PROS AND CONS OF NHS

PROS OF WORKING IN NHS

1. TRAINING You are always supported clinically till you become a consultant. You always have a clinical and an educational supervisor attached to you who will be around you when you are working in the hospital, hence the burden of responsibility will always lie more on them, rather than you. In order to progress your career within NHS, you will need to get your competencies signed from your supervising consultant at each level and unlike back home, where you can get away with almost anything, it’s not the case in UK, because your supervisor will be held responsible for your work in the future. He will only sign the competencies, if he feels you have gained enough experience and skill and are competent enough for the job. Ultimately it all leads you to become a better clinician in future. Secondly, working in NHS not only makes you a good doctor, but also a better human being (ethically speaking). This becomes evident when you are preparing for cases like ‘Breaking Bad News’ or ‘Managing Angry Patients’ during PLAB 2.

2. EDUCATIONAL SUPPORT The trust provides you a study budget for the exams (even up to 600 GBP per year) to write post graduate exams like MRCP.  They also allow paid study leaves for your exams. They encourage out of training educational programs to widen your educational and teaching experience.

3. ADEQUATE SALARY Junior doctors have an annual salary package of 32,000 to 38,000 GBP. You do the math now. Senior doctors earn around 51,000 to 74,000 GBP and consultants earn around 100,000 GBP

4. EXTRA BANDING 7pm-7am time is called ‘non-social hours.’ So, if you are performing duties during this time period, you will get banding (up to 10-20% compensation) depending on your program and contract.

5. LOCUM MONEY You can earn extra money by doing locum duties. A senior once told me that he doesn’t usually do locums, but whenever he has to plan a visit Pakistan, he does two locum shifts during the weekend and voila, money arranged for the return tickets. (Avg Rate: 40 GBP per hour, you do two 8-hour duties at weekend and get 640 GBP or PKR 130,000) 

6. WORK-LIFE BALANCE Rota is really well balanced, let's say you have worked 3 nights in a row, next 2 days will be rest days. The maximum working limit is 48 hours/week. If you work extra, you’ll be paid extra but even then, there is a limit on that extra work.  You want less work, more party? Join NHS. You want more work, more money? Join NHS.

7. SOCIAL LIFE UK is small. The distance between London and Glasgow which are two extreme ends of UK is just 412 miles which can be covered in 7 hours on car. What I am trying to say is that if you have a car, you can always hang out with your desi friends (residing in different cities) whenever and wherever you want. 

8. EASY TRAVELLING A direct flight from UK to Pakistan only takes 7-8 hours. So, you can always come back in no time, in case of any emergency or in case your mother finds a dulha/dulhan for you. Don’t smile, teri nai hone lagi. 

CONS OF WORKING IN NHS

1. WORKING IN DIFFERENT CITIES This is, in fact, the only negative aspect in my eyes. You have to keep moving from one city to another depending on your job. Let's say for aspiring physicians, you'd shift from non training job to 3 years IMT training then to ST training in your desired specialty and then find another job as a consultant. However, you can keep working in the same city if the deanery over there has abundant vacancies.

2. HIGH LEVEL OF ACCOUNTABILITY This one is not a real con actually but for desi doctors like us, it may be. Let me explain, according to a report from The Guardian, NHS paid around 2.63 billion GBP in negligence claims in 2019. Patients can sue doctors on things which we can’t even imagine in Pakistan. For example, a patient can sue a doctor if he disclosed his diagnosis to his family without taking permission from him first. This is called ETHICS. Sadly, in Pakistan, Medical Ethics is only found in 4th year books of Community Medicine. Another time, a friend of mine told me that a doctor got his GMC registration cancelled because she used parking card of her handicapped sister while parking her car outside a market.

3. HIGH TAXES AT SENIOR LEVEL There is a 25% tax on junior doctor’s pay which can go as high as 40% when you progress to higher levels in career. But even that 40% tax won’t be applied on all of your salary, it will only be triggered if you start earning above a given threshold. Let’s say you make 100 quid a month, you won't be taxed for the first 50 quid, then 25% for the next 30 and 40% on the last 20 quid. So, the higher taxes are not on the whole income, rather they apply to the amount that goes beyond the threshold only

PLAB vs USMLE

PLAB vs USMLE

This is the most featured question put by the juniors to PLAB-oriented seniors, “Bhai PLAB better hai ya USMLE better hai.” The answer is complicated. I personally think it depends on how we define the criteria for being “better”. If it means having the best training in the world, sure, nothing beats USMLE, however, if you want a balanced lifestyle with loads of pounds, put on your royal armor and march onward with your golden horse to Buckingham Palace (Or you could always take a flight😂). Secondly, and more importantly, your personal circumstances matter, so choose wisely. Here is a comprehensive comparison:

VARIABLES	USMLE	PLAB
IELTS/OET	Not required	Required (Clearing IELTS/OET itself is relatively more difficult than passing PLAB1)
LEVEL OF EXAM	Difficult Only 1 attempt Scores matter	Easier  Multiple attempts Scores don’t matter
PREPARATION TIME	Depends largely on your clinical knowledge. 8-14 months for STEP 1  4-6 months for STEP 2 CK 2 months for STEP 2 CS	3-4 weeks for IELTS/OET 2 months for PLAB 1. 2-2.5 months for PLAB 2
WHEN CAN YOU TAKE EXAM	Anytime during/after graduation	Only after graduation
COST IN TOTAL	PKR 25-30 lac	PKR 8-10 lac
PAY AT YOUR FIRST JOB (AFTER TAX DEDUCTION)	Avg 3500 USD/month (PKR 550,000)	Avg 2800-3000 GBP/mo (PKR 600,000) 💷
FIRST JOB	Training job	Most probably non-training job
WORKING HOURS IN JOB	Avg 80 hours/week	40-48 hours/week
LOCUM JOBS	No	Yes (30-50 GBP per hour at junior level)

COMMON MYTHS AMONG KEMCOLIANS

1. UKMLA IS COMING AND IT’S BAD Firstly, nobody knows for sure when it will come into action. GMC has been giving tentative dates for this since 2015. The latest expected time for its arrival is 2023. Secondly, contrary to what medical students might think, I personally believe that it will open new doors for immigrants and further increase their chance for getting into specialty training. See, locals do not take PLAB, only we do. But according to GMC, UKMLA will be necessary for all the graduates, locals as well as immigrants, to obtain their GMC registration. Hence, increased prospects for us.

2. THERE ARE NO JOBS IN UK According to a recent survey, UK has the second lowest doctor-to-patient ratio in Europe, so there are plenty of jobs here. To have a brief idea, just visit www.jobs.nhs.uk.

3. UK TRAINING PATHWAY IS WAY LONGER THAN USA It might be longer but it certainly by no means is “way longer”. In reality, it depends on many factors i.e., what specialty you want to pursue, when you are taking the royal college exams, if you are clearing the exams in first attempt, if you are getting your competencies signed in time, if you are taking any breaks during your training. In most of the cases, it takes around 6-8 years to become a consultant from start of your first non-training job.

4. THERE IS TOO MUCH TAX IN UK There is around 25% tax on junior doctors’ pay. After deduction of this “too much tax” if you are still earning 3000 pounds (aka PKR 600,000) per month in your first non-training job, I don’t think it’s a bad deal by any means (And I am not even including the locum money here). Having said that, the tax structure is UK is built in such a way that the higher you earn, the higher the taxes. So, the wages of consultants in UK seem relatively smaller than those in USA. May be that’s why many consultants come back to Pakistan after completing their training. 

5. THERE IS NO SAVINGS IN UK It depends on where you live and how you live. For example, in London, everything including accommodation, commuting and food is expensive, hence, you’ll be having very little savings. On the other hand, working in small county like Durham will result in plenty of savings. 

SUMMARY

After aforementioned discussion, one might think of UK road as a fairy pathway. Theoretically speaking it is, but the ground reality might feel a bit harsh. For example, following recent trends, after clearing PLAB and getting GMC registration, it’ll take months for you to get your first job in UK. Exceptions, however, are always there. I have also seen people getting jobs within one month of their GMC registration but usually it takes around 5-6 months. (We will discuss it in detail in another post and also put light on the factors which can enable you get the job as early as possible).

ENSURE EARLY JOB IN THE NHS

FACTORS WHICH CAN DECREASE DOWNTIME OF GETTING A JOB IN THE UK

4th year marks the start of a big change. All the USMLE guys go into the hibernation mode with their big FAs. Watching your friends studying in the reading room all the time and seeing them boycotting every other event of the university makes you want to question yourself, “Am I doing it right? Am I wasting my time? Will I lag behind my colleagues?” That’s a natural feeling. Many students do not have a natural inclination toward USMLE but owing to this peer pressure they end up mimicking their friends without having proper will and eventually give up after some time. While I believe that gathering knowledge is always a good thing no matter where it comes from, I also feel that if you want to pursue a career in the UK, there is quite a lot of other stuff that you can do in this time period which will increase your likelihood of getting a job in the UK asap. See the thing is, PLAB scores do not matter. Everyone applying for the job will have MBBS and PLAB done, so it’s really your clinical experience and your extra-attributes which can impact your hiring process and increase your chance of getting a job. The most important ones are as follows:

1. BSc ENGLISH

This is a must do for UK fellas. Not only will it add to your CV, it actually carries upto 10 extra points when you apply for the specialty training. Ideal time to take this exam is in 4th year or final year.

2. AWARDS AND DISTINCTION

This includes all types of awards i.e., curricular and extra-curricular.

3. EXTRA COURSES

This might include any clinical or non-clinical courses including BLS, medical education courses or any IT related online diplomas etc.

4. RESEARCH PROJECTS

I cannot emphasize enough on it. Ideally try to get a publication, but even if your research doesn’t get published, it will still be counted in your research experience.

5. QUALITY IMPROVEMENT PROJECTS (QIPS)/ CLINICAL AUDITS

This is perhaps the most underrated subject in clinical practice in Pakistan and one of the highest rated subjects in the NHS. Your interview won’t be complete without the question, “Have you taken any active part in a quality improvement project so far?” I didn't even know what it was until I had to establish my profile on ‘jobs.nhs.uk’ because there was a whole separate section for this subject there. QIPs, as the name suggest include any process in which you improve the quality of care. A simplest example would be provision of hand gels in surgical minor OT to prevent wound infections. Clinical Audit, on the other hand, is a bit more complicated process. It assesses if a certain aspect of health care is attaining a recognized standard. This can tell us where we are doing good and where there is room for improvement. A simplest example would be comparing mortality rates of DKA in a medical ward at Mayo Hospital to a national standard mortality rate of DKA. If it comes out to be higher than national rate, we need to find the possible reasons and then implement changes to improve this. Any doctor who dreams of making a career in UK should take part in at least one Clinical Audit during House Job.

6. DIFFERENT SKILLS LIKE MANAGEMENT, TEAM WORK & TEACHING

The NHS doesn’t want book worms; they want multitasking doctors. Your NHS job profile has separate sections to explain all these skills. You cannot acquire these skills in one night. It’s a gradual process, so keep taking part in extracurricular activities. For example, in management skills, you can explain your experience of being an organizer of a particular event in university. It all matters!

• NHS EXPERIENCE (OBSERVERSHIP or SHADOWING)

In the past, it didn’t have much significance. But lately, it has become a very important desirable criteria for HR departments to recruit doctors. Ideal time to get an observership is soon after you are done with your PLAB 2 exam. 

• MRCP PART 1

Among all the things that I have stated, this is undoubtedly the most important of all. Start preparing for it during your House Job. Passing rate is highest for the doctors who take it within 1-2 years after graduation.

Here is an example of typical Person Specification of a non-training junior doctor post in the NHS:

IDEAL TIMELINE FOR PLAB

IDEAL TIMELINE FOR PLAB PATHWAY

One can take PLAB at any time after graduation, in this post, however, I am going to devise an ideal timeline for kemcolians based on experience of mine, my colleagues and my seniors. The sole purpose is to make things simpler for my juniors and make sure that they don’t make the mistakes that we had made during our road to UK. So, pay full attention, if you don’t read carefully, you’ll miss things, important things. 

(NOTE: This post throws light on most appropriate timeline for PLAB pathway. Details regarding preparation of IELTS/OET, PLAB 1 & 2, MRCP Part 1, VISA process and GMC registration are discussed in separate posts)

FINAL YEAR 

     If you haven’t already taken your BSc English exam, take it now! Having an extra degree has nothing to do with PLAB, but it carries extra points when you are applying for a specialty training post. Strictly speaking, you don’t have to do anything special in final year, but do try to study studiously and refine your clinical knowledge, specially Medicine. This will serve two benefits. Firstly, it’ll make your background knowledge strong which will help you greatly in the upcoming exams. Secondly, getting high marks in final year will help you take rotations of your choice in House Job (HJ) which is going to be very handy for your PLAB 1 preparation. Bear with me, I will explain how.

IELTS/OET

     In KE, final year exams are usually concluded in 2nd or 3rd week of February. That leaves you 2 months before your House Job commences in May and this is the ideal time to take your IELTS/OET. 3-4 weeks preparation should suffice. If you clear it in the first attempt, well and good, if you don’t, try again during your HJ. As soon as you clear it, make your GMC account and book your PLAB 1.

• FAQs: I have been asked this question multiple times by final year students, “Can we take our IELTS/OET in final year?” The answer is, yes, you can, but it’ll be a waste. Why? Because The results of IELTS/OET only stand only for 2 years. This means you will have to get your GMC registration done within this 2-year time frame and that is literally impossible, so you will have to retake ILETS/OET after 2 years. Feeling confused? Again, bear with me.

PLAB 1 

In Pakistan, PLAB 1 is conducted 4 times a year; March, June, September and November. Most ideal time to take PLAB 1 is November or March. If you have cleared IELTS/OET before HJ, book for November. If you have cleared it afterwards, book for March.

Ideal pattern of your HJ rotations should be:

1. Major Medicine (May-Jun-Jul)

2. Minor Medicine (Aug-Sep-Oct)

3. Major Surgery (Nov-Dec-Jan)

4. Minor Surgery (Feb-Mar-Apr)

This pattern is important because in this way November attempt will come just after the minor rotation and March attempt will come within your minor rotation, hence, it will be easy for you to prepare for PLAB 1. Two months preparation should suffice.

• FAQs: “Is House Job necessary for getting a job in UK?” To keep things simple, I would say yes it is necessary if you are not a UK citizen. In order to get into IMT (Internal Medicine Training) you should have done Foundation Year 1 & 2 (FY1 and FY2). The House Job that we do here is equivalent to FY1. After getting done with our PLAB 2, we do a non training for some time (at least 4-6 months) which is equivalent to FY2 and get our FY2 competencies (aka CREST form) signed by our consultant. Only then we can apply for IMT.

• FAQs: “Can I take rotations of my choice during HJ?” No, you cannot unless you have higher merit than your colleagues. The merit is based on your final year marks. Now you know why I asked you to give attention to final year in the first section!

• FAQs: “Is it possible to prepare for PLAB 1 during HJ easily? 100% positive. People have even cleared it during their hectic major rotation, however, just to be on safe side it’s better to do it during minor rotation.

PLAB 2 

There are two ways you can pursue this. I will explain both of these.

1. TAKING MRCP/MRCS PART 1 BEFORE PLAB 2 This is a novel trend. I will strongly recommend it as not only it will boost your clinical skills but also increase your chances to get a job ASAP. One of my colleagues underwent this route. After completion of his HJ in April 2019, he cleared MRCP part 1 in September 2019, followed by PLAB 2 in January 2020 and got a job in March 2020. Remember, usually it takes 5-6 months after your PLAB 2 to get your first Job in UK, but owing to his MRCP part 1, he got the job within 1 month. It takes around 6-8 months for its preparation, so, if you want to pursue this route, start preparing for it during your HJ.

2. TAKING PLAB 2 DIRECTLY AFTER PLAB 1 This is the most common route that doctors take here in KE. In this case, the ideal time to book for PLAB 2 would be August/September following completion of your HJ. You should start working on your VISA application 3 months before your expected date of departure.

• GMC REGISTRATION PLAB 2 results come after1 month. As soon as you pass PLAB 2, you should get yourself registered with GMC and start applying for jobs. 

SUMMARY

For the batch graduating in 2021, the ideal timeline should be:

1. IELTS/OET in April 2021. If not cleared, 2nd attempt during HJ.

2. PLAB 1 in November 2021 or March 2022.

3.  MRCP Part 1 (Important but not essential at this stage) in September 2022 and then PLAB 2 in December 2022. OR PLAB 2 in August/September 2022.

4. GMC registration as soon as you pass PLAB 2.

5. If everything goes according to plan, you will get your first Job in Spring of 2023, Insha'Allah.

• TIDBIT: Now you know the reason why there is no point in taking your IELTS/OET in final year, because in that situation, it will be expired before your GMC registration and you will have to retake it.

FINAL WORDS

This is the crux of my post. As I have been mentioning again and again that this is an “ideal timeline” and it’s natural that most of us won’t be able to keep up with this timeline. Personal reasons, family ties, relationships, failures all come into play in the equation and influence our pathway so it is perfectly normal having a couple of hiccups along the road. Just don’t lose heart and keep believing in God for He has destiny for every one of us. I would conclude by saying that keep your hopes high and expectations low because it’s always better to be surprised than to be disappointed.