The down under dilemma

Anaesthetist Tim, shares his down under dilemma; having completed his training in Australia, discovers some unexpected employment challenges on his return

Thousands of doctors are escaping to Australia or New Zealand every year, for enhanced work/life balance opportunities. What happens when they finally decide to return?  Tim, having completed his postgraduate training in Australia, discovers some unexpected employment challenges on his return provoking thoughts about leaving the profession for good…Read on for his Down Under Dilemma. 

The Down under Dilemma

I’m a Consultant Anaesthetist, practicing in Scotland. I qualified in the UK and did most of my anaesthetic training here, but like many other doctors, I felt the urge to experience life down under, so I moved to New Zealand for a year and then completed my training in Sydney. I’ve spent the last 5 years working as a consultant in Port Macquarie, a beautiful beach-side town in New South Wales, before returning home last year.

It’s not my intention here to convince anyone that the grass is greener in one place or the other, but if I relate my own experiences, it might help some of you facing the dilemma of whether to move overseas.

I decided to return to the UK for many reasons: I missed my family and friends, the hills, the culture, Europe, the changing seasons, the lack of sharks, snakes and spiders. But it was a difficult decision to make, as there’s no denying that life in Australia is sweet.

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Working Down Under

Everything you’ve heard is true:

There’s the flexibility to achieve a sensible work-life balance.

The medical training is world class, within an equitable health care system that works well; a high quality public sector that is free to all, supported by a widely adopted private sector.

If you want a different type of challenge, then the sheer scale and geography of the place means there are opportunities to work in amazingly remote environments, or become involved with Aboriginal Health, or become a Aeromedical Retrieval Doctor as I did.

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Lastly, the remuneration is better.

Returning to work in the UK

Nonetheless, I returned to the UK, to be faced with a pretty depressing situation:

The perennial problems with staffing, funding and low morale in the NHS were still there, but now the medical profession was under attack from politicians and some sections of the media, with junior doctors forced into industrial action. The profession seemed powerless and unable to control its own destiny.

As well as this current crisis, there is another drawback that UK doctors returning from overseas should be aware of. If you complete your training in Australia or New Zealand, you are classed as an overseas specialist, and are not allowed to hold a permanent consultant post in the UK. Inexplicably though, you still can practice as a locum consultant indefinitely.

To overcome this, you must apply for a CESR (Certificate of Eligibility for Specialist Recognition) via the GMC. Having struggled with this process for over 12 months now, I can report that it is so mired in bureaucracy, inconsistency and discrimination, that it’s worthy of a blog in its own right.

down under dilemma
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The way forward might seem simple – bugger off back to Australia. But this ignores the fact that despite their problems, I love the UK and believe in the NHS, and think it has the potential to be the envy of the world.

How can the NHS change?

Having had in depth experience of both health care systems, I can now look at the NHS with fresh eyes, and two things are abundantly clear:

Firstly, the time has come to take control of our profession, so that doctors decide how the health service is run (in consultation with the public), and we dictate how we work within it, not politicians with their vested interests and agendas.

Secondly, it is a matter of urgency to address the workforce dissatisfaction within the NHS, and reverse the trend of alienating doctors and nurses, forcing them to move thousands of miles overseas, away from their families just so they can feel respected and have a life outside work. We need to recognize the value of NHS staff and start showing some appreciation for their commitment, dedication and talent.

It’s always seemed like a no brainer to me: if you continually grind people down by undervaluing them, they will either leave their profession, move away, become unwell, or lose their passion and dedication. None of these outcomes is good for patient care.

On the other hand, simple things can make a big difference to motivation and productivity: having a pleasant working environment and time to interact and collaborate with colleagues. Having the autonomy to dictate your working conditions without political or managerial interference. Not being distracted from patient care by pointless paperwork. Being able to take leave when you want it. Being paid a bit more for working antisocial hours.

The Tipping Point

However, even if we can cure the NHS, that still leaves the obstacle of specialist recognition, which is preventing me from progressing in my career.

My unpleasant experience with the CESR process has forced me to speculate about what alternative careers exist for doctors, because quite frankly, if staying in the UK means I have to spend my anaesthetic career as a locum, fruitlessly trying to convince the GMC that I’m adequately trained, only to be told that I must return to training to get some modules signed off, then I’m getting out.

I don’t mean back to Australia, but out of clinical medicine. I’ll stay and fight for the NHS, but I won’t waste years of my life on an unfair and pointless bureaucratic exercise, that fails to protect patients and only serves to alienate doctors from the UK still further. Life is too short.

Like other doctors, I’ve had occasional doubts about whether I made the right career choice, and at times have indulged in fantasies about living a completely different life, perhaps as a mountain guide or ecologist. However, I’ve always carried on, because after all, medicine is fascinating, it’s a privilege to look after patients, the public still respects doctors, and there is job security and financial stability, and I have a family to support and a mortgage to pay.

But the situation I now find myself in feels like a tipping point. I really want to stay in the UK and contribute to the field of anaesthesia, but I’m being prevented from working in the role I’ve trained long and hard to achieve. Perhaps now is the time to diversify.


For more on working in Australia, check out our Overseas section

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Tim Smith

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