Remember that they hate both you and hard work.

Private Practice (PP) opportunities get asked about* a lot on this subreddit every time someone asks about doing** a speciality. I think unfortunately we need a reality check here.

>Only 15-20% of consultants do regular PP, which means >80% of consultants will do little to no PP during their careers

>Median earnings for those who do regular PP are about ~£30-50k, which will be taxed at >40-60%, along with PP costs (indemnity, room, secretary, etc)

>A handful (5-10%) of consultants in a limited number of specialities in a few select locations (London, South-East) are earning the big bucks >£200-500k

*I'm not criticising those who ask or want to do PP to supplement their income, but the honest truth is most of can can't ever rely on it for any financial planning, and often the time and effort is really not worth it

**There are other ways to earn some extra income unique to different specialties, such as locum shifts, WLI, medical reports, etc

Anaesthetics CT1 approaching my IAC. Had been trotting along through training, generally progressing well, got to a stage where I had successfully intubated my last 20-30 patients fairly smooth and felt a bit more comfortable with the idea of doing it out of hours on call (not confident - was still acutely aware that each airway could present an issue and aware that I’m by no means an expert, just a bit more comfortable). Had a list the other day of very straight forward ASA 1 patients with no airway concerns on examination. 3 patients back to back I struggled immensely to intubate. Got the first two in but with a lot of help (BURP, repositioning etc), third one had to be taken over be the consultant. They were very supportive but couldn’t help thinking that 3 straightforward airways in a row which had been difficult in my hands may represent a flaw in my technique and has really knocked my confidence. Just looking for some advice - should I be asking to delay my IAC? Is this a normal thing? At this stage should I be getting every ASA1 straight forward airway in without fail?

As the title says. Currently working in an ED in Oz as a registrar (PGY3). Am currently hating it. Find it unsupportive, found that I’m given a lot more responsibility then I may should have. Have luckily secured a CT1 post in anaesthetics at my top choice in February which I’m excited to start. But should I keep working until then or should I quit and travel? Finding it difficult to decide. Wondering whether anyone had any advice.

Edit: hate may be a strong word, but I am definitely disliking. And yes I have talked to my supervisor about it who didn’t give much help sadly.

I worked the night shift from 8 pm to 9 am, as per my usual routine, during the clock change. I submitted an exception report because I worked an extra hour due to the clock change. What evidence can I provide for this since they won’t proceed unless I give evidence as I have already explained that I worked the additional hour?

Hello

I’m soon to start a hospital rotation where a standard day shift is 8-4pm, rather than 9-5pm.

This has come as a bit of a surprise to me, and it completely ruins our childcare arrangements and I really don’t know what to do. If anyone has any advice for me I’d really really appreciate it!

I have a one year old in nursery but I live a 40 minute commute away from the hospital where I’m placed. Nursery doesn’t open til 7:30am, so even if I was stood at the door of nursery when it opened and handed my baby over immediately and bolted, I still wouldn’t make it on time to work (not to mention the time to then have to park up and get to the ward).

My partner is not in a position to do nursery drop offs daily. He works 6-3pm. He always said (and had agreed with his boss) he’d be able to make it work on the odd occasions I am on-call, because we expected on calls would be 8-8:30pm (that’s what I’m used to anyway) - we didn’t actually anticipate that every day of the week I would need to be in for 8am, and we just cannot make that work for us every single day. He says at a push he can ask his boss for maybe 2 days a week - but he often has client calls between 7 and 10am, so this is not a guarantee. We don’t have family that are close enough by that I could in good conscience drag them out of bed every day to come and do do a drop off.

I’m really stuck. What do I do? Should I talk to medical staffing? Are they likely to care about my situation at all or is this wishful thinking? Even an 8:15 or 8:30 start would make all the difference and I could make that work, but I seriously don’t see how I am going to be able to start work at 8am every single day. This has really come as a surprise and I don’t know what to do. Do I just suck it up and be late every day and if it gets flagged by my seniors explain my situation then? This doesn’t feel like a good option to me without at least trying to find a middle ground. It would be unprofessional. But the cynic in me can’t help but feel like this is where I’ll end up anyway, because med staffing won’t care - we’re just numbers on a rota.

If anyone has been in this situation or has managed to successfully negotiate their hours can you please let me know! I’m very aware this is a difficult situation because starting late would likely mean I would miss the morning handover/ board round with the nursing staff. I’m at a loss for what to do here. What do people with kids do in this situation???? I cannot even imagine if we were both medics. I really feel for anyone trying to juggle life in the NHS with having a family. Maybe I’m a pessimist but so far i can’t help but feel like the two things are really incompatible and this is just the cherry on the cake to having a very rough time returning from mat leave!

TIA x

What is the etiquette for Halloween night shifts? Is it totally unprofessional to dress up as a plague doctor or something fun? Do people do this?

If so, what's the most fun costume you have seen people dress up as for work?

Bit of a rant;

I work between 2 sites, at one site I wear a scrub top colour that coincides with the scrub colour of theatre staff in the other site I work in.

Today as I was leaving an infection control nurse came up to me and said that she has spoken to me several times before regarding wearing this specific colour and that it is reserved for theatre staff (I have never seen this person before in my life).

I kindly explained that this is the colour I wear at my other site and that I don’t have an alternative colour and that the colour scrub top that she wants me to wear is never available in my size in the hospital. She went on to say how it’s for infection control purposes so I kindly asked whether colour x carries more infection than colour y at which point she said yes. Also, theatre staff float around the hospital too…

What do I do? Buy my own scrub tops? I feel that if it’s not provided at the hospital I am within my right to continue wearing the colour I wear for the other site. Why should I put myself out of pocket?

It all seems a bit silly and unnecessary. Thoughts?

Hello everyone,

I’m feeling quite frustrated with my SBA results, as this was my third attempt. I would really appreciate your advice on alternative preparation resources, courses, or question banks that might help me improve my performance, apart from RCEM-Learning.

For those who have successfully passed the exam after multiple attempts, what resources or study strategies worked best for you?

Thank you in advance for your advice and support.

At 2 previous hospitals I have worked at I have noticed the occasional surgical registrars (ortho, gen surg) working as locums in ED. Usually picking up the patients with reasonably appropriate presentations (e.g any MSK for ortho reg) as first clinician.

Is this common in other EDs? Which tier would surgeons fall under in the RCEM tier system? Would they be able to fill a role in Minors seeing ENT/MSK/OMFS/plastics type presentations, with a UTC GP (or similar) who sees the more "internal" Minors conditions?

I wanted to get an insight on Specialty training programme for Stroke / GIM . This is the new program piloted in 2024 to produce more Stroke specialists with Internal Medicine background . My understanding is Stroke medicine always went combined with Geriatric medicine or neurology historically.

Wanted to know how the curriculum works ? And the availability of the jobs post CCT ( in both in UK and internationally ) and about part time private work as well.

I hope , the first batch of the trainees of this programme is about to get CCT and wanted to explore whether its a worthy pathway to persue. Would appreciate any comment and insight from the existing trainees, their supervisors ot consultants who are working in the specialty .

Should I persue the pathway or not ?

Saw an old post (from roughly 2y ago) on here about accidental arterial cannulation which got me thinking…

IV lines are routine and where I work they are generally sited quickly and really only with USS if difficult but in the past I’ve run gases from cannulas/bloods with a pretty high pO2 although they were sited no where near where I’d expect standard arterial anatomy of the forearm to lay. E.g. a juicy superficial vein on the posterior forearm with good back-flow… should we be recannulating?? What of all the cannulas sited without a gas done? Should we be trying to use USS where accessible all the time?

Appreciate that there are signs like pulsatile flow and colour of blood (though I don’t find this last one particularly reliable in very sick people) but I found it interesting as not something I’ve routinely heard discussed. Where can I read up on this or any input or experiences? Thanks!

I was wondering if anyone might be able to advise on this. I’ve just received relocation mileage for my commutes to work for the first time. I checked my payslip and it looks like the reimbursement was a part of my taxable earnings. Is this normal and can I claim the tax back? Thanks

Applying to core anaesthetics training and it asks you to rank countries. Do I only list one, or can I list multiple and then be considered for a place everywhere in the UK?

Noticed this more in surgery than other specialties.

They don't mind if you claim the money in the form of locum payment but put in an exception report and some consultants react in very strange ways.

This definitely applies only to registrars. If an F1-SHO puts in an exception report, nobody will react negatively.

Tabloid headlines - "corrupt NHS staff sell hospital property to fund drug habit"

On Oriel, there are some ACF listings which you apply to with a single application, but which actually contain multiple ACF posts.

For example, in the London deanery, you submit one application for the ACFs in mental health. However this single application covers 3 separate ACF posts. Each of these posts have separate job descriptions, different academic leads, different research focus’, and (in this case) the different posts are at different universities within London.

There is a question in the application around “why you want this particular Academic Clinical Fellowship”. The fact that there are several (very different) posts within one application makes it difficult to tailor this as much as I would if it were just the one post on offer.

In reality there’s one of these posts that I’m much more interested in than the others, but it would feel somewhat foolish to potentially exclude myself from two other posts in leading research groups/institutions by making this highly tailored.

Am I misunderstanding the application process? If not, I’m wondering how others have approached this? Have you tried to tactically highlight why you’d be a good fit across all the listed posts, or made it explicit that there’s one that you’re specifically interested in, with potential cost of being ruled out of the others?

Thanks!

Hi guys,

As an F2 doctor applying,

What do they mean when they say nhs experience, in total how many months of paid employment as a doctor in the NHS do u have?

Is this same as above when u put ur employment history and include future employment or do u just include exactly how much u have worked at this point in the application ?

thanks guys !

You are the doctor in ED,AMU,GP, wherever. A colleague brings you this ecg for Mr Smith who is 79, and mentioned short lived palpitations.

While your computer is loading up his medical history you consider the ecg

-please describe the ecg

- what do you thinks going on

- what can you do to assess further

- does he need admission/referral- how would you decide on that

Hi all,

Hope all is well. I’m a doctor who works with the medical bank in one of the NHS boards in Scotland, and I happened to be working a night shift when the clock went back (transitioning from BST to GMT) which means I worked an extra hour that night.

I have e-mailed the medical bank asking if that extra hour would be paid, for which they said “An extra hour will not be paid for the shift on Saturday night.”

I wanted to ask if this is normal or if they are legally allowed to refuse paying this extra hour? Given that the bank work is paid on an hourly basis, I don’t understand why they wouldn’t pay me this extra hour I worked.

Thanks in advance

Are we all getting the recommended 7-8 hours per night?

Due to an admin error I have to pay another 300 to extend my visa

I was offered a job in August but never told my start date, despite repeated emails asking this. I also explained my current visa was expiring so I needed to apply for visa soon.

They forgot to send me my sponsorship letter, again after repeated emails asking for it. Finally got it, right before my visa was about to expire.

Visa was granted but only till December 15th. My job starts in December. Because the cos said the job ends December 4th. I should have asked for a correction but i also needed to apply for a new visa

I’ve asked NHS Lothian to supply UKVI with a new COS with the amended dates but I will still likely have to pay 300 for an extension of the visa. I’ve already paid 300 to get this visa in the first place.

Because this is an admin error on their part, and I had sent several emails explaining the urgency of applying for my visa prior to the deadline, is it reasonable to ask NHS Lothian to cover the visa costs - and I am I being delulu in thinking it would be accepted

Opening the application for Oriel this week has made me truly realise how barren my CV is. I’m an FY2 and barely survived through FY1 and medical school. During FY1 I only participated in audit data collection (in the relevant specialty), am yet to lead an audit let alone present one or do a multi cycle one. I have attended a conference in the relevant specialty but haven’t been able to do much else to tick boxes. It was hard enough keeping my head above water to get through FY1 and med school. It makes me feel like there isn’t even any point in applying now, but also that my CV isn’t good enough to get a trust grade job or CEF either.

I’m applying for ACCS and looking at my empty boxes on the application page really has me spiralling. I have no idea how to sell myself on the application or find things to beef up my application in the next two weeks before the oriel deadline. I’m also on a community placement currently that makes it feel hard to jump on any projects outside of the hospital.

Do they use the blank space answers on the supporting information at interview? Is it possible to build my CV between now and potential interview dates and reference those if I were to get an interview? I don’t know anyone who has gone through the ACCS application process, I’ve been in a tiny DGH and most older docs I know have done the IMT/CST route or stayed as trust grades.