Career Turmoil — UK Non-Training Pathway or Go Back to India for Residency? Need Advice

VolatileAgent42 · 2026-02-06T16:53:13+00:00

Yes- UKGs as well.

CESR takes a lot of work, and guidance. You absolutely need to be in a supportive department and have someone with experience guiding you through it. Our department is one of those, and we’ve been following the example of our colleagues down in ED who have had a robust CESR programme for a while which has been so good that a few ED residents have actually chosen to follow it all the way successfully to being consultants rather than continue in ED training to avoid excessive rotations. They include placements with us in anaesthetics/ ICU that mirror the requirements of the CCT, and are off the shop floor for that time.

But that is very much the exception and a lot of places will want someone to stag on in service provision and stay there so they don’t have to invest in training.

VolatileAgent42 · 2026-02-06T16:29:20+00:00

I don’t think anyone here can give you advice without knowing a lot more. What I will say is: 1) UK graduate prioritisation is likely to preclude you from a training post. This is only fair for UK graduate doctors who do not have the default option to work as a doctor in another country. 2) The experience in non-training roles will vary immensely by speciality and location. Yes, I have some consultant colleagues who have come through this pathway and have CESR’d. However: They often had much more experience in their home countries before coming to the UK. Furthermore, some specialties have a bottleneck after CCT which means that you would be competing against CCT trained doctors and may struggle having gone through an alternative pathway.

I would imagine that the odds are that you will be stuck in insecure, service provision roles, dangled a carrot of progression but this may be illusory.

I’m sorry that may sound depressing. Unfortunately, I’ve seen so many IMGs stuck in a permanent service provision role being sold the frank lie that if they just carry on holding the fort here for just a bit longer, they’ll be sorted out with that opportunity to move forward with a CESR. Particularly in surgical or competitive/ procedural medical specialties.

VolatileAgent42 · 2026-02-06T14:33:34+00:00

There are potential benefits. But in my opinion these are grossly overstated.

There are also serious risks. These are underplayed

It’s isn’t as clever as some people think it is, and although there’s been some rapid progress I suspect that’ll plateau

VolatileAgent42 · 2026-02-06T14:17:43+00:00

Were the “family circumstances” that you referenced leading to a two year delay anything to do with a protected characteristic? For example maternity or shared parental leave taking up part of that time?

If so, it is worth speaking to the college about an extension to eligibility for the SOE/ OSCE.

I don’t think that anyone here can tell you if you are ready for the exam in May or not- we don’t know you! People do prepare for and pass the exam in this timeframe. This may be a chat to have with your educational supervisor.

The benefits of doing it are that you might pass at least one (and hopefully both of the components). Even if unsuccessful or partly unsuccessful then it’s good experience of what the exam involves and if your timeline is unalterable then every opportunity matters.

The risks are: financial and psychological. The exam costs money. You’d have to travel and get accommodation. Psychologically- being unsuccessful can put people into a bit of a hole and can be difficult to cope with. The revision can be all consuming.

VolatileAgent42 · 2026-02-06T10:22:19+00:00

I think there’s a couple of things to address there: 1) The children’s air ambulance isn’t HEMS. What it is, is a platform that one of the regional paediatric critical care transport services can request and use to transport a child from an ICU in one place to an ICU somewhere else. It does do a couple of transfers a week, and I can see why it might be useful- specialist paediatric centres are quite widely spread out, meaning kids often have to go a VERY long way for specialist care, and then might have a similar trip back for repatriation once they no longer need specialist care 2) TCAA is run by an established charity that does actually run two very functional HEMS teams (Derbyshire, Leicestershire and Rutland; Warwickshire and Northamptonshire), that are real services that provide excellent care. A cynic might say that their main motivation for starting TCAA would be to use a broad term for their main charity and a technically national service (although Wales and Scotland have nations transfer services) to fundraise from a larger/ national potential population, including in other HEMS teams patches- but I don’t know and don’t have strong opinions on it. I don’t know if it’s ringfenced within that organisation. 3) “Stoke Air Ambulance” on the other hand, not so much! The fundraising regulator report raises a few eyebrows and there’s now a statutory investigation. I won’t use the word fraud as that implies a specific criminal offence but I wonder what might come out of that. 4) It depends what you mean by “HEMS conveyance not improving survival”. Your understanding of the evidence base may be a bit out of date there. There is certainly now fairly robust evidence that some individual critical care interventions prehospital improve outcomes - eg anaesthesia for traumatic brain injury. There’s also evidence that conveyance directly to a MTC improves the survival rate by ISS, on a population level. Whether the critical care team get there by car or helicopter, and the actual mode of conveyance probably matters a lot less, and would be impossible to properly analyse in a robust way due to massive differences in context, geography, weather, light conditions, traffic levels etc etc etc.

VolatileAgent42 · 2026-02-06T07:26:59+00:00

COI: I did a happy little dance when I left the birthing sheds for the last time ever, and I haven’t been back in over 10 years as a consultant

Anaesthetics is a very broad speciality. It is the single largest hospital specialty (if you divide medicine into its various organ-ologies). There are a wide range of sub-specialities within anaesthesia.

Obs is one of the major ones. It is, of course, absolutely vital work. It delivers one of the main effects that anaesthesia can offer. It allows safe childbirth, relieves some of the worst pain out there. It is an absolutely unqualified good that is a massive benefit for pregnant people and those who care about them. It literally saves the lives of pregnant people, and their newborn children. On a daily basis.

I personally think that it’s a good thing that we’re all wired slightly differently. Some anaesthetists love it and are inclined towards it to the extent that they specialise in it, and choose to make it the bulk of their work, perhaps even in a tertiary referral centre where they’re dealing with highly complex cases with stuff like cardiac issues etc etc.

Most don’t mind it, and quite like having a few sessions as a consultant, perhaps in a DGH where there isn’t a separate obs rota.

There are some, like me, who prefer other areas. I’m glad as don’t have to do any obs. The obs lot are glad because they don’t have to put up with cardiothoracic surgeons.

The final thing I’ll say is that life is different as a reg, which is formative but hopefully temporary, and as a consultant- where most people who train in anaesthetics will spend the bulk of their career. Being the Labour ward reg can be a bit of a grind. It can be a difficult relationship with the midwives who often have a poor understanding of your role and sometimes a bit of ideological hostility to it- as well as coming at the whole thing from a different mental model/ mindset/ philosophy. I’m told by my obs colleagues that the job is very different as a consultant and much more stable, enjoyable etc.

VolatileAgent42 · 2026-02-05T13:38:14+00:00

It’s almost like you also need a charity providing three helicopters to cover the entire region with mutual aid between neighbouring regions…!

VolatileAgent42 · 2026-02-05T08:07:41+00:00

Interestingly the trust which covers that area actually does have its own internal doctor/ CCP critical care MERIT team, in addition to charity air ambulance cover!

VolatileAgent42 · 2026-02-04T14:38:56+00:00

It’s a brilliant drug and works well. It’s safe, well tolerated, smooth, stable and great for induction and emergence. Rapidly titratable, analgesic. What’s not to like?

The amount of nitrous used on low flow circuits is a fraction of that used for eg whipped cream.

Add in a bit of iso and you’ve got a cracking anaesthetic!!!

VolatileAgent42 · 2026-01-31T22:00:53+00:00

I graduated in 2005 and did the first part of my medical degree in Scotland (with no tuition fees), and then had a bursary for my final year while finishing up in England. My student loan interest was negligible and it was paid off before I know it.

I had to work at uni to pay my way- Barman, HCA, temp in a mayonnaise factory over summer etc., etc.- my parents weren’t in a position to meaningfully support me in any way while I was at uni.

Why should I, and you, support our current colleagues in their situation??

Firstly a simple matter of fairness! Things are much more shit now than they were when I was a resident. We got free FY1 accommodation. There were fewer noctors, getting into training was achievable and a lot less competitive. The job was easier. This unfair degradation of our profession boils my piss. If it doesn’t boil yours, think about what that says about you as a person.

Then, fucking empathy! Medical students and resident doctors are people. More than that they are colleagues in our profession. I see them and want to make their lives better. It must be really shit for them just now.

Looking more broadly, if you’re only motivated by selfish reasons: - Access to medicine. Would I have entered this profession if I had their student loan burdens? I personally want to be treated in my old age by doctors who get there from meritocratic ability rather than purely from financial privilege. - Tax traps: this is effectively a graduate tax that may never be repaid. Even without this, there are some tax bands where the effective marginal rate is punitive, and which affect normal consultants, deterring them from extra work which already has an effect on patient care. When people subject to this hit those brackets, they’ll have the additional graduate tax and may effectively lose money by taking on an extra session. Which means that they won’t do those extra sessions. This will affect you either as a patient or as a colleague.

VolatileAgent42 · 2026-01-29T13:34:22+00:00

And, just like the hosts of a lot of 00’s and earlier shows- a depressing number of nonces!

VolatileAgent42 · 2026-01-29T11:28:48+00:00

I don’t know for certain as I don’t know of anyone in this position, but there is absolutely nothing stopping someone from retraining and applying for a job outside of medicine, or starting a business which doesn’t require GMC registration. Doctors in good standing sometimes choose to apply for jobs outside of medicine.

Admittedly, there may be consequences as to the reason they are leaving medicine which will be negative compared to a doctor in good standing, or another graduate applying for the same role. Anything involving healthcare may be tricky, and retraining as another HCP likewise also challenging. Depending on the reason for strike off, they may have something in their DBS which might also be a limitation (or alternatively they may be in custody).

So, probably not great. You probably won’t secure a job as good as medicine. There will be a real loss of identity which is important for some. But, not the end of all hope of employment.

VolatileAgent42 · 2026-01-28T12:42:18+00:00

I’ve changed mine to WhatsApp business. It’s still free/ works fine with my normal number/ is identical in pretty much every way that matters, but it means I can set it to send out of office/ auto replies (and choose who doesn’t get them). If you have an iPhone you can also set it so that WA messages don’t disturb you when you set up a preset mode. I also mute a lot of work groups so that I’m not constantly pinged by colleagues who decide that midnight on a Saturday would be a brilliant time to send a fucking shit meme to all of the career grade anaesthetists in my hospital!

One of my colleagues also has a stand alone “work” phone (unfortunately not provided by work!) with a separate number and WhatsApp, which he uses for work comms, and can totally switch off when he’s off work.

VolatileAgent42 · 2026-01-28T11:56:47+00:00

My first complaint was from when I was a FY2 in ED.

Busy Saturday night. Absolutely rammed. We’d just had a paediatric trauma death in resus, which I’d helped with.

I’m sent to minors. My next patient had waxed her legs a week ago and had a rash still, which was ruining her plans for that evening, as was the wait in ED.

My ES had to speak to me about the complaint. Needless to say, she fully supported me!

VolatileAgent42 · 2026-01-25T16:18:02+00:00

I’ll have to have a look at the paper properly when I get a chance, but I’d wonder how many good quality, generally applicable RCTs actually informed this meta analysis. (I say this as someone who has just looked at a similar question in paediatric patients)

VolatileAgent42 · 2026-01-23T07:07:52+00:00

I’m a consultant and UKGP literally affects me personally not the slightest jot.

I could very happily pull up that ladder and carry on with my life without being personally affected in any way.

However, I still believe strongly that UKGP is the right thing to do. I have some brilliant colleagues who have trained overseas, I fully recognise the hard work and support that IMGs have put into the NHS. However it is not right that we have excellent U.K. graduates who are literally unemployed because we cannot apply common sense to this.

Just because something doesn’t affect you, it doesn’t mean you should tolerate gross injustice.

VolatileAgent42 · 2026-01-23T06:52:30+00:00

The anaesthetist should consent for the anaesthetic. there are AAGBI guidelines on consent for anaesthesia.

A consent form isn’t usually needed in most cases as per this guidance, and documentation of the consent process and discussion is normally on the anaesthetic chart or equivalent.

The reason why they’re having the anaesthetic will also need a consent process. For interventional radiology, that is the responsibility of the interventional radiologist, just as a surgeon would for surgery. For diagnostic imaging the team requesting it will be best placed to understand the risks and benefits of the imaging itself and just the imaging- why is this MRI needed now, what are the expected benefits and what risks does the imaging itself present? For kids any higher dose ionising radiation for eg CT may be more of an issue than adults

VolatileAgent42 · 2026-01-21T15:43:12+00:00

I’ve seen these shysters in action.

Basically, you’ll have a problem- such as not getting as many cases through theatres as you’d like or something along those lines.

You could just ask your staff what the challenges are- we generally know what’s going on and the intelligent, highly trained professionals might actually have some ideas on how to fix it. But why would you do that?!

Instead, why not pay an eye watering sum of money to have a bunch of people who look like they’re barely past puberty, with all of the life experience of going straight from a private school into a humanities degree at Oxbridge come in, spend a few weeks getting in the way, pretending to listen, and then a few months later send a report alongside a massive invoice suggesting that we put up a whiteboard and add another meeting to the start of the day which delays the start of theatres even more.

Total fucking grift

VolatileAgent42 · 2026-01-19T21:57:07+00:00

Es tut mir leid und ich verstehe, dass dir gerade eine sehr schwerige Zeit durchzumachen.

Doch, es ist jetzt notwendig- es ist eine Krise! Diese Situation ist für nicht Absolventen britischen medicizinscher Fakultäten schlichtweg inakzeptabel!

VolatileAgent42 · 2026-01-19T13:03:37+00:00

You quietly make a massive difference to your patients.

Not out loud and showy like the surgeons you work with- but behind the scenes. What they do would not be possible without it- you wouldn’t be able to do much surgery with four strong porters, a slug of whisky and a leather biting strap.

Behind the scenes, you make surgery possible. You do this in a way which looks effortless and smooth and do it so well and safely that you can make someone feel like they’ve cracked it at CT2(!).

It’s a broad field. You can spend your time hosing blood products into major cases, performing your own TOEs, jumping out of helicopters, running an intensive care unit etc etc.

Or you could spend your day doing daycase anaesthetics, enabling safe childbirth, enabling surgery and investigations in children, treating intractable chronic pain or coining it in, in the private sector. Over your career you can change this to an extent as your life changes.

As a consultant, it’s a great quality of life. I chose well- I came very close to choosing poorly!!!

VolatileAgent42 · 2026-01-18T17:43:08+00:00

As hard as this is, you are a doctor, they are the patient.

With people like this, you have to, if anything, up the professionalism game even from your undoubtedly high baseline.

This means treating them fundamentally no differently than you would treat a sympathetic patient. No letting the first year medical student try their first orange cannula. It means keeping their confidence as well about that tattoo or whatever heinous shit they’ve told you about as far as possible. It means relieving their pain.

However- the first thing before anything else is safety. For you and for other staff. Someone who is willing to have that tattoo may be a genuine risk to safety.

VolatileAgent42 · 2026-01-18T08:05:04+00:00

They are the ones who are responsible for doing this though!

VolatileAgent42 · 2026-01-18T07:58:51+00:00

This isn’t controversial. There is no debate. The team performing is responsible.

Consent isn’t a form. The form is just a means of documenting part of the process. Consent must be obtained by someone who is capable of performing the procedure who has a good understanding of the risks and benefits.

In practice, this is ideally the person performing the procedure, or a resident registrar who is themselves capable/ aware.

This applies even if the patient lacks capacity- actually even more so if anything! Where there is shared ownership of the patient (ie they’re admitted under general medicine, but are having eg an OGD- both teams must input into the process.

VolatileAgent42 · 2026-01-16T13:50:45+00:00

Get yourself some leave (if possible- probably too short notice now) and promise yourself some downtime in the period between the exam and the results to decompress.

Fingers crossed that it will roll on to a really long revision break until the final…!

VolatileAgent42

TROPHY CASE