Mark Lewis: What to do next?
31 Mar, 08 | by Mark Lewis
I celebrated my parents’ 30th wedding anniversary with them at the weekend, which turned out to be a large family and friends affair with many people that I hadn’t seen for many years. Naturally all wanted to know how things are going with my job and what I’m planning to do next. When I try to explain about the difficulties getting onto a training post they seem astonished - their solutions to the problems are hardly revolutionary - have I considered going abroad? can’t I stay where I am? leave medicine?
Funnily enough I have thought about all these things - and on the surface all look like fantastic ideas; going abroad leaves me with visions of practising medical in a tropical climate with not just a change in location but a total change in lifestyle - I am sure the reality is very different! My own inhibitions about going abroad range from the unnecessary carbon footprint and expense of relocation to leaving behind all the people in my life. Besides, are you running towards something better or running away from something terrible? Plus there are currently concerns about returning to the UK - I already know of a few peers who are staying in Australia to complete training programmes out there - 5 year rotations. I wonder if there will be a large cohort of English emergency medicine consultants in Australia in a few years.
As for staying where I am - we all know that isn’t possible - but the general populace have a difficult time understanding why we are moved hundreds of miles every few months/yearly. Obviously some specialties are bigger culprits here than others. Being an SHO forever doesn’t really appeal anyway!!
Leave medicine? Sounds so simple. Lots of people talk of investment banking and law as if the door is being held open into those professions from medicine. I can see the appeal and the obvious benefits - a fellow SHO who left last year for a desk job at a drug company now has a stable salary, bonuses, car, expenses … however, I just don’t see myself there … yet 
So, what’s left - change specialty, work on CV, research degree? Please send your answers on a postcard …
So other than that discussion, it was a lovely night!
Dear Mark
I know how difficult it can be. I made the tortuous decision to leave medicine nine years ago. I now work as a career coach helping doctors with their careers and lives. Coaching helps people achieve their goals faster than they can on their own. I have no doubt that you will decide on the best course action for you, but if you would like to try some career coaching and post your experiences on your blog, I’d be happy to help.
Emma
Emma Sedgwick
April 2nd, 2008 at 1:32 pm
Hi Mark,
Just read your Blog piece. I’m sure you’re going to get many replies but I’ll throw by bit in antway by letting you know about the research degree side of things.
I have a degree in Biomedical Science, Masters in Tumour endocrinology (all from Trinity College Dublin) and a PhD in immunology from The Royal Free & University College Medical School, UCL. I have been a post doctoral fellow for 5 years now in London and Dublin and have worked with both scientists and clinical colleagues carrying out research degrees.
So, a bit about research. Its relatively poorly paid with a flat hierarchical structure, meaning Post doctoral fellows (equivalent to registrars) are treated like PhD students in many cases. Life is entirely dependent on acquiring research funding every 3-5 years in order to climb the ladder or you can become the perpetual post-doc and work for research teams with their own research funding (and you wont move upwards). If you want to climb the ladder you need to get your own money. If you don’t get funding for your ideas you don’t have a job. There is very little funding for post-doctoral research fellows but a reasonable amount for Principle Investigators (scientist who have gone through the fellowships and are now in senior positions or lectureships).
A friend of mine has said that Research is very similar to the priest hood: little money, little recognition, in other words a vocation.
So why am I in it? I am never board, constantly challenged and on the rare occasion I do stumble across something novel or when a part of my hypothesis rings true there is an enormous buzz.
As far as moving around the globe. Anyone who wants to move up the ladder is expected to go away, acquire experience somewhere else and come back. In the UK there are many reputable institutions so getting a job is not the problem there.
The clinician friends of mine simply used a PhD as a stepping stone to a consultancy post and were never really interested in research. For this reason the shock of how steep the learning curve was (transition from medicine to fundamental research), was shocking but I think they enjoyed their time.
So there you have it. Hope that helps you somewhat.
Pádraic
Padraic Dunne
April 2nd, 2008 at 1:36 pm
Just do it! Life is too short to be left wondering “What if–”.
Leap and the net will appear! If all else fails you can always fall back on your skills/education.
Christine
April 2nd, 2008 at 4:03 pm
Hi Mark - I left clinical medicine over a decade ago and work as a medical writer for the pharmaceutical industry, in one of the many medical education companies that exist (I had never heard of them while I was in the NHS). If you’re any good at writing, it is very easy to get into and well paid. For women like me (I have 3 children), it is brilliant, because the work is so flexible (I work a 3-day week from home).
Whatever you decide, I wish you well - I remember all too well the scary feeling of leaping into the unknown when I left the NHS - but I don’t regret it - and the greatest reward is the improvement in my quality of life (and still feeling that I am using my medical degree).
All the best
Jenny
Jenny Edwards
April 2nd, 2008 at 4:43 pm
Or… probably most depressingly at the moment… just keep on trying for your chosen career.
I was in a similar situation 2 years ago: Over the 5 years following graduation I lived in 6 rented rooms around the country, worked in even more hospitals, rarely saw friends and family who were scattered around the country and I was beginning to feel like there was just no end in sight…
Now I know job prospects are really REALLY awful at the moment but as an excellent trainee things must and will come good eventually - if only because those who have worked with you will be incredibly keen to work with you again.
My advise - and I know this is coming from one of the “lucky few” - is to stick with your dreams: Once your break comes you will have what must be the most fulfilling, interesting and exciting jobs that ever existed.
Fran
April 2nd, 2008 at 7:04 pm
I left medicine 11 years ago, in spite of colleagues and family who tried to dissuade me. I’ve never regretted it! I became a Life Coach for doctors. I’ve been amazed how after a few Coaching sessions the doctors I work with have been able to make the changes they need to make a huge difference in their lives! There is something about having someone to bounce ideas onto, and discuss what might be possible and then with encouragement take the action you want to. I agree with the other correspondents. Go where your spirit leads you, do what your inner voice is telling you to do! It may or may not work out but for sure it will be exciting and if you don’t do it you may regret your decisions for the rest of your life. I discovered there is a life outside of medicine. However I now help doctors make the changes they want to stay working in Medicine, (I want there to be doctors around when I need them!), or to discover things they can do outside of medicine.
Susan Kersley
April 3rd, 2008 at 10:47 am
Caveat - I am in the US and so lack insight into your situation, but I believe I can comment relatively intelligently on medicine and life.
I am now (frighteningly) 21 years from beginning medical school, and 12 years from completing training and beginning “real” life as a physician. I don’t have a respectable income (am earning $30K less than in my first job out of residency), but am working in a tiny “island” of socialized medicine, caring for University students. I started my training in Emergency Medicine, then switched to Family Medicine, which has been a better “fit” for me. I really love patient care, but am starting to consider changes, though my next move will be carefully thought through.
I think the first thing you need to do is explore your values as they impact your life’s work. Is patient care a necessary part of your life? Is work in a non-profit setting necessary? From your remarks about carbon footprint I would guess the answer to these questions is yes, though that is just a guess.
You then need to explore how much professional autonomy you need, and how much job security, and how much income. The money issues may conflict with the values, and you need to find a solution that you are comfortable with.
In my case, I have sacrificed significantly in the income department in order to continue to provide a service to society. I am considering changes, mainly out of a need for control of my practice and to keep my kids fed, but draw the line at working for the large hospital that I feel is trying to take over the local medical community. The catch is, who else is hiring? (And, if I move, who will buy my house? Or get it ready to sell?) Perhaps Susan or Emma can provide me with some insight into the possibilities from your side of the pond…
Iris Gonzalez
April 8th, 2008 at 2:08 am
Mark,
I am British by birth but apart from an enjoyable stint at Queen Square, I am a U.S. trained consultant neurologist. My own desire at your stage was to be the best hospital based and intensive care neurologist in the area….I did just that for about 9 years, and then I realized my financial folly when I pulled up to the curb in my Ford truck and parked next to an exquisite Bentley. I went in for my haircut and casually inquired from my barber about the Bentley, only to learn that it belonged to the next-door chiropractor who only came in once a day to collect the money that the postman had brought that day!
Now I have not been a slave to money, nor have I been brought up that way….but I was a bit put off! Medicine does not have the financial rewards that bring comfortable perks such as private school for the kids, a vacation in Spain, or an S-class Mercedes, much less a Bentley!
My advice: Apportion your time carefully. By all means see and get your fill of traditional patient care….about 5 to 10 patients per week!! Spend the rest of your time as the owner of a clinic staffed by your employees… doctors, nurse practitioners, radiology technicians, and phlebotomists and other ancillary providers. You must make your money when you are not in the office.The old axiom of “one patient=one dollar” now translates to “one patient= five cents + one malpractice lawsuit” in the U.S.
You must think outside of the box. Do not be a slave to the glorious profession of our intellectual fathers with their rooms on Harley Street….you have to own Harley Street and collect the rent from the bastards that practise there! Also, never trust a Hospital Administrator as far as you can throw it.
Sorry to be so bitter, but I’ve done very well by taking a non-traditional path and Medicine is now a business. Caring for patients is a pleasure but is not a financial reward. Therefore, do not expect your fortune from that quarter. Best wishes.
Nicholas
April 8th, 2008 at 10:20 pm
i am also a medical student from Yangon. i just finished my house surgeon internship in December ,07. After that, i want to change my doctor life although i like caring of the patients. A you said, i feel and i am confused about my career. what should i do now? go a straight or change the way? my peers are now working at drugs company and also get a good salary but i can’t find a jobs as a doctor and i am so upset. thanks
yin mon aung
April 10th, 2008 at 1:56 pm
I am also in the same position.I am not a UK graduate but passed my PLAB 6yrs ago than struggled to get into the UK system after 4yrs staying without job than got job for 3yrs and now without job from Aug 07. I am doing locum A&E post here and there but not fully satisfies. I don’t know how long shloud I able to continue like this. I went to my own country to try for higher speciality training but no success.I am not thinking on changing my career but really confused about what should be the nexy step as I can not keep doing locum whole my life as SHO A&E.
singh
May 1st, 2008 at 8:20 pm
[...] you for all the replies to my last blog - I’ve had a lot of very kind feedback and sympathy from readers. [...]
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