled around NZ, Bali, Borneo and went on a silent retreat in Thailand. I also did the Expedition and Wilderness Medicine course.
Any regrets? None (well, perhaps coming back to work in the UK…!)
What are your plans now? I’m an ST4 in Emergency Medicine. I had no problems getting a training post, my experiences abroad gave me good things to talk about at interview. All the medics I met during my travels got their first choice job on their return.
Graduated / Edinburgh, 2006
Time out / One year after FY2 initially, then home and now I’m back continuing my training in Australia.
What did you do? A year in Tauranga, New Zealand doing Emergency Medicine, now in Australia on an Emergency Medicine training programme.
Best bits? The lifestyle, the sports, the money, the weather (not necessarily in that order). A change is as good as a rest, and it certainly helps keep you motivated with medicine rather than grinding out the same daily routine at home.
Any other adventures along the way? I did several courses in expedition and wilderness medicine, a lot of travelling around NZ and some other exciting locations. Locuming back in the UK in the interim facilitated some travels in Europe.
Any regrets? Waiting so long before making the move to Australia!
What are your plans now? To continue my training in Australia. There really is no comparison both professionally and from a lifestyle point of view. Whilst I was in the UK I had job offers to recommence training in Emergency Medicine but I turned them down. The flexibility of the training programme out here allows me time out to pursue expedition-based interests without penalty and the higher wages make time out from work a financially viable option.
Graduated: London, 2006
Time out / After CT2 and two years of research. Duration is as yet undecided – I’m still away!
What did you do? I built and rode a WWII British motorcycle from London to (so far) Addis Ababa, planning to continue to Cape Town, stopping to work in a city hospital in Addis for six months working as a medical doctor, and teaching at a medical school.
Best bits? Crossing the Turkish hinterland, a week camping in the Arabian desert of Egypt, and six weeks travelling and staying with the impossibly hospitable Sudanese: a country which is virtually inaccessible without travelling overland, and a truly amazing culture. Working in Addis has been a spectrum of experience. I’ve had amazing freedom to practice independently, formulate plans, and actually make proper lifesaving decisions singlehanded, unlike the team-based approach to medicine in UK.
It’s also been agonisingly frustrating – in that no-one wants to develop practice, the referrals from other hospitals are catalogues of mismanagement, and now, five months into a six month stint, I’ve been on-call 24/7 since I arrived, running an “ICU” (think HDU ward with a few dodgy ventilators).
Any other adventures along the way? Where to begin? It’s such a freeform journey it’s now hard to decide what has been part of the plan and what’s been diversion.
Any regrets? Nope.
What are your plans now? Interesting: I’ve yet to finish the journey, but I’m sidestepping to go to Manila until December 2013 to be with a girl I met here (didn’t plan that one, either!). She’ll be joining me for the journey south to Cape Town in a sidecar on my motorcycle. We plan on finishing the Journey in March 2014. After that, the plan is to finish training somewhere: maybe the UK, or maybe NZ, depending on where I get the better offer. I’ve a more laid back perspective on life after this break. Do I envisage problems getting back into UK training? Hmm… If there are, then f**k it, there’s other places that’ll train me.
Graduated / Oxford, 2008
Time out / One year after FY2
What did you do? I worked as a Senior Medical Officer at a remote hospital in the Transkei, South Africa. I ran the outpatient HIV clinic, inpatient medical, surgical and paediatric wards and provided most of the anaesthetic cover.
Best bits? “Saving lives” – the sarcastic description we often use for our jobs in the UK, is a daily reality somewhere like Isilimela. Few people want to work there due to the remoteness, so people die from very treatable conditions (sepsis, meningitis, TB, pre-eclampsia, malnutrition) which you can manage even as a relatively junior doctor. I gained proficiency in techniques such as airway management, basic surgical skills like chest tube insertion and suturing wounds, and life saving procedures such as C-sections and D&C. Also the local beaches are stunning, and South Africa as a country is incredible.
Any other adventures along the way? Road trips all over SA and neighbouring countries including one month in a camper van round SA/Swaziland/Botswana/Zimbabwe/Namibia. I ran the Two Oceans half-marathon in Cape Town. I also did courses in Basic Ultrasound, Anaesthesia and HIV/TB.
I bought a motorbike, went on safari, whale dolphin and shark watching, hiked the Giant’s Cup trail through the Drakensberg mountain range.
Any regrets? None whatsoever.
What are your plans now? I’m an ST3 in Anaesthetics. I had no problems getting a training job, and my extra experience abroad has helped massively with applications, as well as in my day-to-day work.
Graduated / Edinburgh, 2002
Time out / I took one year after my PRHO year (I came through the old system), working a five month locum during that time. I then worked for 18 months before working for the British Antarctic Survey for two years.
What did you do? During the first year (after my PRHO year) I was the deputy leader on a large high altitude medical research expedition to Bolivia. Later that year I led an expedition doing an unsupported ski crossing of the Greenland icecap. I worked for the British Antarctic Survey Medical Unit two years later, which included 16 months continuous living and working as the Medical Officer in Antarctica.
Best bits? All of it! I am very proud of the Greenland crossing because I organised and led it, and because it was pretty extreme: 35 days on an entirely featureless icecap, with one other person for company, extremely exposed. Antarctica was a dream come true, a utopian existence for 16 months. I had nightmares about it all being over whilst I was out there.
Any other adventures along the way? I have been blessed in my life to have travelled to many different countries. I still have an interest in polar and expedition medicine, although it is increasingly difficult to do much with it due to family commitments. I am a competitive cyclist and triathlete and spend a lot of time training for that these days. I was fortunate to compete at the Ironman 70.3 World Championships in Nevada this year, which was amazing.
Any regrets? No. I wish I could do more. I’d like to do an Antarctic ski crossing.
What are your plans now? I’m a senior trainee in Anaesthetics in Scotland. I had to leave Antarctica about 4-6 weeks early and fly home, rather than take the ship (which would have been more enjoyable), so that I could attend interviews. It was the sensible decision (I got the job) but a pity to have to leave a little early. I was suspected that if I delayed entering training for much longer that I might find it difficult to get into it, although I might have been wrong. I would like to continue my interest in polar and expedition medicine. I will continue competing in triathlon and cycling as long as I can.
Can I be adventurous with medicine without taking time out?
For various reasons, time out from training might not be for everyone. AM Staff Writer Hannah Evans tells us how she keeps active in the expedition and events medicine world whilst working full time as a GP trainee:
Having itchy feet and a full-time job may sound a bit frustrating…. The truth is it sometimes can be. I decided to expand my portfolio of expedition and wilderness experience without taking time out of a UK specialty training programme or the NHS. Albeit often a little constrictive in terms of timings, with a little imagination and forward planning, it is possible to develop a keen interest in expedition medicine without taking ‘formal’ time out.
As much as I was advised to try and approach training programme directors and educational supervisors and convince them that working as an expedition medic could be counted as study leave, I have so far only managed to take the time as annual leave. I manage about two trips per year of about 10-12 days in length, and often plan these with rota-masters months in advance. This can be tricky, especially if you are planning a trip in the future for a department rota you aren’t even working in yet!
Shorter trips are definitely possible depending on the companies/organisations you are working for, and weekend event work even more tangible with even the tightest of rotas. Amongst the trips I’ve managed in the past few years are two ascents of Kilimanjaro and the Inca Trail in Peru, as well as several mass participation events in Scotland and around the UK.
Adventure Medic’s Top Tips for Taking Time Out
- Plan early and be organised. Taking time out of training is becoming increasingly popular, and jobs (especially in Australia and NZ) are becoming more competitive.
- Research your options carefully, there are lots of opportunities out there, pick the right one to suit your personality/skill set/aspirations. Be aware that for many other countries, the working year doesn’t necessarily run August-August as it does in the UK.
- Also remember to plan carefully for your return to the UK. If you’re taking one year out, you’ll need to factor in time-off and money to return to the UK for interviews/assessments. Many people prefer to take two years out for just that reason. It is a shame to travel halfway around the world to work, but then have to spend all your annual leave travelling back to the UK for applications instead of exploring the country.
- Think about the financial implications of going away. The implications may be very good, if you are working in New Zealand or Australia. However, if you are going elsewhere, think about how you’ll pay your credit card/student loan/mortgage. Students loans need to be paid by direct debit while you are away. These can be frustrating to set up, as you need to give them an assessment of your projected income.
- If you plan on doing some locum work in the UK to help fund your travels, most health boards have a ‘Staff Bank’ – register with them for internal locuming opportunities. There are also many national locum agencies: Medacs, Reed Doctor etc . Be aware the registration process involves a lot of paperwork and can take many weeks – start early.
- Maintain your GMC registration whilst you are away. This may well be a pre-requisite e.g. for any expedition medic work, or for employment abroad. If you’re not doing clinical work, there is the option for ‘voluntary erasure’, but you then face quite a lot of paperwork and hassle to get re-registered on your return to the UK. There is also the option to stay on the register but relinquish your licence to practice. If you’re not sure what to do, clarify the requirements of your overseas employer and talk it through with the GMC.
- On completing Foundation Training you are awarded a ‘FACD 5.2’ certificate – this is mandatory for being accepted onto a Core or Specialty training programme and is valid for 3 years only. If you’re taking longer than 3 years out, you’ll need to provide formal evidence that your foundation competencies are up to date by getting a Consultant who has supervised you for at least 3 months to fill in an ‘Alternative Certificate’ for you. More information can be found on any of the Deanery websites.
- If you plan to return to the UK for further training, check the Person Specification for the Specialty Training programme you hope to apply for. This lists all the criteria and characteristics the admissions panel are looking for in their prospective trainees. Importantly, make sure you don’t end up with too much experience in a particular specialty to be eligible for entry-level training. Most specialties have an upper limit of around 18-24 months experience, any more and you may be forced to apply for jobs higher up the training scale e.g. ST3 and above.
- With GMC revalidation looming, it may pay off to collect a paper trail of references/supervisor reports/mini-CEXs/multi-source feedback as you go along – it can only make your life easier in the long run.
- Be aware that on your job application you will have to give a full employment history, which involves justifying any gaps in employment of four weeks or longer. This is largely for probity/occupational health reasons, to ensure that you weren’t, for example, in a Thai jail. It is unlikely to cause you any penalty on your application, so do not let it put you off taking time time off for travelling, just be aware that you will have to explain the time away.
- If you’re planning on working in a developing world hospital or clinic, try to find out as much as possible about what you’re taking on before you go. Many doctors find themselves in at the deep end on arrival, which may pose difficult professional and ethical dilemmas. Speak to others who’ve been before, try to elicit what will be expected of you, and be explicit about your skill level and scope of practice.
- In checking the Person Specification, you may also be pleasantly surprised to see that there’s actually no scope for discriminating against you for taking time out. Try not to be put off by the fearmongering. In fact, you will more likely give yourself opportunity to acquire more application points through further relevant experience/demonstration of commitment to specialty/further audits & research.
- Finally, when you are back be sure to pen an article detailing your adventures for our esteemed publication. We look forward to reading all about it.
We have a comprehensive list of links in our Resources Section but these are some to get you started.
- Broadening Your Horizons / A brilliant resource published by the British Medical Association, guiding you through every step of the process in taking time out to work and train in a developing country.
- BMA Guide to Working Abroad / Provides some country-specific guidance for working in NZ/Australia/North America/the EU as well as more general guidance for working in the developing world.
- BMA Guide to Out-Of-Programme Experience (OOPE) / Many ST programmes offer this, but your proposal must be approved by your Local Education and Training Board (LETB) in order for you to retain your national training number. The GMC also has a list of FAQs about OOPE and a dedicated email address for queries: email@example.com.
- GMC Certificate of Good Standing / You need one of these to register with an overseas regulatory body.
- NHS Medical Careers website: Medical Training Abroad / Somewhat surprisingly for a website produced by the NHS, this is a brilliantly thoughtful and well laid-out resource for anyone considering taking time out of training to work abroad, or for those considering alternatives to practising NHS medicine. It also includes interesting case studies. Well worth a browse.
- Specialty Training Person Specifications /Outlining the criteria and competencies for selection for all Core and Specialty Training programmes.
- When adventure comes before ambition / The BMA News interviews Expedition and Wilderness Medicine’s Medical Director Amy Hughes on her eclectic path through medical training.
Thanks to Dr Murray Hudson, for advice regarding jobs in Australia.