10 tips for new (and old) doctors

The things I wish I’d known two years ago.

With a fresh cohort of medical graduates ready to hit the wards of our NHS in just over two weeks time, many people have taken to Twitter to offer their pearls of wisdom under the hashtag #TipsForNewDocs. As a foundation doctor coming to the end of my first two years of basic training, here are the ten things I wish I’d known on day 1.

Source: Hamza Butt
  1. Tap into relocation expenses

Junior doctors can claim up to £8,000 during the course of their training to help with the costs of relocation. Whilst it may not be prudent to blow the entire sum right now, the money is there to help you cover the cost of searching for property, letting agents’ fees, solicitors’ fees, stamp duty, and removal costs.

Each deanery and trust has slightly different (?arbitrary) rules as to how much you can claim, and what you can claim for. This will typically be affected by whether you’re moving into rented or owned accommodation, whether you’re a first time buyer, and the length of your training programme within the deanery.

If you haven’t already looked into this — make sure to contact your HR department soon. And if you’ve missed out this time, make sure to claim when you move for your higher training.

2. Claim back your travel expenses

On a similar thread, make sure you know how to claim back your travel expenses. If you’re working at two different hospitals in the area, out on a GP placement, using your car for visits in the community, or rotate to a different area within the deanery, check to see if you’re eligible to have your travel costs reimbursed. The cost of any travel associated with study leave and mandatory training can also be claimed back.

Both public transport and private transport (using your own car) are eligible for reimbursement. However with the latter, check your car insurance policy as it may be necessary to obtain business cover. This may incur a small increase in your premium, but this will almost certainly be offset by the amount you can claim.

3. Use your study leave

Under the new contract, FY1 doctors are entitled to 15 days paid study leave, whilst FY2 doctors and above are entitled to 30 days study leave per year. Make sure you use it. At least six weeks notice may be required.

Each department of medical education will have different rules as to how this time can be used. You may be asked to use it for mandatory training days or induction (although this is frowned upon by the GMC). Typically courses and exams which form an integral part of your training will be eligible. You may be able to use the time to go to relevant conferences or to present your work elsewhere. As noted above, the transport costs entailed as part of your study leave, and sometimes the cost of courses/exams/conferences, should be reimbursed by the trust.

Also make sure that you claim time off in lieu or study leave for any pre-course reading you have to do as part of a course. This includes for ALS!

4. Make good use of annual leave

As a new starter, you are entitled to 27 days annual leave a year + bank holidays on top. Please, make sure you use it.

Again, six weeks notice is usually required. The new 2016 contract stipulates that annual leave has to be granted for ‘life-changing’ events, such as your wedding day, as long as six weeks notice is provided.

If you work any part of a bank holiday, even an hour, you’re entitled to a day back in lieu. Also if you have a ‘zero day’ fall on a bank holiday (ask your SHO), you’re also entitled to a day back in lieu. Make sure you claim them.

You absolutely cannot start to look after patients unless you look after yourself. When you’re working 48 hours a week, annual leave gives you time to rest, recuperate, and realign yourself with your goals (in-work and outside of work).

Source: NeilsPhotography

5. Engage with exception reporting

The 2016 contract has brought in the era of ‘exception reporting’. Love it or hate it, it’s really important that everyone engages.

You can submit an ‘hours’ exception report, for example if you stay half an hour late to stop somebody from dying. In return you should receive time back in lieu, or if not, payment for the extra time worked (at the ‘prevailing’ locum rate which, unfortunately, is crap). If it’s a regular occurrence, you can request a ‘work-schedule review’, during which you discuss the rota with your supervisor to highlight issues and hopefully reach solutions.

Something which hasn’t taken off yet, but totally should, is ‘training’ exception reporting. The idea is that if you miss a theatre list because you’re required on the ward, you miss departmental teaching because you’re needed elsewhere, or you miss any other training opportunity for any reason, you report it. This should identify the reasons for poor training, highlight those departments which don’t particularly care for their trainees (which may end up in trainees being pulled from that department), and hopefully be a force for positive change in the future.

Exception report. No exceptions.

6. Know your Code of Practice

Although the contract was a bit of a catastrophe, HEE and the BMA have come together to produce a rather good Code of Practice which should help alleviate many of the non-contractual issues that impact on junior doctors’ working lives.

For example, you should’ve received notification of where you were going to be placed 12 weeks before the start of August, a generic work schedule and rota 8 weeks before, and know your exact spot on the rota 6 weeks before. Not happened? Make a fuss. Speak to your HR department and contact the BMA.

7. Make sure to claim back tax

Many trainees are still unaware that they can claim back the tax on a large amount of the expense involved with work. The caveat is that the expense has to be incurred solely in conjunction with your work.

New stethoscope? Claim back the tax. Subscribed to the BMA? Claim it. Paying your annual GMC fee? Don’t forget to claim it back. Medical indemnity (MDU/MPS)? You get the jist. That ATLS course required for your training programme? Also yes.

A basic-rate taxpayer claiming the tax on the £425 GMC annual retention fee will get £85 back. That’s more than enough to get you to Barcelona and back for a long weekend escape from the geriatrics’ ward. Not too shabby.

Source: Hamza Butt

8. Make time for yourself

I mentioned it above, but just a reminder to look after yourself.

Working as a doctor is inherently stressful. You will be expected to take on huge levels of life-changing responsibility from very early on in your career, in a healthcare system facing huge stressors and changes. Sometimes it all creeps up on you without you realising, you naively cope for so long, then crash.

Catch up with friends. Go for a run. Read a (non-medical) book. Go to the cinema. Go out for a meal. Be normal every once in a while.

9. Don’t be pushed around

Many of the tips on Twitter mention being nice to the nurses/consultants/rest of the MDT/your colleagues. That should be a given. However, respect works both ways.

As an FY1, you may be at the bottom of the medical pecking order. But that doesn’t mean that you are any less important than anyone else on the ward. You will be the one doing many of the jobs, the one co-ordinating with other specialities and departments, the member of the medical team who likely spends the most time with those patients on the ward, and the first doctor there when things go wrong.

Be confident in your ability — you’ve made it through medical school! — but open to challenge and constructive criticism. If you disagree with someone, it’s OK to gently challenge them too. Does the cannula you’ve been bleeped about at 5am really need doing this second, or can it wait for the day team? Is the catheter downstairs really more important than the peri-arrest on level 12? Are you actually just going to keep quiet and prescribe painkillers for that gentleman with chest pain or go and fully investigate? There is no such thing as an ‘emergency’ discharge letter.

Most importantly, don’t let yourself be bullied. Speak up. Make a fuss to the right people. The trainees rotating into your shoes will thank you.

10. Behave as a professional

Last but not least. A lot of administrative and educational hand-holding goes on in medical school. At the end of the day, they want you to get through, otherwise it looks bad for them. From here on in, I’m sorry, but you’re very much on your own. You’ll have to behave as a fully-fledged professional.

In spite of recent political events, and some of the actions by bodies responsible for our training, doctors are still professionals. Therefore we need to start behaving in that way. The 9 points above wouldn’t be a bad place to start.

Relocation expenses, study leave, annual leave, travel expenses, and indeed other contractual rights will unfortunately not be provided to you on a plate. You will encounter hurdles, contractual misinterpretations (accidental or otherwise), and encounter people who have unreasonable expectations of you or who expect you to give up your time for free. When you encounter such things, think — would I expect a lawyer, or accountant, to be spoken to in this way, or to put up with this?

Just because you are ‘in training’, doesn’t make you any less of a professional. A professional, secure, happy doctor will provide good care for patients.

Good luck with your future career. I look forward to seeing you on the wards.

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