Work and electives overseas
Medicine can provide fantastic opportunities to travel the world, but organising such trips, either as an elective or to work, does take some planning. You can’t start too soon. Mark Wilson, a neurosurgery and helicopter emergency medical services (HEMS) registrar at Royal London Hospital, poses some questions you should be asking yourself.
Why and when?
What are the main reasons to work outside the UK?
Everyone has their own reasons, some go because they want to experience medicine in a different culture, and some feel they want to do their bit for the developing world. Others want to see an advanced form of their speciality, eg cardiology in the USA. Whatever your reason, avoid saying things like ‘I can’t stand working in the NHS’ at interview!
Can working outside the UK be good for your medical career?
Yes it certainly can. Most doctors have pretty similar CVs – medical exams, maybe a couple of prizes – work overseas can make you stand out from the crowd. If you can explain what you have done and why you believe it will benefit your work back home, there is no need to be afraid. The Department of Health (DoH) has recently released the first in a series of ‘tool kits’ that explain that working overseas is to be encouraged. It also gives practical advice. A copy can be downloaded from the Department of Health's website
When is a good time to do it?
Well, times are changing – the simple way to think about it is the more junior you are, the less likely you are to have ties such as a mortgage, spouse, children etc. Unfortunately, you’re also less skilled and hence may find that you are not wanted (this is especially true for the major non-governmental organisations (NGOs)). The more senior you are, the more skills you will have, but unforeseen home circumstances may keep you from travelling. However, things are changing. With the new foundation programme, many junior doctors are concerned that there will be no capacity in the system to take time to work overseas. This is unlikely to be the case and would be very short-sighted if it turned out to be true. Unhappy doctors will leave. Have a chat with your foundation programme co-ordinator to get more advice. Alternatively, plan to do an out of programme experience’ (OOPE) as soon as you become a registrar.
What and where?
What are the main options?
The world is your oyster. However, some places have more restrictions than others. If working through an organisation (either NGO or locum agency), problems such as visas and medical registration will be worked out for you. If organising things yourself, you will have to sort this out. For most developing world countries there will be few problems if you trained in the UK. For the USA however, you will have to sit the United States Medical Licensing Examinations (USMLE) – three complex exams equivalent to finals. For Australia and New Zealand, you can register if registered in the UK, however, you will only be allowed to practise for around a year. If intending to stay and work in hospital medicine, you will probably have to do the Australian Medical Council (AMC) exams.
What experience and skills are needed?
The skills needed vary greatly depending on where you are going and what is required of you. For example, running a refugee camp for the Red Cross will require skills in public health and tropical and hygiene medicine. If working as an A&E doctor in Australia, a broad set of skills similar to those back home is required.
Where can UK doctors work?
If you can register (see above) you can work anywhere and in any capacity. From a high-tech western hospital to a deprived mission hospital; from researcher for NASA, to mountain rescue doctor in the Himalayas. To find out about hospitals around the world for both work and electives visit Medics Travel. The biggest restriction will probably be a language barrier. Europe has now opened up. While this means your qualification is valid in any EU country, you should remember that most of Europe has a surplus of doctors, so competition is stiff even for home-grown doctors.
What are the more popular destinations?
Australia and New Zealand have always been popular with British doctors. The ease with which shortterm work can be organised, the fact you get paid and the relaxed lifestyle when there make them very attractive to the debt-ridden junior doctor who wants a year out of the NHS. Mission hospital work, for example in Africa, is also popular with those who don’t have a mortgage back home.
How?
What preparation and planning is needed?
Plan early. The first decision to make is: do you organise it yourself (eg by checking hospital websites for jobs) or do you let someone else do the work (eg an NGO if wanting to work in the developing world or a recruitment agency if in the developed world)? If you have left it to the last minute, recruitment agencies can often fill you in to urgently required posts. While organising this also think about getting a job back home to return to (can you apply for this intake then defer a year?). You really don’t want the hassle of applying for jobs from overseas.
How can doctors find out about opportunities?
In addition to Medics Travel there are websites specific for missionary work, eg Mission Finder. There are many recruitment agencies (these can be found in the back of the British Medical Journal) and many hospitals overseas now actually put job adverts on their own websites.
What regulations and red tape do doctors need to be aware of?
This is a complex area that varies from country to country. A good place to start is the DoH tool kit (see above). The Medics Guide to Work and Electives Around the World (published by Arnold 2004, ISBN 0340810513) goes through hospitals in over 100 countries explaining that they are like and what you need to do to organise work or an elective at them.
What practical things need to be taken into account?
Finding a place to work is actually the simple thing. You still need to sort out visas, indemnity insurance, travel insurance, occupational health clearance, vaccinations, flights and accommodation. You should also tell the UK Pensions authority that you are taking time out to work as a doctor overseas (they will then keep your pension open – failure to do this in your first two years post qualification may result in your pension being cancelled!). Working overseas or doing an elective for many people captures the essence of why they are doing medicine. You have a fantastic opportunity. Plan things well and make the most of it!
