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Helen Carnaghan on the cost of becoming a surgeon

10 Jul, 09 | by BMJ Group

Helen Carnaghan

So you want to be a surgeon? As a new medical graduate do you really know what this entails? I thought I did, but quickly learnt otherwise.

It has always been impressed upon me that surgery requires hard graft and the building of a strong CV. I thought my Foundation Year 1 was going well with a publication here, a presentation there, an audit under my belt and a date for MRCS Part A, until one of the surgical registrars gave me some helpful advice and pointed out a gap in my CV. What could this hole be? I hear the medical students ask. Courses, courses, courses! That’s what it is.

What I found out was the number of courses that are required to become a surgeon. My Registrar advised; ‘ignore the fact the Royal College of Surgeons state MRCS and compulsory training courses should be undertaken at Core Training 1 or 2 level, start them early. When it comes to applying for core surgical training posts, points will be awarded for pretty much everything, so don’t miss out.’

Ok, I thought, that sounds very sensible and logged onto the Royal College of Surgeon of England website to find out what all the fuss was about. What I found was a multitude of courses ranging from core surgical to sub-specialty training. As I digested the information I removed the speciality and non-essential courses from my consciousness narrowing my focus to 3 compulsory core surgery courses; Advanced Trauma Life Support (ATLS), Basic Surgical Skills (BSS) and Care of the Critically Ill Surgical Patient (CCRISP). That’s not too bad, I thought, until I looked at the prices and my jaw dropped!

So here is a run down of the cost: MRCS Part A – £415, MRCS Part B – £750 (both of which are set to increase in price in October 2009), MRCS completion fee £150, BSS – £600, ATLS – £600, CCRISP – £645 (the cost of these courses varies slightly between hospitals). On top of that there is the cost of; MRCS revision books – approximately £100 per exam, MRCS Part B revision courses (if you choose to do one) in the region of £1000 and also Advanced Life Support (ALS), which is compulsory for all Foundation 2 Doctors, around £400 (if you are very lucky your trust will pay for ALS). Giving a grand total for core surgical training of: £4760 all in. However, don’t forget the potential cost of travel expenses and hotel rooms. Also be aware that all courses/exams require an up front payment at time of application

After all this I didn’t dare look at the number or price of sub-specialty training courses in fear of having a small myocardial infarction or cerebral vascular accident.

Now you would think a substantial study budget would be in place to help with all these expenses. Unfortunately not, the budget provided is a mere drop in the ocean with Foundation 2 Doctors receiving an allowance of approximately £200 – £400 for the year.

So what about study leave? Well from Foundation 2 onward at least 30 days of study leave are allocated. However, any courses completed during Foundation 1 must be undertaken within annual leave with no financial aid. This seems a bit strange when applications for core surgical training occur in the first half of Foundation Year 2 with points being awarded for attendance of courses and completion of exams.

So what is the cost of becoming a surgeon? Monetary value high, the odd month here and there when you revert to eating beans on toast, loss of holidays if you are undertaking courses as a Foundation Year 1 Doctor and the frustration of seeing your peers in other careers earning the same as you whilst having their professional courses paid for by their company. This situation is of course not restricted to a surgical career as all branches of medicine incur their own costs and investments.

As a student I naïvely thought I could spend and save my hard earned pay with freedom. Unfortunately, I was wrong. This month my credit card bill is £2110 (break down: MRCS Part B – £750, MRCS course £1000 and GMC registration £410) that is £300 above my monthly income. Luckily, I recently got a new credit card with 10 months interest free credit allowing me to spread the cost over a few months.

This all seems a bit bleak, so why do we put ourselves through all this? Well I challenge anyone to find a profession that like medicine has such a diversity of jobs, enabling anyone to carve their own niche based largely on their personality traits, life style choices and skills. In addition, medicine is hugely rewarding, challenging, varied, academically stimulating, people centered and encompasses a wide skill set from practical to teaching to leadership.  Personally I can’t imagine myself in any other career. For me surgery is my chosen route and unfortunately this involves financial costs that I had never expected but I am viewing it as an investment for my future. Though I can’t help feel frustrated that I can barely pay for my rent in the process!

Helen Carnaghan is a Foundation Year 1 doctor in the Eastern Deanery and a member of BMJ Junior Doctor Advisory Panel.

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  • Emma Scott

    I completely agree, and as an Undergraduate I find the prices for the courses aimed at students high. I realise that there are costs involved, but the Royal College of Physicians of Edinburgh manage to make all symposia and other educational events free of charge for students[1] which is very welcome!

    I think that it completely unacceptable that people with a lower income are discriminated against in this way, and could potentially be ruining their chances of a career in surgery because of the money that they do (or do not) have!

    1. Royal College of Physicians of Edinburgh, College events http://www.rcpe.ac.uk/education/events/index.php

  • http://www.rejuvenecercentrolaser.com Andres

    Dear Helen, 5.000 thousand pounds means more or less 7.500 us dollars,Do you know how costs in the u.s.?
    Her in Colombia, each semester of pre-grade costs 6.000 U.S. Dollars, and we do 12 semesters, plus 3 or 4 in residence, and sometimes we must to pays for it also.
    Best regards
    Andres Barrera van Hissenhoven M.D. Plastic Surgeon

  • Dr. Michael Green

    Compared to the £2530 it costs a “mature” GP to become an MRCGP by assessment, that sounds fairly reasonable.
    You have to remember that the college assessors expect to be paid well for their work!

  • Dr Roderick Neilson

    Dear Helen,

    Your post, although heartfelt, annoyed me. Nobody has asked you to be a surgeon, it is your choice. Given it is your choice, why do you assume the rest of the us should feel obliged to pay for it or even support you? You seem to want to have your cake and eat it. Sadly for you, as you appear to be finding out, real life is not the way you want it to be.

    Welcome to the real world. As a FY1 you earn considerably more than many people you work with who support whole families. If you doubt this speak to the nurses and clerical staff in your hospital. Postgraduate medicine is not university with knobs on. You are now, like it or lump it, a qualified medical practitioner, earning a salary, who now has to make decisions as regards your future that have costs and implications. What you do is entirely up to you. Don’t expect people like me to feel sorry for your alleged difficulties; ‘Oh me, a holiday missed, what am I to do?. Oh Lordy, those pesky Royal Colleges demand cash to sit thier exams-how dare they! The naughty post graduate deanery insists I do some work rather than be a perpetual student-it’s just not fair’ (Stamp foot and hold breath until sick).

    Grow up. You are privileged, educated and employed. What more do you expect at your stage of experience and training? If you want to be a surgeon, physician or GP do so but do NOT bleat about the very minor sacrifices you may have to make. Absolutely nobody is interested Compared to trainee barristers, lawyers, teachers or whatever you have it easy.

    In case you think I don’t understand I’m a consultant haematologist, university teacher, Royal College Council Member and Examiner and have worked bloody hard, with a whole range of sacrifices, to get where I am now. Your concerns about where you are now and what you have to do strike me as self indulgent, blinkered, nonsense.

  • Chris Johnson

    I am a medical student and I disagree with Dr Neilson particularly with the statement ‘absolutely nobody is interested’. I certainly am. I think this sort of information should be discussed openly at medical school and better careers advice given. This was a very useful article showing a case study of surgery. I wonder what costs are involved for hospital medicine?

    Why should such costs be a right of passage in any profession? An engineering friend of mine is being sent on training courses by his company to improve his skills at no cost to him. Equally the same is true for my friends in teaching with the local teaching authority paying. To me it seems like medicine is getting worse what with the recent loss of free hospital accommodation for first year doctors. Perhaps Dr Neilson has forgotten what it was like when he was first starting his career, or maybe costs have gone up without the associated increase in wage making it more difficult now.

  • Dr Roderick Neilson

    Dear Chris,

    No I haven’t forgotten what it was like when I was a junior doctor. It was harder and we were paid less. Trust me on this. Exams cost less but that was then and, as a proportion of salary, probably were more.

    As regards paying for rights of passage medicine gets off lightly. I have a young relative who is a lawyer and wishes to become an advocate in Scotland. His training, after a law degree, is nine months unpaid study to be admitted to the Faculty of Advocates. He certainly does not feel the world owes him a living. Sadly you and Helen seem to think it does.

    I say again, as nobody tells you what branch of the profession to enter when you qualify, why should the rest of us feel obliged to take responsibility for what is a personal decision? You’ve got or are about to get your basic medical degree. How much further do you want or need to be spoon fed?

  • wildgunman999

    Nice to see you’ve taken (or are taking) MRCS Part B in FY1. You didn’t add the cost of re-taking an exam- my first attempt at Part B cost me £2500 in total, and my repeat is costing me near same.
    Boy, am I dreading Dr Roderick Neilson’s unforgiving comments about paying the price for my dullness, being an adult and not needing to be spoon-fed, et cetera!
    Chin up and bear it- life is hard, then you die. Especially if you’ve chosen to be a doctor, or worse still, a surgeon. Or, to plumb the depths of foolery (like me,have chosen a career in Orthopaedic surgery.
    I’ll dry your tears when you get here.

  • Dr Reynolds

    Dr Roderick Neilson

    We should feel obliged to take responsibility for other peoples personal decisions in some situations because, as in this example, we like to have good surgeons.
    They require the gift (I would say mostly physiological) of extended practical ability coupled with good old fashioned intelligence.
    It is not possible to choose to simply pay for and educate yourself to have this combination of abilities and become a good surgeon and these types of people are no more likely to be from privileged backgrounds than from poor ones. They certainly should not be excluded because of lack of money.
    Get the fees low and the criteria high.
    This is a developing ‘ relatively modern’ philosophical idea which is gaining not waning in popularity. Consider athletes as an example, there are many more.

    Department of Philosophy University of Oxford

  • Dr Roderick Neilson

    Dr Reynolds,

    I agree with you as regards access to undergraduate medical education. However we are talking about qualified earning medical practitioners not students with no source of income. The minimum salary for a newly qualified doctor is £22,190 and that’s before any additional payments. Doctors further up the training scale earn more. You can find exact details at this link:
    http://www.bma.org.uk/sc/employmentandcontracts/pay/doctorspaysupp.jsp

    As such, how much more do such doctors need to be financially nursed through their career choices when their choice of postgraduate career path is their’s alone and they are earning a salary that can easily support career advancement should tney wish it?

  • Hannah

    Dr Neilson, although you may have a point, you sure are going about it in an extreme way. To me, it just sounds like you’re being bitter because you had a tough time getting where you are, and therefore you don’t see why anyone in this newer generation should get away without suffering. How about we save up for the MRCS and do the exams when we’re 60?
    Dr Reynolds, you sure do raise a good point. What should poorer doctors do, when they have no family help, and their income doesn’t cover the total MRCS costs? They may be extremely gifted and have a lot to offer to the surgical world, but the ones who make it are the ones who could afford to spend their money…. Surely that doesn’t seem right!
    A slight decrease in cost could be to borrow books other surgeons already used, and to ask surgeons for tutorials etc., this could help reduce the cost, but only very slightly.

  • H

    Wow – grow up! A few years back I had the opportunity to be flatmates with a medical student. I asked her why she did not do on-call shifts and the response was,” well then I would be too tired to learn.” Guess what – real life does not wait for you to be well rested….

    That first night when you are responsible and realize that you are in over your head but have no reserve to call upon, because it would have meant making you too tired to learn – god help you, because experience won’t!

  • Roddy Neilson

    Dear Hannah,

    I’m sorry of you think I’m being harsh and yes, I suppose it was harder when I was a junior doctor but in different ways to now. In relation to my casreer choice, nobody asked me to be a haematologist and I took responsibility for my preparation for exams and the funding of them. If you think it’s tough doing one postgrad exam try haematology where you have to do two. As regards your comment that poorer doctors can’t afford it I can accept that may be a fair comment for some doctors from overseas. However, if you can show me a working doctor in the UK in real poverty I’d be very surprised

    As regards the cost of the MRCS, on checking the RCS Eng website it appears to be £258 for parts 1&2 and £930 for part 3, making a total of £1448. Let’s double that for the books/training materials and add a bit more to make it up to £3000. This amount isn’t even required all in one go.I do feel it’s stretching credibility somewhat to complain about the costs of postgraduate exams when, as a percentage of a junior doctor’s salary in the UK they amount to significantly less than 10% over a three year period.

    I think if you are privileged enough to possess a medical degree and are earining a salary in the UK as the vast bulk of trainees will be it is a bit much to complain about the costs of exams and training, especailly when no one is forcing you to do these exams in the first place.

    Roddy

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