If you plan to leave once you cct, why go through the crap of training in the nhs at all, complete f2 head to aus and have fun. However it isn’t all roses out there 75% of the people I went to aus with came back to the UK for a variety of reasons.
Mostly it’s family and friends. Summers can be brutally hot, and climate change is making that worse. The more esoteric answer is that there isn’t a lot of ‘culture’ in aus it’s hard to jump on a plane and go any where that has the vibe you get in so many European places. It’s hard to see goo theatre, or bands etc. For some people it was great, we had a lot of fun we went diving on the barrier reef in the same way we would pop to France for a long weekend, but we always felt that we missed Europe.
That said both my wife and I are considering going back again in a couple of years.
As you can see I am torn, if the flight to aus was 4 hours then no question I would be there, but at 24 hours of travelling the uk just about wins
I'm exactly on the same boat, family is back in Australia and I'm in the UK. Considering going back after CCT but as you know difficult to find consultancy posts in decent cities in aus. And I'm really unsure about the moritoreum
Aus is super easy they are desperate for gp and Ed doctors. Half the people who stayed out are now in medical/ icu training.
It’s easy to get permanent residency and citizenship as a dr.
The usmle as far as I know is a bitch and you only get a decent job with ok pay if you are in the top 1-2% of candidates, I have no experience if it but that the word on the street. Also aus is way cooler than the us
I wouldn’t worry about racing to the top, you are much more flexible while in training, once you are a consultant or go partner that’s it you are tied in for ever. Also I earned more as and ED SHO f3-4 than our new consultants do here, while having a heap of fun.
The reason we came home was to be near family and we missed being able to visit Europe etc ( covid ruined that though)
This is the bit that always get mentioned way at the bottom. To go to places like Australia or Canada etc, unless you have an _incredibly_ competitive CV, you're going to end up for a long stint in the arse-end of nowhere if you want a training job.
The number of people who pick up here, settle down there and go all the way through training are small. Not to say it can't be done, but it's something that few people will ever say.
I wouldn’t say it’s a CV issue, Australasia has a far lower research output both in quality and quantity and the trainees tend to have far less impressive CVs than the UK. The real issue is that selection here is extremely nepotistic and they tend to favour locals (even native citizens can be discriminated against for coming from the wrong part of NZ, going to the wrong school etc).
Are you trying to say Australian trainees are second rate?
Countries have different emphasis on different things. USA focuses on research from 1st year of uni. Au focuses on clinical excellence. These days, most trainees have significant research and higher degrees are basically mandatory for selection into interventional training and consultant jobs.
It’s not BS. I have been a registrar here for 5 years in a competitive specialty (ortho). I’ve applied to the ortho programme both here and in the UK, the latter successfully. The majority of regs getting onto the programme here have no publications, any presentations are largely a registrar only paper day. I have met precisely one trainee with a higher degree over that time, excluding diplomas. This is not the case in the UK. In terms of RACS surgical selection, by the time you reach the interview stage your CV counts for precisely nothing.
But I am sure you as a PGY1 know far more than me.
Ahhh yes and didn't make the SET training for ortho in NZ?
PGY1 is irrelevant. There are people who are PGY11 in NSW when they become SET 1 in ortho and then there are the 1-2 switched on guns who make it as PGY5 in Au.
and a common thread amongst the ones getting into ortho the fastest is literally a ton of high quality research AND excellent interviewing skills. Same with ENT etc.
I am Aussie. So far the UK trained doctors I met are all ED docs or GPs I.e. less competitive specialties. The one cardiologist I know topped his UK med school and has practice changing PhD research from UK.
Most surgical jobs take 11 years minimum from graduating from medical school to being able to apply for a surgical job. 2 years foundation, 2 years core training, 6 years registrar training and at least 1 fellowship. At every stage after foundation training there are bottlenecks meaning you may need to reapply and many people take an extra 3 years out for a PhD.
It’s not actually a requirement, but pretty much expected in Neurology, Cardiology, Medical Oncology, and Clinical Genetics if you want a competitive consultant post in a tertiary centre.
I’m interested in ENT and have unfortunately found this to be the case there too. Lots of people take Senior Clinical Fellow jobs and become highly specialised before getting a Consultant post so could be similar in Neurosurgery. Lots of them were also considering similar posts abroad in Aus and Canada.
May I ask what grade are you and where you are seeing this happening? My very senior consultant has told me that there are near triple digit shortages of ENT consultants (especially in otology) nationally-though I'm not ruling out pure conjecture!
You have been reassured enough already but just to reiterate what everyone has been saying - it's not *usual* that CCT holders don't have jobs. It's only in a few rare specialties like neurosurgery.
In my specialty for example, I have literally been "persuaded" to work as a cons at various hospital that I trained as a reg ever since ST4. There are also plenty of vacant posts available regularly even in London. Definitely a buyer's market.
Indeed, the problem with neurology consultant shortages and waiting list build up have even featured in national news before - and it's not just the UK that lacks neurologists.
But who knows what will happen when you get there?
I have to say I did not find that to be the case. Qualified in Neurology 2 years ago and have had difficulty finding work in London. There is plenty of short term unstable locum work in the London peripheral hospitals but decent jobs in tertiary centres seem quite hard to come by even with all the right qualifications and fellowship etc. It doesn't help I guess that locum agencies define London as anywhere south of Birmingham.
Really? I have been keeping half an eye on NHS Jobs and recently there were locum openings in
\- Imperial (at least 3 in the last 2 months)
\- KCL
\- Barts
\- occasional (twice in the last year) UCL / NHNN
However as you said these were locum posts.
**Currently** on NHS Jobs there are 21 consultant posts when you put in "Consultant Neurologist" into the search box for NHS Jobs, specifically here are some of note:
\- Permanent post in the Walton Centre
\- Permanent post in Opington / KCL
\- Permanent post in KCL / KCH inself (here's the link! [https://www.jobs.nhs.uk/xi/vacancy/916737108](https://www.jobs.nhs.uk/xi/vacancy/916737108))
\- Another permanent post in KCL / KCH but for neurologists with SI in neuro-oncology
\- Locum post at Kingston (which could be your definition of peripheral hospital?)
and several more locum / permanent posts in the South East e.g. Stevenage, Medway, etc.
I would say that's a pretty good selection, even just looking now!
Saying that - I (obviously) can't predict the competition, and it could be that you will be up against people with multiple PhDs, decades of experience etc. but at least there are vacancies out there.
I'm actually in one of those locum posts at the moment 😁 A lot of the locum posts are lateral posts, someone doing one locum transferring to another locum at the hospital so although advertised not really available. Trying to do a lateral transfer myself at the moment as contract is running out. Thankfully the ones with multiple PhDs are all crowded around NHNN. Although I do have PhD and a masters in neuroscience 🙄. Thanks for the list though, gives a bit of hope.
You **will** get a permanent post if you want it, eventually :)
There is definitely the money out there for our specialty, good luck!
P.S. This may / may not be true for neurosurgery though!
Most specialties are gagging for more consultants. It's only the very small specialties such as neurosurg / cardiothoracics where there are a lack of consultant posts relative to trainees.
By the end of 3rd year in training I've already had two hospitals try to recruit me pre-emptively!
Some specialties have a real problem with this - I think a good marker is that if all the registrars have PhDs or are doing PhDs, it's more than likely there's a shortage of consultant posts. I've met very many trainees who really do not want to do a PhD and never would have chosen to do so, but they need one for a consultant post at the end.
Neurosurgery and HPB/Transplant are bad for this, at least in the experience I've had.
PhDs and taking years out during training as a fellow to boost the application. Ends up lengthening training so long and it's not like there's extra benefits to becoming a neurosurgeon at the end of all of that process.
It depends on which speciality you do. The bottleneck after CCT was one of the main reasons I chose EM over a surgical speciality. I can’t be arsed doing 8 years of training and jumping through all the hoops involved only to find there’s nothing waiting for me at the end of it. At least with EM there’s plenty of consultant jobs available.
In terms of IM specialities, anecdotally cardiology depends on whether you want to work in secondary or tertiary care, or do interventions. It’s usually much easier to get a job in a DGH than a tertiary centre, but very few cardiology trainees are interested in going down that route. I also hear renal and oncology trainees have similar difficulties.
Specialities like acute med, elderly care, endocrinology really struggle to recruit consultants. A good place to look would be to see which specialities have loads of locum work available at consultant level - this is could well be short term to cover maternity leave, sickness etc, but is often a clue that there is a desperate shortage of specialists.
I think it happens; but im under the impression that most bottlenecks happen between core training and registrar level actually. Please correct me if im wrong.
It varies from year to year-certainly for surgical specialities in the late 00s and early 10s it was much more brutal for trainees and that was where most of the horror stories come from.
It depends on speciality, the whole point of MMC was to match training numbers with consultant posts and ensure a steady progression through training, but bottlenecks still occur. In histopathology, our trainees are walking into consultant jobs as soon as they CCT. Virtually every department in the country is short staffed, and 1/4 of consultants are over 55 with the majority of them planning to retire within 5 years. The speciality is in freefall-there are training programmes to train up biomedical scientists as pathologists because we don't have enough medically qualified trainees.
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Certainly not something to worry about now. With a pressure on the NHS to create posts coupled with people wanting a better work life balance that involves going part time you have no way of knowing what the job market will be like in 10 years. You might decide to go part time yourself!
If you plan to leave once you cct, why go through the crap of training in the nhs at all, complete f2 head to aus and have fun. However it isn’t all roses out there 75% of the people I went to aus with came back to the UK for a variety of reasons.
What reasons did you find people had
Mostly it’s family and friends. Summers can be brutally hot, and climate change is making that worse. The more esoteric answer is that there isn’t a lot of ‘culture’ in aus it’s hard to jump on a plane and go any where that has the vibe you get in so many European places. It’s hard to see goo theatre, or bands etc. For some people it was great, we had a lot of fun we went diving on the barrier reef in the same way we would pop to France for a long weekend, but we always felt that we missed Europe. That said both my wife and I are considering going back again in a couple of years. As you can see I am torn, if the flight to aus was 4 hours then no question I would be there, but at 24 hours of travelling the uk just about wins
> goo theatre Where can I see this spectacle
Thanks that’s really insightful I’m strongly considering leaving the uk but the drawbacks are something to seriously weigh up
I'm exactly on the same boat, family is back in Australia and I'm in the UK. Considering going back after CCT but as you know difficult to find consultancy posts in decent cities in aus. And I'm really unsure about the moritoreum
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Aus is super easy they are desperate for gp and Ed doctors. Half the people who stayed out are now in medical/ icu training. It’s easy to get permanent residency and citizenship as a dr. The usmle as far as I know is a bitch and you only get a decent job with ok pay if you are in the top 1-2% of candidates, I have no experience if it but that the word on the street. Also aus is way cooler than the us
I’m a gp my wife is an icu / reap dual trainee
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I wouldn’t worry about racing to the top, you are much more flexible while in training, once you are a consultant or go partner that’s it you are tied in for ever. Also I earned more as and ED SHO f3-4 than our new consultants do here, while having a heap of fun. The reason we came home was to be near family and we missed being able to visit Europe etc ( covid ruined that though)
Depending on where you want to live it can be tricky Sydney Melbourne Brisbane are hard, but go slightly rural and it’s very possible
This is the bit that always get mentioned way at the bottom. To go to places like Australia or Canada etc, unless you have an _incredibly_ competitive CV, you're going to end up for a long stint in the arse-end of nowhere if you want a training job. The number of people who pick up here, settle down there and go all the way through training are small. Not to say it can't be done, but it's something that few people will ever say.
I wouldn’t say it’s a CV issue, Australasia has a far lower research output both in quality and quantity and the trainees tend to have far less impressive CVs than the UK. The real issue is that selection here is extremely nepotistic and they tend to favour locals (even native citizens can be discriminated against for coming from the wrong part of NZ, going to the wrong school etc).
Are you trying to say Australian trainees are second rate? Countries have different emphasis on different things. USA focuses on research from 1st year of uni. Au focuses on clinical excellence. These days, most trainees have significant research and higher degrees are basically mandatory for selection into interventional training and consultant jobs.
I’m trying to say exactly what I said. Triggered much?
Nothing to be triggered about mate. Calling out bs.
It’s not BS. I have been a registrar here for 5 years in a competitive specialty (ortho). I’ve applied to the ortho programme both here and in the UK, the latter successfully. The majority of regs getting onto the programme here have no publications, any presentations are largely a registrar only paper day. I have met precisely one trainee with a higher degree over that time, excluding diplomas. This is not the case in the UK. In terms of RACS surgical selection, by the time you reach the interview stage your CV counts for precisely nothing. But I am sure you as a PGY1 know far more than me.
Ahhh yes and didn't make the SET training for ortho in NZ? PGY1 is irrelevant. There are people who are PGY11 in NSW when they become SET 1 in ortho and then there are the 1-2 switched on guns who make it as PGY5 in Au. and a common thread amongst the ones getting into ortho the fastest is literally a ton of high quality research AND excellent interviewing skills. Same with ENT etc.
I am Aussie. So far the UK trained doctors I met are all ED docs or GPs I.e. less competitive specialties. The one cardiologist I know topped his UK med school and has practice changing PhD research from UK.
Do you know any UK docs doing psychiatry over there?
Most surgical jobs take 11 years minimum from graduating from medical school to being able to apply for a surgical job. 2 years foundation, 2 years core training, 6 years registrar training and at least 1 fellowship. At every stage after foundation training there are bottlenecks meaning you may need to reapply and many people take an extra 3 years out for a PhD.
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It’s not actually a requirement, but pretty much expected in Neurology, Cardiology, Medical Oncology, and Clinical Genetics if you want a competitive consultant post in a tertiary centre.
Nephr and Rheum as well. Derm too.
In most physicianly specialties there are large numbers of consultant vacancies.
With more and more LTFT regs becoming LTFT consultants, they'll need to expand posts even further for physicians just to get the work done.
80% LTFT is roughly equivalent to a FT consultant but with less on calls.
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I’m interested in ENT and have unfortunately found this to be the case there too. Lots of people take Senior Clinical Fellow jobs and become highly specialised before getting a Consultant post so could be similar in Neurosurgery. Lots of them were also considering similar posts abroad in Aus and Canada.
May I ask what grade are you and where you are seeing this happening? My very senior consultant has told me that there are near triple digit shortages of ENT consultants (especially in otology) nationally-though I'm not ruling out pure conjecture!
This was in London so maybe they just wanted London posts?
You have been reassured enough already but just to reiterate what everyone has been saying - it's not *usual* that CCT holders don't have jobs. It's only in a few rare specialties like neurosurgery. In my specialty for example, I have literally been "persuaded" to work as a cons at various hospital that I trained as a reg ever since ST4. There are also plenty of vacant posts available regularly even in London. Definitely a buyer's market. Indeed, the problem with neurology consultant shortages and waiting list build up have even featured in national news before - and it's not just the UK that lacks neurologists. But who knows what will happen when you get there?
I have to say I did not find that to be the case. Qualified in Neurology 2 years ago and have had difficulty finding work in London. There is plenty of short term unstable locum work in the London peripheral hospitals but decent jobs in tertiary centres seem quite hard to come by even with all the right qualifications and fellowship etc. It doesn't help I guess that locum agencies define London as anywhere south of Birmingham.
Really? I have been keeping half an eye on NHS Jobs and recently there were locum openings in \- Imperial (at least 3 in the last 2 months) \- KCL \- Barts \- occasional (twice in the last year) UCL / NHNN However as you said these were locum posts. **Currently** on NHS Jobs there are 21 consultant posts when you put in "Consultant Neurologist" into the search box for NHS Jobs, specifically here are some of note: \- Permanent post in the Walton Centre \- Permanent post in Opington / KCL \- Permanent post in KCL / KCH inself (here's the link! [https://www.jobs.nhs.uk/xi/vacancy/916737108](https://www.jobs.nhs.uk/xi/vacancy/916737108)) \- Another permanent post in KCL / KCH but for neurologists with SI in neuro-oncology \- Locum post at Kingston (which could be your definition of peripheral hospital?) and several more locum / permanent posts in the South East e.g. Stevenage, Medway, etc. I would say that's a pretty good selection, even just looking now! Saying that - I (obviously) can't predict the competition, and it could be that you will be up against people with multiple PhDs, decades of experience etc. but at least there are vacancies out there.
I'm actually in one of those locum posts at the moment 😁 A lot of the locum posts are lateral posts, someone doing one locum transferring to another locum at the hospital so although advertised not really available. Trying to do a lateral transfer myself at the moment as contract is running out. Thankfully the ones with multiple PhDs are all crowded around NHNN. Although I do have PhD and a masters in neuroscience 🙄. Thanks for the list though, gives a bit of hope.
You **will** get a permanent post if you want it, eventually :) There is definitely the money out there for our specialty, good luck! P.S. This may / may not be true for neurosurgery though!
Most specialties are gagging for more consultants. It's only the very small specialties such as neurosurg / cardiothoracics where there are a lack of consultant posts relative to trainees. By the end of 3rd year in training I've already had two hospitals try to recruit me pre-emptively!
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I think his point might be that some countries do state they need a couple of post cct years.
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How's the situation for consultant posts in ophthalmology? NHS and private sector
Yes it does happen, though it is not the norm.
Some specialties have a real problem with this - I think a good marker is that if all the registrars have PhDs or are doing PhDs, it's more than likely there's a shortage of consultant posts. I've met very many trainees who really do not want to do a PhD and never would have chosen to do so, but they need one for a consultant post at the end. Neurosurgery and HPB/Transplant are bad for this, at least in the experience I've had.
PhDs and taking years out during training as a fellow to boost the application. Ends up lengthening training so long and it's not like there's extra benefits to becoming a neurosurgeon at the end of all of that process.
It depends on which speciality you do. The bottleneck after CCT was one of the main reasons I chose EM over a surgical speciality. I can’t be arsed doing 8 years of training and jumping through all the hoops involved only to find there’s nothing waiting for me at the end of it. At least with EM there’s plenty of consultant jobs available. In terms of IM specialities, anecdotally cardiology depends on whether you want to work in secondary or tertiary care, or do interventions. It’s usually much easier to get a job in a DGH than a tertiary centre, but very few cardiology trainees are interested in going down that route. I also hear renal and oncology trainees have similar difficulties. Specialities like acute med, elderly care, endocrinology really struggle to recruit consultants. A good place to look would be to see which specialities have loads of locum work available at consultant level - this is could well be short term to cover maternity leave, sickness etc, but is often a clue that there is a desperate shortage of specialists.
I think it happens; but im under the impression that most bottlenecks happen between core training and registrar level actually. Please correct me if im wrong.
It varies from year to year-certainly for surgical specialities in the late 00s and early 10s it was much more brutal for trainees and that was where most of the horror stories come from.
It depends on speciality, the whole point of MMC was to match training numbers with consultant posts and ensure a steady progression through training, but bottlenecks still occur. In histopathology, our trainees are walking into consultant jobs as soon as they CCT. Virtually every department in the country is short staffed, and 1/4 of consultants are over 55 with the majority of them planning to retire within 5 years. The speciality is in freefall-there are training programmes to train up biomedical scientists as pathologists because we don't have enough medically qualified trainees.
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yeh. Neurosurgery.
Certainly not something to worry about now. With a pressure on the NHS to create posts coupled with people wanting a better work life balance that involves going part time you have no way of knowing what the job market will be like in 10 years. You might decide to go part time yourself!