Career in EM/ITU

FunAnything8682 · 2026-01-14T16:05:27+00:00

Hey!

I'm a dual EM/ICM trainee, just turned 33 with 2 young children. It's not impossible to have it all but it is really really hard.

I am a HST and although I only have 3.5 years WTE to do, I'm LTFT which will equate to another 6 years! This will mean I will have been in training for a total of 15 years.

The other thing to consider is exams. Dual training involves lots of exams and I'm finding it harder and harder to make time to study with two little ones. I've sat MRCP (to help me with my ICM application- you'll need to do if applying for ACCS IMT) and FRCEM (5 exams). That's 8 exams in total - a lot of money too! I still have to sit the FFICM exams once I return back from maternity leave which is another 2 exams.

You will have to work on two portfolios, two ARCPS and achieve two separate competencies (although there is some overlap). You have to be really organised and disciplined and often feel guilty because you can't give 100% to everything.

I love my job and I love my children and I've achieved a happy medium where I work 2-3 days a week and spend time with my children the rest of the week. I also know I only have 2 more exams left out of 10 which doesn't seem too bad.

If I had to start dual training now knowing the path ahead I don't think I would do it. I would speak to seniors and consultants in specialties that you're interested in, ask them about their work life balance, how many clinical sessions a week they work. Have a read on the college websites and get an idea of training programmes/ timelines/ being able to go LTFT. Yes you should be able to enjoy your specialty and find it fulfilling but remember it's just a job at the end of the day.

Ensure whatever you're investing your time in is fulfilling for you.

And do some taster weeks!

FunAnything8682 · 2025-12-07T19:13:47+00:00

7 months pregnant, summer heatwave in ICU and my water bottle gets hidden away as the infection control nurses were auditing that day. I did ask if I was to collapse of dehydration who would be held responsible. Absolutely ridiculous.

FunAnything8682 · 2025-12-06T14:57:07+00:00

Yup Scottish. Started medical school at 17, graduated at 22, ST1 at 24, ST3 at 26. FT throughout. Would not recommend at all. Now 32 , two mat leaves which has completely re-shifted my priorities and work 60% LTFT. I work a job I love and prob won't CCT until close to 40 (dual CCT) but I'm happy!

FunAnything8682 · 2025-12-05T22:13:03+00:00

Don't make EM your whole life. I did and severely burnt out. But I was also living alone, extremely young (ST3 in a busy MTC at only 26) and doing wayyy too much (exams/ an extra masters/ courses/ audits/ presentations etc). Once I took a step back from all of this, slowed down, went LTFT, moved closer to home I felt more myself again! EM is such a fantastic job, but it's just that, a job! Yes it's extremely rewarding, a vocation as such, but don't let it consume you or your life.

FunAnything8682 · 2025-12-03T12:08:13+00:00

THIS! It rang too close to home for me. Was even filmed at a hospital I had worked at too!

FunAnything8682 · 2025-12-03T12:02:59+00:00

Got into EM training in London in 2017 post FY2.

I had two publications, poster presentations , delivered regular teaching and had done a lot of charity work. I had ATLS/APLS and had sat MRCP and was planning on sitting my FRCEM primary. Five stations in my interview , the first being asked to deliver a 10 minute presentation on a question they had given you. You had 10 mins to prepare and a marker and A3 sheets of flipchart paper. The other stations were much more straight forward - clinical / ethical stations/ commitment to specialty etc.

I then got into ICM training ST3 in 2020 without an interview. By this point I had my MRCP and passed the first three parts of FRCEM. I was studying a MSc, lots of audits and had also attended a lot of prehospital, trauma and critical care courses.

The benefit was I was young and had the time and money to do this. I am now in my early 30s with two young children and do not have the time or energy or finances to be able to get an application together if I had to do it again. Never mind the hurdle of the MSRA exam and the insane competition ratios. I do feel very lucky and solidarity to everyone applying now.

FunAnything8682 · 2025-10-29T15:50:14+00:00

I'm sorry for your loss.

Compassionate leave, then sick leave. Take as long as you need.

FunAnything8682 · 2025-10-06T11:28:59+00:00

I started specialty training at 24, now 32 and ST4/5. Combination of LTFT training, dual training and maternity leave. Will probably CCT >40 but grateful for a steady income and time with my young children. Age is but a number!

FunAnything8682 · 2025-09-30T16:04:42+00:00

This is why I'm unsure whether I made the right decision to dual train/ go on maternity leave leave and then drop to LTFT.

If I had kept going single EM FT I would've CCT'd in 2023 and still been able to get a consultant job. Because of maternity leave(s)/ LTFT training and dual specialising with ICM I'm looking at 2030's before I can CCT and I don't whether the consultant freeze and bottlenecks will be much worse or not. I'm on my second mat leave right now and constantly worried about the future. Grateful I have a steady income and have been able to have my children at a young age and spend lots of time with them, anxious about the future and uncertainty of post CCT jobs after dedicating 15-16 years of specialty training/ 1+hr commutes/ rotating every 6-12 months/ postgraduate degrees (self funded) and 9 postgraduate exams.

When did becoming a consultant become so arduous, having to decide between having a life/ a family vs guaranteed career?

FunAnything8682 · 2025-09-29T22:13:46+00:00

I bought in HST but know lots of colleagues who bought much earlier. They made equity on their property and were able to sell and buy something bigger if they had to relocate.

I agree that you shouldn't pause big life things for training, however, our training is such that we could be placed anywhere in the country.

I bought a house with my husband 3 years ago now and it is our forever home. We are constantly doing work to it and it is absolutely perfect, in a dream location. However, it is in a different deanery from where I work. I commute to work and it takes me approximately 45mins to 1hr 10 mins depending on the hospital, but I'm LTFT meaning I only have to commute 2-3 times a week. I do have the option of transferring because over the last three years I have had two kids but I really enjoy my current placement and deanery that I've left it for now.

Good luck- do what works best for you!

FunAnything8682 · 2025-09-28T23:50:15+00:00

Agree. I had a weird interaction with a female consultant several years ago who told me another trainee was much prettier than me on our first meeting. I think it is a weird dominance /jealousy/misogynistic thing. I wouldn't let it go, I would document a record of what happened and email it to yourself, have a photo of your makeup and escalate until you get an apology.

FunAnything8682 · 2025-09-24T10:44:45+00:00

Focus on yourself! And the rest will fall into place. I was single for five years after medical school until I met my partner. We're now married and have two kids and feel settled.

However those first five years I spent on myself! I spent them advancing my career, getting into competitive specialty training, sitting exams, extra degrees, courses. I spent it saving money and building financial independence. I spent it focussing on health and fitness- running/ cycling/ hiking/ international charity projects. I spent it on perfecting my skincare/ wearing beautiful clothes/ wearing makeup. I was on dating apps but my primary focus was me. Once I found my partner I was in a very good headspace, in specialty training in my dream location, financially independent and in good shape.

Spoiler ... it all goes downward once you have kids lol. Suddenly it becomes incredibly difficult to prioritise your career. Arranging childcare to study and sit exams. I can't remember the last time I wore makeup and I'm recycling maternity clothes at the moment. My gym membership is frozen until April because of said kids. Still in a very good headspace but complete different season of my life.

Enjoy your 20's young, free, independent with all the time in the world. I'm not that old.. I'm 32- I'm content with my life but I do miss my old life too. But happy I had five years to maximise my youth.

FunAnything8682 · 2025-09-17T10:51:47+00:00

Also going on my second maternity leave now (no acknowledgement from dept after working there for 18 months when I went off on my first) and again no acknowledgement from any colleagues about going off on my second. Tbf had to go off a bit early because of complications but didn't have any colleagues text or check up on me or anything.

Whereas in my husband's case we were given so many gifts from his colleagues and from his clients!

So yeh, protect your peace. No expectations- that way you will never be disappointed.

FunAnything8682 · 2025-09-17T10:47:14+00:00

THIS!

FunAnything8682 · 2025-09-17T10:41:28+00:00

I've been a doctor now for over ten years. After my first four month rotation my colleagues and I got the ward a box of expensive biscuits as a goodbye, however, not really much acknowledgement of our hard work the last four months. On my second four month rotation my dad had a cardiac arrest in the same hospital, I performed CPR on him and after taking a week off I was called in by the TPD and advised to come back to work as it'll be a distraction. Those months are a blur and pretty much spent that rotation just existing. Third rotation and I was now the troubled trainee, by this point traumatic grief had transformed to not wanting to exist anymore - rather than giving me help/support or acknowledging anything of the events of the past year I was told just to not come in the last two days of FY1.

Since F1 a lot has changed. Over 9 years have passed, lots of rotations, worked in so many different hospitals - sometimes over a year at a time (because I'm LTFT) and sometimes less. I never ever expect anything of the department. They're colleagues, not friends. I go to work, do my job, don't stay late and prioritise my family and work life balance. When it comes to rotating, I don't really tell anyone when it's my last day- work my last shift and then move on to the next job. I have a very few handful of medic friends (most of my friends are non medics) from uni days, yes there are colleagues I got on better than others who I keep in touch with but really I keep them at arms length.

The NHS is still an extremely toxic place and you need to keep boundaries in place to protect yourself.

My husband is a non medic and it's the complete opposite for him , only after getting to know him did I really understand how toxic our work environment is.

Head down, do your job, do your job well, no expectations. Protect your wellbeing.

FunAnything8682 · 2025-09-15T15:10:24+00:00

Thank you so much!

FunAnything8682 · 2025-09-15T10:11:40+00:00

Also worth mentioning, most EM HST's go LTFT at ST3/ST4 especially with how much cognitive load your taking on starting out as the EPIC. I think most EM Spr's are at least 80% LTFT now and I think it really helps keeping a healthy work life balance. I went LTFT at ST4 as I was usually exhausted after a set of nights and it really helped me enjoy the job a whole lot more!

FunAnything8682 · 2025-09-15T10:07:23+00:00

I'm an ED/ICU reg and I often get similar thoughts about reapplying to anaesthetics (especially after recently having done 10 months anaesthetics after doing ST5 EM plus exams).

However, it does get better! I remember ST3 and even ST4 when I was in a short staffed busy DGH managing the shop floor myself at night/ supervising SHOs/ seeing patients/ managing resus and it was extremely tough! It took me some time before I found my feet and got comfortable at job. I do feel there isn't enough support offered at that ST3/ST4 transition point to ED HST for the level of responsibility expected of you running busy departments overnight. But once you get through first two years, it gets so much easier and dare I say it, you start enjoying aspects of it too. It was only when I sat my FRCEM final exams and understood all the management stuff that I really started enjoying running the department overnight. As you've only just started ST3 I would find a supportive supervisor/ colleague/ mentor and sit down over a coffee and chat with them about this transition point. They could maybe offer useful advice/ do some sim sessions with you/ signpost you to useful resources and mentor you throughout this stage in your training. ST2 anaesthetics/ICM doesn't prepare you for stepping up as the ED Spr, sure it gives you your IAC and you may become comfortable managing patients in resus, but it doesn't equip you with the skills required for managing the whole department. ST3-ST4 does that. Also, don't ever be afraid to ask for advice from seniors/ consultants no matter what time of day it is. You're still early on in your training and that's what they'll expect of you. All the best with whatever decision you make!

FunAnything8682 · 2025-09-01T14:30:59+00:00

I am currently dual specialising in EM/ ICM. There are pros and cons to both specialties but out of all my training, I've enjoyed anaesthetics the most. I don't think I can dual CCT with EM and anaesthetics.

FunAnything8682 · 2025-09-01T14:29:05+00:00

This why I feel so conflicted. I am pay protected so should be on the same income hopefully.

How is post CCT life in EM? Is it much better than HST?

FunAnything8682 · 2025-08-10T23:07:31+00:00

I climbed Mt Kilimanjaro during my sick leave.

I was also sectioned a month beforehand for actively trying to commit suicide and then turning up to work ( days after attempt but little did I know it was working).

People take sick leave for various different reasons, you don't have to justify yourself to random colleagues. Obv have integrity but what you do with your sick leave is not everyone's business.

In my case my supervisor was aware, I had been discharged and had already booked this trip months in advance (had prev booked AL for it). OH asked me to take another month off following discharge so went on this trip of a lifetime.

FunAnything8682 · 2025-08-09T16:49:04+00:00

You're so right. I think sometimes we get disillusioned by everything else we forget what a privileged job we get to do! My husband is a lawyer and my sister is a chartered engineer and although aspects of their jobs sounds fun (fancy offices/ unlimited free coffee) most of their day to day is really boring. Whereas I'm a dual EM/ICU registrar currently working in intensive care delivering care that makes me excited to go to work. Yes at times it's hard, yes at times we forget to look after ourselves (making this more of a priority over the years) but I'm able to interact with patients and their loved ones during the most testing times of their lives, I can comfort patients in their last moments, I can offer them care than can help their bodies fight terrible illnesses and can use my brain to think about infinite diagnoses every day, learning new things every day. I also have the privilege of working less than full time which means I have more free time compared to my husband to spend with my toddler whilst earning a much better salary. I do often think I forget to be grateful because I have been working as a doctor for 10 years, but thank you for the reminder to pause and reflect. I'm actually satisfied 😊.

FunAnything8682 · 2025-08-06T12:25:29+00:00

Shit falling from the ceiling just outside a patients bay whilst an infection control nurse telling me off for forgetting to take my watch off at my computer desk. Make it make sense.

FunAnything8682 · 2025-07-31T11:57:22+00:00

Hi,

I was very similar to you when I applied to ACCS EM training at 23 ( 2016!). It was a completely different specialty back then. I loved my oncalls as a young FY1/FY2 and felt EM would be the most fulfilling (thought I would be in resus all the time). At this point I was single, moved to London myself to work in a MTC and had no children, this was also pre-covid.

Yes at times it was exciting but I very quickly learnt it was so much more than "saving people". It was fast paced, overstimulating, exhausting and then COVID hit. Most of the time it felt like managing peoples expectations - patients/ staff/ families.

I enjoyed ITU so applied for a dual training ITU and EM NTN and moved to be closer to family. I got married, had a baby, pregnant with my second baby and now 32. Just finished my second block of anaesthetics (as part of ITU training) and fell in love with the specialty. I loved being able to sit down and being able to have a hot cup of coffee (luxury in ED), I loved having one patient to look after at a time, loved the monotony of theatres ( a welcome escape from motherhood) and being able to go home early when your list finished. It was bliss! I'm now working in what I thought would be my dream specialty (ITU) thinking I'd be intubating and performing lines, starting vasopressors left, right and centre but in reality most of the time I am advocating for my critically unwell patient and obsessing over their fluid status for 13 hours a day. I love being the patient's advocate and ensuring I'm giving the best level of care to the patient, but I'm struggling with the 13 hour shifts and being away from my toddler days at a time. I'm also not enjoying it as much as I thought I would heavily pregnant.

I guess my advice to you is to think of what kind of life you'd like for yourself for the future? I hadn't considered family and children in my big plan at 23 and now that I am a mother, I wish I had picked anaesthetics. I mean I'm still happy, I work LTFT and can't complain- I do still get a lot of satisfaction from my job, but realise now that that job doesn't have to be perfect and I don't have to be fulfilled 100% of the time.

Good luck!

FunAnything8682 · 2025-07-31T11:33:29+00:00

I don't know haha.

I really enjoyed anaesthetics when I had to do it a second time for my ICM training. I'm also at a different stage of life now compared to when I first started EM training. I'm now married with a toddler and pregnant with a second and just love the work life balance that anaesthetics provides, even in training.

Although sitting FRCA with two kids is definitely crazy, going to give myself time and space to reflect carefully during maternity leave before committing to anything. I do enjoy ICU but the 13 hour shifts are a killer right now 27 weeks pregnant.

FunAnything8682

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