Now this post is all about the vagaries of medical training, and I appreciate that this is a rather niche subject, so feel free to skip. Lots of people have asked me though what these exams are that I’m taking, why I’m taking them, what they mean, so I thought I could explain it all a little here for anybody that was curious.
To start with, most doctors go to medical school, get their degrees, get registered with the GMC and after a couple of years just getting to grips with the process of actually being a doctor looking after patients, and then maybe do some travelling, maybe do some locuming, but usually within a few years they decide on a specialty that they wish to pursue for the rest of their careers. They apply for a training post, which lasts anywhere between three and seven or eight years full time. At the end of that training post, where they will often have to move to a new hospital every year, if they pass all their exams and get loads of bits of paperwork signed off, and pass various courses, then eventually they get something called CCT – certificate of completion of training. At that point they become a consultant or a GP and their name gets entered by the General Medical Council onto a specialty register. This is the established path that the majority of doctors chose to go down and eventually become GPs or consultants.
I have recently become a tiny bit obsessed with the GMC register. A friend suggested looking somebody up, anybody can go to the GMC website and look to see if a doctor is on the specialty register. It was a bit of a giggle. But then I decided to go through every single person in our year at university and check out what they ended up doing. I admit this is a little crazy and stalkerish…
Admittedly there were a few people who I couldn’t find, who must have changed their names since qualifying, like I myself have. But of the people I could find 67 people have become fully qualified GPs. 12 people are consultant anaesthetists. 3 people are ITU consultants. There are 4 orthopods, 6 obs and gynae, 1 urologist, 3 ENT surgeons and 2 neurosurgeons. There are 7 people in various sub specialties of psychiatry and 12 in medical specialties. There are a smattering of rather niche specialties like pathology and microbiology. There are 10 people who have relinquished their registration entirely or not renewed their licenses. I guess they have either left the country or left the profession completely. There are 22 people still in training programmes and then there are a lonely 4 people who are in non-training jobs. There is nobody who has become a consultant in emergency medicine.
So here I find myself, very much in the minority, as a non-training doctor, and as an emergency medic. So what exactly is a non-training doctor? It is a qualified doctor who is employed to just turn up and do the job every day. They are there for what is called ‘service provision’. Essentially they see and manage patients, but do not have any training provided within the job, they are not working towards anything, they are not on the road to being a consultant, they are not growing and developing, they are just seeing patients. They do have a duty to show they are staying current and up to date with their practice in order to keep their licenses, but not really to further their careers. Non-training doctors are a crucial part of the NHS workforce. In certain specialties they make up a large proportion of the middle tiers of medical staff. In Emergency Medicine there are lots of them. At my level in my hospital we have two training doctors compared to eight non-training in ED. This is true of most hospitals in the country. A lot of these doctors tend to have studied medicine overseas and have difficulty accessing training posts, and many of them are women who have decided that the demands of training are not compatible with their plans for being mothers.
I say that being a mother is my reason for being a non-training doctor, and it certainly is a major factor now. But I was already a non-training doctor before I ever had children. I started in a surgical training post, but then had a change of heart, and then a period of indecision, and then got a little stuck being too experienced in my chosen specialty to apply at the beginning of training but unable to apply further up either. Plus if I’m being entirely honest it wasreally nice having a few years not thinking about exams, and research projects and interviews and assessments after all the years of GCSEs and A levels and medical school exams. Since having children though I have very much settled myself in my little corner of Britain, with no desire to move every year, and like the fact that even working full time on my contract I still get to be home a lot. Neither of those things would be true if I was a trainee.
For many years I resolved myself to this situation. That I would always be a non-training doctor. That my name would never be there for anyone to search on the specialty register. I thought I was fine with that. Last summer though that changed. The chip on my shoulder feeling that though I knew I had the potential to be a really good doctor, that everybody would always look down on me because I would never be a consultant, well it just kept getting heavier and heavier until it felt like it would crush me. Deciding that something needed to change was such a hard decision.
I had two choices really. Go back to the very beginning and apply for a training post. This would mean the last nine years of my experience would count for nothing, that I would have to apply to start again, and could end up being assigned anywhere in the country. That even after potentially needing to uproot my family I would still be expected to rotate around different hospitals, meaning more uncertainty and change for them. I would have a full seven years of full time training still ahead of me.
My other choice was CESR. This stands for certificate of eligibility for specialist registration. It means that my name would be on that specialist register, that I could work as a consultant alongside others who had gone through the training route. And I could do that whilst working in my hospital, living in my house, and with my children staying where they are established and happy. But CESR is not the easy route by any means.
I still need to pass all the examinations that form the Fellowship of the Royal College of Emergency Medicine. There are seven exams in total. I have passed the first exam, have sat another two (fingers crossed I have passed) and have a whole four still ahead of me. But passing all those exams forms just one tick on several pages of necessary ticks to say that I am eligible to become a consultant. I also need several other qualifications, and research and audit projects. I need to gain evidence that I am knowledgable in, and have practical skills in managing a whole range of areas. I need to do audit and teaching and management. I also need to gain experience in other specialties; anaesthetics, intensive care, acute medicine, paediatrics, orthopaedics. Some of these I can mainly do whilst carrying on with my normal job, but anaesthetics and intensive care particularly I will need to work in for at least three months each. This will somehow involve me convincing my bosses to release me from my job for months on end, which may be a challenge considering how hideously understaffed our rota already is. I’m also not entirely sure who would be paying me for this… This is a major hurdle which I have not yet worked out how I will get over.
The whole process of gathering all this evidence will probably still take me several years and lots of my own hard earned cash. Even once I have gathered the evidence it takes even more money and at least six months for the GMC and the Royal College of Emergency Medicine to decide whether I have fulfilled all their criteria. But then, hopefully then, my name will be on that register, and I can finally call myself a consultant, being found equal to all those others who followed the more conventional route.
Now that I have made my decision I am totally determined. No matter how long it takes, how much work I need to do, how many hours I will be found sat at my desk, I am going to do this somehow. I am getting myself organised. I am writing massive to do lists. I am making plans. I am booking courses. I am looking forward to more exams. It’s going to take the next few years of my life, but I’ve got to get somebody from my year at med school into emergency medicine!
Inner Grace 