Working abroad (30 Aug 2023)

SPEAKER_01 0:00

If you enjoy listening to career conversations, why not become a member of the Royal College of Physicians of Edinburgh? Our membership provides you with access to the RCPE educational portal with live evening medical updates, and you have options to view the symposia both in person or online. If you would like to learn more about this, please go to the Royal College of Physicians of Edinburgh website. Hello everyone and welcome to another episode of Career Conversations brought to you by the Royal College of Physicians of Edinburgh Training and Members Committee. My name's Dr. Marilena Gianudi, and I am on the TMC, and today I'm delighted to be joined by Dr. Cajal Rafferty, who is an IMT doctor currently based in Southampton. Today's episode is focused on how you can go about working abroad. I know that many people are interested in potentially working in Australia and New Zealand. And Dr. Rafferty has worked in Australia for closer over a year and a half?

SPEAKER_00 1:05

Yeah, it was about 18 months or so.

SPEAKER_01 1:07

Excellent. So first of all, welcome.

SPEAKER_00 1:09

Thank you.

SPEAKER_01 1:10

And can you tell us a bit about when in your training you took the time out to go to Australia?

SPEAKER_00 1:16

Yeah, so I took the year and a half out just after F2. So between F2 and IMT.

SPEAKER_01 1:23

And how far in advance did you have to think about planning that out-of-program experience?

SPEAKER_00 1:30

So it does take a fair bit of planning. There was a few of us who went and we knew that we wanted to work abroad. And I think probably around September time, we originally looked into going to New Zealand, but then I think around January time decided we wanted to go to Australia instead, having visited friends there. While we managed to get everything done from January to August, it was quite frantic at times. So I'd say probably pre-Christmas is when you need to start planning your move.

SPEAKER_01 1:58

And what kind of things do you need to plan in order to facilitate that?

SPEAKER_00 2:02

So from what I remember, it's quite a complicated process. To get the correct visa requirement for Australia, you need to have proof of having a job there. So you kind of need to apply to hospitals. You just apply directly to hospitals. And whether you know someone out there already who has contact details for the recruitment for a particular hospital, or you can usually find it online. And what we did is we sent the HR department an email and eventually got a reply back asking for an interview and you know went through that process. And then once that's in place, then you can start to apply for a visa, which does take a few months at least. And you have to apply for APRA, which is like sort of the Australian version of GMC, which also again takes a few months.

SPEAKER_01 2:48

Okay. There's no equivalent of NHS jobs or something like that. You apply directly to the hospital.

SPEAKER_00 2:54

We originally went through a sort of like a medical locum agency, but my experience was that they weren't overly helpful. And most of the people I know who were working there as well tended to apply directly to hospitals. They just got in touch with HR and asked if they had any vacancies coming up for, you know, whenever they wanted to go.

SPEAKER_01 3:15

And then the APRED that you mentioned, is it just a case of filling out paperwork? Do you need to sit any exams? Is there a fee? How does that work?

SPEAKER_00 3:25

So there's no exams. It is a case of filling out paperwork. And from what I remember, it is quite a lengthy, complex document. It's about 20 pages or so. And a lot of it is sort of to do with where, you know, just where you've worked before, your medical qualifications, which you need to get notarised and sent across, getting your passport notarized and sent across. And there is a fee for it. So I can't remember the specifics of the APRA fee, visa fees, etc. But I think the whole thing in total was probably without flights about £2,000.

SPEAKER_01 4:00

Oh wow. Okay.

SPEAKER_00 4:01

Again, yeah, if you're starting to plan your move, you do need to have some money saved.

SPEAKER_01 4:06

Yeah. And with the APRA, do they need evidence of your portfolio to say, you know, that you are competent in certain things, or is it literally just you filling out the paperwork saying that you are?

SPEAKER_00 4:16

No, it's for APRA, it's mainly just filling out paperwork to, you know, prove that you've graduated, that sort of aspect of things. In our interviews, we did sort of get asked about what are various competencies, but we never really had to provide a portfolio for the for where we worked anyway. We didn't have to provide a portfolio. I'm not sure if it's different for other hospitals.

SPEAKER_01 4:37

And can I ask a where did you go in Australia?

SPEAKER_00 4:39

So we worked in Adelaide, in the Lyle McEwen Hospital, in the north of the city. But I know like some of our friends who are out there worked in the other two or three hospitals that are in Adelaide, and we knew people working in pretty much every city. The options are there to pick any city, really.

SPEAKER_01 4:58

And why did you choose Australia? I know that you said there were friends already there, but why did you make that move in the first place?

SPEAKER_00 5:05

So, well, I think that's probably a lot of people can relate to. I think just after foundation, we were quite keen for not, I don't know if a break is the right word, but you know, to sort of step off the training mill a bit and take a bit of time just in a different country, seeing what that was like. And like I said, then when we went to visit friends who had already been there a year or so, we just sort of, you know, absolutely fell in love with the lifestyle that they clearly had and just went for it, I guess. Yeah.

SPEAKER_01 5:30

I do think there's a single doctor listening to this who doesn't know someone who has worked in either Australia or New Zealand if they haven't done it themselves. Yeah. For those who perhaps don't have a lot of, you know, firsthand information, what is the lifestyle like when you do work there? What's the work life balance like? What might a typical week look like for you?

SPEAKER_00 5:50

I would say in general, the work life balance we found was much, much better than it has been working here, especially compared to now with like, you know, the current pressures and everything that the whole system's under. So we worked in AE exclusively. So a typical work week for us, we would usually work three to four days a week with a mixture of evenings, nights, and days, all 10-hour shifts. But I guess what we really liked is, and I think most hospitals, so most of my friends who worked in other hospitals, what we found was before the rotor came out, every three months or so, you could get in touch with the rotor coordinator and ask for days off, days that you didn't want to be rotored on. That that wasn't like annual leave. They would just do their best to accommodate you to try to give you the time off that you'd asked for beforehand. So if you and your friends were there, you could all ask for the same weekend off or just ask not to work it. And more often than not, they would be able to be able to do that for you. So I think in terms of the work-life balance, it was it was much, much better, noticeably better. Yeah.

SPEAKER_01 6:52

And you mentioned that you worked in A, but obviously you're doing IMT now. Is there a reason that you chose AE at that time?

SPEAKER_00 7:01

So I think you kind of have to fit into the Australian system just where they have vacancies and they tend to have most vacancies in A. I do know that the hospital that we worked in, we did know a couple of British doctors who are working in medicine, and the rotor did seem very different to what we were working. So I don't know what their thoughts would be on the work-life balance. So, for example, they worked seven long days in a row, had seven days off, worked seven nights in a row, had seven days off. I think they didn't have as good a time with the rotor as we did. So I guess just like anywhere here, it's very job dependent and centre dependent. But we sort of just went for AE because we knew there would be spaces there. And well, I've enjoyed A and E before, so had no qualms working there.

SPEAKER_01 7:48

What's the pay like?

SPEAKER_00 7:50

Again, the pay is much, much better than the UK. So I was getting paid double roughly what I've been paid in the UK. And I guess that's considering that you were working what would essentially be an 80% rotor for double the pay. So yeah, the pay was much better.

SPEAKER_01 8:06

Obviously, you went there, you had what sounds like a really good time under really good working conditions. Ultimately, was there a reason to stay there long term? Do you regret not staying there long term?

SPEAKER_00 8:19

A lot of people do decide to stay long term, don't they, just because of those the reasons that I guess we've discussed. And yeah, I definitely had serious thoughts about staying long term, and every now and again still do have thoughts about moving back to Australia. But I mean, we came back because of family and friends here, and I don't think that changes, and that is obviously one of the downsides of working there that you do spend a significant amount of time away from family, and it does become difficult at times. Overall, I don't regret coming back, but I just look back on that time as a a really, really fun time that I was very lucky to have.

SPEAKER_01 8:54

Yeah, I guess it's really difficult because you can't just say I'll hop on a plane and come and see you. It needs a lot of planning.

SPEAKER_00 8:59

Exactly. And like so, my family did come out for a bit, but then I guess you know, you see them for and we managed to come back once in between. But it is, you know, it's a significant amount of time without seeing your family. And like you say, it's not like just getting the train home.

SPEAKER_01 9:13

Yeah. Obviously, you were only working what you said was an 80% rotor. What kind of things did you do whilst you were out there that weren't related to medicine? Because I think a lot of people, when they are thinking about doing such an experience, they do want to, you know, obviously work, keep on top of their skills, but have something else outside of work, which is what makes them, I think, ultimately take that decision.

SPEAKER_00 9:36

Yeah. So we we have had a lot of hobbies when we were there. And I really got into running when I was there, particularly like trail running, because of the good weather, everything's sort of so geared towards the outdoors. I guess the culture there towards the outdoors is a bit different to here. If you are into sort of outdoor activities, then there's so much you can do. And obviously, there's sort of like the we live a minute's walk from the beach. A lot of people I know got into surfing, a lot of people got into swimming. There's incredible snorkeling, even like in areas that aren't like renowned for it. So Adelaide had some amazing snorkeling. So I guess the out-of-work lifestyle is also very different to what you can experience here.

SPEAKER_01 10:14

And when you'd got into that mindset that actually we can't stay here and we should probably go back, what did you do about applying for IMT at that time?

SPEAKER_00 10:24

So I knew that I wanted to take a bit of time out to sort of build my portfolio for higher specialty um applications. So I didn't go straight into training when I came back, but I know a few people who did. And I don't think they had any issues with, you know, using Oriel, et cetera, abroad. I don't think that was an issue. But what people did have a tough time with was setting membership exams and things. So I think that was one of the drawbacks that some of us noticed in that it's more expensive to sit your exams, from what I remember. So I didn't set any exams when I was there because of that reason. And this was all obviously pre-COVID. So you sort of still had to go to centres in person to sit exams. So I think if you were considering going to Australia and that was something that you wanted to do while you were there, I'd you know, you'd either have to do it before or accept the fact that it might be just easier to do it once you get back.

SPEAKER_01 11:17

Yeah. And looking back now, do you think going after F2 was an appropriate time to go? Or do you think that actually if you could turn back the time you would have kind of gone through IMT and then decided to go? Do you think there is a right time to go?

SPEAKER_00 11:35

I think if you are set on a particular specialty, so if you don't mind what you do, and by that that really means if you don't mind working in AE, and A and E there is different to AE here. I think most people actually quite liked it. But if you don't mind what you're going there to do, then going after F2 is a perfect time. I would say, like, you know, I didn't feel that we were out of our depth at all. We were always really supported. So I think it was an absolutely fine time to go. Whereas if you know exactly which specialty you want to work in, or you want to work in a fairly competitive specialty. So for example, one of my friends is an orthopedic surgeon now, but he waited till after CST to go because I think, you know, you're then much more employable by that hospital to pick and choose your specialty, I guess. So it just depends what it is you want to do when you're there.

SPEAKER_01 12:24

And you mentioned that AE, for example, is very different there. And obviously, we are the Royal College of Physicians, but I do think it's very common for IMTs to go and work in AE in Australia. So do you maybe mind talking us through maybe a couple of interesting cases that you saw, or you know, something that's really stuck with you from a medical point of view, from your time there?

SPEAKER_00 12:48

The main thing that probably stands out for me from working in AE there that makes it a bit different is one, they don't really have the, you know, the whole four-hour wait criteria. So you you kind of hold on to patients a lot longer until you have a diagnosis, which from an AE point of view is actually really good because you know you don't feel like you're just spending a few minutes with a patient and then sort of triaging them off to another specialty. You actually get to have a think about things and investigate things a bit more, which we found, you know, I found really interesting. And then the other thing that's very different is that unfortunately Australia seems to have a wide to big methamphetamine problem at the moment. So what we would often see really frequently would be patients who were psychotic from methamphetamine overdoses, and they were incredibly difficult to manage. We would hold it was a bit of a myth that patients came in, what the Australians call netted. So they came in with paramedic crews in big nets, essentially holding them down. We thought our Australian colleagues were joking when they first told us that. And it turns out that actually happens. People come in in nets because they're so psychotic. And yeah, it's definitely something that stands out and is really challenging to manage, but also really interesting and something I don't think I've ever heard of anything like that in a UK AE.

SPEAKER_01 14:04

I've definitely never seen that before.

SPEAKER_00 14:05

It's quite the sight when it comes through the doors.

SPEAKER_01 14:08

So, how do you manage those patients?

SPEAKER_00 14:10

Because they're so floridly psychotic, there was no real talking those patients down, and they're often really aggressive and really strong. So, you know, we would often see like four or five policemen and security guards on top of one person. So I guess the only real option is to just sedate that person. And you kind of just have to let them ride it out, sedated. But again, the sedation doses that were used over there were way higher than anything we'd see here. You know, people were getting, I think, 10 milligrams of a lanzipine and five of Larazapam at a time, just and they would, you know, be sedated for 12 hours or so. Yeah, it's just sort of things that you I don't think you would ever come across in the UK.

SPEAKER_01 14:49

I mean, I think you've sold Australia very well, and you're certainly regret not to. But if you had, you know, a piece of advice to give to anybody who's potentially thinking about doing it, what would that be?

SPEAKER_00 15:04

So I think my advice would be just get prepared earlier than you think you need to. Don't be really put off by the upfront costs because you kind of make that money back almost within your first month. And if you are thinking of going, just go for it. It's an absolutely incredible experience. I don't regret it for a minute at all.

SPEAKER_01 15:23

And one last question that's just come to me, you've obviously mentioned that there was a big group of you that went and you knew, you know, other people working in different hospitals kind of dotted around. Were there people that actually had made that decision to come by themselves? And if so, how do you find that they settled into that experience?

SPEAKER_00 15:42

Yeah, like I said, we did go with a a bit of a group of us and knew some people already there, but there were, I think, two or three people sort of in the first year that we worked there who had come over on their own, and another two sort of joined into our second year of being there. And, you know, they fit in absolutely fine. It's I guess like any new job, and especially with AE, is a bit of camaraderie. And then especially because you all know that you're all away from your family and friends, there's a very tight-knit group of sort of uh British doctors over there. So, you know, we ended up having Benin New Year's and Christmas with those people who'd come across on their own. So I think if people are worried about going on their own, I wouldn't be.

SPEAKER_01 16:22

And one last question. You mentioned you were there for 18 months. Was that always the plan, or was your initial contract less than that and you asked for an extension?

SPEAKER_00 16:32

So our initial contract was 12 months. And I know some people go on six-month contracts. I guess it just depends what the hospital offers. We asked to extend by another six months. Once you're there, it almost becomes the norm to extend and it becomes less common for people to go straight away once their contract finishes.

SPEAKER_01 16:51

Yeah. How far in advance did you have to tell them that actually I want to extend?

SPEAKER_00 16:56

Probably about three months or so.

SPEAKER_01 16:58

Okay.

SPEAKER_00 16:58

Yeah. So it wasn't a decision that needed to be made as quickly as deciding to go to Australia.

SPEAKER_01 17:04

Yeah. Yeah.

SPEAKER_00 17:05

Once you're there, it's definitely much easier to stay.

SPEAKER_01 17:07

Perfect. Cachel, I have nothing to say other than thank you ever so much for joining us. Thank you for answering my many, many questions. And I'm sure our listeners have found it really, really interesting. And they'll all be looking it up. And for those who are too far ahead in their training, I guess you've showed us that actually you can go at any time. And it's an experience worth pursuing if that's something that interests you.

SPEAKER_00 17:32

Yeah, definitely. Well, thanks so much for having me on.

SPEAKER_01 17:34

Thank you so much.

SPEAKER_00 17:34

Bye bye.

SPEAKER_01 17:35

Bye.