Transitioning to the NHS from an International Healthcare System (3 Oct 2024)

SPEAKER_00 0:15

Hello, and welcome to Consultant Conversations, a podcast series developed by the Recently Appointed Consultant Committee at the Royal College of Physicians, Edinburgh. This is for the new consultants within 10 years of starting their post and also for senior trainees so that they can benefit from this. My name is Dr. Cosmos Alazado. I'm a member of the Recently Appointed Consultant Committee, and I'm a stole consultant working at the Lancashire Teaching Hospital NHS Trust. Today I will be discussing with my guests transitioning to the NHS as a consultant for international healthcare system. My guest is Dr. Abij Das, who is a consultant neurologist at Lancashire Tishing Hospital NHS Foundation Trust. He is the regional lead for the Functional Neurological Disorder Service. He's also an honorary associate professor at the University of Central Lancashire. Dr. Das has more than 20 years' experience in clinical neurology and research in neuroengineering. He has international experience in education and research, as well as experience of industry collaboration and entrepreneurship. He holds multiple international patents in neuroengineering, and he has published research work in peer-reviewed journals and is the winner of multiple awards and research grants. And also has an extensive international research work. Dr. Dance, you are welcome to the recently appointed consultant committee podcast.

SPEAKER_01 1:57

Thank you, Cosmos, and thank you for your kind introduction.

SPEAKER_00 2:00

Thank you so much. So before we can go delve into the discussion, I want you to introduce yourself and your background before coming to the UK.

SPEAKER_01 2:12

I think you have given a nice introduction to my background already. So my training has been done in India and also partly in the US. So I've completed my MBBS, MD, and DM Neurology Training in India in different parts of India. And my MBBS was from Medical College Calcutta, which is one of the oldest medical colleges in the world. Then I did my medicine training, internal medicine training for MD, which is the rule in India at the PGI Chandigar. Then I did my DM neurology training, kind of neurology registership from Sri Chitra Tional Institute at Kerala, India. Then I did my postdoctoral training in neural rehabilitation from the Kassel Foundation, Rogers University in the US. Then I came back to India. I was working as a consultant and I was also director of the neurorehabilitation service. First was in the Institute of Neuroscience Kolonkata, then I was working the same position, senior consultant neurologist, and also the director of the neurorehabilitation service at AMRI Hospitals in Kolkata. And then I decided to come to UK and I came here back in 2019. I initially worked as a Nukham consultant in Stroke, and then I joined as a Lukum Consultant Neurology in Bow Walton Center. And since 2022, I'm a I cleared my CESR and then become a substantive consultant in neurology in the Royal Prison Hospital, at the Lancashire Teaching Hospital NHS Foundation Trust. So this was quite a long journey and thankful for the experiences that I have throughout the period. Thank you so much.

SPEAKER_00 3:38

It seems to already have quite a vast experience before coming to UK. Okay. If I may ask, uh what made you to come to UK? What made you to change your mind to come over here?

SPEAKER_01 3:51

That's a very important, interesting question. So it was not an easy decision because I was quite well settled in Calcutta and had a private practice, but I enjoyed the practice there. We had a nice group. But the main problem in India that I was facing was the work pressure. And I was not having enough academic exposure during my post. Although I am having some collaboration, but just the academic research, the lack of academic research was hard because I'm a private practitioner. So that's the main thing. So main thing that because I had one of my close friends joined NHS that time, and he described the main theme was the what life balance. And also, frankly, I'm a big supporter of the main ethos of NHS. So often I see that people in NHS do not realize the value that NHS brings, not only to the patients, but to the doctors. So in one of the main causes of burnout when I was in Calcutta was the incessant demand and the discussions that we're facing with the patients, discussing with them regarding the cost. Because it was a private practice, and we all know the private practice account, 70 to 80% of people in India seeing the private practice, and cost is a big issue because the patient be out of their pocket. Often there are insurance coverage, but they're often inadequate. So and that's a big factor. So it's difficult for a clinician when going to someone, say for thrombolizing a stroke patient, the first discussion that you had, can you afford the treatment? And those kind of discussions and the financial issues, there's also a draining. And there was increasing doctor-patient relationship was at the bottom during that period in India, and still going on if you look at the media and other things. So it was very stressful to work as a doctor in of India during that period. And adding to this, there was no much academic exposure because I was in the practice. And that's why I decided to join the NHS. Because at NHS, we have a lot of protected time. Although NHS has its own challenges, but there are a few things which still make for uh many people like me. NHS is one of the best places to be a doctor. It is still very much a democratic organization, and it is at the point of care. You do not have to bother about the cost, you don't have to discuss that issue with the patients. What a great release it is. There's people who have worked throughout NHS, they possibly will never realize what a great relief it gives to you, the freedom that it gives to you. It's all the main factors.

SPEAKER_00 6:13

Well, that's very good. I've seen some people who came from overseas, even when they were consultants over there, but they came over here and then they started as a middle grade because of the different systems for overseas to join NHS, but you came in and they started a looking consultant. So, how do you manage to move into the consultant level where you move from international health system to NHS? How do you manage to do this?

SPEAKER_01 6:41

Yeah, so actually I'm not the only one. There are many other consultants who often join directly as a consultant. It depends on your background and things, because NHS is a very structured organization. So if you have worked in the past in a very structured way, so I will give credit to my training because I've been trained in some of the premier institutes of India, like PGH Indiga and Sri Chitra, those institutes are modeled up on some of the best institutes in the world, like Howard and others. So our training, the way we handle the data and our exposure to MDTs. So for the international people coming to NHS, there are a few things that often stand out, like the multidisciplinary nature of NHS, that you have to take account of all the all your colleagues and everyone. So this was often not there in the other countries, like India or the developing countries, where doctor is the only one making all the decisions. So this is somewhat different in NHS. But because I had worked in similar situations in others, so I was quite exposed to it. The other thing is the detail of documentation, which is often people who are coming from outside, the documentation is not often as detailed. And the kind of discussion with the patients, informing the patients, and the other issues, those are the huge things in NHS, and rightly so. Those are often kind of not followed in that details in other places because of the time. You do not have enough time to keep all these things because the doctors are very busy. But because I have already been trained in this and also I have worked in the US in the past. So those exposures, and because I was exposed to HIPAA and other things, those documentation, and so those gave me the ability to come and join directly as a consultant.

SPEAKER_00 8:21

Thank you. So, Rosh. Is there any valuable experience that made you at least help you to settle quickly when you came into the NHS? I know you have explained about working in the US and other places and documentation, because there is there should be some challenges you might have faced when you join into the NHS, especially as a consultant. Great. What other experience that made you to overcome these challenges?

SPEAKER_01 8:48

No, what I found that uh trusted joined. I joined, I initially worked in Preston, and the trust was very helpful. So when I joined, like one month, I shadowed another consultant and learned the ways around and the everybody has been very helpful. So one thing in NHS, and uh people understand that it's a very structured organization, but it is a very democratic. Again, everyone is supportive, the nurses, the other occupational therapists, physiotherapists, everyone from the duty managers, they have been very supportive and structured. So because of the structure of the NHS, and everything, and your rights have predicted. So, like although you're a new consultant, that like the other bullying cultures and other things existent in some other areas where it is there. Fortunately, I've not faced it, so it was very smooth transition for me. And uh, one thing uh bit uh challenging for me, private practitioner, was that speed that is somewhat I had to adjust because when I joined the NHS, it was possibly and still continuing the waiting period and the other issues, the management, and that started. And I joined just before the COVID, and even the COVID, everything uh kind of uh got stopped. So that is something which uh I found it difficult to adjust because I was accustomed to seeing patients quickly, treating them quickly, getting the results out in the same day, discussing with them in the same day. So that is something I found missing in the NHS. And yeah, I still miss it, but hopefully someday we'll get better.

SPEAKER_00 10:20

Yeah, would you say that your specialty, neurology and stroke, made it easy for you to move into the NHS as a cause? Other than grades, for instance, if you come to other specialty like surgery, is this something people who are coming to surgery, do they think they will be able to settle that quickly in that specialty?

SPEAKER_01 10:41

I yeah, uh partially, maybe partially true. But I have seen other uh some of my consulting colleagues, maybe some in radiology, they they also have seen them coming and joining directly as a consultant. But yeah, the main issues are you need to understand the structure of the images and the way images work, that takes a bit of time. So, and the documentation, the need of documentation, the detailing of the documentation, and what to maintain, how to maintain, then working in a multidisciplinary team environment, respecting everyone. And also, because people who have not worked in this kind of situations, the the detailing that you need to talk to the patients and other things, these are the kind of things different. Because in some other parts of the world, the doctors are a kind of the most authority, so that has to change. When you come to NHS, you have to understand you are part of the system, you are not the only system that is available. This is something that needs to change, and these are the main transitions. Otherwise, the clinics part, I think the doctors, if they're trained well and have seen enough patients, they're the same world over. But the other things, the documentation other things, these are the critical differences in HS. But I have seen other people coming from and joining NHS from, say, Canada and from Australia, and they have transitions very well because they're coming from the same structured system.

SPEAKER_00 12:02

Yeah, thank you, sir. For your biography, so that it seems your associate professor at the University of Central Lancashire. Yeah, I will manage within the short time of being in the UK to become the associate professor. So some people who might come from overseas as a consultant and also maybe they are quite experienced in the academic career, how would they go into academic also to go up the trade and also the level that we have achieved this within this time?

SPEAKER_01 12:33

Well, I'm very much thankful uh for the University of Central Lancashire. So, and that was one of the main reasons I left India. I have been throughout my career, I have been kind of academic-oriented. I have published case reports in Lancet, I've published in neurology, even from India. So when I went for the postdoctoral fellowship, I had the NIDRR grant from the government of US to the Kesla Foundation. I am fortunate to have some good mentors, so I could do some good research. So even in going back to India, although I'm private sector, I didn't want to do kind of clinical research I could not do, but I was having collaboration with a lot of engineers because I'm in rehabilitation, so some innovative work and the patents. So my publications continue. And I had some grants in India as well, some more kind of industry clinical partnership grants. So I maintained it. And after coming here, I was fortunate I got support. So I just say very thankful to this country. Although I'm a kind of new entrance, but say for now I'm in the field of functional neurological disorder. So when I moved in, I decided I will do it. I just approached some of the big names just directly, like Professor Johnstone, Professor Alan Carson. They just allowed me to come in and sit in their clinics. This is the most beautiful thing that has happened to me. So they're kind of so Professor Johnstone, Professor Alan Cullen, they're kind of my unofficial mentor. Although I'm not their direct students, but I would say I've learned from them. So when I just came here, I'm decided to enjoy functional neurological disorder because of my rehab background. So I just wrote to John. So it's like Professor Stone, I'm neurologist, blah, blah, blah. I'm to do this, but can I come and see how it's working? I went to his clinic. He allowed me to sit in his clinic for two days. I also attended uh Alan's uh ward round and have communicated with everyone and I'm learning from everyone. So this is another beautiful thing about this country. This is the structure is very much democratic. So if any international colleagues were listening to this, I would say this is a big country of opportunity. So if you're willing to do good work, you can do it. And same experience I got from the Stroke Association BIAS. So when I joined it, there was a scientific subcommittee. I just entered my nominee, nobody knew me, but I got elected, and it was a great boost for me. And later I worked as a chairperson of the scientific subcommittee of the BIOS fund, and they're so helpful. I they they they knew that I am new to this person, I do not know the structure, and they supported me like anything. It was a great experience, great learning experience. I've learned a lot, and I'm putting those experiences back now because I'm developing my own service in the Royal Preston, this functional neurological disorder service, starting from scratch, and all my colleagues, my clinical director, has been very supportive so far. So all these things that I've learned, because I developed service back in India. I developed the new revolution service. So I know how to work with people, how to work through groups, but with the support, I'm again uh able to put my knowledge and my experience back to work. So this is again, I say I said this is the beauty of NHS, and because of the structure, it allows you to grow.

SPEAKER_00 15:31

Yeah, thank you so much. That's very encouraging, especially for people who are interested to come over to UK, because some people are still having that fear that coming to NHS will quite different from their system, and that is the belief of everyone. But I still know that message is the same. Anyway, you read it, they're all the same. What you need is to have the confidence and uh be able to adapt into the system, and as you said, you have some period of attachment, or yeah, following the senior people to learn a bit before you delve into the NHS at that level, you know. So, and I know many people are still planning to come into NHS even at that level as a consultant. Some people, due to fear, as we said, would apply for a junior post. You have to settle before moving up the ladder. What would be the advice to these kind of people who have this good experience at the as a consultant coming to UK? What do you advise them to do and how to prepare themselves coming into UK and into the NHS?

SPEAKER_01 16:45

Yeah, so what I would say now uh NHS, because of the difficult situation it's going through. I think some people feel NHS is still not the best place to work, but I would like to differ. NHS for the doctor, so what I've seen so far is still possibly the best place to work. Yeah, there are challenges. We are facing challenges, the waiting period is going up, and we are facing all the challenges due to it. But still, as a doctor, possibly you are the most supported here. I'll give one more example to everyone and ask the difference between. So in India, I was working around 100 hours a week, and I used to handle how many calls if I forward, so say 50 or 60 calls a day, just by myself, because the patients are calling me, asking the simple questions. Here in this country, I just only get how many calls? Two or three calls a day, mostly from the family, they're only from the hospital of time on the phone. And this is because the secretaries are handling all these issues, the tiny nitty-gritty issues, and this will because of the structure of the energy. The managers are answering the questions that people have previously asked to do me. So, okay, so there's a device breaking down. What do you need to do? Because I was in charge of the re-hab service, I was to answer all these questions. New device coming in. Who's going to check that? Is it okay? Is it under license? I have to do it myself. I don't have to bother about this. There are people who are doing this for you. So only thing I would advise so people just they can come here as an observership after they do the degree. Maybe come as they say, senior clinical seller, work here for six months or one year, collect their because if they're coming through like this pathway, then they need to do their CSR as well. So CSR is a very good pathway for people like me to come and join here. Because the moment you start working here, build up your portfolio, which is really important for CSR, build up all the data that you need to showcase the CSR. So if you are still, so I would say come here, work here. Maybe if you are not confident enough, join is a junior commission, observe how things are doing, and then when you are ready, just step up. And people are always willing to support because what I will see most trust, they want the people to grow into their roles, and because they know when we have people whom you know, they're growing into their roles, and they're going to stay there because we always want colleagues, we always want to look for good colleagues to stay around because we work with your colleagues because actually they're a team, you only good team members.

SPEAKER_00 19:05

You talk about coming to UK also because of the work-life balance. Do you think your expectation has been met since you arrived here? Do you see you think you have that time to stay with your family also? Oh, definitely.

SPEAKER_01 19:19

I think my wife and my kid is seeing me more now. They are definitely happy about it previously. According to them, I was absent. Although I was there around, but I was coming to the home just to sleep. And again, morning away to the work. So, yeah, this is definitely things. So I can completely agree. My personal growth, I consider my academic growth is a kind of personal growth as well. It has taken new wings after coming to this because of the work-life balance I could achieve here. That is definitely, and that is still another big draw, I should say, for NHS.

SPEAKER_00 19:51

That's very good. So, would you say that you're quite improved academically and clinically since coming over to NHS compared to what you were before oversea?

SPEAKER_01 20:02

Yeah, definitely, yes. I think I have matured more clinically as well after coming to NHS. So if I look back, say five years before, I think my prescriptions are more mature now. And definitely my English has improved. If I read my letters, say three years back, even now, my letters are better now. Uh clinically and uh clinical decision making has definitely improved. So, because in NHS, uh the other thing, beauty of NHS, is that it's a closed system. So you see your own prescription turning up back to you after three years, then you can reflect, okay, I could have done it better. Then you reflect, okay, I could have done it better. And this is a good opportunity. And you also see because there's other people, and there are role models. So there are many colleagues. I consider them as my role model. When I see their letters, I say, oh my God, look how beautiful they have written. So can I do like it? Or look at that beautiful decision making has taken place. Also in MDT, there are beautiful case reports, the difficult cases diagnosed, identified, and you see, you participate, you learn. So another good part of NHS is that continuous learning. So you are always learning, and also you have studied it. You can go to conferences, you can attend conferences. This was a luxury for me.

SPEAKER_00 21:17

Thank you so much. It's a very well-rounded experience for me. That's very good. I think we will come to the close of this short discussion on transitioning from international healthcare system to NHS as a consultant. We had previous podcasts in the junior level who want to transit into NHS. So that will be found in the LCP Edinburgh website. So people who are juniors can go there and listen to that and see how they can come into NHS. So thank you so much, Dr. Abijit Das, for honoring our invitation to talk on this topic. I will hope that we can discuss with you in the future if we if there's opportunity to do that. Thank you very much. Thank you so bye bye.