Only 37% of foundation doctors went straight into specialty training during the last recruitment round. This is a dramatic decrease from 71% in 2011. There is no doubt that the worsening crisis state of the NHS has greatly impacted on junior doctors’ wellbeing and enthusiasm for the profession. Instead of entering straight into a training programme, many junior doctors want to pursue other interests or experience working in other countries, while a further significant number feel they would risk burnout or leaving the profession altogether were they to carry on.
When I called my dad from an Australian beach some years ago to let him know that I was not going to come back to start medical school in my German hometown as planned, he was not impressed. I spent the next two years working on farms, building sheds and working as a waffle baker, and then travelled around Central America, South East Asia, and the Middle East with the money I made. To my dad’s great relief, I did not spend the rest of my life waxing surfboards in Fiji, but instead went on to collect a first class BSc before getting into Graduate Medicine at Cambridge: my watermelon picking days made for interesting conversation at medical school interview. I loved every minute of my seven years at university and I am sure this was due to having a wider perspective and life experience as well as a good amount of rest before I started this huge commitment. It turns out I’m not alone. A clear majority of doctors in training reflect very positively upon their reasons for interrupting their clinical training. 
Despite that, throughout medical school and foundation training, proposing any deviation from the norm and investing in a portfolio career is almost always met with discouragement and words of caution by programme directors. How will I retain my GMC licence? How will I compete on my return? Why am I doing a specialty taster week in Malmö, not Manchester? But taking an “F3″—the widely used term for a year out before specialty training has become the norm and yet the non-sensical stigma of taking time out is not shifting.
Recently we have made some progress with time-out-of-programme-opportunities becoming more accessible, if one can cope with the mountain of paperwork that goes with it. General practice, which is experiencing some of the most severe recruitment difficulties, is the only specialty that has recently started to consider deferred entry into training. Why are we waiting until crisis point before we make training more attractive to doctors? Allowances are made to interrupt training for exceptional circumstances, but why must I carry on unless I get sick or pregnant? The truth is, I do not think that NHS specialty recruitment can afford to make such rigid demands for much longer as they will be losing more and more doctors to other countries, alternative careers, and locum agencies.
Quitting a training post and trying to re-enter at a later point is still regarded as career suicide in the NHS despite many specialties asking for a seven year commitment to training. Due to the lack of training flexibility, many of my colleagues had no choice but to quit their training posts to go abroad and take up the extraordinary opportunities offered to them: anaesthetics placements with Australia’s Royal Flying Doctors, diplomas in tropical medicine in Costa Rica, paediatrics fellowships at Boston Children’s Hospital. They all would have loved to return to NHS training, better equipped and with refreshed enthusiasm for the specialty—yet they were told they “lacked commitment” because they had left.
While I was unsure about training location, I never had doubts about picking anaesthetics as my specialty. Among multiple other factors, it carries a very high trainee satisfaction rate and I am convinced a flat hierarchy and the general shared assumption that doctors have lives outside medicine contribute significantly towards that. At my specialty interview, we could have spent plenty of time talking about compulsory work-based assessments and hand-washing audits, but instead we talked about my martial arts competitions and looked at photos of my extracurricular time spent with the Norwegian air ambulance. I walked away with my first choice core training post and full marks for my portfolio. Ironically, it seems that the aspects of our careers that make us doctors human, unique, and apparently also very employable are the very things that are so vehemently neglected when it comes to training programme design. We are told to be competitive and “stand out from the crowd,” but how can we set ourselves apart while following the rigid path we are told to walk?
Eventually my decision to accept a UK training post over alternative training options was partly driven by London’s varied pathology and the politically threatened, yet still multi-cultural, workforce found in the NHS. However, interestingly, I mainly wanted to spend a few more years acquiring the transferable skills that working under high external pressures brings with it for potential future work I am planning to do in the humanitarian and disaster sector. This is a motivator that perhaps neither the founders of the NHS, nor the health secretary, had envisaged and not exactly sustainable to keeping the majority of junior doctors in the NHS. Our workforce will continue to decline in numbers and morale unless we finally start to realise that taking time out of training to pursue our passions, care for our families, or our own mental health, really is investing into our career, not detracting from it. Taking time out allows us to return with the vigour and enthusiasm we had when we signed up.
Competing interests: None declared