I get messages from IMGs on a regular basis that they took a registrar post in medicine in haste as their first job in the NHS and are now struggling.
Luckily, we have colleagues who flag this up to consultants and the directorate who then make amends ( ie put them on the SHO rota , etc ) but sometimes mistakes happen. And the GMC doesn't take this lightly.
I also know some IMGs who started as registrars and have been comfortable working at that position from the first day. This could be because they were well supported and did not forget to ask everyone around them for help ( and everyone does help unless it is exceptionally busy in which case the inexperienced registrar may not know what to do). But quite a few are not this lucky.
So for the sake of your sanity and patient safety, please do not start as a registrar as your first job in the NHS. If you meet the qualification criteria on paper ( that is given MRCP) , things are a bit different in reality- it takes time to understand how the NHS works. Knowledge is never an issue. Its the "logistical" angle which people struggle with.
Trusts are desperate for registrars in every specialty. They will do a quick interview and select you ( everyone can tell the management of MI , PE, and the typical interview questions) however when you start here, it is a whirlwind unless you know the system well. Please be cautious. I have tried my best to support as many people as I can. Unfortunately a few of them were referred to the GMC for being unsafe ( when facing the MPTS panel and when in court , it is you and your documentation - registrars are expected to run the hospital at night).
So please be cautious , the reg pay of 60k GBP per annum does appeal to many. However a lot of people struggle and some unlucky ones suffer long term.
Here is my advice for people who are over qualified for SHO posts
1. Apply for registrar level posts
2. Request them to pay you as SHO for the first few months.
3. Shadow on call registrars
4. Do a reg shift with an on call registrar supervising you.
5. Then request them to put you on the reg rota once you are more confident.
OR
1. Apply for SHO posts and start working as SHO on the SHO rota
2. Shadow on call registrars once you feel settled.
3. Do a reg shift with an on call registrar supervising you.
4. Then request them to put you on the reg rota with reg pay once you are more confident.
Again, I know my colleagues are way more qualified and knowledgeable than any consultant in the UK ( and they are - since they see loads of patients in their home countries ) and I am in no way suggesting that they are incompetent.
WHAT IF YOU ARE WORKING AS A REGISTRAR ALREADY AS YOUR FIRST JOB IN THE NHS AND ARE STRUGGLING
Talk to your supervisor ASAP.
Meet with them in person and explain everything to them. Sometimes the way we communicate can be perceived differently hence you can email something along the lines of
" Hello Dr **** ,
This is *** - the new non trainee registrar who started in **** on the ***. Unfortunately I have been struggling with understanding the system and I am constantly worried that I will make a mistake. I have given the relevant UK based post graduate exam ( MRCP/ MRCS , etc ) and I do not face any problems with my clinical knowledge. It is mainly the " logistical" knowledge I struggle with. For example, requesting investigations, discussing them with the radiologist , bleeping colleagues. As I have come from *** , this system is completely new to me. I feel it help me a lot if I could work as a SHO as I will be able to understand how the system works and then I can step up after a few months.
Here is what I feel would help
1. I am put on the SHO rota
2. I do on calls as a SHO
3. I do all procedures expected from a registrar who has recently completed their SHO training post.
4. I meet with you on a regular basis to discuss my progress
5. Once we feel that I can manage confidently , I can step up as a registrar.
I completely understand your frustration as you expected me to work as a registrar but I have really struggled and it is getting worse. I am worried I will loose my confidence completely and will make a mistake if I continue like this. However I do believe that if I can work as a SHO , I can regain my confidence and work on the registrar rota.
I can also help the trust in inducting registrars who have not worked in the NHS before so that they too , can start as a SHO initially and then step up on the registrar rota once they are confident.
I am hoping we could meet and discuss these different options.
Many thanks ,
**** "
Also
Ensure you have medical indemnity cover to cover you for any serious mistakes
http://omarsguidelines.blogspot.co.uk/2017/08/indemnity-insurance-for-imgs.html
( every doctor in the NHS should have this regardless )
This is what I have seen :
1. You will be put on a SHO rota
2. You will be supported more by regular meetings with your supervisor in this time to see how you're getting on.
3. Once you feel confident and understand the system ( it takes a few weeks to months ) , you can then meet with your supervisor again
4. If you both agree , you can work as a registrar.
This post comes from 2 separate incidents which happened with registrars who had started in the NHS.
So why is this happening
1. Understaffing on the middle grade ( registrar) rota. Almost every Trust has gaps. They have to put out locums which can be escalated upto 100/ hr. Hence it costs the trust 1200 to 1300 GBP to cover one on call shift. If they get a permanent registrar, they save up in the long run ( by paying them 60 to 65k , putting them on the on call rota )
2. Lack of communication - the doctor may not have informed the trust about their situation- as in , the fact that they have never worked in the NHS before and need more supervision
http://omarsguidelines.blogspot.com/2015/09/what-to-do-once-your-job-has-been.html
And that they will need shadowing:
https://omarsguidelines.blogspot.com/2021/10/the-importance-of-shaowding-when.html
3. Lack of understanding of the fact that a new IMG may have completed UK based post graduate exams does not automatically mean they can manage on the registrar rota. But not everyone here understands this. The rota team sees a gap which is constant , costing the trust money in terms of hiring locums , they inform recruitment and the HR puts out an advertisement on NHS jobs.
Candidates are selected on the basis of whether they meet the criteria ( tick box system - like UK based post graduate exams)
The interview is like any other interview- management of chest pain , definition of governance, etc and if the doctor has read medical interview books , they will answer all the questions.
The trust is desperate to take the doctor. They accept the offer. Sometimes in haste.
Then they are thrown into the deep end when they come here.
Things I have seen
1. An IMG accepted a job as a registrar
2. Did not inform the trust that they have never worked in the NHS and need a period of observership , working as a SHO for the first few weeks although it was quite clear on their CV and NHS jobs profile that they did not have any NHS jobs experience.
3. They were put on the registrar rota 3 days after they started.
4. They had no idea about the " logistical side" - ie the importance of answering bleeps , reviewing unwell patients ASAP, working with the senior nurse to manage patient flow, not being aware that you can call the consultant when you are not sure, discussions with other specialities.
5. As a result there was a massive complaint against them
6. It took a toll on their mental well being and personal life.
7. It took some time for them to realise this and they then took a SHO post , are much happy and have recently been stepped up as a registrar
Another example
1. An IMG colleague took a middle grade post but clearly stated in their interview that they have never worked in the NHS
2. Before they accepted the post , they spoke to the consultant via email and CC'd HR into it requesting them to
- arrange a proper induction for IT systems as they would be starting at a time different than the usual induction ( which is normally in August )
- a period of shadowing
- allowing them to work as a SHO initially
- to start on calls as a SHO 4 weeks after they start
- regular meetings to ensure they are progressing appropriately
- 3 months and then 6 months review to see if they can manage a registrar post.
3. The consultant and HR agreed.
4. They applied for indemnity cover the day they started in the NHS
5. They met their supervisor regularly
6. They kept an open mind , allowed the trust to pay them as a SHO ( with on call supplement ) till they stepped up
7. It was mutually agreed in 4 months that they have now gained the confidence to step up and manage on the registrar rota.
8. They performed brilliantly!
Now compare both situations- Which one would you want to be in ?
Some colleagues whom I have spoken to state
1. They need the registrar pay as they cannot manage on a SHO pay.
I have personally managed with 2 dependants , a nice apartment , a car on a finance deal easily. So I assure you a SHO salary with on call supplement is enough.
2. They wouldn't have been selected as a middle grade had the trust not thought that they're competent enough.
They have the clinical knowledge. They just need an understanding of the "logistical" side which takes 3 to 6 months
3. They have given UK based post graduate exams and hence have an understanding of the system. Exams and the actual working environment here are very different.
Because of the gaps in the registrar rota, trusts are very desperate to take middle grades just to fill that cell in that excel sheet. So please do not risk it. Ask the right questions at the right time. Get the right support early. Do not delay it. If you're struggling, please don't suffer in silence. It will take a toll on your mental well being.
Ps - this is in no way a criticism of your competence. I know you have more clinical knowledge by working in your home country than any consultant here. But things are different here. With the right support and starting at the right level , you can flourish and train well.
Luckily, we have colleagues who flag this up to consultants and the directorate who then make amends ( ie put them on the SHO rota , etc ) but sometimes mistakes happen. And the GMC doesn't take this lightly.
I also know some IMGs who started as registrars and have been comfortable working at that position from the first day. This could be because they were well supported and did not forget to ask everyone around them for help ( and everyone does help unless it is exceptionally busy in which case the inexperienced registrar may not know what to do). But quite a few are not this lucky.
So for the sake of your sanity and patient safety, please do not start as a registrar as your first job in the NHS. If you meet the qualification criteria on paper ( that is given MRCP) , things are a bit different in reality- it takes time to understand how the NHS works. Knowledge is never an issue. Its the "logistical" angle which people struggle with.
Trusts are desperate for registrars in every specialty. They will do a quick interview and select you ( everyone can tell the management of MI , PE, and the typical interview questions) however when you start here, it is a whirlwind unless you know the system well. Please be cautious. I have tried my best to support as many people as I can. Unfortunately a few of them were referred to the GMC for being unsafe ( when facing the MPTS panel and when in court , it is you and your documentation - registrars are expected to run the hospital at night).
So please be cautious , the reg pay of 60k GBP per annum does appeal to many. However a lot of people struggle and some unlucky ones suffer long term.
Here is my advice for people who are over qualified for SHO posts
1. Apply for registrar level posts
2. Request them to pay you as SHO for the first few months.
3. Shadow on call registrars
4. Do a reg shift with an on call registrar supervising you.
5. Then request them to put you on the reg rota once you are more confident.
OR
1. Apply for SHO posts and start working as SHO on the SHO rota
2. Shadow on call registrars once you feel settled.
3. Do a reg shift with an on call registrar supervising you.
4. Then request them to put you on the reg rota with reg pay once you are more confident.
Again, I know my colleagues are way more qualified and knowledgeable than any consultant in the UK ( and they are - since they see loads of patients in their home countries ) and I am in no way suggesting that they are incompetent.
WHAT IF YOU ARE WORKING AS A REGISTRAR ALREADY AS YOUR FIRST JOB IN THE NHS AND ARE STRUGGLING
Talk to your supervisor ASAP.
Meet with them in person and explain everything to them. Sometimes the way we communicate can be perceived differently hence you can email something along the lines of
" Hello Dr **** ,
This is *** - the new non trainee registrar who started in **** on the ***. Unfortunately I have been struggling with understanding the system and I am constantly worried that I will make a mistake. I have given the relevant UK based post graduate exam ( MRCP/ MRCS , etc ) and I do not face any problems with my clinical knowledge. It is mainly the " logistical" knowledge I struggle with. For example, requesting investigations, discussing them with the radiologist , bleeping colleagues. As I have come from *** , this system is completely new to me. I feel it help me a lot if I could work as a SHO as I will be able to understand how the system works and then I can step up after a few months.
Here is what I feel would help
1. I am put on the SHO rota
2. I do on calls as a SHO
3. I do all procedures expected from a registrar who has recently completed their SHO training post.
4. I meet with you on a regular basis to discuss my progress
5. Once we feel that I can manage confidently , I can step up as a registrar.
I completely understand your frustration as you expected me to work as a registrar but I have really struggled and it is getting worse. I am worried I will loose my confidence completely and will make a mistake if I continue like this. However I do believe that if I can work as a SHO , I can regain my confidence and work on the registrar rota.
I can also help the trust in inducting registrars who have not worked in the NHS before so that they too , can start as a SHO initially and then step up on the registrar rota once they are confident.
I am hoping we could meet and discuss these different options.
Many thanks ,
**** "
Also
Ensure you have medical indemnity cover to cover you for any serious mistakes
http://omarsguidelines.blogspot.co.uk/2017/08/indemnity-insurance-for-imgs.html
( every doctor in the NHS should have this regardless )
This is what I have seen :
1. You will be put on a SHO rota
2. You will be supported more by regular meetings with your supervisor in this time to see how you're getting on.
3. Once you feel confident and understand the system ( it takes a few weeks to months ) , you can then meet with your supervisor again
4. If you both agree , you can work as a registrar.
This post comes from 2 separate incidents which happened with registrars who had started in the NHS.
So why is this happening
1. Understaffing on the middle grade ( registrar) rota. Almost every Trust has gaps. They have to put out locums which can be escalated upto 100/ hr. Hence it costs the trust 1200 to 1300 GBP to cover one on call shift. If they get a permanent registrar, they save up in the long run ( by paying them 60 to 65k , putting them on the on call rota )
2. Lack of communication - the doctor may not have informed the trust about their situation- as in , the fact that they have never worked in the NHS before and need more supervision
http://omarsguidelines.blogspot.com/2015/09/what-to-do-once-your-job-has-been.html
And that they will need shadowing:
https://omarsguidelines.blogspot.com/2021/10/the-importance-of-shaowding-when.html
3. Lack of understanding of the fact that a new IMG may have completed UK based post graduate exams does not automatically mean they can manage on the registrar rota. But not everyone here understands this. The rota team sees a gap which is constant , costing the trust money in terms of hiring locums , they inform recruitment and the HR puts out an advertisement on NHS jobs.
Candidates are selected on the basis of whether they meet the criteria ( tick box system - like UK based post graduate exams)
The interview is like any other interview- management of chest pain , definition of governance, etc and if the doctor has read medical interview books , they will answer all the questions.
The trust is desperate to take the doctor. They accept the offer. Sometimes in haste.
Then they are thrown into the deep end when they come here.
Things I have seen
1. An IMG accepted a job as a registrar
2. Did not inform the trust that they have never worked in the NHS and need a period of observership , working as a SHO for the first few weeks although it was quite clear on their CV and NHS jobs profile that they did not have any NHS jobs experience.
3. They were put on the registrar rota 3 days after they started.
4. They had no idea about the " logistical side" - ie the importance of answering bleeps , reviewing unwell patients ASAP, working with the senior nurse to manage patient flow, not being aware that you can call the consultant when you are not sure, discussions with other specialities.
5. As a result there was a massive complaint against them
6. It took a toll on their mental well being and personal life.
7. It took some time for them to realise this and they then took a SHO post , are much happy and have recently been stepped up as a registrar
Another example
1. An IMG colleague took a middle grade post but clearly stated in their interview that they have never worked in the NHS
2. Before they accepted the post , they spoke to the consultant via email and CC'd HR into it requesting them to
- arrange a proper induction for IT systems as they would be starting at a time different than the usual induction ( which is normally in August )
- a period of shadowing
- allowing them to work as a SHO initially
- to start on calls as a SHO 4 weeks after they start
- regular meetings to ensure they are progressing appropriately
- 3 months and then 6 months review to see if they can manage a registrar post.
3. The consultant and HR agreed.
4. They applied for indemnity cover the day they started in the NHS
5. They met their supervisor regularly
6. They kept an open mind , allowed the trust to pay them as a SHO ( with on call supplement ) till they stepped up
7. It was mutually agreed in 4 months that they have now gained the confidence to step up and manage on the registrar rota.
8. They performed brilliantly!
Now compare both situations- Which one would you want to be in ?
Some colleagues whom I have spoken to state
1. They need the registrar pay as they cannot manage on a SHO pay.
I have personally managed with 2 dependants , a nice apartment , a car on a finance deal easily. So I assure you a SHO salary with on call supplement is enough.
2. They wouldn't have been selected as a middle grade had the trust not thought that they're competent enough.
They have the clinical knowledge. They just need an understanding of the "logistical" side which takes 3 to 6 months
3. They have given UK based post graduate exams and hence have an understanding of the system. Exams and the actual working environment here are very different.
Because of the gaps in the registrar rota, trusts are very desperate to take middle grades just to fill that cell in that excel sheet. So please do not risk it. Ask the right questions at the right time. Get the right support early. Do not delay it. If you're struggling, please don't suffer in silence. It will take a toll on your mental well being.
Ps - this is in no way a criticism of your competence. I know you have more clinical knowledge by working in your home country than any consultant here. But things are different here. With the right support and starting at the right level , you can flourish and train well.
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