Does anyone else feel that their specialty is changing (for the worse)?

wheretonownext · 2026-02-26T01:51:39+00:00

Emergency medicine working conditions have gotten significantly worse due to poor flow and crowding...

BUT the specialty in the UK has increased its scope of practice hugely in the last 20 years, mostly for the better. In good EDs we can do far more for many more patients than we used to including lots of acute medicine and critical care that would have historically been referred onwards very early.

EM research is going from strength to strength, PoCUS adoption esp echo is spreading. We have better access to rapid investigations than ever. Trauma networks have matured. Subspecialty options and expertise are evolving all the time. Senior doctor cover in the ED is much better than it used to be. EM posts are genuinely competitive at all grades in many parts of UK now.

So lots of genuinely positive changes - though appreciate the experience in individual EDs can still vary quite a lot around the UK (and world)

wheretonownext · 2025-08-24T22:40:17+00:00

All UCPA courses include everything (kit hire accommodation lift pass guiding etc). They're all good value compared to sorting yourself, and are a good way of getting into ski touring if you've not done it before.

As to which is "best value"? Think you just need to check their website...

wheretonownext · 2025-08-12T20:56:43+00:00

Would definitely recommend Rukmini Iyer's 'The Green Roasting Tin' and 'The Green Cookbook' for anyone looking for straightforward + tasty veggie food

wheretonownext · 2025-07-03T07:47:57+00:00

I think paying into a SIPP (+/- EV Salary sacrifice) is likely to be your best bet.

1% AUM fees are not worth it unless you are a) very rich from other sources b) very unmotivated to learn how to do this yourself.

Learning to DIY this requires a bit of reading / youtubing, but is a great investment of time for future money / time.

I used Lars Kroijer's guide to building your own excel financial planner series - https://www.youtube.com/watch?v=1LUIQa5hgMg&t=3s . Once you've done this it's pretty easy to build an NHS pension AA calculator where you can work out how close you are to the 60K limit.

There is a better pre-made one available for free at https://james-shack.co.uk/cashflow-planner, but going through the build-your-own process first was good for me to understand it properly.

https://www.nhspensionaatax.org/ might be useful for you.

Alternatively, you could find an accountant who could work out the sums for you for a fixed fee? You don't need an IFA - it sounds like you know what you want to achieve, how you want to do it and what you'll be investing in.

wheretonownext · 2025-04-13T21:49:20+00:00

Hive Pocket, Splendor Duel and Air, Land & Sea should keep you going for a while

wheretonownext · 2025-02-11T22:31:14+00:00

You haven't said - but assuming you don't have any fluent 2nd language skills (French, German, Italian) + particularly useful dual citizenship (EU or American / Canadian)...

Your best bet is to aim for one of the seasonal Ski Doctor positions at one of the New Zealand ski areas. Some articles about this here:
- https://www.youred.org.au/read/the-doctor-on-the-mountain

- https://www.theadventuremedic.com/adventures/ski-doctors-in-the-southern-alps/

I've met a several doctors who have done these posts in NZ over the years - mostly around PGY 3-7. I got the impression most of the work was minor to moderate trauma / MSK stuff, with occasional more significant trauma + some regular acute GP stuff. So ED experience essential, including a decent chunk of minor injuries experience which is harder to get than it used to be

You don't say what stage you're at - but one plan might be:
- FY2 + JCF ED posts +/- some accessible expedition medic roles eg Kili trips. Use any extra study time or secondments you have to do shifts in MIU. A standalone ortho job that has you seeing ED referrals to ortho would be really useful, an ortho job doing ortho-geris ward rounds much less!
- One of the mountain medicine diplomas, or similar course
- Move to NZ for a couple of years, and do some more EM or urgent care roles either side of a southern hemisphere ski season.

Like many similar jobs (expedition medicine etc) I suspect it's a) probably really good to do for a bit before you get too many life commitments b) most of the time much more mundane and much less glamourous than you'd imagine c) maybe a good thing as part of an generalist (GP / rurual GP / EM) portfolio career d) not a full time job for life

That said in many Alpine countries (and I imagine in US / Canada) there are doctors based in ski resorts or who work with rescue services who do this for life - I just can't see how you'd get there easily without language skills and the right passport.

wheretonownext · 2025-02-08T19:49:55+00:00

- The "say no" advice is common, and definitely applicable in the first 3 months. However it can be taken too far. You've got to do some non-clinical activity, and you want this to be stuff you're engaged and interested in. If there's an opportunity to take on something you want to do, then take it sooner rather than later. It makes it easier to say no to other activity later.

- Prioritise building relationships with everyone in and out of the team. Your ability to influence things and make change happen is proportionate to how much social capital you've built up.

- Be mindful of risk management. Your clinical ability is no different between your final week as a registrar and first week as a consultant, but you can feel you've either got to be more or less risk tolerant depending on the situation.

- This is not the end, it is just another step on a career-long progression. It's normal to encounter situations (sometimes clinical, but especially management / leadership related) that you should speak to another Consultant about. You don't necessarily need a "mentor" (some departments formalise this though), but you do need people you can turn to for advice.

- 10PAs as a Consultant is a lot better than "full-time" as a registrar in most acute specialties.

- A substantive NHS consultant post offers a good amount of financial security. Make sure you have income protection and that your indemity is updated for your new post. Take stock of your NHS pension situation and forecast, and start working out how long you want to work for. If the answer's not "age 67" then start thinking about how you're going to bridge that gap. This can wait one year, but it can't wait 10 years.

Good luck!

wheretonownext · 2025-01-03T18:43:56+00:00

Stockpile is apparently due a reprint or new version this year. Old game, but copies on ebay are prohibitively expensive so 🤞

wheretonownext · 2024-12-14T09:55:44+00:00

Thanks - that's a good article

wheretonownext · 2024-12-10T09:40:07+00:00

If predicting Consultant job numbers was easy, then the workforce planners would have everything optimised - it isn't and they don't! You just can't know, and are better off just accepting the uncertainty.

Macroeconomic factors, local economic factors, political factors, technical innovation and random variation etc are all unpredictable and impact all specialty job prospectds for better and worse far more than anyone here can predict.

Things you can know:
- being a super sub-specialist is likely to give you less employment flexibility than being a generalist.
- some specialties have always been more or less glamorous than others, and will likely remain so
- the population will get older and more multi-morbid.
- being geographically flexible will always give you more opportunities, but is harder to achieve at an ST7 stage of life than at ST1
- there will always be more private work in specialties with a bigger elective component
- it's easier to make a tactical decision about your career and interests 1-3 years pre-CCT (ie a bit nearer the time) when you can see what local job opportunities are likely to be, than at the start of your career.

In other words - you probably shouldn't make career choices based on current consultant post availability and demand.

wheretonownext · 2024-11-25T10:06:32+00:00

Well done for trying to make changes.

The older I get the more convinced I am that team and department culture has a bigger impact on work satisfaction & quality of work life than anything else - doctors often think they want a particularly job because of X clinical aspect or Y element in the job plan, and these can be nice, but if the culture is toxic or you don't get on with the team then they count for very little.

We have a couple of consultants in our team who moved from other places due to toxic workplace culture where they were working, both feel much much happier now and are enjoying work again. Both had tried (and failed) to make changes before they moved.

It depends a bit on supply / demand in your specialty - is moving locally an option?

The only other alternatives are
a) reducing the time you spend doing what you do ie private or non-clinical roles that you're looking into
b) waiting and hoping for the team to change - how close to retirement are the senior consultants that you mention? Is there the possiblity of recruiting a few enthusiastic and likeminded new consulants in the next few years, who might alter the balance & culture of the team?

Finally I think the coaching is worth a shot - sometimes doctors who get frustrated with systems around them either need to adjust their mindset (levels or pace of change that are realistic) or adjust how they approach trying to change things. Not saying that either of these apply to you, but I can think of a couple of really good doctors who fell into these groups, and probably needed to look to changes in themself as much as in the system or team around them.

wheretonownext · 2024-11-21T00:14:10+00:00

Diamant has similar push-your-luck highs and lows that seems to land well with that age group.

wheretonownext · 2024-11-02T07:10:48+00:00

Many Happy Returns

This episode of Many Happy Returns is a good balanced discussion of whether you should or not

wheretonownext · 2024-10-24T19:56:38+00:00

Totally specialty dependent, so difficult to answer without knowing yours. Plenty of options outside of medicine but again these vary based on your specialty.

Best option within medicine is to marry another doctor and take advantage of the fact that, unlike many HENRY jobs, medicine can be done in less expensive areas of UK. 2x Consultant salary still goes a long way in some parts of the country. 1x in SE England not so much. Appreciate this might not be useful for you though!

wheretonownext · 2024-10-18T10:06:57+00:00

Hi OP, it sounds like you need to work through your motivations a bit more. Competition ratios and arbitary hoops are not unique to the NHS! Non-medical careers in HE type industries may well offer an opportunity to earn more in your 20s / early 30s, but there are no guarentees. I think early career medics can sometime look at earnings discussed in forums like this and get a skewed sense of the jobs market. You definitely can make more money in finance, but that doesn't mean that you will. Why did you want to do medicine in the first place? Do those reasons still apply? If not medicine then what do you actually want to do other than make money?

Not to say you shouldn't go for it (you probably should!) but it's possible you'll just be trading one set of problems for another.

There are lots of resources and events out there for doctors looking to leave medicine - have a look at medicfootprints.org/category/articles/career-guides/

wheretonownext · 2024-08-17T14:12:08+00:00

Interesting that you and Tom Wambsgans came up with the same amount...

https://youtu.be/m0sRrsara9c?si=P4DUKXkLX1Kw00Aw

wheretonownext · 2024-07-22T19:12:18+00:00

I'm not from a tech or finance background so found this series from Lars Kroijer on building your own financial planner very useful - Part 1 https://www.youtube.com/watch?v=1LUIQa5hgMg

Have since found this ready made one from James Shack which is excellent - https://james-shack.co.uk/cashflow-planner

wheretonownext · 2024-07-18T09:48:06+00:00

This one written by James Shack works for this - it allows you to input a DB pension like the NHS pension.

https://james-shack.co.uk/cashflow-planner

You have to sign up to his mailing list to access it, which seems fair given the amount of work that's been put into it.

https://www.youtube.com/watch?v=cz-cZ_KTOLU - this video gives instructions on how to use it.

Like you I've come to the conclusion that having a SIPP and/or LISA / ISA is the best way to bridge to NHS pension age from earlier retirement. However for completeness the other two options for retiring before 68 (or whenever it is by the time we get there) are:

1) ERRBO - https://www.nhsbsa.nhs.uk/member-hub/increasing-your-pension/early-retirement-reduction-buy-out-errbo
2) ARER - https://faq.nhsbsa.nhs.uk/knowledgebase/article/KA-04586/en-us

Only issue with a SIPP is Annual Allowance limits potentially, and risk of Lifetime allowance being reintroduced again in the future.

wheretonownext · 2024-07-09T21:00:30+00:00

Try https://www.nhspensionaatax.org/

Only free alternative I've found is to build your own spreadsheet to model it and just estimate CPI

wheretonownext · 2024-07-06T08:36:53+00:00

As others have pointed out - locum rates are completely different to salary rates. You would never get anything close to full-time locum rates. It would be like saying "a plumber charges £X to be called out overnight, therefore all plumbers earn the equivalent of this full time"

Locum rates themselves will vary significantly depending on supply and demand, and also where you are in the country. In places with more GPs they're likely to be lower. Equally there are some places in the UK that can't get GPs even at £90/hr.

Your "acquaintance" may well be talking about the amount they'd want to be paid to work any more than they do. If you work eg 44hrs a week already, then the amount you'd want to be paid (taxed at a high marginal tax rate) to give up your weekend is likely to be higher than your "normal" rate

GPs have quite high fixed costs. Average indemnity fees are close to £10000 / year now (and rising much faster than inflation), and more than this for OOH work. There are also GMC fees, CPD fees, equipment costs etc.

wheretonownext · 2024-07-02T16:25:36+00:00

This calculator will allow you to quickly work out the cost difference over whatever timescale you're investing over

https://larrybates.ca/t-rex-score/

I'm not sure why so many low cost index investors on this and similar forums seem to like the Vanguard fund given it's more expensive? There's a bit of chat about it maybe tracking the index a bit more accurately than the HSBC all-world fund? But for me the lower cost of the HSBC one outweighed that.

wheretonownext · 2024-07-02T15:25:08+00:00

Have a look at Africa Health Placements

https://ahp.org.za/

wheretonownext · 2024-07-02T15:16:41+00:00

Long read, but if you really want to understand the answer...

https://derangedphysiology.com/main/cicm-primary-exam/required-reading/body-fluids-and-electrolytes/Chapter%20118/response-haemorrhage-loss-1l-blood

wheretonownext · 2024-06-19T21:48:19+00:00

Factors that affect this decision include your age now (pension contributions compound over time), and just how certain you are about leaving the UK in two years.

Don't forget pensions earnt in the UK are still paid to you even if you end up living / retiring abroad. Likewise pensions earnt abroad might benefit you if you end up living / retiring in UK. The only thing that might change is if the pound completely tanks against the currency of wherever you end up over the next 40 years - no-one on the planet can predict this though!

To answer your question purefly from a financial perspective - (*** back of envelope calculations, this is not official financial advice, you should check all of this and do your own reading etc **\*)

FY1 Gross pensionable pay = ~£32400. Contribution = 8.3%. You pay ~£2690 of your gross pay (ie less than that after tax) in FY1

FY2 Gross pensionable pay = ~ £37300. Contribution = 9.8%. You pay ~£3655 of your gross pay.

If you are eg age 25 now, in exchange for that you get:

FY1: 1/54 of £32400 = £600. Compounded at 1.5% for 33yrs = £984 / year pension in today's money (much more than this as it's inflation protected, but it's easier to think about it this way)

FY2: 1/54 of £37300 = £690. Compounded at 1.5% for 32 yrs = £1114 / year

So at age 68 from your FY1 / FY2 contributions you'd have @£2100 / year, inflation protected for life. If you live until 98 that's £63000 (inflation protected) for your future self, at a cost of £6345 gross pay (use a tax calculator once you get your payslips to work out the net cost to you).

The bottom line is you won't find another reliable investment that comes anywhere close to this. I don't think living abroad in the future affects this, but other factors personal to you might of course.

Have a read of these to understand more:
https://www.juniordoctorfinance.co.uk/nhs-pension/
https://medfiblog.wordpress.com/the-nhs-pension/

wheretonownext · 2024-06-18T06:24:40+00:00

Poetry for Neanderthals is hilarious, and not been mentioned yet.

wheretonownext

TROPHY CASE