To work abroad or not to work abroad…

So, myself and a few members of the team were invited to the London GP trainee conference, sponsored by Health Education England, in July where we were able to run a workshop for GP trainees who were keen to have some international experience. It’s a lot to cover in 45 minute workshop and it ended up being somewhat of a Q&A session. Apparently, we were so oversubscribed that we were allowed to run the workshop twice and some people got turned away!

From this experience, it made me realise that there were similar themes to the questions that were asked and I thought I would give a stab at answering some of these now. My disclaimer here is that this is generally based on my opinion – and the facts (especially around appraisals) are very regional and you will need to make sure you contact your Responsible Officer to ensure that you are jumping through the right hoops. Nonetheless, I realise that it can be very difficult for trainees and qualified GPs to get a coherent answer. So here we go…

Can you go away?

This is obviously thinking about the practicalities of going abroad. If you are going away for an extended period of time, you will need to consider jobs, rental/mortgages, partners and family.

As a GP, we can be partners, salaried GPs and locums. Locum is often the favoured choice amongst young doctors who want to be involved in international primary care but it can be stressful as it can be quite admin heavy – chasing practices for form A’s and having to complete pension Form B’s in a timely manner as well as paying your own student loan etc. Personally, I felt that locuming was less mentally challenging as often there is no continuity of care so I felt that I was deskilling and some people may find it lonesome. Salaried posts are good for learning and it can be very rewarding when in the right practice. However, they can often be perceived as inflexible and certainly only having six weeks off pro rata can feel rather obstructive to an international career. My advice is choose your practice carefully. I can only talk about my practice in London, but they allow me two months off a year although we have an agreement that they are not obliged to hold my job for me during the time I’m away. Personally, I think this is fair but I know some of you won’t so it’s completely about finding what works for you. They also let me swap my days off during the week (i.e. work a Wednesday instead of a Thursday) so that I can attend all the random RCGP meetings I get invited to. And I’ve certainly heard of practices offering six months of unpaid sabbatical for ever five years of service. The best thing to do is to always ask as the worst they can say is no. Generally, I would say empathise with the practice’s standpoint and be willing to meet them in the middle. At the end of the day, they are also a business and you need to bring them value for them to bend the rules for you. The more you offer them, the more valuable a commodity you become so be helpful when you are there and don’t be tempted just to clock in and clock out.

Rental/mortgages and family commitments is a question much more difficult to answer. As we enter an age groups where parents are getting older and children are appearing on the scene, our ties and commitments to the UK are ever increasing. Here, I have no concrete answers for you but there are plenty of ways to involve global health on your doorstep. Get involved with twinning projects, host doctors from abroad. get involved with marginalised populations in the UK or with charities, like Virtual Doctors who use telemedicine to help rural patients in Zambia. Global health is everywhere around us and the UK needs us more than ever in this hostile environment. Get in contact with me if you want to know more options (chairjic@rcgp.org.uk)

What about career development in the UK?

I was slightly stumped by this question asked by a trainee because I had never considered it before. Certainly, in my surgical days of yore, I used to worry about everything on my CV having a purpose and a direction. Nothing could be on there without being able to justify it and it was such a breath of fresh air to step into GP where everything I did only added to my tool-belt. As one of my GP friends told me before I applied for general practice, “whatever you’ve done before will only serve you to be a better GP” and I stand by that and say that all life experiences are valuable.

Don’t be put off by the negativity that is rife in general practice at the moment.The great thing about general practice is that you can always decide to pick up a new interest whenever you want. A CV reflecting proactivity and interest looks good and if one practice doesn’t feel that way, look for another one – every saucepan has its lid.

Very importantly, if you do international work (short-term or long-term), you do not have to give up your UK license. I heard from one trainee that the word on the street is that giving up your UK license is necessary if you want to follow a global health career and this misinformation really broke my heart. Off the back of this, I’ve written a piece in conjunction with Health Education England (so I know the facts are right!) for the BJGP on how to navigate appraisals and revalidation which will be out in September. I will link it in when it gets published. There is a lot of positivity at the top about doctors who engage in international primary care but unfortunately the message gets lost in the red tape and bureaucracy by the time it gets to us GPs on the shop floor. The JIC is working hard to keep making the process more user-friendly so keep sending me stories and cases so that I can keep educating the RCGP on the barriers people are facing.

Funding?

We all know that a lot of the voluntary work is just that – unpaid. This can be a huge pressure on the millennial generation who are already burdened with tuition fees and the rising cost of living.

Unfortunately there are no easy answers. I have spent hours on Google with pitiful results. Local RCGP Faculties will have funding for WONCA events. (Check now as most of the deadlines are September for next June’s conference). Don’t forget that the RCGP international have a travel scholarship for UK doctors going abroad or international doctors coming to the UK. There are rules and it’s only open twice a year but it’s a good funding pot for primary care activities.

Final words

You may feel that you’re on your own wanting an international career. Finding the tribe that suits you – whether that is GPs who are interested in global health, or GPs into lifestyle medicine or GPs with a special interest in unicorns – is essential to feel supported and resilient. The JIC run an annual symposium every summer where you can meet your fam which I promise will keep you feeling energised. We’re all about the positivity so get in touch if you want to get connected!

Further to this, if you have any questions that you want answered, send them to me at Chairjic@RCGP.org.uk and we’ll try to get some more answered!

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