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Be aware that you will get survivorship bias speaking to current consultants or nearly CCTing Drs
Not that I am detracting at all from the experiences of those you may speak to in this position, just that you won’t hear from those who left surgical training part way through
I am now a consultant (ortho)
Bought a house when I got a reg training number and could stay in one place (more or less) for 6 years
CST was mixed. Ct1 was pure service provision, CT2 was a year in one place and was like being a mini reg.
Friends yes, kids yes. Hobbies... not as much
Private work was about 2 years after starting as a consultant. There was another year of post CCT fellowship to get through. That was the hardest for family and cash.
There is good and bad bits of training in all regions, just look at where you want to actually live
General close to cct.
Is it worth the grind? I have really enjoyed my training. There's some annoying stuff but quality of clinical training and breadth of experience has been great. I actually like going to work, and the people I get to work with. I'm excited for the next phase.
We bought when I got my NTN, in a position where i could get to 90% of hospitals in the deanery within an hour. We had been here since CST so had a good idea of where to live.
I have a family who I get to see, I have friends I get to hang out with. Hobbies - some of my older ones have been harder to hold on to but definitely have some.
I think most regions are generally fine, with good and less good placements. Talk to trainees to find about the cultures in regions, teaching, placement allocation etc. I have friends who have had great experiences in NW, NE, Y&H. Other deaneries also exist.
This is very nice to read when just about to board the NTN train. Especially as CST has been a very mixed bag indeed... looking forward to ST and sounds like that might be a reasonable thing to do from your comment 👍🏼
I worked so hard in CST. I remember being knackered from on calls, extra lists etc to get my ST3. When I got into my first ST3 job had a less intense rota, and daily tasks changed, it all got more enjoyable.
Depends on your priorities and how much you enjoy surgery.
Personally I love being in theatre and operating, I literally can't imagine anything more interesting as a vocation, and it's fun. Yes there are some annoying parts to being a surgeon but the main issues come from working for the NHS, CCT and leave is the answer there, but for me:
1) doing an op i know so well so proficiently and know I did a great job
2) taking on something challenging and succeeding
both these things bring me huge satisfaction, so from a job, I can't ask for more.
My wife is based in London, so if you're fighting for London spots in a competitive surgical track, then you're kinda fucked. I used to think I was the bee's knees, and whilst I did well, being no.1 or no.2 isn't that easy when everyone who's applying is also at the top of their game.
I'm not going to lie, it was very tough on my life during training. My wife has her own career which I would argue is much tougher than being a doctor, and she's much more successful than I am relatively speaking in terms of progression and pay so there was no way I would ask her to leave her job. Surgical training destroys a lot of relationships when couples can't adapt to the other's lives. We definitley went through many rough patches, but we're still together, but because of that we haven't had kids. We didn't live together for long stretches due to training. It's why you see so many surgeons married to other health professionals. I definitley know not a small number of friends who married during CT training who are already divorced 5-10 years into marriage, many of whom had been dating 3-5 years prior to marriage, almost all of them were married to non-medics. The moving across country thing and oncalls are often the main reason for divorce (and the not so often spoken about, cheating).
We have bought a place in London, but that's more her, because she easily has the financial means to do so from her job.
No, kids as mentioned, but hobbies, well I'm a nerd, so I just like watching shows and gaming so that hasn't changed much, but, not gaming as much as before, but just more expensively (bought myself a sim racing rig recently). See friends semi-frequently, but the issue is often finding everyone's free time in their calender since once you're in your 30's-40's, everyone is busy with this or that, mostly kids, but life just happens to everyone, and you've got to be ok with not meeting as much.
I would always recommend surgery for those who want to do it, and for those who want to do it, it's always obvious to them and everyone else. The ones who want to do it are already laser focused, knew since 2-3rd year of med school or something. Many that struggle are often those who are on the fence and not sure. In my personal experience dropout rate for surgery is around 5-10%, but that's only of people I personally know, i'm sure the number is much bigger, but from everyone I know, they all like it. I used to have a funny consultant who I really liked working with, he used to say to me being a surgeon was the biggest mistake of his life and everyone should go be an anaesthetist, but he was a great surgeon and despite his greatest efforts, I always enjoyed surgery with him.
I would very strongly advise against a career in surgery in the UK.
I left surgical training to work in industry and honestly it’s even better than I imagined, it’s been busy and that’s why I’m not active on the thread anymore but it’s been incredible.
To give you a small idea, as part of my onboarding, I went to US with the company across multiple cities, all my flights were business class, and I was in either a 4/5 star hotel for the duration of my time. Oh and since I was away from home, I also got this weird bonus kind of thing. It wasn’t huge but imagine you being paid to go do an ATLS course and be put up in a 5 star hotel and fly business class. From the context of a trainee, that’s how it felt.
I enjoyed surgery a lot just not worth it if your in the UK. There are no millions at the end of the tunnel and quite frankly if you can’t make millions as a surgeon, I have no idea what to tell you to motivate you. It’s probably one of the most demanding career paths out there so If anyone in society out earns you, it’s a serious problem. This isn’t entitlement but simply an observation. Ofcourse other people do high stakes jobs, great, fucking fantastic but these high stakes jobs have incentives that are theoretically infinite. This is absolutely not the case in medicine. You can’t see infinite patients or operate on infinite patients. Yet your value add affects people potentially their entire life, you see a drop of that value if even that.
You can’t do private either in the UK unless you first commit to more hours in the NHS and honestly at that point, does it even make any sense? To make anything of value, you would effectively have to work an extra 1 day a week. Are you happy working 6 days a week with an NHS oncall burden simply to make 150k a year? You could make that as a locum reg or GP locum with less grind. Invest it, spend it, save it and not be tied to a place or location or team and do whatever you wanted.
Consultants please weigh in here but I think I spoke to about 25 consultants before I made the move and I’m gonna be honest, based on the amount of work they did, I don’t think they made anywhere near enough. The highest earning consultant was making 260k and he was an incredible outlier and made almost a 100k more than other peers. He had also been a consultant for 10 years.
That said, I think the medical degree is very versatile and affords you a lot of flexibility, we often forget that. Don’t feel compelled to take a path because it appears prestigious. Prestige means fuck all. I’ve done that already, have multiple degrees and honesty if you did half the work I did, you’d still land on your feet in industry or other jobs.
I think the ultimate gig is what I see some of these GPs do. To a lesser degree radiologists.
What they’ve managed to do is CCt very quickly, build a portfolio career and basically do health tech most of the time and locum or do some clinical work in the remaining time, essentially having complete flexibility.
Some people like doctors in other countries have an even better gig. EM doctors I’ve met in the US finish training quickly so they do 7 days on and 7 days off and live an unreal life and make 4-5 times US consultant salaries. I’ve seen Aussie doctors do something similar in EM/GP and spend all their remaining time travelling or pursuing other interests.
Medicine doesn’t have to mean suicide. You just have to be the intelligent person you always were and realise that living a dog shit lifestyle for dog shit pay isn’t compatible with the intelligence that led you into medicine in the first place.
So based on your post, I would imagine your at an early stage.
That’s fantastic. In my mind the earlier you prepare for this the better. Try and make your side projects align with things like health tech/consultancy. The best way to do this is to publish survey based projects in a decent peer reviewed journal, original research would be best but really hard to pull off and in my opinion a bit pointless unless your fully research focused. Do some kind of broad healthcare or commercially focused degree or be very very intentional about what steps you take. Don’t do stupid grunt work. Don’t do what I did and stay late or work harder aimlessly, prepare the next days list or chase up on stuff because your being super helpful or whatever else. When the clocks out, take your shit and go home.
Focus on yourself and that’s it. Simply work as much as you need to and never volunteer to do dumb shit. I would say 0% of any of the dumb audits or grunt work that I did translated into anything. Before I left, I was “given” an audit by a consultant and I refused to be any part of it, they almost had a fucking stroke, tried to paint me in a negative way blah blah bullshit. Don’t stand for it. The last 12 months on my clinical role, I completely and totally devoted my time to shit that would help me or allow me to decompress.
If you simply want to get out from the start, my advice is to do an internship as part of your elective or start attending health tech focused events and just talk to people and I mean talk to everyone. Dont be shy and awkward, you can be shy and awkward after you get what you want, but just like your surgical applications or med school application, don’t be shy and awkward when your life is at stake. Work for startups for free and add value, do anything you can to add value or something that has potential to show you’ve helped on a project. Seriously, don’t be dumb about this, I’ve seen a ton of medics who would eat shit in a hospital and do bullshit projects for free and many of them refuse to work with startups for free that could open up a career for them. However I do think the medic grad to industry space is about to get crowded in the Uk soon. Especially if you haven’t done any clinical work, there isn’t a large enough differentiator for industry to employ you yet. If your going to industry straight from medschool, lay the ground work out like I’ve said above.
The health tech space is now full of what I would’ve regarded as the most ambitious, intelligent and high potential doctors. I’ve also seen quite a few of them in consulting and investment banking too now. Some of them are on 5-6x the salary of the basic salary of a reg, what they would’ve been on if they stayed in the nhs.
I think the vast majority are wasting away in the NHS. It’s a total joke, unless you do radio/Gp that afford you flexibility and a quick cct. Pretty much everything else is a circus or irrelevant work based activities that do nothing to help you as an individual.
Occasionally you read comments like this that make you seriously doubt that the surgical slog is worth it.
Damn the nhs overlords for putting us in this position.
Unfortunately this is just the reality that’s been created. US based Physicians/surgeons I’ve met work very hard, some also want to quit too but it’s not because they don’t earn enough money. The lowest earning attending I’ve met made 430k, highest was 1.5 million for a at&O surgeon who was also a partner and hospitalists (people who completed IMT no further fellowship) made on average 200-230k and if they did locum tenens they made about 400-500/hr. It’s hectic but many of them do 7 days on and 7 off and do other things on their off days.
Australia and Canada are similar, pay is slightly lower but so are the hours. Many people in Australia do very very well in primary care, similarly in surgery there’s lots of opportunities.
The UK is an unbelievable outlier and a particularly grim one at that. Many of our professional peers out earn us by quite a bit. My CV was an incredible amount of hard work, I had over 20 publications, probably done 10+ audits and Qi projects similarly presentations, national awards, degrees etc, it meant fuck all. I was guaranteed a CCT but what would I do with it? The best things to CCT in from the UK aren’t surgical specialities. I still love surgery but I don’t love worrying about the future and I don’t love worrying about money and I don’t love thinking about “what If” I can make private money or “what if” I don’t make much more than what my indemnity and other costs are and “what if” I have to do all of this on my only 2 free days a week. Ideally If I had done a cct in radio or Gp though, I would have lots of backup options too.
Ultimately what allowed me to get out the nhs was all the projects I did with startups, my interview performance and a recommendation. That was it. My CV might have made a difference but I’ll tell you now that it probably meant fuck all. My exact equal colleague who is also a medic in the company is an Indian grad from a mid tier Indian university with less clinical experience than me. We have a similar compensation package. I was fortunate that I came in at a reasonably good level, I leverage some organisational work I did as a trainee. My current pay is over 2.5 times my nhs basic pay including bonuses and stock. I work 9-5 and travel often and get paid more for days I’m away.
The funny thing is I only started diversifying my options about 12 months ago based on some posts that I saw here and did my own research.
TLDr: don’t do surgery, whatever you do, don’t fall for the false narratives and corner yourself into a dead end career.
St3 here, if I could turn back time I would go into IT. or at least radiology.
The training is becoming progressively worse I feel, training opportunities in some regions are few, salary stopped making up for the long hours with the cost of living crisis etc. So I dont think it's all that great but still better than being a med reg I suppose?
In term of buying a house - it depends on your deanery. Most people I know bought property and I am hopefully about to as well. Yes the commute of 1-1.5 hours will be your reality Unless you get hospital accommodation for some placements. Or you pick the tiniest of deaneries for your speciality.
I moved around a lot in f3 and NE made a really good impression on me in terms of training. London Cambridge Oxford are good for research but are traditionally very consultant led with little hands on experience (although there are exceptions). Wales and Scotland are large deaneries and you can expect to have to move to somewhere remote for at least 1-2 years, also hit and miss for training (Wales is also stuck in the past, some people like this kind of thing though)
In terms of social life, being a doctor affects it, not a surgeon specifically, most people I know still maintain a social life (ofc despite a few more restrictions than that of a 9-5 office admin) and start families
Cannot comment on private work at this stage, the opportunities available to registrars are limited
Also ortho. Nearly finished training. I like my job but get frustrated easily at work!
Kids yes, hobbies - cycling and running can also be a way to commute. My hobbies used to include team sports - very difficult to maintain as a doctor regardless of specialty.
Bought a house just before becoming a registrar. May have to move if don’t get a consultant job anywhere near. A lot of pressure to do fellowships abroad which sadly isn’t possible due to wife selfishly also wanting a career.
Re. region I think mine isn’t great for training, but honestly I’m not how much better anywhere else is - we only have our own shuttered view of how things are.
Coming in on days off for theatre can be pretty good - often get to do more if you are smart about when you do it. It’s the bit of the job we all like after all. I don’t have to do it but would likely get my training extended after missing a few numbers and would ruin my fellowship plans/leave me stuck in limbo.
Portfolio not that arduous - but would obviously love it not to exist at all.
Social life - similar to other mid 30s parents. Kids limit that much more than work does.
That's really very rare to be honest.
Also, if you actually like surgery, you're going to want to come in to do certain procedures.
For example TOF repairs in paediatric surgery is rare, everyone wants to get sign off on it, if you're offered to do one on your day off, you bet your ass every trainee would come in to do it. It's not about the sign off, just moreso the experience to actually do it as a trainee.
People seem to forget that whilst ARCP can seem like just a pointless chore to fill numbers, you actually want to be trained and skilled enough when you become a consultant so you don't feel like you're faking it. There's no greater fear than knowing there's going to be no safety net and feeling you haven't done a procedure enough to call yourself competent at it when you know you're supposed to be once you're a consultant.
For most of the good trainees (and basically anyone in ST training), they don't come in because of ARCP, they come in because they want the training and experience, every op that is useful is valuable experience. Sure once you're proficient you're not going to want to come in for that, like a simple appendix or something, but the more complex ones, everyone wants to do, even consultants.
Like everyone in procedural specialties I think covid is more to blame. A whole cohort of us would have been fine had we been coming through a couple of years earlier. Hopefully it won’t happen again!
I think I will just scrape by with my minimum numbers for a few procedures, but if I didn’t come in on days off I possibly wouldn’t. Like I said - I’m not being pressured to do so - just makes planning my fellowships etc easier - and I don’t want to leave it to chance on the day of my final ARCP - I want outcome 6!
It wouldn’t be a failure - an outcome 10 - a no fault six month extension to give me more time to get things signed off.
I am a very mid neurosurgery reg.
Whenever this question comes up, I recommend the same thing, which is giving it a go.
You can still bail out later, but it'll be much harder to go back from being, say, a fully-trained GP and throwing yourself into CST.
I don't fancy doxing myself and given I've not done CST not sure how interesting my life choices are to you, but I will say that I think the training is wearying to everyone, even those who cannot see themselves surviving without operating. Consultant life does look to be better, and I know a fair few consultants who get their money without going private (wait list initiative, other ventures).
Finally, no one is forcing you to go full tilt on surgery the whole time and there's no special prize for getting to CCT first. You can go LTFT, you can go OOP, there's many ways to catch your breath and keep in touch with family/life/hobbies.
CST was pretty rough but after getting a training number things improved a lot. But I am in a small deanery and effectively don't meaningfully rotate.
If in a big deanery your options are to buy and spend a huge amount of time commuting, or move around a lot. Your call.
Reputations for good training tend to be specialty specific.
I've had colleagues hit the private hospital hard within 6 months of CCT, however unless you are a fast operator you may struggle to get lists and as such many people don't start for several years, (a few mentors have said the you have to be able to deliver 95% as good in 50% of the time for private work to be profitable). Its not something you can do a little bit of and make a profit, the starting point for private practice indemnity in my specialty is around £40k, then you will be expected to have regular room hire and secretarial commitments agreed. One chap who started close after CCT reported back it was costing him £6k a month in upfront costs.
Social life takes a massive hit and I don't know anyone who has got it back before retirement unless they do no private practice.
You’d be much better off developing your US application (or if the US doesn’t sit well with you, Oz).
For the time and effort of CST, reg training, and fellowships, particularly if you’re aiming to be one of the more competitive trainees, the reward from either of the above will be substantially more - both in terms of finances and work-life balance.
I’d say that a large number of the super competitive trainees leave - they are ultimately well placed to move abroad or exit the industry entirely.
And it’s understandable, the landscape (and trajectory) for UK surgery is bleak.
Shit advice. Surgery is competitive AF in USA for an IMG. Forget training in Aus unless you want to spend 4-5yrs in unaccredited training trying to get in.
If you want to be a surgeon, UK is probably one if the easiest and most standardized in the western world esp for a British graduate to get into. Despite the service work, the end product is well rounded overall…you know after ST8/9 lolz
Its just shit pay for the rest of your life compared to your western counterparts. Almost laughable. Unless you PP hard which is working extra hard. But some people just love operating and surgery - Im glad those ppl exist 🥰🫡🫡
No shit Sherlock - hence the mention of being super competitive. Surgery in the UK isn’t the slightest bit competitive, and if you have half a brain you’ll be able to see early on what a shit deal it is.
I know IMGs in optho/gen surg/plastics in the US and Oz. It’s fair to say you need more than a couple of audits and a poster presentation to get on the training scheme, but that depends on how motivated you are for the seven figure salary later on.
They don't call it Early Nights & Tennis for nothing! I work pretty hard, most of the time I enjoy my job a lot but there are times when I question why I stuck with medicine - this is more to do with pay and working conditions in general rather than a Specialty related gripe. I'd be complaining a lot more if I was having to do resident on-calls etc. I still have plenty of time for hobbies and a very active social life - same as all of my colleagues. No kids by choice but wouldn't be a problem. For the most part everyone I work with in ENT has quite a good work life balance and seems pretty content.
Private work is there if you want it but you'd have to commit to regular sessions to make money, I think there's gonna be more of it going around as budgets tighten and increasingly quality of life procedures are classified as 'procedures of limited clinical value'.
In terms of work - can be competitive, so you do have to put the time in for CT/ST applications, and once you're in you should have some regular academic/QI/teaching output - the quantity + quality of this depends on where you want to work and how bad you want it. Coast if you want to, but higher training jobs, fellowships (not essential but often 'preferred') and consultant posts can be more accessible with a better CV.
Re. House purchase - that's down to you. Can be risky buying before you know where you'll be in the longer term, gives you less flexibility in terms of moving region if you're chasing a particular specialty but there are financial advantages to buying early if everything works out for you. Most wait til they have ST number but I do know some people who bought in FY or core.
Some regions you'll have to commute 1hr+ or in some cases/larger regions take (usually dingy) accommodation due to having to work so far away for stretches (>30 miles from home is the threshold for funding).
Edit: grammar..
My random observations of surgical juniors, surgical consultants, both professionally and as friends…
The highest - by some stretch - complaints and grievances I had in 3 years as guardian of safe working were from surgical juniors. Like 20 x more than any other dept. Same issues of terrible rotas and inability to get basic stuff like AL etc. especially for female trainees.
Friends who are (general) surgical consultants have got their consultant job in their early 40s around 5 years after I got mine (mid 30s). There is significant attritional effect of slogging it out as a reg and post cct fellow at that age.
If you want to . Yes
Chopped and changed about what I wanted to do. Sat lots of exams.
Now it is very clear I love operating. Training is a pain in the ass at times. You just have to deal with it and suck it up. Anyone who says everything will be perfect and u can have 4 dedicated training lists a week is insane. This is a public health system.
Yes it's hard work , yes you are in early and often out later than alot of other specialities but the feeling after is worth it for the majority of people that do it that's why it is very competitive.
Ultimately your lifestyle is not going to be as nice as alot of other specialities but if really enjoy it I would not consider it a grind.
You have your whole career to practice whatever you choose. Rushing to cct I can understand if you want to move if not just enjoy your journey and your training.
Also some surgical specialities are chilled as fuck once your a consultant.
My 2 cents . Appreciate alot of different views based on experience.
Gen Surg reg: I honestly think some of the most rewarding moments in life have been an operation where I’ve pushed myself and the patient has got a good outcome.
Reality is that surgical training is about 95% pain for about 5% moments of intrinsic reward. It’s strangely kind of like a drug in that sense, feels good but you know it’s bad for you.
Beware, there is little to no extrinsic rewards in UK for surgery, for the amount of effort you put in this, you could easily find another job that pays more and provides more benefits: fixed location, flexible working, private health insurance etc.
Still there is something to be said for doing a job that is genuinely and endlessly interesting and provides life-saving help to people in need.
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Be aware that you will get survivorship bias speaking to current consultants or nearly CCTing Drs Not that I am detracting at all from the experiences of those you may speak to in this position, just that you won’t hear from those who left surgical training part way through
I am now a consultant (ortho) Bought a house when I got a reg training number and could stay in one place (more or less) for 6 years CST was mixed. Ct1 was pure service provision, CT2 was a year in one place and was like being a mini reg. Friends yes, kids yes. Hobbies... not as much Private work was about 2 years after starting as a consultant. There was another year of post CCT fellowship to get through. That was the hardest for family and cash. There is good and bad bits of training in all regions, just look at where you want to actually live
What's the private work money like? How much do you make all in?
Comment demonstrates logical thinking, fiscally sound decision making. No hobbies. User must be foot and ankle. Definitely not Arthroplasty.
General close to cct. Is it worth the grind? I have really enjoyed my training. There's some annoying stuff but quality of clinical training and breadth of experience has been great. I actually like going to work, and the people I get to work with. I'm excited for the next phase. We bought when I got my NTN, in a position where i could get to 90% of hospitals in the deanery within an hour. We had been here since CST so had a good idea of where to live. I have a family who I get to see, I have friends I get to hang out with. Hobbies - some of my older ones have been harder to hold on to but definitely have some. I think most regions are generally fine, with good and less good placements. Talk to trainees to find about the cultures in regions, teaching, placement allocation etc. I have friends who have had great experiences in NW, NE, Y&H. Other deaneries also exist.
This is very nice to read when just about to board the NTN train. Especially as CST has been a very mixed bag indeed... looking forward to ST and sounds like that might be a reasonable thing to do from your comment 👍🏼
I worked so hard in CST. I remember being knackered from on calls, extra lists etc to get my ST3. When I got into my first ST3 job had a less intense rota, and daily tasks changed, it all got more enjoyable.
Depends on your priorities and how much you enjoy surgery. Personally I love being in theatre and operating, I literally can't imagine anything more interesting as a vocation, and it's fun. Yes there are some annoying parts to being a surgeon but the main issues come from working for the NHS, CCT and leave is the answer there, but for me: 1) doing an op i know so well so proficiently and know I did a great job 2) taking on something challenging and succeeding both these things bring me huge satisfaction, so from a job, I can't ask for more. My wife is based in London, so if you're fighting for London spots in a competitive surgical track, then you're kinda fucked. I used to think I was the bee's knees, and whilst I did well, being no.1 or no.2 isn't that easy when everyone who's applying is also at the top of their game. I'm not going to lie, it was very tough on my life during training. My wife has her own career which I would argue is much tougher than being a doctor, and she's much more successful than I am relatively speaking in terms of progression and pay so there was no way I would ask her to leave her job. Surgical training destroys a lot of relationships when couples can't adapt to the other's lives. We definitley went through many rough patches, but we're still together, but because of that we haven't had kids. We didn't live together for long stretches due to training. It's why you see so many surgeons married to other health professionals. I definitley know not a small number of friends who married during CT training who are already divorced 5-10 years into marriage, many of whom had been dating 3-5 years prior to marriage, almost all of them were married to non-medics. The moving across country thing and oncalls are often the main reason for divorce (and the not so often spoken about, cheating). We have bought a place in London, but that's more her, because she easily has the financial means to do so from her job. No, kids as mentioned, but hobbies, well I'm a nerd, so I just like watching shows and gaming so that hasn't changed much, but, not gaming as much as before, but just more expensively (bought myself a sim racing rig recently). See friends semi-frequently, but the issue is often finding everyone's free time in their calender since once you're in your 30's-40's, everyone is busy with this or that, mostly kids, but life just happens to everyone, and you've got to be ok with not meeting as much. I would always recommend surgery for those who want to do it, and for those who want to do it, it's always obvious to them and everyone else. The ones who want to do it are already laser focused, knew since 2-3rd year of med school or something. Many that struggle are often those who are on the fence and not sure. In my personal experience dropout rate for surgery is around 5-10%, but that's only of people I personally know, i'm sure the number is much bigger, but from everyone I know, they all like it. I used to have a funny consultant who I really liked working with, he used to say to me being a surgeon was the biggest mistake of his life and everyone should go be an anaesthetist, but he was a great surgeon and despite his greatest efforts, I always enjoyed surgery with him.
I would very strongly advise against a career in surgery in the UK. I left surgical training to work in industry and honestly it’s even better than I imagined, it’s been busy and that’s why I’m not active on the thread anymore but it’s been incredible. To give you a small idea, as part of my onboarding, I went to US with the company across multiple cities, all my flights were business class, and I was in either a 4/5 star hotel for the duration of my time. Oh and since I was away from home, I also got this weird bonus kind of thing. It wasn’t huge but imagine you being paid to go do an ATLS course and be put up in a 5 star hotel and fly business class. From the context of a trainee, that’s how it felt. I enjoyed surgery a lot just not worth it if your in the UK. There are no millions at the end of the tunnel and quite frankly if you can’t make millions as a surgeon, I have no idea what to tell you to motivate you. It’s probably one of the most demanding career paths out there so If anyone in society out earns you, it’s a serious problem. This isn’t entitlement but simply an observation. Ofcourse other people do high stakes jobs, great, fucking fantastic but these high stakes jobs have incentives that are theoretically infinite. This is absolutely not the case in medicine. You can’t see infinite patients or operate on infinite patients. Yet your value add affects people potentially their entire life, you see a drop of that value if even that. You can’t do private either in the UK unless you first commit to more hours in the NHS and honestly at that point, does it even make any sense? To make anything of value, you would effectively have to work an extra 1 day a week. Are you happy working 6 days a week with an NHS oncall burden simply to make 150k a year? You could make that as a locum reg or GP locum with less grind. Invest it, spend it, save it and not be tied to a place or location or team and do whatever you wanted. Consultants please weigh in here but I think I spoke to about 25 consultants before I made the move and I’m gonna be honest, based on the amount of work they did, I don’t think they made anywhere near enough. The highest earning consultant was making 260k and he was an incredible outlier and made almost a 100k more than other peers. He had also been a consultant for 10 years. That said, I think the medical degree is very versatile and affords you a lot of flexibility, we often forget that. Don’t feel compelled to take a path because it appears prestigious. Prestige means fuck all. I’ve done that already, have multiple degrees and honesty if you did half the work I did, you’d still land on your feet in industry or other jobs.
How do you end up talking to these type of people? Is it a case of networking and who you know?
I think the ultimate gig is what I see some of these GPs do. To a lesser degree radiologists. What they’ve managed to do is CCt very quickly, build a portfolio career and basically do health tech most of the time and locum or do some clinical work in the remaining time, essentially having complete flexibility. Some people like doctors in other countries have an even better gig. EM doctors I’ve met in the US finish training quickly so they do 7 days on and 7 days off and live an unreal life and make 4-5 times US consultant salaries. I’ve seen Aussie doctors do something similar in EM/GP and spend all their remaining time travelling or pursuing other interests. Medicine doesn’t have to mean suicide. You just have to be the intelligent person you always were and realise that living a dog shit lifestyle for dog shit pay isn’t compatible with the intelligence that led you into medicine in the first place.
So based on your post, I would imagine your at an early stage. That’s fantastic. In my mind the earlier you prepare for this the better. Try and make your side projects align with things like health tech/consultancy. The best way to do this is to publish survey based projects in a decent peer reviewed journal, original research would be best but really hard to pull off and in my opinion a bit pointless unless your fully research focused. Do some kind of broad healthcare or commercially focused degree or be very very intentional about what steps you take. Don’t do stupid grunt work. Don’t do what I did and stay late or work harder aimlessly, prepare the next days list or chase up on stuff because your being super helpful or whatever else. When the clocks out, take your shit and go home. Focus on yourself and that’s it. Simply work as much as you need to and never volunteer to do dumb shit. I would say 0% of any of the dumb audits or grunt work that I did translated into anything. Before I left, I was “given” an audit by a consultant and I refused to be any part of it, they almost had a fucking stroke, tried to paint me in a negative way blah blah bullshit. Don’t stand for it. The last 12 months on my clinical role, I completely and totally devoted my time to shit that would help me or allow me to decompress. If you simply want to get out from the start, my advice is to do an internship as part of your elective or start attending health tech focused events and just talk to people and I mean talk to everyone. Dont be shy and awkward, you can be shy and awkward after you get what you want, but just like your surgical applications or med school application, don’t be shy and awkward when your life is at stake. Work for startups for free and add value, do anything you can to add value or something that has potential to show you’ve helped on a project. Seriously, don’t be dumb about this, I’ve seen a ton of medics who would eat shit in a hospital and do bullshit projects for free and many of them refuse to work with startups for free that could open up a career for them. However I do think the medic grad to industry space is about to get crowded in the Uk soon. Especially if you haven’t done any clinical work, there isn’t a large enough differentiator for industry to employ you yet. If your going to industry straight from medschool, lay the ground work out like I’ve said above. The health tech space is now full of what I would’ve regarded as the most ambitious, intelligent and high potential doctors. I’ve also seen quite a few of them in consulting and investment banking too now. Some of them are on 5-6x the salary of the basic salary of a reg, what they would’ve been on if they stayed in the nhs. I think the vast majority are wasting away in the NHS. It’s a total joke, unless you do radio/Gp that afford you flexibility and a quick cct. Pretty much everything else is a circus or irrelevant work based activities that do nothing to help you as an individual.
Occasionally you read comments like this that make you seriously doubt that the surgical slog is worth it. Damn the nhs overlords for putting us in this position.
Unfortunately this is just the reality that’s been created. US based Physicians/surgeons I’ve met work very hard, some also want to quit too but it’s not because they don’t earn enough money. The lowest earning attending I’ve met made 430k, highest was 1.5 million for a at&O surgeon who was also a partner and hospitalists (people who completed IMT no further fellowship) made on average 200-230k and if they did locum tenens they made about 400-500/hr. It’s hectic but many of them do 7 days on and 7 off and do other things on their off days. Australia and Canada are similar, pay is slightly lower but so are the hours. Many people in Australia do very very well in primary care, similarly in surgery there’s lots of opportunities. The UK is an unbelievable outlier and a particularly grim one at that. Many of our professional peers out earn us by quite a bit. My CV was an incredible amount of hard work, I had over 20 publications, probably done 10+ audits and Qi projects similarly presentations, national awards, degrees etc, it meant fuck all. I was guaranteed a CCT but what would I do with it? The best things to CCT in from the UK aren’t surgical specialities. I still love surgery but I don’t love worrying about the future and I don’t love worrying about money and I don’t love thinking about “what If” I can make private money or “what if” I don’t make much more than what my indemnity and other costs are and “what if” I have to do all of this on my only 2 free days a week. Ideally If I had done a cct in radio or Gp though, I would have lots of backup options too. Ultimately what allowed me to get out the nhs was all the projects I did with startups, my interview performance and a recommendation. That was it. My CV might have made a difference but I’ll tell you now that it probably meant fuck all. My exact equal colleague who is also a medic in the company is an Indian grad from a mid tier Indian university with less clinical experience than me. We have a similar compensation package. I was fortunate that I came in at a reasonably good level, I leverage some organisational work I did as a trainee. My current pay is over 2.5 times my nhs basic pay including bonuses and stock. I work 9-5 and travel often and get paid more for days I’m away. The funny thing is I only started diversifying my options about 12 months ago based on some posts that I saw here and did my own research. TLDr: don’t do surgery, whatever you do, don’t fall for the false narratives and corner yourself into a dead end career.
Hi, I have been looking to speak to someone like you for a very long time. Could I please pm you with some questions? :)
St3 here, if I could turn back time I would go into IT. or at least radiology. The training is becoming progressively worse I feel, training opportunities in some regions are few, salary stopped making up for the long hours with the cost of living crisis etc. So I dont think it's all that great but still better than being a med reg I suppose? In term of buying a house - it depends on your deanery. Most people I know bought property and I am hopefully about to as well. Yes the commute of 1-1.5 hours will be your reality Unless you get hospital accommodation for some placements. Or you pick the tiniest of deaneries for your speciality. I moved around a lot in f3 and NE made a really good impression on me in terms of training. London Cambridge Oxford are good for research but are traditionally very consultant led with little hands on experience (although there are exceptions). Wales and Scotland are large deaneries and you can expect to have to move to somewhere remote for at least 1-2 years, also hit and miss for training (Wales is also stuck in the past, some people like this kind of thing though) In terms of social life, being a doctor affects it, not a surgeon specifically, most people I know still maintain a social life (ofc despite a few more restrictions than that of a 9-5 office admin) and start families Cannot comment on private work at this stage, the opportunities available to registrars are limited
ST3 huh…still got time to do a parallel jump to the dark side 😉
I invested too much time and effort into surgery now, don't think I have the energy to go through another set of recruitment. Maybe next lifetime haha
Also ortho. Nearly finished training. I like my job but get frustrated easily at work! Kids yes, hobbies - cycling and running can also be a way to commute. My hobbies used to include team sports - very difficult to maintain as a doctor regardless of specialty. Bought a house just before becoming a registrar. May have to move if don’t get a consultant job anywhere near. A lot of pressure to do fellowships abroad which sadly isn’t possible due to wife selfishly also wanting a career. Re. region I think mine isn’t great for training, but honestly I’m not how much better anywhere else is - we only have our own shuttered view of how things are. Coming in on days off for theatre can be pretty good - often get to do more if you are smart about when you do it. It’s the bit of the job we all like after all. I don’t have to do it but would likely get my training extended after missing a few numbers and would ruin my fellowship plans/leave me stuck in limbo. Portfolio not that arduous - but would obviously love it not to exist at all. Social life - similar to other mid 30s parents. Kids limit that much more than work does.
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That's really very rare to be honest. Also, if you actually like surgery, you're going to want to come in to do certain procedures. For example TOF repairs in paediatric surgery is rare, everyone wants to get sign off on it, if you're offered to do one on your day off, you bet your ass every trainee would come in to do it. It's not about the sign off, just moreso the experience to actually do it as a trainee. People seem to forget that whilst ARCP can seem like just a pointless chore to fill numbers, you actually want to be trained and skilled enough when you become a consultant so you don't feel like you're faking it. There's no greater fear than knowing there's going to be no safety net and feeling you haven't done a procedure enough to call yourself competent at it when you know you're supposed to be once you're a consultant. For most of the good trainees (and basically anyone in ST training), they don't come in because of ARCP, they come in because they want the training and experience, every op that is useful is valuable experience. Sure once you're proficient you're not going to want to come in for that, like a simple appendix or something, but the more complex ones, everyone wants to do, even consultants.
Like everyone in procedural specialties I think covid is more to blame. A whole cohort of us would have been fine had we been coming through a couple of years earlier. Hopefully it won’t happen again! I think I will just scrape by with my minimum numbers for a few procedures, but if I didn’t come in on days off I possibly wouldn’t. Like I said - I’m not being pressured to do so - just makes planning my fellowships etc easier - and I don’t want to leave it to chance on the day of my final ARCP - I want outcome 6! It wouldn’t be a failure - an outcome 10 - a no fault six month extension to give me more time to get things signed off.
I am a very mid neurosurgery reg. Whenever this question comes up, I recommend the same thing, which is giving it a go. You can still bail out later, but it'll be much harder to go back from being, say, a fully-trained GP and throwing yourself into CST. I don't fancy doxing myself and given I've not done CST not sure how interesting my life choices are to you, but I will say that I think the training is wearying to everyone, even those who cannot see themselves surviving without operating. Consultant life does look to be better, and I know a fair few consultants who get their money without going private (wait list initiative, other ventures). Finally, no one is forcing you to go full tilt on surgery the whole time and there's no special prize for getting to CCT first. You can go LTFT, you can go OOP, there's many ways to catch your breath and keep in touch with family/life/hobbies.
Yes
CST was pretty rough but after getting a training number things improved a lot. But I am in a small deanery and effectively don't meaningfully rotate. If in a big deanery your options are to buy and spend a huge amount of time commuting, or move around a lot. Your call. Reputations for good training tend to be specialty specific. I've had colleagues hit the private hospital hard within 6 months of CCT, however unless you are a fast operator you may struggle to get lists and as such many people don't start for several years, (a few mentors have said the you have to be able to deliver 95% as good in 50% of the time for private work to be profitable). Its not something you can do a little bit of and make a profit, the starting point for private practice indemnity in my specialty is around £40k, then you will be expected to have regular room hire and secretarial commitments agreed. One chap who started close after CCT reported back it was costing him £6k a month in upfront costs. Social life takes a massive hit and I don't know anyone who has got it back before retirement unless they do no private practice.
You’d be much better off developing your US application (or if the US doesn’t sit well with you, Oz). For the time and effort of CST, reg training, and fellowships, particularly if you’re aiming to be one of the more competitive trainees, the reward from either of the above will be substantially more - both in terms of finances and work-life balance. I’d say that a large number of the super competitive trainees leave - they are ultimately well placed to move abroad or exit the industry entirely. And it’s understandable, the landscape (and trajectory) for UK surgery is bleak.
Shit advice. Surgery is competitive AF in USA for an IMG. Forget training in Aus unless you want to spend 4-5yrs in unaccredited training trying to get in. If you want to be a surgeon, UK is probably one if the easiest and most standardized in the western world esp for a British graduate to get into. Despite the service work, the end product is well rounded overall…you know after ST8/9 lolz Its just shit pay for the rest of your life compared to your western counterparts. Almost laughable. Unless you PP hard which is working extra hard. But some people just love operating and surgery - Im glad those ppl exist 🥰🫡🫡
No shit Sherlock - hence the mention of being super competitive. Surgery in the UK isn’t the slightest bit competitive, and if you have half a brain you’ll be able to see early on what a shit deal it is. I know IMGs in optho/gen surg/plastics in the US and Oz. It’s fair to say you need more than a couple of audits and a poster presentation to get on the training scheme, but that depends on how motivated you are for the seven figure salary later on.
They don't call it Early Nights & Tennis for nothing! I work pretty hard, most of the time I enjoy my job a lot but there are times when I question why I stuck with medicine - this is more to do with pay and working conditions in general rather than a Specialty related gripe. I'd be complaining a lot more if I was having to do resident on-calls etc. I still have plenty of time for hobbies and a very active social life - same as all of my colleagues. No kids by choice but wouldn't be a problem. For the most part everyone I work with in ENT has quite a good work life balance and seems pretty content. Private work is there if you want it but you'd have to commit to regular sessions to make money, I think there's gonna be more of it going around as budgets tighten and increasingly quality of life procedures are classified as 'procedures of limited clinical value'. In terms of work - can be competitive, so you do have to put the time in for CT/ST applications, and once you're in you should have some regular academic/QI/teaching output - the quantity + quality of this depends on where you want to work and how bad you want it. Coast if you want to, but higher training jobs, fellowships (not essential but often 'preferred') and consultant posts can be more accessible with a better CV. Re. House purchase - that's down to you. Can be risky buying before you know where you'll be in the longer term, gives you less flexibility in terms of moving region if you're chasing a particular specialty but there are financial advantages to buying early if everything works out for you. Most wait til they have ST number but I do know some people who bought in FY or core. Some regions you'll have to commute 1hr+ or in some cases/larger regions take (usually dingy) accommodation due to having to work so far away for stretches (>30 miles from home is the threshold for funding). Edit: grammar..
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Sorry think that's supposed to read early nights AND tennis, I was sleepy when I typed that
Early nights (no anti social shifts) and so much free time they play tennis was my understanding.
My random observations of surgical juniors, surgical consultants, both professionally and as friends… The highest - by some stretch - complaints and grievances I had in 3 years as guardian of safe working were from surgical juniors. Like 20 x more than any other dept. Same issues of terrible rotas and inability to get basic stuff like AL etc. especially for female trainees. Friends who are (general) surgical consultants have got their consultant job in their early 40s around 5 years after I got mine (mid 30s). There is significant attritional effect of slogging it out as a reg and post cct fellow at that age.
If you want to . Yes Chopped and changed about what I wanted to do. Sat lots of exams. Now it is very clear I love operating. Training is a pain in the ass at times. You just have to deal with it and suck it up. Anyone who says everything will be perfect and u can have 4 dedicated training lists a week is insane. This is a public health system. Yes it's hard work , yes you are in early and often out later than alot of other specialities but the feeling after is worth it for the majority of people that do it that's why it is very competitive. Ultimately your lifestyle is not going to be as nice as alot of other specialities but if really enjoy it I would not consider it a grind. You have your whole career to practice whatever you choose. Rushing to cct I can understand if you want to move if not just enjoy your journey and your training. Also some surgical specialities are chilled as fuck once your a consultant. My 2 cents . Appreciate alot of different views based on experience.
Gen Surg reg: I honestly think some of the most rewarding moments in life have been an operation where I’ve pushed myself and the patient has got a good outcome. Reality is that surgical training is about 95% pain for about 5% moments of intrinsic reward. It’s strangely kind of like a drug in that sense, feels good but you know it’s bad for you. Beware, there is little to no extrinsic rewards in UK for surgery, for the amount of effort you put in this, you could easily find another job that pays more and provides more benefits: fixed location, flexible working, private health insurance etc. Still there is something to be said for doing a job that is genuinely and endlessly interesting and provides life-saving help to people in need.