IMGs

It is a very bad time to be an IMG in Britain. For those who don't know what this means, an IMG is an international medical graduate - someone who took their medical degree outside the EU area. Life is chaotic enough for all junior doctors at the moment with the new system called MMC, where everybody is given their jobs through a centralised computer system and there is an entirely new system of training, as I briefly ranted about before here. I am one of the few to be immune from this intensely stressful process, as the people already on a GP training scheme are able to complete it without having to apply for anything else. Click on this link to see how it's affecting someone else in the system. So there is an immense amount of uncertainty around for most people, but it is much much worse if you graduated outside the UK and Europe. In March of last year, with scarcely any warning, the Department of Health announced that it was abolishing permit-free training for doctors from overseas. In effect this means that if an applicant for a post is from the UK or EEA, and is competent for that post, the post cannot be given to a doctor from overseas.


There are many reasons for this. Historically, 30% of UK doctors have been IMGs, they could train in this country without a work permit due to our need for their skills and the shortage of UK trained doctors. In recent years the number of UK graduates has risen and the number of doctors coming in from abroad has also risen due to the popularity of the UK for training and the access to the assessment exams to work in this country. This in addition to the reorganisation of jobs for MMC has led to a lot of competition for posts. While most people agree that it is important for all UK trained doctors to be able to get a job in this country, and that the GMC should stop encouraging IMGs to come to this country by continuing to conduct the PLAB (Professional and Linguistic Assessment Board) exams, it is the effect on those doctors already here that seems deeply unfair.


Doctors from other nations who come here first have to pass the PLAB exams (which are expensive), then frequently have to work in non-training approved posts to get experience to get to the final goal - jobs approved for training which can then lead on to registrar and even consultant posts if they are very successful. Many doctors have been here for several years, moving around different SHO (senior house officer) jobs, working away from their families (especially if they are married to another doctor), moving around, living in hospital accommodation, uprooting their families and working difficult shift systems. Suddenly many of them feel that it has all been for nothing, they will not be able to get onto training posts, and many will probably have to leave the country and try to start post-graduate training again elsewhere.


I am pretty aware of these issues at the moment, as I am the only UK graduate working as an SHO in this psychiatry department at my current hospital. The other SHOs are all IMGs and they all have a very high level of stress at the moment. Some have been shortlisted for interviews, some have not. Most have spent at least some time on the internet in recent weeks looking at jobs in Australia. One is currently in Australia checking things out there. Others are chasing round gathering information for their interviews, trying to second-guess what the interview process will be like. Several have been ill. A young Pakistani doctor who was working in the UK, and involved in the legal challenge from BAPIO to the DoH's decision has recently commited suicide. It all makes me feel very guilty, both that my job is so safe because I am British and to be part of a country that would do this to people who have been helping to provide a service to our NHS for many years.

A Friend

Having moaned excessively here about having difficulty making proper friends at work due to all the moving around different jobs, I have now managed to make a friend after 9 days in my new job, and I feel that she will be a good one. She's the only other female SHO, she grew up in India, she is married with a little daughter, but lives apart from her husband during the week, so is effectively a single parent doing a full-time medical job in terms of her workload. Somehow we seemed to like each other straight away - kind of had to, being the only 2 girls, but today it well and truly leapfrogged the colleague-friend barrier due to a discussion about faith. I won't go into our whole discussion here, as it was a private one. Briefly, she is a Muslim, but with a lot of interest in Christianity and we found lots of things in common to talk about. Also chatted about recipes and skincare (which overlap each other a lot more in Indian culture than in ours - think I would like to try the crushed almonds and milk face treatment) and other girly issues. Am invited to go to her house soon and meet her daughter etc. Feel hugely encouraged about this - I know I sound a bit pathetic being so excited to make a friend, but it did feel special. Maybe partly because it wasn't some diffident British affair where we both gradually come to understand we are friends by little gestures and invitations and understandings. She just came right out and said she was happy to have met me and she has been praying for someone at work to talk to about her faith. After my general whining previously about friendships not ever going beyond the end of the six-month job, I propose to make sure that this one is different.

Middle aged Saturday

I am now officially old. Here is how I have spent my Saturday. I got up when mr me left to play football, spent the morning going food shopping, taking my bottles to the recycling bin and doing the washing. Then I had lunch while reading the paper. I spent the afternoon setting up my new compost bin and filling it with alternate layers of rotting apples from the bottom of the garden (where they fell from the tree in autumn) and paper from the shredder and then generally tidying up the garden. Then I got in and sat down with a cup of tea and a crossword, then called my parents, then got the washing in and had a conversation over the garden fence with my next-door neighbour about the weather, his chest and the garden. I have no plans for Saturday night except that maybe the bathroom needs cleaning!

I am maybe not quite as sad as this sounds. I did have plans last night (meal out with mr me for belated Valentine's day) and do have plans tomorrow night (friend's birthday), but I do feel a bit old and boring nowadays because owing your own house just seems to swallow your weekends, whether it's doing the garden, DIY or just trying to vaguely get on top of the housework. People keep telling me I should get a cleaner, and maybe they are right, but it just seems so appallingly middle class. However, the real proof that I am getting old is that I quite enjoyed the day- just pottering round on my own getting things sorted. I do like being out in the garden. I should just stop fighting it and give in to being middle aged.

(My garden, but taken in the autumn before I'd done much to it.)

Being a wife

On Sunday at church, one of my friends asked me whether I would be interested in a Bible study course for some married girls in the church about marriage and how we are all getting on with it. She asked me to bring the benefit of my experience, as I will be the longest married in the group. (It will be our 5th wedding anniversary this year.) Probably sounds like a bit of a cheesy idea, but I think it's a good idea to reasess these things from time to time and look at the foundations of a good marriage over again with some supportive friends. I agreed that I would like to be involved, but just thinking about it has set me off wondering how good I am at being a wife. The best book I read about marriage on our wedding preparation course was "The Mystery of Marriage" by Mike Mason. Bit highbrow, but a lot of interesting and good stuff about learning to put another person before yourself etc - can't remember all the details now - should probably buy the book and read it again. Just started thinking that I spend so much of the time at the moment being tired and a bit needy that I probably don't very often put mr me's needs first. Not helped by the fact that he is normally fairly undemanding himself. But surely I could be more creative in making him feel loved and special. To be completely honest, I normally spend more of the time thinking and daydreaming about what he might do for me, what he has and hasn't done recently to show me he loves me, rather than considering what his needs might be. We are both good at some stuff in marriage - we always have a date night once a week, we don't argue much and mostly in a non-destructive way, we are good at regular hugs and stuff. Think that this group will be good and helpful, but how much of a good example I am as a wife... I'm not sure at all.

talking for a living

Psychiatry so far is a little bit like falling into thick treacle. Have had to slow my brain right down so it doesn't particularly expect me to be doing something all the time. As I had been warned it is a completely different pace of life. But maybe it needs to be so you have time to process and deal with the volume of heartbreak or craziness that can come out of just one patient when you ask them everything about their life, which is pretty much what you have to do to take a psychiatric history. I know craziness is not a very politically correct word to use and I'm sure that sometime soon I will be saying "this person is suffering from paranoid delusions with a formal thought disorder due to drug-induced psychosis" with the best of them, but just now my immediate gut reaction seems to be "wow, this person is really mad". Think I will enjoy it, certain I will enjoy having more time for my life outside of work. I can even do my on-calls from home! Hoorah for being able to sleep in my own bed with mr me and just going in if I'm needed!

Has been wintry weather this week - snowed yesterday and there's a severe weather warning out again tonight, which has meant that me and my sister have cancelled plans to drive down and see my grandad in Hertfordshire this weekend. Maybe not strictly necessary, but I think he would have worried a lot about our journey. Much more so than if one of our husbands was driving us, I suspect. But then Grandpa is 89, so I suppose I may overlook his old-fashioned attitudes and not mind. Especially as mr me tends to be a much more confident driver than me, so I suppose he is right in a way. Anyway, we will rearrange to go down and see him soon. Will be nice to have a weekend with no active plans. Mr me had got used to the idea of having a weekend on his own, so perhaps I will go round to my sisters' and watch TV and drink wine...

rhinovirus

Well, I had a horrible cold over the weekend. Was feeling quite proud of myself for making it though the winter so far without one, especially considering I have been working in general practice, with a minimum of 3 people per day trying to persuade me that they need antibiotics for their cold. Came down with it suddenly and badly though, spending the first half of the weekend in agony with sinus pain and unable to sleep, and the second half sounding like Nina Simone, but not in a good way. Recovered rapidly just in time for work Monday - doh!

Felt guilty about being ill because this was the weekend we hired a floor sander to create a lovely wooden floor in our back bedroom, and meant that mr me (as he shall henceforth be known) ended up doing all the work. He thought the machine was too heavy for me anyway really, so I sat around helplessly mopping my nose and stuffing decongestants down my throat while he manfully pushed power tools around in his safety googles and ear protection. Didn't quite manage to get the edges done though, so some hands and knees work with some sandpaper and a block may be in order. (by me - I'm not going to make him do that, seeing as the whole affair was my idea).

Had also booked to go and see Sleeping Beauty by the St Petersburg ballet at the Alhambra in Bradford with my sister, and couldn't really cancel having paid for tickets, so I went, and probably deeply annoyed the people next to me with my explosive nose-blowing. Enjoyed the ballet, but was probably a bit more detatched than I would normally have been.

Left work today - took in some cakes and fruit to say thank you and presents for my trainer. Everybody was very nice saying goodbye to me and I deeply enjoyed throwing away large quantities of useless memos and drug company promotions, but was sad to leave. and found the whole thing a bit tiring. So there is an update on my not-very-exciting life.

Moving on...

One of the things I find difficult about being a junior doctor is the changing jobs. Just to explain my current training scheme... I started it in Feb 2006 and it lasts for 3 years, involving six 6 month posts. 3 are in hospitals, 2 in general practice and one half and half. So far I have done a job in A+E and am just coming to the end of my first general practice job. Next Wednesday (it's always a Wednesday - I'm not sure why) I shall start my new post in Psychiatry in a nearby hospital.

There are some good things about this system, but quite a few bad ones as well.

Good things:

• you don't feel stuck in a rut, and you keep learning new things.
• it makes you adaptable and better at getting on with people
• no problem seems quite as bad - eg you find a colleague difficult to deal with, you can say "oh well, I'll never have to see him/her again in a few months"

Bad things

• All the forms!!! Every 6 months I fill out a CRB form, a wages form, an occupational health form, a car parking form, a name badge form, and I have to show up with the same collection of important documents. This time I can't find my passport - not a good sign
• it is unsettling. my wages, my rota, my journey time all change every 6 months, not to mention what I do all day at work. this time my wages are going down. boo.
• because you know from the start, and so does everybody else, that you are only there for 6 months, you just don't invest emotionally in the job and the place as much as you would if it was permanent. and likewise people don't see you as a long term colleague or potential friend in quite the same way that they might if you were staying around. In hospital maybe the consultant never quite learns your name properly, or you don't fight quite so hard against the stupidity of the rota because as above, you know you only have to put up with it a bit longer by the time you've realised how rubbish it is. Or as in my current job in general practice, you're working with a team of people who know they'll probably be together the rest of their working lives. They know each others' families, habits, they remember weddings and births, mishaps, illnesses etc. And although they've all been kind and friendly to me, it's not the same and you can feel the slight (very slight) distance. It makes me sad and means maybe I don't expect to find lifelong friends at work. I think some people are better than me at this, maybe they live more in the moment, invest emotionally even though they know it's only for a short time, and are more likely to see colleagues outside of work and stay in touch afterwards. Maybe it is partly to do with the fact that I find initiating a friendship a little bit difficult. It's that step between "I like you and we chat about stuff and get on well" and "you are my friend and not just a colleague", that I find difficult to get over. Whether this is because of all the job changing, or whether I'm just using that as an excuse for my own hesitancy and insecurity I'm not sure.

Anyway, that was far too long for the content of a bullet point! I will be sad to leave this job - the people are all nice. Particularly enjoyable to rant along with the other doctors about the state of the nhs, the patients, hospital medicine - everybody except us really - at lunchtimes. Have got to know a few patients - some see me regularly as "their doctor" and I've never had that before. Have got used to finding out what happens to people instead of them vanishing off into the ether and never seeing them again, which is what happens in hospital medicine. Anyway, I could happily work here for longer. However, psychiatry sounds like it will be fairly relaxing, I had some good feedback from my GP trainer today, so there's not too much to grumble about. I can cope with moving on.