The Great North Move

Less than a week to go before I start my annual leave and finish my second F2 year. Was planning to move out straight to the new property I was in the process of buying in Leeds, but it's looking increasingly likely that it's going to fall through, as sudden hidden costs have appeared. Obviously this means hospital accommodation, and fortunately Huddersfield were kind enough to fit me in due to a cancellation, else I would have been really in trouble.

So.....unless anything changes next week, it's back to property hunting!

On a completely unrelated note, most of my F2 colleagues have nabbed ST1 or CT1 posts this year, which is a stark contrast to last year. Perhaps things worked a little better for specialities outside ophthalmology, or perhaps we were damn lucky.

Either way, I still believe the reduction in training hours for junior doctors and the increased pressures for service provision resulting in reduced organised training for juniors is going to have a bad long-term effect on the NHS that the public are going to be completely oblivious to (like they are to most things that "doesn't affect them") until it's too late....at which point they'll start whining (too little, too late).

In the mean time, let's start the ST1 countdown....And I pray that I don't get stuck with managerial/departmental politics, or seniors who aren't interested in supporting their juniors openly....

Success!

Just heard from Yorkshire deanery the other week. I have been offered ST1 Ophthalmology for this year. Was originally offered FTSTA1, but it seems that a lot of people turned down offers sent to them because Yorkshire were so slow to come out with results compared to other deaneries who had already made offers, so I got upgraded. Add in the fact that the way shortlisting was someone somehow resulted in most of the same people being shortlisted in most places (with a handful of extra people getting the 1 interview), and it's unsurprising that when those people have taken jobs somewhere else, there's going to be a lot of "no" responses if you hand out offers last. While i'm but no means sorry that things turned out this way, you have to wonder exactly how the deaneries carried out their shortlisting for this to happen. When you hear of people passionate about the speciality with courses, audits, and presentations related to the speciality on their CV not being shortlisted, and general surgical registrars applying on a whim with nothing ophthalmic on their CV getting shortlisted, it does make a mockery of the system.

Oh Dear, Here We Go Again

Yes, it's that time again. MMC v2.0 is well underway. Gone is the useful one-time application form that allowed you to save time and concentrate on one things (even if the way the system was built was bad), and back is the old-school system of 15 page forms, with each place having their own version and rules, and wanting multiple copies posted to them (probably because they don't want to face the costs/labour of photocopying themselves). When you're spending £5-10 per application on postage, it begins to get ridiculous. Fortunately, some deaneries have seen the light this year, and have taken applications by e-mail.

Ophthalmology has 49 ST1 posts this year (yes there are FTSTA1's, but for a speciality that offers run-through, it's not a very sensible option), and as usual, the competition will be sick. Whether an extra year at the FY2 level will make a difference remains to be seen....

On another note, I took the Myers-Briggs test. Interestingly, whenever I had taken the free versions on the internet, I'd always been labelled as an INTJ. With the official long test (you get what you pay for I suppose), I've been labelled as an ISTJ (21/30 I, 5/30 S, 28/30 T, 30/30 J). I can see where the confusion in labelling either the S or N comes from as I scored low on that, so I have a feeling that in reality, I'm more of a combination IS/NTJ.

So, if you're reading what that's supposed to mean for my personality, check out these 2 links which cover the 2 types, and see for yourself how similar I seem:

INTJ

ISTJ

For Those Who Find The Reality Of Unemployed Doctors Boring....

Ok, this entry is for those of you who can't cope with reality because it's "too boring" >.> (FD and DD). I cannot guarantee the veracity of the following entry in any way after this point (ie: it's all made up)....

Today I left my phone in a patient. It wasn't until after I'd closed up that I realised what had happened when it started ringing. I reached for the scissors to undo the stitches, and found that I'd left them inside as well. Bummer.

After retrieving my phone I left the theatre staff to fix the patient back up and wandered off in search of my next patient. As I strolled along the corridor I came across one of my A+E colleagues (Dr A) copping off with a nursing student (Ms B) in the middle of the corridor. Stepping round them, I continued on my journey.

Arriving in A+E, it was immediately obvious that I would have plenty to do. Bypassing the first few cubicles because they either smelt of stale urine or of infected ulcers, I entered the resuscitation area to find half a dozen patients who looked like their legs had been put onto them the wrong way round.

After persuading one of them that they didn't need sedation or anaesthetic before I did anything, I grabbed their foot and yanked it round to where it should be while she cursed obscenities at me and continued spurting blood from the wound on her face. Eventually she became quiet and I thanked my lucky stars. Then shortly realised it was because her heart had stopped.

I decided to leave because I couldn't be bothered with all that resuscitation nonsense because it was tiring....

Will I Ever Escape?

Well, it would appear that I am destined to remain in Ashford, Kent for 1 more year. I have been offered a repeat FY2 scheme, rotating through General Surgery (colorectal), Microbiology, and Ophthalmology. The up side is that having finished a FY2 already this year, I will not be expected to attend all the "mandatory" FY2 teaching, and will be allowed to do other things at the time instead - like teaching students/juniors, or attending theatre/clinics.

Why do a repeat FY2? Well, like I've said before, as far as I am concerned, FTSTA posts are a career killer, and the only reason why any one with a brain cell should be doing them is for money to pay the bills. This repeat year offers me officially recognised training at a pre-ST level, so it will not affect my chances of applying for ST1. However, because of this "repeat time", it means I shall be more experienced (on top of the fact that I will already have an added 2 years post-PRHO on my colleagues), and will take the opportunity to "beef up" my CV more than ever before.

When I apply to ST1 next time, I aim to have them drooling over my application and regretting they never too me first time round.....

They Think It's All Over.....It Is Now

Ok, Round 1 is officially over, and Round 2 is about to kick off. I was unsuccessful in obtaining an Ophthalmology ST1 post this year. So....now what?

Well, at the moment it looks like I may be offered a repeat Foundation Year 2 program, but that's still to be confirmed. I'm also attempting to get confirmation about a possible Research post at the Massachusett's Eye and Ear Institute, which would be a fantastic opportunity to get involved in ophthalmological research and fill my time. If neither of those pan out, it looks like i'll be heading abroad. Either way, the aim is now to be constructive until applications for ST1 come round again later this year for August 2008 entry, with the goal of making my CV strong enough to blow the competition away this time round, allowing me to have multiple shots at an offer through then-interviews. This time failure is not an option.....

The Beginning Of The End

It's finally begun. Following the decision of the judicial review 2 weeks ago where RemedyUK lost their battle to have MMC essentially scrapped this year, deaneries have now begun handing out offers of ST programme places to candidates. Every day now, people wait - hoping that today will be the day they receive that letter in the post or that e-mail in the inbox. And every day, that hope is beginning to fall. Almost all the offers that were going to be made now have been done, so until 10th June there is not much to do, as people with multiple offers are holding onto them in the hope that perhaps they might get offered something better in the meantime. After 10th June, deaneries will re-release refused offers to the next person on the list....and the game of musical chairs will go on, until there's no more chairs for people to sit in.

And how are the deaneries choosing candidates? Well, unfortunately, now that the online MTAS system has been scrapped, and power devolved to individual deaneries once more, there is little to ensure that fair practices are followed. If there is an answer, it isn't being given to candidates. Perhaps all offer decisions were already made at Round 1a interviews, with 1b just being an exercise for fun. Perhaps the offers are only being made to local candidates, as they're "known". And perhaps for once in the entire history of this sorry affair the people in charge have got it right, and have ranked all candidates and are choosing like that. We may never know.

Where I'm currently working (William Harvey Hospital, Ashford, Kent), up until today, there has been not a single word of anyone obtaining an ST offer bar a surgical registrar that was offered an ST3 post. However, I have finally heard of someone receiving an ST1 post in Ophthalmology via the Eastern Deanery, which currently makes him the luckiest person in the hospital as he can now relax in the knowledge that his life has been spared any further trauma, emotional, financial, or otherwise.

As for the rest of us, all we can do is stand here in the dark with our candles, hoping that we too will get let inside before the little flame between our hands gutters and dies out....

Judicial Review Finally Over!

Well, the news was just released a little after 4pm today (see BBC article here). The judicial review has found in favour of the Department of Health (DoH). This means that the current plans on the MMC website will go through - see here. The basic outline of these plans?

1. Posts will be offered by UoAs to the highest ranked candidates irrespective of the candidate’s order of preference. You may receive more than one offer through this revised process.

2. The deadline for acceptance is 23:59 on 10th June.

3. Additional offers will be made from 11th June to 20nd June, with 48 hours to accept or decline and offer, so the final final deadline is 22nd June.

4. If you accept a FTSTA post, but subsequently get offered a ST programme post, you may decline the first even if already accepted and take up the latter offer. This does not apply between FTSTA-FTSTA or ST-ST.

5. Round 2 is planned to start in June, and last until November. It will only be open to those who applied in Round 1.

6. Further information about Round 2 and support plans for those who are unsuccessful in Round 1 are to be released shortly.

Everyone on their marks? Let's brace ourselves for the First Great ST Post Rush.....

Interview #2

Well, I had my second interview for Specialist Training (ST) applications this Wednesday gone (under the auspices of Round 1B). This time the setting was almost as for from the North and Newcastle as you could get - Plymouth and the South-West Pensinsula Deanery. The interview was at the fairly new Plymouth Radiology Academy, which for some reason is set in a business park. Fortunately, there's also a hotel in the same business park, so it meant finding accommodation was that much easier.

Having had a total of 23 applications at the start of Round 1 for Ophthalmology ST Year 1 (OST1), Peninsula originally only interviewed 8 candidates (unfortunately, I wasn't one), of whom 4 had placed it as 1st choice. Imagine my surprise when I arrived on Wednesday morning to find only 2 other people there to be interviewed - out of a possible maximum of 15! This means that there are 11 people going for 2 jobs, and that somewhere between 3 to 11 of us have placed Peninsula in the Number 1 slot.

The interview had 3 stations. Station 1 was split into 2 parts. 12 minutes to read a paper (on intravitreal triamcinolone for macular edema) and critically appraise it, and prepare a flip-chart summary presentation. The second part was 5 minutes to present your findings, then a further 5 minutes to be asked questions.

Station 2 covered my portfolio (taken from us when we arrived) and general questions covering standard topics such as clinical governance, research, audit...etc...This was 10 minutes.

Station 3 consisted of 2 ophthalmic scenarios over 10 minutes:

1) Patient with an acutely red, painful eye.
2) Telling a patient they had optic neuritis, and dealing with the question of MS.


All in all, I came out of this interview feeling that things had at least gone ok, compared to my interview in Newcastle, where I felt I had not done as well - especially when they sprung ophthalmic-style suturing on us, something I thought was unfair as anyone who hadn't been in an ophthalmic training post was not allowed to do the Royal College of Ophthalmologys' (RCOphth) Microsurgical Skills Course and would therefore find it hard, even if you were told that only your "general dexterity" was going to be looked at. It's a biased test.

So now what? Well, like many of my other colleagues, I'll now wait for sometime in June when the results should be released. If I'm lucky enough to have scraped one of the 55 highly sought after OST1 posts in the UK, then I can relax, secure in the knowledge my training is finally available all the way to completion. Otherwise, along with 1000's (around 12,000) of other doctors, I'm going to have to leave the UK for work abroad, with the knowledge I'll essentially never be able to return to work in the UK training system again - At least, not in a training post (and if i'd wanted a non-training post in the first place I might as well have applied for it now, but I didn't go to medical school in the UK to be shunted into a dead end job, possibly even in a speciality I didn't want).

Brace Yourself Again......

If you're confused about the following, you probably want to start from: here

From Monday the MTAS site goes live again (after shamefully having to be taken off as it was shown someone had hacked it, making it possible for everyone to everyone else's application), and new interviews for Round 1 are released.

It seems that after all the rumour-mongering, only your rank order was changable. That, and whether you'd accept an FTSTA or not. This isn't as bad as I thought it'd be, as it means that the total number of applications listed under the statistics pages are still viable, as you can't apply anywhere new. With that in mind, I've decided to switch my 1st choice (London/KSS), for my 3rd choice (Peninsula), as there have been only 23 applications total to Peninsula for 3 posts. Considering my Northern application interviewed 23 people for 3 ST and 2 FTSTA posts, and that there are another 23 people who could switch to there, I think that Peninsula represents my best bet of being offered a proper training post. Which probably means my chances just went from 0.1% to 1%, lol.

As to whether interviews will be conducted differently, noone knows. However, everyone now knows what to expect if they don't change, so the element of surprise of having "more than 1 interview" has been lost, and people have now had considerable time to prepare. That alone makes the competition stiff, let alone if they decide to toughen (the already tough) the interviews up.

On another note, it seems Australia and New Zealand have been inundated with requests for locum work, which they are ecstatic about, because they are both short of doctors - Something that probably won't be a problem from August onwards.

It also turns out that with upto 8 grand available for transfer allowance, if everyone has to apply for allowance and uproot to a new post across the country, there's close to a 100 MILLION that's going to be spent. Once again, money that the Governement haven't even considered and will try and avoid paying out, resulting in many doctors and their families being left to fork out massive fees to move furniture and belongings, let alone pay stamp duty and all that other crap the suits leech from us when we buy a property.

The only other shocking development is the Government's laughable idea about sending those who are unable to secure jobs on voluntary work for various organisations, as a way of ensuring people have work. Yeah, screw us over, then try and pack us off to a far flung corner of the world to work without pay in a job that will no doubt be unrecognised for any kind of training. Idiots.

We're All So Screwed

So, a few days ago, the MTAS/MMC review committee finally came out with their Master Plan to fix this ongoin fiasco.....Give everyone an interview!

Yes folks, instead of having some kind of preliminary filtering system to decide on shortlisting people, that's been scrapped, and now on April 19th, everyone will be asked to re-pick their 1st choice place/speciality, and will obtain an interview there (unless you've already had one there). What does this mean? Well.....

Those who didn't get an interview are happy, because they get to jump into th fire now as well - and with interview questions/general information now being out, everyone knows what to expect from their interview and can prepare accordingly......possibly discriminating against those who had early interviews.

Those who had multiple interviews are happy, because they can gauge what their best interview was and pick a first choice from them, or have a completely new interview. Either way, they have 4 places to be chosen from.

Then there're those (like me), who only had 1 interview. Not much to gauge on how well the interview went, these people can either move their interviewed place to 1st (if it isn't already), or they can choose a new place for interview. What's the problem with this? Well.....

The competition statistics/ratios have been released, so now everyone knows how popular each place is, and how over/under-subscribed it was, and how likely they might stand a chance. This means just like applying originally again for Round 1, except with a few more statistics to play the guessing game with, and knowing that noone is going to get dropped this time as there's no shortlisting - just an interview +/- CV.

This means that statistics are going to go out the window, as everyone starts second-guessing them. Some will apply to the most popular places hoping others will leave them. Some will apply to the least popular places. Others will stay where they are, hoping they did well enough and that the numbers won't change enough to make a big difference.

And when are they going to tell us if we get to keep a job or not? JUNE! Most probably not even at the start either. Wheich means if you have no job, you're screwed, cause then over 8,000 of your colleagues are going to try emigrating at once.

Well done Patricia Hewitt and the Labour Governement. I salute you for your continued stupidity.

The Sky Is Falling

I'm writing this again as Seamonkey crashed, so unfortunately it's not as good as the original, which I couldn't save ; ;

Set The Scene
==============

10-15 years ago the Government decided that as we were short of doctors in the UK, it would advertise abroad. This was successful, and many international graduates came, especially from places like India and Pakistan. At the same time, they planned to increase the numbers of medical school intakes, and build new medical schools for the future.

Over 5 years ago, it was realised that the UK was quickly becoming saturated. Instead of applying the brakes slowly, the Government continued recruiting at break neck speed. Suddenly in 2006, having had multiple reports in 2005 of UK graduates being unemployed and finding it hard to even get a locum post (it was in the news in case you missed it >.>), they carried out their patented emergency stop (as they do with all policies, especially those connected to the NHS), and suddenly essentially "banned" those with the wrong type of visa - a not so insignificant population of junior doctors who spent a lot of money and effort to get here and uprooted their families to do it, and have spent many years propping up the NHS, only to find themselves out on the doorstep suddenly.

Unfortunately, this only caused more problems as by now more medical school existed, and more medical students were being pumped out than ever before. Even though the international influx had subsided to an extent, the recent introduction of EU laws that allowed EU trained doctors to work in the UK more than made up for it, so we were back to square 1.....too many doctors.

At this time, expansion of Consultant posts was frozen, as there was barely enough money (some say not even that) to support those already there, let alone new ones. This meant that Registrar posts were frozen as well and more and more doctors were left at the Senior House Officer (SHO) position, milling around from post to post until a Registrar National Training Number (NTN) opened up.

NHS debts were also piling up over this time. Some of the blame has gone on the pay of Consultants and GP's (a very small minority of GP's actually earn as much as the newspapers say, and that's because they own their own practices and do more than just GP'ing - ie: they earn it), but this is the Governments' fault. They negotiated pay contracts with these 2 groups, and through their ignorance and denial of reality, bypassed the fact that a lot of work gets done in the NHS through goodwill of doctors staying late to finish clinics...etc... When payment for all these efforts finally began to take place, the Government suddenly realised (too late again of course) what a monumental cock-up they had made...resulting in an estimated extra £500 MILLION being spent paying for these services.

Also adding to debts was the fact that medical students each take £250,000 (remember this number, because this is what will have been wasted if a UK graduate ends up leaving the UK because they can't get a job) to train over 5 years. By increasing the number of doctors being trained in the UK (and paying for medical schools to be built and hiring staff...etc...), a lot more money was spent too...

Bring On The Clowns
=====================

Over the last 5 years, the Government, spurred on by recent medical scandals (Shipman, Bristol Heart Scandal....etc....etc....), and their own lack of sense and general ability to "fix" everything by going completely the other way (also totally inappropriate, but they conveniently ignore this part because it's "their" choice), devised a new system to train junior doctors to Consultant, called Modernising Medical Careers (MMC). However, in typical civil servant fashion, they did not think things through, and much of the planning was superficial. This became more and more apparent as the deadline for implementing MMC loomed (2007), and still little information was available. What little there was changed from deanery to deanery, and noone could separate fact from fiction.

In preparation for MMC, all SHO contracts that extended beyond August 2007 were cancelled, so anyone who had been on a 2-3 year rotation was screwed after all the work they did to secure the rotation in the first place. These people had to apply for ST posts too.

Mangling Medical Careers / Massive Medical Cull
===============================================

The Medical Training Application Service (MTAS) went live late 2006 (around October). It was a while before personal specifications were released on the MMC website for each new grade (number ST1 upwards) of each Speciality Training (ST) Programme. Unfortunately, no info on job numbers was given, and so juniors had to wait another 1-2 months before this was seen fit to be released (ie: almost less than a month before the applications began), which meant that no planning could be carried out as to where to apply based on the number of posts.

Applications were submitted on 05/02/07 and already problems had appeared. Some candidates had been unable to send in their application (this was all online) as servers had problems. Some referees sent incomplete/wrong references for their juniors. The application form essentially consisted of around 14 "fluffy" questions that had to be answered in 150 words or less. An example: "Describe a time when you have had to explain a complex term or procedure to someone. What were the main challenges and the strategies you used?". This meant that candidates were no longer able to send in beautifully crafted CV's that had been honed over many weeks/months/years, but instead were resigned to an ugly white box format that did not allow the opportunity to give a personal statement or show any other achievements beyond the little that was requested.

Applications
===============

These allowed a candidate 4 applications:

1) 2 locations in 2 specialities.
2) 1 location in 4 specialities.
3) 4 locations in 1 speciality.

With no previous statistics, noone knew what was going to be more popular, so essentially people just guessed, or used other personal reasons to pick essentially random places.

Shortlisting
=============

How was this done? Well, some of us still wonder that. This was a highly guarded secret pretty much up until applications were sent it, though it has since transpired that this was because noone knew what the hell was going on, even the people making the decisions. It turns out there was a wishy-washy set of marking criteria used, and it also turns out that this was leaked to some candidates before applications were submitted, thus giving these candidates an unfair advantage - something that this "perfect online system" was supposed to have prevented.

As for how people were shortlisted after these criteria were followed, we don't know, as it hasn't been publically acknowledged, nor likely will ever be. (ie: 100 candidates have the same top score after marking with the wishy-washy criteria, yet only 30 can be interviewed. how do you select when the application forms don't give any other information to go on?)

However, the result was that around the UK on 28th Feb, thousands of junior doctors were left gobsmacked, as the ineptitude of MTAS really became apparent. Many highly qualified candidates were left without an interview. Some were given multiple interviews. Some were given interviews in specialities they hadn't even applied for! The deaneries were (as expected based on previous MMC deadline dates) late in giving final reports of shortlistings, so some people had to wait almost a week before finding out whether they could have an interview or not.

At this point, the medical profession erupted. Unfortunately, this mostly consisted of juniors with little senior or Royal College support (the majority of which supported MMC blindly having become Governmental lapdogs). Eventually under pressure, the Government reluctantly agreed to review applications and decide if people had been unfairly not shortlisted. This has meant more work for everyone involved in shortlisting as they now have to call back even more candidates.

Interviews
============

These have been messy. To start, with the huge numbers of SHO's and Foundation Year 2 (FY2) doctors (Foundation Years 1 and 2 have already been brought into replace the old style Pre-Registration House Officer and first year SHO years) going for interview, arranging departmental cover around the country has been catastrophic, with some departments being left dangerously understaffed (the Government said this wouldn't be a problem, and once again they've been proven wrong).

Interviews themselves have been variable, with some places being extremely hardcore (F2 doctors getting grilled, having to critically appriase research papers...etc...), and others being more bizarre....(sugical interviewees being asked to make origami paper cranes).

The deadline for results is 19th March, but with all the new interviews that are taking place as a result of the Governmental "inquiry" into "MTAS/MMC flaws", this is probably going to be pushed back, so that Round 2 (assuming any jobs are left) will take place later....

Jobs
======

The whole point of the new MMC scheme is that the bottleneck is brought down to post-FY level, so juniors are forced to decide earlier what they want to specialise in, rather than the old system of bouncing round the SHO grade from speciality to speciality until they decide. On top of this, the number of jobs has been streamlined to match the number of current Consultant posts, so that only "needed" doctors are trained. These posts are Speciality Training (ST) posts. The Government have also introduced Fixed Term Speciality Training Appointments (FTSTA's), with the aim of maintaining service provision with these 1 year posts that do not count for official training. What some people don't realise (though as time goes on, more and more people have become clued in, so this number is dropping) is that:

1) In order to advance from an FTSTA to a ST post, someone needs to leave that ST post to free it up, and everyone who is suitable (ie: by experience and person spec) can apply for it, so there will be a lot of competition, probably even more than there is now.

2) FTSTA's are rumoured to possibly be phased out in a few years to some extent, with the minority left becoming new equivalents to Trust (SHO level) and Staff (Registrar level) Grade jobs, albeit most likely with a new title.

3) Essentially if you do not get a ST post now, your career is destroyed in this country. If you are unsuccessful in applying to a speciality, you will not be allowed to apply for it again, and you will be offered an alternative speciality post (or more likely an alternative FTSTA).

At last count, it looks like approximately 8,000 doctors will be left without a job come August 2007. This is assuming all jobs are filled (i'm sure this will happen as somewhere there is always someone willing to do what you're not). These people are most likely either going to Australia, New Zealand, or Canada, as they are all recruiting at the moment. The rest will go to other countries, or leave Medicine for good for a job in the city, or even unemployment. Some of these will be people unsuccessful in Rounds 1 and/or 2, and some will be those who are not interested in taking the random FTSTA offered by the Government in order to ensure "Services are provided".

Responses
============

The number of doctors that became sick on 28th February when shortlisting results of Round 1 were first released was unprecedented. Many broke down crying on wards, some were sent home. 3 have since committed suicide. This is the biggest crisis to hit junior doctors since the inception of the NHS.

Over 10,000 doctors marched on London in March to show their displeasure at the incompetent handling of their careers.

Some of the media has been sympathetic and have runs pieces on the whole mess, or just shown snapshots (BBC, Channel 4, The Telegraph, The Guardian).

The Government, headed by Patricia Hewitt and Lord Hunt, still deny the magnitude of all this, and refuse to stop the MMC juggernaut, or even overhaul it properly. To the date of this blog, only the miniscule inquiry so far has occurred.

Personally
============

I've had 1 Ophthalmology ST1 interview in Newcastle (Northern Deanery), which involved 4 stations of 10 mins:

1) Clinical Scenarios:

a) A untreatably blind patient comes into your clinic. What do you do?

b) A patient in for pre-assessment for her cataract operation is found to have severe heart failure.

2) Ophthalmic (yes, not normal surgical) suturing - 3 interrupted sutures with instrument ties (we'll ignore the fact that FY2's are not officially allowed to go on Royal College of Ophthalmology Microsurgical Skills Courses and learn such techniques properly).

3) Standard interview grilling.

4) Communications skills - Tell an patient (actress) that she cannot have the cataract operation she's waited months for and come in for today because the operating scope is broken, there is no spare, and it cannot be fixed today.

I am not interested in anything bar ophthalmology (eye surgery). I have experienced other specialities, and while some hold passing interest, I cannot see myself doing anything else for the rest of my career. This means I will not accept a token FTSTA in Gynaecology or Orthopaedics when the Governement want to get the not-so-popular posts filled. Unfortunately, this means my options are limited to emigration - essentially permenantly, as once the new system is in swing, it'll be nigh on impossible to come in again - or quitting medicine. Unsurprisingly, having devoted 9 years to the profession (and countless years in school aiming for my shot at it) and my love of helping people, the thought of having to walk away from it all makes me nauseous. Yet, reality beckons, and there are times when one has to make a hard choice in order to survive. Hopefully it won't come to that, but we'll see....Where would I go if I did quit? Well, that's a good question, and is something medics are not advised well about. Generally medics in this category either end up in pharmaceuticals, medical journalism, (medical) law, medical education, or finance (of some kind). I have no idea which of these would suit me, and I hope I don't have to find out.

Other Related Links
====================

These are other blogs covering this

http://murderingmycareer.blogspot.com/index.html
http://aphrabehn.wordpress.com/
http://thejuniordoctor.blogspot.com/index.html
http://nhsblogdoc.blogspot.com/
http://ferretfancier.blogspot.com/index.html

Another view of MTAS/MMC

http://aphrabehn.wordpress.com/2007/03/09/a-patients-guide-to-modernising-medical-careers-and-mtas-part-1/

NHS Part 2 - Pay

Ok, now I'm going to talk about pay....

For some reason, the general public feel nurses are extremely hard done by, and that doctors wipe their asses with bank notes. Today I'm going to look at this with proper numbers.

The image above is of NHS Doctor Pay Banding Rules, which i'll refer to later. All other info used in calculations is either from the Royal College of Nursing, the British Medical Association, or the BBC.

Let's assume I'm a Year 1 Senior House Officer (SHO), and therefore have been working in the NHS for AT LEAST 1 year.

My basic salary will be approximately £25,000 / year. Based on current job bandings, I'm likely to be banded at either 1A or 2B, which is 50% supplementation of basic salary, giving us £37,500 / year in terms of gross earnings. Now, after taxes (income and National Insurance contributions), this gives us annual earnings of £27,265.92. For the purposes of this blog, I am going to round numbers from now on to the nearest whole. This works out at monthly take home pay of £2272, or weekly pay of £524. At a 37.5 hour working week (what nurses and most other medically related professions do), that works out at £14 / hour. Sounds very good, right? Wrong, because you can probably count on one hand the number of hospital doctors in the UK who do that few hours, if any.

Remember I said Band 1A or 2B? These jobs generally sit between 48-50 hours, which works out at £11 / hour (for 48 hours).

Band 2A jobs (there are still jobs at this level - I'm about to do one this August), will take you to the European Working Time Directive (EWTD) legal maximum of 56 hours a week. Assuming you do this for a year, this gives you £45,000 before taxes, and £31,690 after taxes. This makes a monthly take home of £2641, and weekly of £609. This makes an hourly pay rate of under £11 / hour.

Now, let's throw in the fact that while nurses almost always get to arrive and leave on their "official" times, doctors - hospital juniors especially - rarely get to do so, and in fact generally spend at least 1-2 hours / day extra at work because they feel guilty about leaving so much additional work for the on-call colleague, or because it would be inappropriate to do so (ie: patient just had a heart attack, or you're in the middle of an operation). Ignoring extra time on the weekends, that already works out at a minimum increase of 5 hours a week, so the Band 1A / 2B people are suddenly floating at 53 hours / week and a rate of a little under £10 / hour, and the Band 2A people are in breach of the EWTD and doing at least 61 hours / week at a rate of approx. £10 / hour.

This is based on the 2005/6 pay scale for doctors, and the 2003/4 pay scale for nurses. Since 2003/4, nurses pay has gone up each year, so in fact they're earning more than what I have stated at these grades.....Oh, and they get overtime at either 30% of basic salary for unsocial hours, or 60% of basic salary for Sundays and bank holidays.

Not let's get some perspective, shall we?

Grade D (basic qualified - approx. equivalent to PRHO) nurses get around £9-10 /hour.
Grade E (senior nurses - approx. equivalent to SHO) nurses get around £9-11 / hour.
Grade F (ward sisters - approx. equivalent to experienced SHO) nurses get £10-13 / hour.

Band 1A / 2B / 2A = Approx. £11 / hour (not counting extra hours normally done).
Band 1A / 2B / 2A = Approx. £10 / hour (counting minimum extra hours normally done).

So, what does this show? Well, that a new SHO nowadays most probably earns an hourly rate equal to that of a BRAND NEW QUALIFIED NURSE, who has only spent 3 years studying, and has no post-qualification experience, versus the SHO who has spent 5-6 years studying, and has at least 1 year post-qualification experience. Or that the nurse actually earns MORE than the SHO.

And remember, up until August 2004, the EWTD wasn't enforced, and doctors were working waaay in excess of the current legal maximum of 56 hours a week. I regularly did 80-100 hour weeks as a PRHO back then. The 2005/6 basic pay for a PRHO was £20,295 (more than 2003/4). For a year of Band 2A, this works out at £36,531 before taxes, and £26,694 after taxes., giving a monthly rate of £2225, and a weekly rate of £513. Now, this is not too far off SHO salaries, is it? Ah, but let's add in the fact that I was working minimum 80 hour weeks around 90% of the time (the fact that I've rounded down to 80 helps offset the other 10% which weren't too far below that anyway), shall we....?

At 80 hours / week, that gives almost £6.50 / hour!

I'm not saying that very senior SHO's, Registrars, and Consultants don't earn more (and in the cases of the top, a fair bit more), but you need to take into account the number of years they've been working, the skill of the profession and the amount of training required, and the responsibility they're under - By which I mean if something goes pear shaped, they take the rap, not the senior nurse who was also present. Personally, I think they've earned it. And conversely, I think that the more senior nurses on the wards who do a lot (not the management gimps) and actually keep order, deserve more pay than they get, which still works out at £15-19 / hour - not bad considering.

But next time you fancy being ignorant and tarring junior doctors with the same brush as a Consultant without checking your facts, don't be surprised if you get the crap kicked out of you by the people who work their asses off at probably twice the hours a plumber does, at half their hourly rate.....

NHS Part 1 - Modernising Medical Careers

I've decided to write about my general dissatisfaction with the NHS and the medical profession. So, this blog is about "Modernising Medical Careers", or MMC for short. But first, a little intro...

MMC is a new initiative that has been in the works for a few years now. The idea was to re-organise and streamline post-graduate medical training into an efficient system where doctors would gain a good grounding in medicine and surgery, before entering specialist training schemes designed to take them all the way to "Consultant" grade.


Currently, after graduation you spend 2 years in a new "Foundation Programme" (replacing the old Pre-Registration House Officer (PRHO), and first year of Senior House Officer (SHO) grades), spending 4 month rotations in medicine, surgery, and various specialities. Then you enter either SHO posts for speciality training, or pilots of the new "Specialist Training" (ST) programmes, due to go into full flow in 2007.

The problems? Well......

Instead of having a good deal of medicine and surgery experience after the first 2 years, some people are walking away with a minimal amount of medical and surgical experience, having spent the rest of the time doing something like General Practice, or Obstetrics & Gynaecology. Fortunately, not everyone has this nightmare, and so for the most part, juniors are getting a decent grounding - just about.

From 2007, the SHO grade is supposed to be (for all intents and purposes) abolished, as the new ST run-through programmes enter "full-release" from "beta testing" this year. But there's a problem....Noone's decided how current SHO's will feed into the new programme. They can't enter from ST1, because they've had more training (generally) than those finishing Foundation Year 2 (FY2), and they haven't completed a FY2 year (unless they were lucky enough to have done a pilot in the last 1-2 years), so they aren't eligible to apply anyway. This means that somewhere in the region of 20,000 SHO's are going to have to fight for entry into ST2 and ST3 (ST3 being where Registrar training will "begin" in the new system) years. However, with waaay more SHO's than ST posts and National Training Numbers (NTN's - Required to ensure Registrar training "counts" officially), this is going to cause a lot of problems. Add in the fact that noone has decided how people get sorted into where, and you start to realise the extent of the problem that is looming on the horizon.

If you're unlucky (ie: in the majority), and don't end up with a ST post, then you're going to have to fight with everyone else for the last few remaining SHO speciality posts around, which are only going to be 6 month posts as far as we can tell, so job security is crap, and you're going to be looking for the "next job" almost as soon as you start the one you just got.

Just as they can't decide how SHO's will feed in, they haven't decided how FY2's will feed into ST1. At least, not in detail. They state that people will be shortlisted based on whether they have have achieved FY competencies, but considering that you will have finished a FY2 post (and therefore said competencies have been achieved), this means very little. Individual Royal Colleges have little or no clue how they will cut down the competition at the "interview" stage, considering tha pretty much everyone who applies will probably meet the criteria for shortlisting. In the past this would be done through assessment of experience in audits, presentations, and research, but this is no longer allowed (at least for initial shortlisting, and perhaps at "interview").....

About Me

Ok, now that I've set a few ground rules, before I start with "the ranting", I might as well give people a quick run down about me, so you know where i'm coming from:

Name: Karnesh Patel
Age: 25
Location: London, England (I'd say UK, but I know it'd confuse some people)
Nationality: British (born and raised)
Religion: Hindu
Profession: Doctor (medical, not PhD...etc...)

Previously:

Currently unemployed (yes you heard right). I took time out from the completion of my pre-registration house officer (PRHO) year (which you do after graduating from medical school in the UK) in August 2004, having obtained full registration with the General Medical Council (GMC) and being licensed to practice medicine. The reason? I'd become fed up with the NHS and the people in it, and I'd always wanted to work abroad. I started work on my United States Medical Licensing Examinations (USMLE's), and in-between, carried out locum (also known as temping/moonlighting) work to keep my skills current and pay the bills, travelled, and taught medical students for their exams (I like teaching). After passing 2 of the 3 exams (needed to apply for training in the USA) in June 2005, I began applying again for full-time work in the NHS, as I felt I was out of full-time work for too long and needed to get back into things, despite having had locum work. Nothing. Not a single interview or job offer. And so, I kept on with the USMLE's, and even began applying to residency programs in the USA (training programs you take up there after finishing medical school). By the end of November 2005, I had finished all the required USMLE's, and was just awaiting results. In the meantime I continued applying for jobs in the UK again. Locum work had become scarcer since August, when it turned out a fair number of UK trained doctors were unemployed, either from lack of jobs in the NHS, or from people being "recruited" abroad over them (the EU and India in general). By the end of January 2006, my USMLE results were released (almost 3 months late - the weak excuse given was that marking schemes were being "recalibrated" - and ensuring that I didn't receive a single interview from the residency programs that I applied to, by not having all my paperwork in order, when it should have been ready months earlier), and I still did not have a job for the start of UK posts in February. After a quick trip to New York at the start of March for "The Scramble" (a last minute application process for those people who did not get a residency program position, similar to "Clearing" at A-levels in the UK) which was unsuccessful, I returned to the UK.

Currently:

I am looking for work, in any speciality that will take me, in any location that I can get to, for any duration possible (assuming it's sensible - a 1 day post in Scotland when i'm in London is just ridiculous, and you may laugh but it happens). I cannot re-apply for US programs again until August/September when the next years' application process starts, so I need to occupy myself for the next 6-12 months. I am also due to be looking at Australia, in the possibility of getting a job there. Considering the current state of jobs available for junior doctors, and the laughable system used to shortlist them for posts (I'll talk all about this next time I think), I probably do stand more chance of a job in Australia than here, even though I'm UK trained. The British Government would have you believe that people such as myself are not willing to apply for certain specialities or are not willing to goto the middle of nowhere, and that's why we're unemployed. That's just plain bollocks. I've applied for every speciality possible, and I'm not afraid of going to the Hebrides if it gets me a job. Of course, the Government (like most Governments) is very good at ignoring what it wants to, or making up facts and figures for what it cannot, in order to deceive the General Public about the actual situation in question.

Introduction

Hello.

If you're reading this, then you either know me, or have been intrigued by the title of this blog.

There's no real mystery to be found in the title. If that's what you were after, you can go now.

Basically, in the past (and even nowadays) some people had trouble remembering or pronouncing my name when they first met me (Karnesh, pronounced Car-nEsh), and so, I decided to adopt myself a nickname to make things easier, and shortened my name to its first letter - K. While this works well, the only downside is that a lot of people only know me by my nickname now, and couldn't give my full name if their lives depended on it.

By now you may (or may not) be wondering why i've started a blog. I decided that it was about time that I put my thoughts down in writing. I have too many opinions, and no real outlet for them, so where else to say what I think than in a blog? As with any viewpoint, there are always those who will disagree with it, to varying degrees.

Let me make one thing clear right now - I'm not interested in people replying to my blogs either in agreement with what I say or not. If you share my point of view, that's nice. If you don't, that's nice too. One thing that I believe strongly is that a person should always keep an open mind, and respect anothers' right to speak their mind, and hold opinions different to their own. People who go round saying that only "their" (whether referring to just themselves, a specific group of people, or even an entire society) point of view is the only correct point of view, and expect others to drop their beliefs and opinions because of this, have (in my opinion) closed their minds to possibilities, and will most likely never open them again (though stranger things have happened).

If you want to post a reply here, regardless of which way you stand on my views, that's fine. The only thing I will not stand for is insulting other people in any way, shape, or form. If you want to swear that's fine. If you want to disagree that's fine too. If you want to slag off someone who'd just posted before you, that's not fine. If you want to make racist (or other types generally not accepted by civilized society) comments, that's not fine either. I shall be moderating all posts, and if anything here approaches the kind of unacceptable behaviour I have talked about, the post shall not be put up, and the person in question will be "named and shamed".

Hmm, I think that's more than enough.