Helen Carnaghan on the cost of becoming a surgeon

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.