Inc. date 5 Aug 2015 PT sal/wage 22636.00 NI number JD354523D 1 2 Amount 4 1886.33 Amount 494.22 6 Description Basic pay 7 Banding supplement 754.53 NI 219.05 5 NHS Pension Mess fee 169.77 6.00 8 Student loan 119.23 9 This period summary Pensionable pay 1886.33 Pay date 26 March 2015 Pay method BACS Taxable pay 2471.09 15 Total payments 2640.86 Total deductions 1008.27 Gross pay Taxable pay 10 12 13 Tax paid NI letter D 11 Pension conts 14 Employee number 16 17 18 NET PAY 1632.59 1 This is the total annual basic salary for your pay point. Latest updates are released as Pay Circulars on the NHS Employers website (cid:27) www.nhsemployers.org 2 This is the date when you are next due to go a point up the pay scale, usually 12 months of full time employment after your previous date (or date of first starting working as a do ctor). When changing trusts mistakes can be made so always check this date is correct. 3 Your tax code shows the amount of income you are entitled to earn in the current tax year that you do not pay any tax on. This figure should be multiplied by 10 to give your total allowance. This will be the basic personal allowance for the tax year, as set by the govern ment, adjusted to take account of any under- or over-payments you may have made in previous years. Each tax year runs from April to April. After your first tax year in paid employmen t, you will receive a P60 summarizing your tax paid during that year with the code that sho uld apply to you in the next tax year. A copy should also be sent to your trust, but if you move trusts around this time, the new trust may not receive the correct information unless you show them your copy of the P60. If your new trust does not know the correct code for y ou, they will use an emergency code, set as the basic personal allowance, which may or ma y not be correct. The letter after the code should be an L unless very specific circumsta nces apply to you. See also (cid:27) www.hmrc.gov.uk 4 This will be approximately 1/12 of your annual salary. 5 6 Under the Pay as you earn sc heme (PAYE), your trust will automatically deduct your tax from your income each month. Bot h your basic pay and your banding supplement are taxable. In your first few months of emplo yment, you may not pay any tax until your income has risen above the personal allowance for that year. Enjoy this while it lasts! If you receive a banding supplement, it will appear here (see Table 1.6). 7 National Insurance contributions pay for certain state benefits, including your state pen sion. These are not optional, and will be deducted automatically, according to thresholds. The current rate is 9% of income over 149/week, though this is subject to annual review. 8 The NHS pension scheme remains a very good deal, although terms and conditions have been changed significantly in recent years and are subject to further negotiations. Your pension contributions are not taxed and will also be deducted automatically according to various earnings thresholds, unless you o pt out of the scheme. Pension contributions are calculated from your basic pay - your bandi ng supplement is not subject to any deductions. See also (cid:27) www.nhsbsa.nhs.uk/pension s 9 Any loan you have taken from the Student Loans Company will enter repayment in the April of the first year after you graduate in which your gross pre-tax income rises above a threshold (currently 16,365). A ny earnings should be deducted automatically at 9% of earnings above this threshold. You ca n choose to repay faster if you wish. Keep a record of all repayments you make and check th em against your annual statement - errors are common when changing trusts. Payments that ap pear to have gone missing can be credited to your account easily if you can provide a copy of your payslips. See (cid:27) www.studentloanrepayment.co.uk 10 The numbers in this section will keep a tally of your total payments from that employer during the current tax year. If you change trusts, the numbers will be reset, but your tax thresholds should not be. 11 Your NI letter reflects the contribution group you fall into. For almost all of those in the NHS pension scheme, this will be D . 12 Pensionable pay does not include any banding supplement. 13 Pay dates will vary between trusts but are generally around the last Thursda y in the month. It can be difficult to get paid on time at the start of employment with a new trust. 14 Trusts will transfer the money into your bank account by BACS transfer. These can take u p to 3 working days. 15 Your taxable pay includes your basic pay and your banding supplemen t, less any pension contributions. 16 Don t get too excited by this number \200 17 \200 a nd try not to get too sad about this one \200 18 \200 because this is what you re going t o have to spend until next month comes around. _OHFP.indb 39 _OHFP.indb 39 30/05/2014 16:17 30/05/2014 16:17 40 CHAPTER 1 Being a doctor Money and debt As the average medical graduate debt now exceeds 24,000, and rising fast, fi nancial management priorities have changed. This section is not compre- hensive but aims to give some important pointers and warnings. Debt clearance Most graduates have three diff erent types of debt: (1) Short-term high-inte rest debts (eg credit cards overdraft, if at full charge). Pay these back fi rst and as fast as possible. Try not to extend them just be cause you have an income (2) Medium-term commercial loans (eg a high street bank graduate studies loan). These should be paid back next, as spare funds allow (3) Student-loans at very low rates of interest \200\223 pay these back last. Pay close at tention to the annual percentage rate (APR) and charges attached to any loan arrangement. I nterest-free loans or credit cards can help in the short term but ensure you don \200\231t get saddled with a high APR later. Loans are a competitive market so shop around \200\223 especially for something like a car loan where the car dealer rarely off ers the best rate. Think \200\230total cost \200\231 not just \200\230monthly repayments \200\231. Some basic rules for \201 nancial planning \200 Short term Clear debts with the highest interest as soon as possible \200 Medium term Try to accumulate about one month \200\231 s salary as \200\230emergency \200\231 savings Long term The NHS pension scheme remains the best available at present and you will be auto matically enrolled in it unless you opt out. With this taken care of, you could think about trying to save for the deposit on a property (even if just 100/mth). With interest rates currently low, home ownership is an attractive option if you can raise a deposit. Bear in mind that there are large up-front costs to house buying (eg legal fees, stamp duty), you w ill be responsible for all maintenance and will not be able to take the property with you w hen you move to another part of the country. Financial advice Since you now have a salary increasing every year and virtually guaran- te ed for life, fi nance companies will swarm round you like wasps round jam. Beware of some v ery slick sharks \200\223 their aim is only to get you to buy their products. There is no altruism here: \200 Truly independent fi nancial advice is hard to obtain \200\223 ask h ow independent they really are Firms must now show what commission will be received for any product you choose, both to the individual who sold it to you as well as to their company Do not buy from the fi rst or most persuasive salesperson, but take your time to consider what you really want and need. Financial and other products Critical illness cover and income protection See b p11. Check if it still pays if you are capable of doing a less demanding job. Check if it pays for all conditions you may get at work. OHFP.indb 40 OHFP.indb 40 30/05/2014 16:17 30/05/2014 16:17 41 MONEY AND DEBT Life insurance Pays out a lump sum if you die; only really makes sense if you have dependan ts. Pension The NHS scheme is getting more expensive but still better than commercial alter natives. You should revisit your retirement planning at regular intervals through your care er. You will also receive a state pension through your NI payments. You will also receive a state pension through your NI payments. BMA Protection for non-clinical matters, eg wrong salary or poor accom modation; the trade union for doctors. Tax Now that you are earning a salary you will be paying tax. Most will be collected by PAYE (Pay As You Earn). If you hav e no other sources of income then you can leave it at that. If you have any other income th en you should ask for a tax return and complete it. Tax codes See b p39. Tax deductible It is possible to claim back the income tax you paid on: \200 Job-related expenses (eg steth oscope); make sure you keep receipts \200 Professional subscriptions eg GMC, BMA, MDU/MPS , Royal College \200 Examination fees and course fees (previously not deductible, but HMRC has relented on this since 2012). Tax reclaims may be made through full self-assessment, but this is not essential. If you pa y tax through PAYE, simply send a letter to HM Revenue & Customs, Pay As You Earn, PO Box 1 970 stating your name, NI number and detailing your professional expenses as listed above. You must also include details of any additional, undeclared income, including cremation for ms. Your tax code for subsequent years will be adjusted accordingly. Tax returns A tax retu rn is an online form asking for details of all the money you have received which may have t ax owing on it. This includes your salary and other income whether earned (eg locum shifts or crema- tion fees) or unearned (eg lodger/fl atmate, bank interest and dividend yields). \200 If you are asked to complete one then obtain a Government Gateway ID (www.gov.uk) an d password. This takes time, don t leave it until January Fill it in on-line and the math is done automatically \200 Return it after 1st February y ou will be fi ned 100/6mth plus interest \200 Claim your deductible allowances but also list your additional income. The Inland Revenue has been known to ask an undertaker to lis t all pay- ments to doctors and then cross-check. If your tax is simple then tax returns ar e not hard to do, otherwise pay a company/accountant to do it for you. Documents to keep safe for at least 7 years \200 P60 \200\223 sent every April to all em ployees \200 P45 \200\223 sent to you every time you change trust \200 Pay slips \200 \223 issued every month \200\223 if electronic, then save copies \200 Record of addition al income \200\223 eg locums \200 Annual interest statements from bank, savings/shares \200\223 issued annually. _OHFP.indb 41 _OHFP.indb 41 30/05/2014 16:17 30/05/2014 16:17 42 CHAPTER 1 Being a doctor NHS entitlements As a doctor working in the NHS you have certain entitlements, defi ned und er your \200\230Terms and Conditions of Service \200\231. Those relating to salary are dis cussed in \200\230Pay and contracts \200\231 (b p36). Others are listed here. Your fi rst point of contact for any questions is your local medical staffi ng department and the Found ation school. Always ask for copies of their written policies. Accommodation \200 Doctors in their fi rst year after graduation are no longer entitled t o free accommodation at their employing trust, except in Wales \200 Rooms may well be avail able on site at a market rate and can be useful when attached to a trust for a short period that would otherwise make fi nding lo cal accommodation diffi cult. Leave entitlement \200 You are entitled to a total of 27d/yr of paid leave or 9d/4mth. Yo u are also entitled to all bank holidays in addition \200\223 or compensatory days off if you are scheduled to work on any part of a bank holiday \200 If a compensatory day off eg after working nights, or pre-allocated annual leave falls on a bank holiday, you are entitled to an extra day off \200 You are rarely a llowed to carry leave over between jobs/years \200 You will usually need to give 6wk noti ce for leave not pre-assigned; arrange this in good time and have your form signed by your consultant \200 Many posts ha ve \200\230fi xed leave \200\231 instead of allowing you to choose when to take it. Swaps are often diffi cult; ask your consultant or colleagues \200 If you need leave in a upcom ing post (eg getting married), write to let them know. Ask for the rota position which is o ff for those dates \200 Study leave entitlements vary between Foundation schools, with so me counting mandatory teaching sessions as taking place during study leave. Check local pol icy and discuss requests with your educational supervisor. Maternity/paternity leave \200 All women are entitled to up to 52wk of maternity leave an d must be allowed to return to work after this. Those who have worked for the NHS for 26wk by the 15th wk before their due date are entitled to statutory maternity pay (SMP) of 90% o f full pay for 6wk, and at 136.78 for 33wk (39wk total). In addition, if you have worked for the NHS for 12 continuous mth by the 11th wk before your due date, you receive occupati onal maternity pay for 8wk at your full time salary (during which you don t receive SMP) an d 18wk at half pay (alongside SMP payments) \200 Fathers are currently entitled to up to 2wk paid paternity leave if they have worked for over 6mth. New regulations relating to the transfer of parental leave between parents are due to come into force and you should consu lt local policies If you are absent from your F1 or F2 post for any reason for >4wk, you are unlikely to be s igned off and will need to arrange to complete your training on your return. For practical reasons, your foundation school may ask you to repeat the whole year \200\223 ask your edu cational supervisor. Less than full-time/ \202 exible training \200 Foundation Program doctors are entitled t o train less than full- time if they have a valid reason A comprehensive list of valid reasons (eg having a baby or ill health) and advice on how to apply is available from your Foundation school. OHFP.indb 42 OHFP.indb 42 30/05/2014 16:17 30/05/2014 16:17 43 SPECIALTY TRAINING Specialty training After the FP you need to apply for specialty training. You have three main choices: \200 Specialty training (ST) or Core-training (CT), the majority of junior doctors will choose this route Academic clinical fellowship (ACF) for those interested in research (b p64 and www.nihrtcc. nhs.uk) The recruitment process takes place earlier in the year than for other posts so tha t those who are unsuccessful are not disadvantaged from applying to regular ST/CT posts Locum appointment for Training/for Service (LAT/LAS) single-year posts for specialty traini ng for those who cannot commit to, or are unable to secure, a formal training rotation. LAT posts can count towards formal training requirements whereas LAS will off er experience bu t no formal training recognition. Posts are advertised and appointed locally, and may only be available in a highly restricted number of specialties. Routes to CCT The ultimate goal of all training programs is the awarding of a Certifi cate of Completion of Training (CCT). This qualifi es the doctor for entry to the Specialist or GP Register held by the GMC and entitles them to work as a consultant or GP. After leaving the foundation pro- gramme, there are two distinct paths to CCT: Run-through training In ce rtain specialties (eg pediatrics, GP, neurosur- gery) competitive entry at ST1 leads to a 4 \200\2238yr run-through pro- gramme in one region (up to ST8 in some specialties), with no further competition points. Core training In other specialties (eg medical training, mos t surgical specialties) competitive entry for core training leads to a 2 \200\2233yr cor e training . Successful completion of this entitles the doctor to apply on a competitive ba sis for higher training (ST3/4 and above) in a related sub- specialty, leading to CCT. Such specialties are said to be uncoupled . The job titles for core-training are CT1, CT2 (and CT3 where used) depending on the year of training. If you apply to an uncoupled specialty, you will initially train via one of these routes: \200 Acute Care Common Stem programs ( ACCS b p46 \200\223 3 years) \200 Anesthesia \200 Core Medical Training (2 years) \200 Core Psychiatry Training (3 years) \200 Core Surgical Training (2 years) \200 Bro ad Based Training (2 years) \200\223 a structured, core training program newly introduced in 2013 and only available in a few regions; placements in medicin e, GP, psychiatry and pediatrics lead to entry at CT2/ST2 level into 1 of these programs, w ithout further competition and in the same region. CESR For those who do not follow a straightforward career path through to CCT, periods of t ime spent in training posts and experience gained may all be taken into consideration as pa rt of an application to the GMC for a certifi cate of eligibility for specialist registrat ion (CESR). This route is especially useful for those who have spent considerable time ove rseas. _OHFP.indb 43 _OHFP.indb 43 30/05/2014 16:17 30/05/2014 16:17 44 CHAPTER 1 Being a doctor Specialty training applications Recruitment process The application process varies between specialties and is rapidly evolving. Most recruitment is organized nationally by the approp riate Royal College or a lead LETB using a web-based application system. A small number o f specialties still recruit through local applications. There is no limit to the number of specialties you can apply to, providing you fulfi l the eligibility cri- teria set out in t he person specifi cation . Begin preparing well in advance. \200 Choose a specialty/spec ialties (b p51) considering person specifi cations and competition rates available at specialtytraining.hee.nhs.uk Check your eligibility for applying to a training program eg GMC registration, right to work in the UK, language skills, prior experience Find suitable jobs (b p50) These will be advertised by recruitment offi ces according to a nationally agreed timetable Complete the application form paying close attention to deadlines. For several specialties, a single online application portal called Oriel is being developed Wait As applications are reviewed applicants are shortlisted for interview; in certain spec ialties (eg GP) a further assessment is used in shortlisting Interview/selection center (b p56) You should receive at least 5d notice, but this is not a lways adhered to; you need to bring a long list of supporting documentation, including your portfolio (b p18). Formats will vary between a traditional panel based interview (eg core training programs) or performing a number of exercises in front of assessors (eg GP) Off ers are made electronically through the UK off ers system according to a coordinated ti metable. You will be asked to rank all LETBs where you would accept a job; successful appli cants are then allocated to LETBs in score order (you will be allocated to your highest pre ference that still has places when your turn comes). You then have 48h to review off ers an d decide whether to accept, hold, or reject. You may also elect to receive automatic upgra des if a higher ranking choice becomes available Re-advertisement to unfi lled posts will take place in a 2nd application round. If you accept a job in round 1, you may still apply for a diff erent post in round 2 , but you need to inform all those concerned \200 Employment checks and contract signing \200\223 remarkably NHS employers claim to need up to 2 months after you start work to get around to issuing a contract and some manage to miss even this. Speak to your BMA represen tative in the event of contract problems. Unsuccessful applications \200\230If you can trust yourself when all men doubt you, But ma ke allowance for their doubting too If you can dream \200\223 and not make dreams your master If you can meet with Triumph and Disaster And treat those two impostors just th e same Yours is the Earth and everything that \200\231s in it, And \200\223 which is m ore \200\223 you \200\231ll be a Man, my son! \200\2311 The nature of a competitive jobs f i eld, is that not everyone will get their fi rst choice post on fi rst application. In thi s instance, a miss and a mile are very diff erent entities and it is important that you ask for feedback to establish how far wide of the mark you were and whether you need to consid er an application to a less competitive specialty. Discuss your options with your clinical and educational supervisors. Look and ask around for LAT and LAS posts advertised locally, and consider how else you may enhance your CV. 1 Rudyard Kipling (1865 \200\2231936) \200 \230If \200\231, fi rst published in \200\230Rewards and Fairies \200\231 (1910). OHFP.indb 44 OHFP.indb 44 30/05/2014 16:17 30/05/2014 16:17 _ _ O O H H F F P P i i n n d d b b 4 4 5 5 C a r e e r Academic career Consultant GP Clinical lectureship GP Registrar s t r u c t u r e Specialist training ST3/4 onwards Academic clinical fellowship Specialist training ST1 \200\223ST2/3 GP training GP VTS Core training CT1 \200\223CT2/3 LAT/LAS F2 F1 C A R E E R Medical school S T R U C T U R E Fig. 1.2 Career structure for NHS doctors. 4 5 3 3 0 0 / / 0 0 5 5 / / 2 2 0 0 1 1 4 4 1 1 6 6 1 1 7 7 : : 46 CHAPTER 1 Being a doctor Specialty training options There are 23 diff erent training schemes that an F2 can apply to (shown in Table 1.4). On top of these there are: \200 Academic clinical fellowships in m ost specialties with separate nationwide application procedures that take place in advance of the main recruitment process, so that unsuccessful candidates can still apply for a regu lar training post. Most ACFs allow for run-through training, even in specialties where unco upling is the norm LAT/LAS posts in many specialties (generally just in run-through specialties). Applications may take place alongside or after the main application process at any point through the ye ar. Acute care common stem (ACCS) For trainees with an interest in acute specialties ACCS provi des a core 2yr experience in acute medicine, anesthetics, emergency medicine, and critical care, with a further training year spent in one of three streams (acute medi- cine, anesthe tics, emergency medicine). Choice of stream is determined at the point of application to AC CS. Although the curriculums and competences gained are transferable between ACCS streams, it is not possible to move between career paths without further competitive selection. \200 Acute medicine CT1 and CT2 in ACCS specialties then a CT3 year spent in acute medicin e. At the end of CT3 it is theoretically possible to switch specialties from acute medicine to a General Internal Medicine specialty Anesthetics CT1 and CT2 in ACCS specialties then an extra CT2 year of anesthetics; competitive entry to ST3 anesthetics requires having passed the Primar y FRCA (b p57). Anesthetics can also be applied for directly as a 2yr core-training program Emergency medicine CT1 and CT2 in ACCS specialties then a CT3 year of emergency medicine; c ompetitive entry to ST4 emergency medicine requires having passed the MCEM (b p57). General Practice Specialty Training General practice has run-through training coordinated t hrough a nation- wide application. The application consists of four stages: \200 Applicat ion form (establish eligibility) \200 Computer-based testing (clinical problems and profe ssional dilemmas) \200 Assessment center selection (communication and written exercises) \200 Job allocation and off er. Successful applicants undertake 18mth spent in hospital s pecialties, fol- lowed by 18mth as a GP registrar during which the MRCGP must be completed to join the GP register and get a job. Core Surgery/Core Medical Training These are popular uncoupled training schemes. You apply for core- training, with most deaneries allowing a choice of specifi c rotations only after successful appointment into post. After 2yr of core-training (CT1 \200\223 CT2) there is a competitive application for ST3 in a specifi c surgical or medical specialty. To apply for ST3 in surgery you need full MRCS; for medical ST3 posts you need Part 1 of MRCP to apply, but need full MRCP by the date of starting your ST3 post. It should be possible to apply f or specialties other than those in which you did your core-training if you can demonstrate appropriate competences; it helps if you can arrange taster weeks, audit or research in the subspecialty you are applying for. OHFP.indb 46 OHFP.indb 46 30/05/2014 16:17 30/05/2014 16:17 47 SPECIALTY TRAINING OPTIONS Table 1.4 Specialty training programs at CT1/ST1 (2014)1 Specialty Recruitment contact details Run-through specialties Academic clinical fellowships Cardiothoracic surgery Health Education Wessex (cid:27)wessex .hee.nhs.uk Chemical pathology Emergency medicine2 Health Education Yorkshire & the Humber (cid:27)yh.hee.nhs.uk General practice National Institute for Health Research Trainees Coordinating Center (NIHRTCC) (cid:27)www.n ihrtcc.nhs.uk Local recruitment \200\223 see individual deanery websites National Recruitment Offi ce for GP Training (cid:27)gprecruitment.hee.nhs.uk Histopathology London Shared Services (cid:27)www.londondeanery.ac.uk Medical microbiology NHS Education for Scotland (cid:27)www.nes.scot.nhs.uk Medical virology NHS Education for S cotland (cid:27)www.nes.scot.nhs.uk Neurosurgery Health Education Yorkshire & the Humber (cid:27)yh.hee.nhs.uk Royal College of Obstetrician s and Gynecologists (cid:27)obsjobs.rcog.org.uk Obstetrics and gynecology Ophthalmology MaxFax surgery2 Health Education South West (cid:27)southwest.hee.nhs.uk Health Education South West (cid:27)southwest.hee.nhs.uk Royal College of Pediatrics and Ch ild Health (cid:27)www.rcpch.ac.uk Pediatrics and child health Public health Health Education East Midlands (cid:27)em.hee.nhs.uk Clinical radiology London Shared Services (cid:27)www.londondeanery.ac.uk Sexual health Health Education East of England (cid:27)eoe.hee.nhs.uk Uncoupled specialties ACCS \200\223 Acute medicine Royal College of Physicians (cid:27)www .ct1recruitment.org.uk ACCS \200\223 Anesthetics Health Education West Midlands (cid:27)wm.hee.nhs.uk ACCS \200 \223 Emergency medicine Anesthetics London Shared Services (cid:27)www.londondeanery.ac.uk Health Education West Midlands (cid:27)wm.hee.nhs.uk Broad-based training Health Education North West (cid:27)nw.hee.nhs.uk Core medical training Royal College of Physicians (cid:27)www.ct1recruitment.org.uk Core su rgical training Health Education Kent, Surrey and Sussex (cid:27)kss.hee.nhs. uk and (cid:27)www.surgeryrecruitment.nhs.uk Core psychiatry training Health Education North West (cid:27)nw.hee.nhs.uk 1 From (cid:27)specialtytraining.hee.nhs.uk \200\223 this website is the best starting poi nt. 2 New programs being piloted in 2014. Person speci \201 cations These list the required competences for that specialty. In makin g an application, you will need to provide evidence to prove that you have achieved the spe cifi ed competences. Consult these as soon as you anticipate an application to a scheme so that you can see what you need to do. Full details are available at (cid:27)specialtytraini ng.hee.nhs.uk If you are applying for an Academic Clinical Fellowship (ACF), you will need to meet the criteria in both the clinical person specifi cation for your chosen specialty a nd level and the ACF person specifi cation. _OHFP.indb 47 _OHFP.indb 47 30/05/2014 16:17 30/05/2014 16:17 48 CHAPTER 1 Being a doctor Specialty training competition Competition for diff erent specialties varies, as does compe tition for the same specialty in diff erent parts of the country. Competition ratios are published annually to allow applicants to view the previous year \200\231s ratios. These typically show the number of applications received for each special ty and the number of posts available; a competi- tion ratio is derived by dividing the form er (number of applications) by the latter (number of posts). This ratio roughly represents the number of people applying for each available post (see Table 1.5). Only the highest scoring candidates will stand a chance at getting a job in specialties wit h a high competition ratio; for specialties with a lower compe- tition ratio the applicant must still meet the minimum requirements for the job to be off ered it. Remember that appli cants can apply for multiple posts so the actual chances of getting a job are higher than t he ratio shown. In previous years, applicants have had to factor in not only competition ratios by specialt y, but also by deanery. The move to national recruitment has removed this element \200\223 you can rank all deaneries/LETBs where you would be prepared to accept a job without disad vantaging your chances in any one region. After completion of the assessment process you wi ll be ranked nationally, and assigned to your highest choice deanery that still has a vacan cy when your turn in the queue comes. That said, it is important to consider what your own priorities are. If you are adamant tha t you want to stay in one particular area of the country, you may need to recognize that th e area may be very popular (eg London). Are you happy to pick a less popular specialty to i ncrease your chances? Equally, if you are determined that you want to enter a highly compet itive specialty, are you willing to pick a region potentially miles away from your current home as the competition there is much less? These are decisions which should be talked thro ugh with friends, family, mentors and your edu- cational supervisor. Specialty training in the UK Although applications to specialty training are coordinated th roughout the UK, within each of the four countries a degree of local structure remains. \200 England specialtytraining.hee.nhs.uk \200 Northern Ireland www.nimdta.gov.uk \200 Scotland www.scotmt.scot.nhs.uk/ \200 Wales www.walesdeanery.org OHFP.indb 48 OHFP.indb 48 30/05/2014 16:17 30/05/2014 16:17 49 SPECIALTY TRAINING COMPETITION Table 1.5 Competition ratios for CT1/ST1 applications (2013)1 Competition Ratio Fill rate Specialty Applications Posts ACCS \200\223 Emergency medicine Anesthetics Broad-based training Cardiothoracics Radiolog y Core medical training Core psychiatric training Core surgical training GP Histopathology Microbiology and virology Neurosurgery O&G Ophthalmology Pediatrics Public health 534 203 2.6 100% 1189 429 68 751 3088 650 1296 6447 154 108 183 591 323 793 602 478 52 6 185 1209 437 676 2787 120 21 37 204 71 360 70 2.5 8.3 11.3 4.1 2.6 1.5 1.9 2.3 1.3 5.1 4.9 2.9 4.5 2.2 8.6 100% 82% 100% 100% 100% 89% 99% 99% 61% 90% 89% 100% 100% 100% 97% 1 From (cid:27)specialtytraining.hee.nhs.uk \200\223 visit website for most recent data. D ata is not avail- able for all training programs. Applications and posts are for Round 1 on ly and do not count subsequent re-advertisements. Competition ratio represents the number o f appli- cants per post \200\223 bear in mind that candidates may apply for multiple train ing posts. Fill rate is the fi nal number of posts in each specialty that were fi lled \200\223 including appointments made in additional rounds of re-advertisement. _OHFP.indb 49 _OHFP.indb 49 30/05/2014 16:17 30/05/2014 16:17 50 CHAPTER 1 Being a doctor Choosing a job Once you have secured a training rotation, you still need to choose which sp ecifi c jobs to do. There are also jobs outside of specialty training rotations (such as LA T/LAS posts) that have a local application process. This page gives ideas about how to fi n d and choose jobs. Priorities Before looking for a job, write a list of factors that matter to you in making this potentially life-changing decision. Important consid- erations inclu de: \200 Partner/spouse Can they get a job nearby? \200 Location Could you move? How fa r would you commute? \200 Family/friends How far away are you willing to go? \200 Caree r Is the job in the right specialty/specialties? \200 Duration Can you commit to several years in the same area? \200 Rota/pay What banding and rota do you want or need? \200 T ype of hospital Large teaching hospital vs. district general. If you have no fi rm career i ntentions then choose by location and rota since these will aff ect your life most over the next few months. Look for suitable jobs on (cid:27)www.jobs.nhs.uk, (cid:27)specialtytrain ing.hee.nhs.uk, deanery websites, or the BMJ. Job off ers A national timescale for FP and S T/CT job applications exists whereby all job off ers are made at the same time. This allows you to accept the highest ranked job that you applied for. Bear in mind that you cannot ch ange your job rankings after submitting your application. Competition Medical jobs are competitive; it is important to maximize your chances of getti ng a job. Apply for several specialties; rank as many regions as possible; check competitio n ratios and person specifi cations (b p49, (cid:27)specialtytraining.hee.nhs.uk); consider a back-up choice, eg a less competitive specialty or region. A good CV also helps (b p54). Researching a job Adverts rarely give a true refl ection of a job. Phone up hospitals withi n the region and ask to speak to the person doing the job at the moment. Quiz them on the t ypes of placements available, hours, support, teaching, conditions, and what their intervie w was like. Would they accept the job again? Contacts With human resource departments and structured inter- views, the days of jobs bein g just a consultant phone call away have gone. There is no doubt that some networking still occurs, with mixed results. Senior contacts are useful for tailored career guidance, CV ad vice, and giving realistic views of where your CV can get you. Accepting a job With a move towards unifi ed, online application processes, strict and auto mated rules are essential to ensure a rapid and fair allocation to posts. In order to allow for choice, under certain circumstances it may be possible to accept, or hold, an off er, and later upgrade, or apply to a diff erent post, providing you notify all those con- cerne d. Outside of this formal process, it is unacceptable to turn down a post you have already accepted unless you have an extremely good reason. The GMC take a clear position on your ob ligation to protect patient care by not compromising the recruitment process in this way, t hough notice periods vary by seniority. OHFP.indb 50 OHFP.indb 50 30/05/2014 16:17 30/05/2014 16:17 51 SPECIALTIES IN MEDICINE Specialties in medicine The Certifi cate of Completion of Training (CCT) can be awarded in numerous specialties shown as follows. A selection of subspecialties are also shown with bu llet points: Allergy Anesthesia Immunology Infectious diseases Intensive care medicine Medical microbiology and virology Me dical oncology Medical ophthalmology Medical psychotherapy Neurology Neurosurgery Nuclear m edicine Obstetrics and gynecology Pediatric anesthesia \200 Obstetric anesthesia \200 Pain management Acute medicine Audiological medicine Cardiology Cardiothoracic surgery Chemical pathology C hild and adolescent psychiatry Clinical genetics Clinical neurophysiology Clinical oncology Clinical pharmacology Clinical radiology Materno-fetal medicine \200 Gynecological oncology \200 Urogynaecology Occupational med icine Old age psychiatry Ophthalmology Oral and maxillo-facial surgery Otolaryngology (ENT surgery) Pediatric surgery Pediatrics Interventional radiology Dermatology Emergency medicine (EM) Endocrinology and diabetes Forensic psychiatry Gastroen terology \200 Hepatology Community pediatrics \200 Neonatology \200 Oncology Palliative medicine Pharmaceutical medicine Plastic surgery Psychiatry of learning disability Public health medicine Rehabilit ation medicine Renal medicine Respiratory medicine Rheumatology Sport and exercise medicine Sexual health and reproductive medicine Trauma and orthopedic surgery General adult psychiatry Addictions psychiatry \200 Liaison psychiatry \200 Rehabilitation psychiatry General internal medicine General practice General surgery Breast surgery \200 Colorectal surgery \200 Upper GI surgery \200 Vascular surgery Ge nitourinary medicine Geriatric medicine Stroke \200 Orthogeriatrics Hand surgery \200 Spinal surgery Tropical medicine Urology. Hematology Histopathology Forensic pathology For more details on the career options available to doctors, including all of the above, se e So You Want To Be A Brain Surgeon? (Eccles and Sanders, OUP, 2008). _OHFP.indb 51 _OHFP.indb 51 30/05/2014 16:17 30/05/2014 16:17 52 CHAPTER 1 Being a doctor Your curriculum vitae What is a CV? This is a Latin phrase which means \200\230course of l ife \200\231. In modern days it means a document by which you advertise yourself to a poten tial employer: a summary of you. When will I use a CV? You will need a CV for many of the jobs you will apply for after grad uating. If you join a locum agency, they will use your CV when fi nding you work. You shoul d also upload your current CV to your ePortfolio in advance of every annual review. What is included in a CV? The most important information to include are your contact detail s, a list of your qualifi cations (those already acquired and those you are studying for), any outstanding achievements, a summary of your employment to date, and the details of your referees. Other information can be included, but do not overcrowd your CV. CV philosophy Your CV should not be a static piece of work, it should evolve with you and r efl ect your changing skills and attitudes. It is important to keep your CV up to date, and from time to time reformat it to freshen it up. Use your CV to demonstrate how you have le arned from your experiences rather than just listing them; a potential employer will be muc h more impressed if you indicate you learned about the impor- tance of clear communication whilst working at a holiday resort, than by the actual job itself. Getting help Human resource departments and educational supervisors can give advice on writ ing a CV, and often you can fi nd people \200\231s CVs or templates on the internet by sear ching for \200\230CV \200\231. Try to keep your CV individualized, so do not simply copy s omeone else \200\231s template. Before writing your CV Ascertain what a potential employer is looking for when sending in y our CV; check the essential and desirable criteria and try to echo these. You need to alter the emphasis in your CV to match the position you are applying for, eg highlighting your c ommu- nication skills or leadership experience. Layout Your CV should look impressive; for many jobs hundreds of CVs are received and yours must stand out. It needs to be clearly laid out and easy to follow. The key information an d your most important attributes should stand out prominently. Think about the layout befor e you start writing. Length Two sides of A4 paper are ideal for a basic CV (and an optional front page); add mor e as your career progresses. Remember For most jobs, the candidates applying will have very similar qualifi cations and so the only way you may stand out to be short- listed for interview is via your CV. Make it as interesting as possible, without it looking ludicrous.