Bradford VTS Online Resources:
Career Opportunities & Planning
by Dr Nicola Gill (York) & Ramesh Mehay (Bradford)
- career advice for gp trainees (TEACHING RESOURCE).pdf
- career planning.ppt
- expedition medicine.ppt
- practitioners with special interests – GPSIs.ppt
- salaried GPs.ppt
- applying for a job – curriculum vitae and interviews.doc
- applying for a new job.doc
- interview prep and technique.pdf
- interview questions for a GP job.doc
- interview questions for salaried GP job.doc
- interview questions.pdf
- job hunting.doc
- medical curriculum vitaes – guidance.docx
- what to look for in a new practice.doc
If you are on the GMC GP Register and the Performers List, you are eligible to work as a GP anywhere in the UK. Historically once a doctor entered general practice they became a principal and worked on in the same post until retirement. The 1990 GP contract and 1997 NHS Primary Care Act which introduced PMS contracts brought with them much change. The changes paved the way for doctors to have more flexible career paths in general practice. You may be clear about which direction you wish your career to take. However, many GPs find it hard to decide the right career path.
There are many paths you can choose to take on your career in general practice.
This guide has been written to help you choose the right path for you.
One career, endless opportunities
I absolutely love being a GP. Why?
- Because you can work the hours you want to work. And you can do more or less as your life evolves.
- You can do full-time or part-time.
- You can mix up your GP job. There are so many GP subspecialties that you can develop an interest in. And after a few years of say being a GP with a special interest in ENT, you can go into Dermatology, Cardiology, Teaching, the Homeless and so much more.
- The work is exciting. General Practice is forever changing. It means the job never become hum drum and dry!
- And you want to manage systems of healthcare rather than individual people – then YOU CAN!!! Via involvement with CCGs and Primary Care Hubs.
- And if you love teaching – there are endless opportunities. Teach medical students, GP trainees, Advanced Health Practitioners, Physician Associates and so on.
- You can take a break and easily come back to GP (caution: never leave the Performers’ List for more than 2 years because your name will be removed and you have to come back to GP via the Induction & Refresher scheme).
- “I used to want to be a Cardiologist. And when I did cardiology as an SHO, I loved it. Getting involved in pacing, stenting people and so on. Loved it! But then I had to remember, I was a junior. Once you become a consultant, many of these things are done by your Registrar or juniors. Most of the time, my consultant was doing clinics, ward rounds, reading echos or ECGs. And then it dawned on me. Could I do that for the rest of my life?”
- “I wanted to be a Paediatrician at first because I loved the job as an SHO and although busy, it was exciting. And Paediatricians are one of the hardest working specialists I have ever come across. During on-call, the consultant on duty would always come in about two or three times during the night. And I admired them for doing that. But some of the consultants were in their 50s and 60s. Although I loved my busy but exciting on-calls, I thought to myself, do I still want to be doing that when I am 40, 50 or 60? What about my own family and their needs? And now, in GP, I still get to see lots and lots of kids and practice my Paediatric Medicine”
- “I never thought I wanted to be a Psychiatrist until I did the job. It was relaxed and I loved the narrative aspect of it. You get to see how wonderfully complex people and their minds are. And it’s great to help people get back on track with their lives. But after a while, I missed the medicine. If there was anything medical, like chest pain, it would be “get the cardiologist people in”. I once had such a patient and to my horror, I could see myself losing the ability to read something basic as an ECG. So, I decided to go into GP, where I can still do lots of psychiatry, but not lose my clinical skills and the wider knowledge that is medicine”.
Where are you now?
You may be….
A GP at the end of your VTS
A GP returning to the workforce
A GP wishing to change your career path
A GP approaching retirement
If you are looking for some help in deciding how to continue your general practice career then this webpage may help you.
The 1st step: defining what you want to do
Take time to think about how you wish to work as a GP. Choosing a job is a bit like buying a house, you should be clear about what your requirements are and what you are prepared to compromise. You will need to balance what you want with what is available in the job market. You might find it helpful to think about the following questions before embarking on finding the right job for you.
- Which geographic location do you want to work in?
- How far are you prepared to travel to and from work?
- Do you want to work full time or part time?
- Are you looking for 1 job or several different posts to make up your hours?
- Do you have other commitments that set boundaries to your working day, e.g. children, an existing job you wish to continue?
- Do you want to be:
- A partner in a practice?
- A salaried GP?
- A locum?
- Do you feel you would like to be part of a scheme that offers educational support?
- How much money do you want and/or need to earn?
- How important are the demographics of the practice you will be working at? Remember the practice team may change with time, but the patients will be the same, so if you struggle with working with patients for whom English is not their first language, don’t like working in an affluent area with the worried well or have a wish to work with patients from deprived backgrounds think carefully about the patient population before applying for a post.
- What is your ideal practice team?
- Do you know what gives you job satisfaction?
Most individuals find that if they work in a job that has meaning, is suitably challenging and they feel valued then they will experience high levels of job satisfaction.
- Are you looking for a long term or short-term post?
- Do you know where you want to be in five years?
The 2nd Step: considering your career options
The following items will help you think about the choices open to you. This is not intended to be comprehensive guidance, but aims to cover in brief some of the main aspects to be considered. All the career options describe below can be full time or part time.
- As a partner you will be running your own small business. As well as clinical responsibility for your patients you will be responsible for the premises you work from, your staff and the day-to-day running of your surgery.
- GP Partners may work in a single-handed practice or as part of a partnership.
- ‘A partnership is the relation which subsists between persons carrying on a business in common with a view of profit’
- 1890 Partnership act
- Partners practice under a PMS contract or nGMS contract. Both contracts have brought many changes to the way GPs are able to earn money and structure their working day.
- It is essential that any practice you plan to join has a written partnership agreement and allow you access to the accounts.
- Most practices will ask you to work a period of mutual assessment (usually 6 months) before you formally decide to join the partnership.
- Many practices still ask GPs to work ‘to parity’. This means that for a period of time you will earn a percentage of your final salary, this is supposed to be in recognition of a settling in period.
- The term ‘salaried partner’ often leads to misunderstanding. Posts advertised as such should be treated with caution and the exact status of the post fully explored.
- The RCGP website has several downloadable information leaflets on many aspects of working as a GP partner
- The BMA have several booklets on aspects of working as a GP partner which are available to members.
- A salaried GP is a GP who is employed by a an organisation to provide primary care to patients e.g. a private provider, OOH service, a GP practice, Darzi centre, homeless centre.
- The role allows a GP to avoid the employment responsibilities of a GP partner.
- You can be employed for any number of hours. Full time under the EU working time directive is classified as 37.5 hours/week.
- The BMA are not allowed to recommend pay rates. Salaries vary dramatically across the country depending on availability of GPs and experience.
- The GPC have negotiated a salaried GP contract which was published with the nGMS contract. The contract (or one no less advantageous) should be used by all employers of salaried GPs.
- Salaried GPs can negotiate their hours and the duties they undertake in their employed hours. They are often just employed to see patients but are frequently encouraged to develop their role by teaching students, undertaking minor surgery, mentoring a nurse practitioner.
- Many Deaneries have a number of academic salaried posts that combine time as a salaried GP with research or teaching work for Deanery/University.
- Many GPs choose to spend time working ’freelance’. This may involve working short term in many different practices, or longer term e.g. as a maternity locum in one practice.
- This is an excellent way of getting to know a new area. Many GPs choose to work long term in this way.
An Associate or Assistant GP
- The associate scheme enables single handed, isolated GPs to employ a doctor. They are often employed by two practices. This is only really an option in romote areas of Scotland and Wales.
- Assistants can be employed as a salaried GP by any practice. Some practices in certain areas may get funding for these posts. (An assistant allowance)
The BMA website is a source of more information on this form of employment.
The National Association of Sessional GPs website also has a section on Assistant GPs. www.nasgp.org.uk
Retainer Scheme GP
- Started in the 1960s. The scheme is organised by the Deanery for any GP who has a need to work part time, e.g. have children, sick relative, or recovering from illness themselves.
- Any GP who is eligible can apply, the scheme needs the financial support of the local PCT.
- A retainee can work a maximum of 4-sessions in an approved practice. They can also work an additional 2 sessions in any other non-GP employment.
- The scheme is time limited usually for five years.
- Retainees are paid by the practice as a salaried GP and the practice receives a sessional grant for supporting the GP on the scheme.
- A nominated GP at the practice provides support.
- The Deanery organise educational study days and small learning groups.
- All Deaneries have details about their retainer schemes on their websites.
- The BMA has a series of useful articles on working abroad.
- Including articles on
- Taking time out to work or volunteer overseas
- Opportunities for doctors within the EEA
- Overseas contracts
- You don’t have to be a member to access this information.
Returning to work
- Guidance for GPs who have had a career break from general practice can be found on your local Deanery website.
GP work is often described in term of sessions.
- For an employed GP full time is 37.5 hours/week or 9 sessions.
- This equates to a session being 4 hours and 10 minutes work.
- As a partner a session is usually defined as half a day and the number of hours will vary between practices.
- Full time varies with geography; full time is usually equivalent to either eight or nine ½ days weekly.
You can also choose to job share, the BMA has a useful leaflet describing how this can work in practice. GPs can also use their skills in other ways e.g. Clinical assistants, GPwSI, teaching, medical journalism, to mention just a few. The term portfolio career refers to GPs who have chosen to try their hand at different career paths and are now working in several posts, one or all of them in general practice.
The 3rd Step: making decisions
How do I decide what is right for me?
- Spend time deciding what it is you are looking for.
- Your ideal job may not exist but there is nothing wrong with knowing what you are looking for and what is likely to give you job satisfaction.
- Jobs are advertised in the BMJ, GP magazines, PCT, local postgraduate office. You can approach local practices directly.
- BMA series Career Focus has produced many useful articles.
- Work a few sessions in a practice as a locum before deciding whether it is the right place for you.
- Make time to regularly review the direction your career is going in.
- General practitioners are the first port of call for patients seeking the help of a NHS medical professional. As the lead clinicians in primary care, where some ninety percent of healthcare episodes take place, they provide a wide range of personal medical care and refer patients to specialist services when they need them.
- This factual definition of general practice does not convey the true nature of the varied, challenging, and demanding work involved in being a GP. General practice in the 21st Century offers individual doctors a varied experience and career path.
- The aim for you is to find the path that meets your needs and helps you make the most of your individual skills as a GP. It is unfortunate that stress features highly in a GPs working life. Studies have shown that having job satisfaction protects against suffering from stress. Try to find a job where you are able to have job satisfaction. You need to feel valued in your work and be in a job that is challenging and has meaning to experience job satisfaction.
Creating a portfolio GP career
In the old days, if you decided to become a GP, that is mostly all that you did. Day in and day out you would see patients in surgeries or home visits. Nowadays, General Practice is exciting, dynamic and fun because you can become a portfolio GP. The term portfolio means multiple. In other words, you can do the usual GP work as part time and during other parts of the week you can do one or more other types of work. Examples include…
- Medical Education (Associate Physician Trainer, Advanced Health Practitioner Trainer, Medical Student Trainer, GP Trainer, Training Programme Director, Associate Postgraduate Director, or even become a GP Director!)
- GPSI – a GP with a Special Interest in something – like diabetes, dermatology, cardiology, respiratory, sexual health
- CCG work – like be the lead for safeguarding, developing new clinical protocols, other clinical lead work like prescribing, referrals management and so on
- Appraiser – to appraise other GPs on an annual basis
- Sign up to Out of Hours and GP A&E work
- Get involved with services for the Homeless
- Be a Prison Doctor or Forensic Medical Examiner
- Or get involved in Telehealth
Working abroad can be fun. Many GPs go to Australia and New Zealand for a while, but don’t forget other countries. Think wider. But remember, DO NOT LEAVE THE UK for more than 2 years – because you will be removed from the Performers List and it can be a headache to get back on.
- Working Abroad as a Medic – is a great practical article for getting you up and running. Although it’s written by Medical Women’s Federation, the advice offered is generic, practical and simply great.
- BMA resources and advice on working abroad (excellent)
- NASGP on working overseas
- Options available for medical experience abroad
- Current opportunities available through RCGP international
- Volunteering abroad for doctors
- Working abroad in developing countries
Registration without conditions enables doctors to practise unsupervised. It is only available to UK trainees who have applied for migrant status and have completed the Australian Medical Council examinations and a period of approved training. Registration with conditions is available to overseas medical graduates who will be temporarily in Australia to work in one of the following areas: postgraduate training, supervised training, teaching or research, public interest or areas of need, such as positions or locations where there are shortages. The types of conditions vary depending on the category of registration and the individual doctor.
The preferred temporary visa pathway for doctors is the Temporary Business (Long Stay) visa (Subclass 457) which has a streamlined application process. In order to apply for a visa you must first find a post, you will also need to provide evidence that you are eligible for registration with the appropriate State Medical Board.
Doctor Connect – Work as a doctor in Australia (Government website)
There is no nationally regulated system for applications to work in the medical system in Australia. You must apply to all of the following:
- State or Territory Health Department for a job
- State or Medical Territory Medical Board for registration
- Department of Immigration for a visa
- Medicare Australia for a Medicare Provider Number
The process for applying to train/work in Canada is a similar challenge to that of the USA. However, each province has different rules and regulations and you will need to check what is required, once you have decided in which area you would like to work.
British medical graduates must establish professional competence. Each province has a licensing authority, which will require UK doctors to pass the Medical Council of Canada Evaluating Examination (MCCEE), administered by the Medical Council of Canada (MCC). This is an exam for international medical graduates which tests general clinical competence in comparison with graduates from Canadian medical schools.
Employment authorisation and a work permit are needed from the Canadian High Commission and doctors have to have a medical examination.
Once the MCCEE is passed, doctors can take the MCC Qualifying Examination (MCCQE) Part 1. This is a one-day computer based test assessing an individual’s competency for entry into supervised clinical practice in postgraduate training programmes.
Quebec has separate immigration procedures.
Canadian Information Centre for International Medical Graduates
This tool helps identify your occupation as well as labour market information
New Zealand is similar to Australia but does not have different states or a territory, once you are registered to practice this applies to the whole country, however, there may be restrictions depending on your work permit/immigration status.
In New Zealand there are no registration categories. Instead, doctors are registered in a ’scope of practice’. Your scope of practice will depend on your qualifications, experience and the purpose and duration of your employment in New Zealand.
All new registrants, regardless of seniority, must work under supervision for at least their first 12 months in New Zealand to become familiar with the culture.
Registration is only granted when a doctor has a confirmed job offer under supervision in an approved hospital, practice or educational institution. The registration application should be submitted to the prospective employer, who will check it and send to the Medical Council of New Zealand with a supporting application.
Registration and the NZREX examinations – which doctors have to sit if they don’t meet the scope of practice – are regulated by the MCNZ. If the doctor intends to stay less than three years in New Zealand, they should apply for a temporary work permit.
The Medical Council registers doctors in New Zealand and carries responsibilities in the areas of standards, conduct and competence.
If you would like to register to practice in NZ you can use the online self-assessment tool to check your eligibility.
You must also go through the New Zealand Immigration process for a visa/work permit etc.
UK trained doctors need certification from the Educational Commission for Foreign Medical Graduates (ECFMG) in order to be eligible to enrol in a GME program and eventually apply for licensure to practice medicine.
To proceed towards ECFMG certification, the doctor’s medical school and the year that they graduated must be in the International Medical Education Directory.
The doctor will need to satisfy a Medical Science Examination Requirement and Clinical Skills Requirement. Visit the ECFMG website for full details.
Employment visas are usually not issued until you have obtained ECFMG certification. Temporary visas are available as an Exchange Visitor (J1), for those taking an appointment under an officially approved programme and sponsored by an educational institution, and as a Temporary Worker (H1), for those working in a highly skilled job for which there is no US worker available. This must have prior approval by the Immigration and Naturalization Service. The ECFMG is authorised to sponsor foreign national physicians for the J-1 visa.
They are only issued to doctors who have a letter from the Department of Health, confirming that they will return to the UK on completion of their training. Visit the AMA website for comprehensive information.
More detailed information on residency programs is available from the AMA’s FREIDA Online database (Fellowship and Residency Electronic Interactive Database Access).
Educational Commission for Foreign Medical Graduates (ECFMG) – Assess whether International Medical Graduates are ready to enter programs of graduate medical education in the United States’ you must have this certification.
Do you research.
- For the country you are thinking of, have you found an opportunity or post over there?
- How easy is it to gain registration, get visas etc?
- When are you required to work? How will this period affect your career progression on return to the UK? Remember, if you are out of the UK for 2 years or more, you will be removed from the GP Performers List. And it’s a pain to get back on!
- Develop contacts in the country before going out. Talk, chat, network and learn about that country and how medicine works.
- Talk to colleague who have worked abroad for some top tips.
- Visa to allow the doctor to work in the country
- Registration with the country, state or territory Medical Council or medical licensing authority
- A medical check and certificate
- Evidence of current registration
- Certificate of good standing from current and previous registration boards
- Degree certificates
- References from senior medical colleagues
- An English language test
- A letter of appointment from your new employer
- Clinicians offer favourable transferable skills including: Medical knowledge and clinical management in all branches of medicine and surgery are transferable; people are people the world over.
- While facilities and processes vary from country to country most hospitals and clinics in Europe, USA, Canada, Australia and New Zealand will be equipped and work in a similar way to those in the UK.
- Facilities in the developing world vary greatly and you may find techniques differ greatly from those in the UK.
- You may need to sit an equivalence examination to work in some countries – you will need to check with the relevant licensing board
- Pay varies depending on where you work and at what level. Working in the developing world is often voluntary or paid at local rates.
- Training pay in the USA is lower than in Europe but the scope for earning increases significantly post qualification.
- The European working time directive limits working hours to 48 per week in Europe, the USA and Australasia have similar directives limiting working time to under 80 hours in the USA and under 40 hours in Australia.
- As in the UK, working overseas can be just as demanding, but this will ultimately depend upon your speciality and location.
- The rewards, monetary and personally, will differ but particularly when undertaking work in the developing world, they can be extremely invigorating.
- As with the UK, a well-rounded portfolio and evidence to support your CV/ application is essential for success overseas.
- Any unique selling point will help with making it to the top of your profession both at home and abroad.
- If you are aiming to work in an international centre of excellence for example: a suitable interest in the relevant research would be a great help.
- Additional qualifications and retraining may be required depending upon where you are intending to work. For example, to work in the United States of America you will be required to pass the United States Medical Licensing Examinations (USMLE).
Extreme & Varied Medicine!
EXPEDITION MEDICINE DOCTOR
- wildernessdentistry.com (emergency dentistry for doctors on expeditions)
- antarctic medicine – the challenge of being a doctor in an isolated and confined environment
SHIP’S CRUISE DOCTOR
Being a cruise ship doctor may seem like the medical profession’s dream – it pays well and often tax free! You can earn big money fairly quickly. But don’t forget, the job comes with an incredible amount of responsibility: you see everything from sprained ankles to potentially deadly heart attacks. You’re responsible for the lives of thousands of passengers and don’t forget the crew too. You will generally need BLS, ACLS or ALS. It’s worthwhile doing PALS or APLS as well as ATLS.
- Confessions of a cruise ship doctor (excellent, with practical advice)
- Career paths – cruise ship medicine
- My role as a cruise ship doctor
- Why work on a cruise ship?