My life as a medical registrar - is it that horrible?
I am a ST3 trainee registrar in Acute Internal Medicine (AIM), Scarborough Hospital.
I am going to clear some misconceptions people have about working as a trainee medical registrar.
They never have time for their families because they are always on call!
Look at my rota here:
https://omarsguidelines.blogspot.com/2019/07/my-st3-post-in-acute-medicine.html
Let's look at November, for example:
I was on annual leave from the 1st to 6th of November
I have every weekend off.
I have a total of 7 long shifts ( ie from 0900 to 2100) in November.
Total number of days off: 16
Study days: 2
Regular days on the ward: 5
I come home at around 1730 ( I leave the hospital at 1700 almost everyday) and have a good 3 hours on working days. My weekends are mostly free and I spend that time with my family as well. I have driven 3000 miles in 2 months already! ( which shows how much time I have now).
The pay is not enough!
The pay of a trainee registrar varies from 3300 to 3800 GBP per month ( after tax deduction) depending on on calls.
The expenses for relocation, study leave are reimbursed by the trust. We can also claim for taxes.
You can also do locums which can be 70 to 100 GBP an hour depending on how desperate the trust is.
I am saving more now than what I was as a trainee SHO. I have 2 dependents, a reasonable lifestyle and we eat out almost every weekend.
They never have time off for professional development
There is a clear rule in my trust- request leaves 6 weeks in advance.
In acute internal medicine, we have to attend 4 types of mandatory training:
1. GIM training - arranged by the Royal College of Physicians which is announced on their website here ( This is for East Yorskhire only!):
https://www.rcplondon.ac.uk/events/career-stage/spr/career-stage/specialty-trainee/region/yorkshire-0
2. AIM training ( For Yorkshire only!) :
This is announced 4 months in advance:
https://heeyh-deanery-live.azurewebsites.net/node/306
3. Deanery based courses:
https://www.maxcourse.co.uk/heeyhme/guestHome.asp ( This particular link is for York and Humber only! )
These are announced a year in advance.
4. Society of acute medicine events
https://www.acutemedicine.org.uk/sam-events/
All I have to do is book the relevant courses, print out a study leave form, get it signed by my supervisor ( educational or clinical) who is always available, scan it and email it to my rota coordinator and post graduate center coordinator.
I filled out all my leaves and gave them to the relevant teams as soon as I got the dates.
The rota team never arranges swaps!
In my case, I had the following issues:
1. I had some necessary annual leaves to book and I was on nights. I had emailed the rota team before the rota was released about this and unfortunately, they had put me on nights during that time.
When I informed them, they immediately swapped me out and gave me a list of vacant shifts which I chose from.
2. Similarly, 2 of my GIM study days were falling on my night shifts and the rota team very kindly offered me vacant shifts to do.
The rota team forces registrars to do on calls!
Not in my trust! They call when there is sickness however they never force anyone to do on calls. They may give an incentive - ie a higher rate ( once they were offering 150 GBP an hour for sickness cover at a very short notice for a night shift!)
The medical registrar has to arrange cover if the other team members are sick!
Not true. I just call the rota team and inform them and let them know that the clerking board is very busy and there are a few sick patients as well. I use these terms:
'Patient safety'
'Stress for the on call team'
'Risks of serious incidents'
They arrange cover almost immediately. The rota team here is excellent. They have a list of SHOs who can come to help whenever needed ( known as bank SHOs). Their contact details are also in the switchboard office and out of hours, the bed managers contact them. I have never had a shift where the on call team is understaffed.
The medical registrars are completely on their own when they are on night shifts!
This is not true.
You have the following people to help:
1. Consultant on call - you can ring the medical consultant on call at any time. I have called my consultants whenever I have been stuck and they have always supported me - even at 0300 AM!
2. Outreach team - These are highly training ITU nurses who help to manage sick patients on the ward. They can do anything from doing ABGs to calling the ITU consultant ( However usually, the ITU reg does that).
3. ITU team - The ITU registrar is available to help, give advice and manage patients. When the patients are unwell and if it is appropriate , they take over care of the patient.
4. Other specialties - You have on call cardiology teams, respiratory teams, neurology teams ( if not on site, they are available on the phone)
5. Your own SHOs and FY1s. They are equally good and provide support - especially the SHOs preparing for PACES. They are the best assessors as they have been polishing their examination skills on a regular basis and can pick up even the most subtle clinical findings.
The medical registrars are just bed managers
This is not true. The only 'bed management' I am involved in is:
1. Identifying patients from a list of patients the nurse in charge has already made who are safe to be moved out of AMU without a consultant post take to outlier wards (where they would be post taked by the consultants covering outlier wards - they are seen at the same time as the AMU patients as there is a separate consultant for outlier wards)
2. Deeming medical patients safe for transfer from the ED department whom I have clerked ( which is not difficult at all).
The job of a medical registrar is very stressful.
I find it less stressful than my core medical training for the following reasons
1. I am in a specialty now. I was always worried about which specialty I would go for for training in my CMT.
2. I have passed my exams. MRCP exams can be quite stressful.
3. Finances - I had to do a few locums to save up for visa extension fees which is no longer applicable as I have a visa for a few years now.
The medical registrar cannot bring any improvement and is just stuck in the system.
This is not true. As a medical registrar , I am :
1. The associate college tutor - My role is to improve training for IMT trainees and I have given a few suggestions to improve this. I have been listened to and those changes are being implemented as well.
2. I have raised concerns which have been sorted before there was a serious incident.
3. I have ensured that we have minimum staffing on my ward. I managed this by encouraging juniors to exception report and encouraged consultants to fill the exception reports in. Things improved within a few weeks!
4. I am liaising with the directorate to improve patient flow - by meeting the directors in person and feeding any suggestions back to the respective managers.
5. I arrange regular PACES sessions with MRCP examiners in my trust and sometimes even agree to carry the on call SHOs bleeps whilst they are practicing with the MRCP examiners. They feel more supported and this way.
I am passionate about improving training, patient flow and staff morale. And the management is fully on board with me.
No one respects the medical registrar!
Again, this is not true. We are at the forefront of the hospital when we are on call. We know the problems and our solutions, if implemented can improve patient flow and patient care. Hence, all consultants and the management respects us, listens to us and asks for our suggestions.
Who are the ones who suffer then?
The life of a medical registrar is not a bed of roses. We have issues too. I have mentioned some here after hearing this from my fellow registrars ( with solutions - which they implemented and then improved their training this way.
With every problem, there is a solution.
TRAINEE REGISTRARS WHO ARE PROCEDURE BASED:
Being unable to do procedures due to lack of time/ no space in the procedure room.
This is an issue in busy wards like Gastroenterology ( where specialty trainees need a minimum number of scopes however there are other health professionals who need to get their requirements met as well like endoscopy nurses, gastro ACPs, non trainee registrars applying for consultant posts via CESR route). This can be very challenging especially if the ward is busy as well.
These are a few solutions which I have seen have worked:
1. The trainee registrars spoke to their supervisors about this first to see if they could be helped.
2. The trainee registrars then emailed the progamme directors (TPD)about this. They CC'd their supervisors in this email. They did this early in their rotations ( ie within 1 to 2 months)
3. The TPDs liaised with the trainee representatives and spoke to the trainees supervisor to reach an agreement.
4. The supervisor liaised with the rota team to ensure there was enough cover on the ward to ensure the trainees needs were met.
Solutions:
1. The trainee registrars have dedicated 'procedure days/clinics' on their rotas .
2. The rota team ensured that there was minimum staffing on the ward at all times ensuring that trainee registrars could meet their training needs ( procedures, clinics, seeing referrals).
But why would the supervisors want this to work? The trainee registrars are there just for a year and then move on.
We give feedback to the Health Education England, local deanery and GMC every year about the quality of our training and if there were any issues. We are encouraged to raise any concerns with our supervisors earlier ( and if they do not help, with the trainee reps and TPD). If there are major concerns and there is consistency in those concerns, the can possibly loose all trainees next year - ie, the deanery will not include this trust in the hospitals trainees are supposed to be rotated in. This has happened in the past and the deanery is very strict about this.
So what? Even if the hospital does not have any trainees, it can still function on the basis of consultants and non trainees.
The quality of patient care deteriorates. Trainees are more dedicated, motivated ( mainly by force as they have annual assessments and ARCPs and they need to be good). Plus they want to have a very good portfolio as they know they have a certain number of years to become a consultant.
I am not saying that non trainees are bad, it is just that trainees are more motivated ( by force) to deliver better patient care.
Hence the hospitals want to have trainees. They can improve patient care by doing QIPs, presenting in national conferences, giving good feedback about their training in that trust so that more trainees ( and hence more staff) join it in the future.
TRAINEE REGISTRARS WHO ARE STUCK IN A HORRIBLE TRUST:
Not all NHS hospitals are amazing. These are the people who can be obstructive
1. Supervisors
Raise concerns to your TPD and trainee reps early! They are very good and so sort things out.
2. Management
Raise issues! If the on call is understaffed, email the rota team, CC the consultant on call. Mention 'patient safety', 'risk of serious incidents', 'staff stress'.
If nothing works, escalate to the guardian of safe working. They are appointed in the trust to feedback to the relevant teams anonymously if there are any concerns and they are excellent at their job.
3. Fellow registrars
Not everyone thinks alike. You do not need to agree however you do not need to get into arguments either. Remember, they are your fellow consultant colleagues in a few years and you, as a consultant will always need their assistance ( and vice versa) - good connections always help.
4. SHOs and foundation trainees.
They are usually very good however some may not be interested in working. Sit with them, talk to them, ask them what is bothering them. We have all been there when we have lost interest and there is always a reason. And we have always seen that one amazing registrar/consultant talk sense to us- be that amazing registrar!
TRAINEE REGISTRARS WHO ARE MOVING TO A NEW TRUST EVERY YEAR
This can be a problem especially if you have bought a house, have family (especially with kids who are going to nursery/school) and have settled in a city in that deanery.
The best thing of working in a training post is that you will not be relocated far - all hospitals in my deanery ( except 1) are within an hours drive of each other.
What if I am rotated into that city which is far away?
You can let your TPD know ( early) that you would like to work in a particular area and (s)he will see if you can be adjusted accordingly. But you must talk to your TPD ASAP and the earlier you inform him/her, the more chances you will have to not be relocated to that city which too far away from your base city.
IMG REGISTRARS WHO HAVE NOT GONE THROUGH THE TRAINING ROUTE :
This is for those IMG registrars who have not done CMT/IMT and have applied for ST3 training posts directly as their first job in the NHS. They find the e portofolio, new NHS system , cultural differences too overwhelming.
However if they work as a non trainee SHO for at least 12 months, they seem to do fine. I would still suggest that IMGs should do training SHO posts ( ie IMT) wherever possible.
Please read the relevant blog posts in the " guideline to registrar posts" section here:
http://omarsguidelines.blogspot.com/
To summarize,
I am thoroughly enjoying my job as a medical registrar. I love my on calls, working on the ward and getting involved in projects to improve the morale and training of all health care professionals. I do not regret this for even once.
I identify a problem, work towards a solution and then ensure that the solution is implemented - I am very grateful to be in a position in which I can improve things.
Dedicated to the amazing team of healthcare professionals in Scarborough District Hospital (from the amazing nurses to the passionate directorate) - who have made me love my job.
I am going to clear some misconceptions people have about working as a trainee medical registrar.
They never have time for their families because they are always on call!
Look at my rota here:
https://omarsguidelines.blogspot.com/2019/07/my-st3-post-in-acute-medicine.html
Let's look at November, for example:
I was on annual leave from the 1st to 6th of November
I have every weekend off.
I have a total of 7 long shifts ( ie from 0900 to 2100) in November.
Total number of days off: 16
Study days: 2
Regular days on the ward: 5
I come home at around 1730 ( I leave the hospital at 1700 almost everyday) and have a good 3 hours on working days. My weekends are mostly free and I spend that time with my family as well. I have driven 3000 miles in 2 months already! ( which shows how much time I have now).
The pay is not enough!
The pay of a trainee registrar varies from 3300 to 3800 GBP per month ( after tax deduction) depending on on calls.
The expenses for relocation, study leave are reimbursed by the trust. We can also claim for taxes.
You can also do locums which can be 70 to 100 GBP an hour depending on how desperate the trust is.
I am saving more now than what I was as a trainee SHO. I have 2 dependents, a reasonable lifestyle and we eat out almost every weekend.
They never have time off for professional development
There is a clear rule in my trust- request leaves 6 weeks in advance.
In acute internal medicine, we have to attend 4 types of mandatory training:
1. GIM training - arranged by the Royal College of Physicians which is announced on their website here ( This is for East Yorskhire only!):
https://www.rcplondon.ac.uk/events/career-stage/spr/career-stage/specialty-trainee/region/yorkshire-0
2. AIM training ( For Yorkshire only!) :
This is announced 4 months in advance:
https://heeyh-deanery-live.azurewebsites.net/node/306
3. Deanery based courses:
https://www.maxcourse.co.uk/heeyhme/guestHome.asp ( This particular link is for York and Humber only! )
These are announced a year in advance.
4. Society of acute medicine events
https://www.acutemedicine.org.uk/sam-events/
All I have to do is book the relevant courses, print out a study leave form, get it signed by my supervisor ( educational or clinical) who is always available, scan it and email it to my rota coordinator and post graduate center coordinator.
I filled out all my leaves and gave them to the relevant teams as soon as I got the dates.
The rota team never arranges swaps!
In my case, I had the following issues:
1. I had some necessary annual leaves to book and I was on nights. I had emailed the rota team before the rota was released about this and unfortunately, they had put me on nights during that time.
When I informed them, they immediately swapped me out and gave me a list of vacant shifts which I chose from.
2. Similarly, 2 of my GIM study days were falling on my night shifts and the rota team very kindly offered me vacant shifts to do.
The rota team forces registrars to do on calls!
Not in my trust! They call when there is sickness however they never force anyone to do on calls. They may give an incentive - ie a higher rate ( once they were offering 150 GBP an hour for sickness cover at a very short notice for a night shift!)
The medical registrar has to arrange cover if the other team members are sick!
Not true. I just call the rota team and inform them and let them know that the clerking board is very busy and there are a few sick patients as well. I use these terms:
'Patient safety'
'Stress for the on call team'
'Risks of serious incidents'
They arrange cover almost immediately. The rota team here is excellent. They have a list of SHOs who can come to help whenever needed ( known as bank SHOs). Their contact details are also in the switchboard office and out of hours, the bed managers contact them. I have never had a shift where the on call team is understaffed.
The medical registrars are completely on their own when they are on night shifts!
This is not true.
You have the following people to help:
1. Consultant on call - you can ring the medical consultant on call at any time. I have called my consultants whenever I have been stuck and they have always supported me - even at 0300 AM!
2. Outreach team - These are highly training ITU nurses who help to manage sick patients on the ward. They can do anything from doing ABGs to calling the ITU consultant ( However usually, the ITU reg does that).
3. ITU team - The ITU registrar is available to help, give advice and manage patients. When the patients are unwell and if it is appropriate , they take over care of the patient.
4. Other specialties - You have on call cardiology teams, respiratory teams, neurology teams ( if not on site, they are available on the phone)
5. Your own SHOs and FY1s. They are equally good and provide support - especially the SHOs preparing for PACES. They are the best assessors as they have been polishing their examination skills on a regular basis and can pick up even the most subtle clinical findings.
The medical registrars are just bed managers
This is not true. The only 'bed management' I am involved in is:
1. Identifying patients from a list of patients the nurse in charge has already made who are safe to be moved out of AMU without a consultant post take to outlier wards (where they would be post taked by the consultants covering outlier wards - they are seen at the same time as the AMU patients as there is a separate consultant for outlier wards)
2. Deeming medical patients safe for transfer from the ED department whom I have clerked ( which is not difficult at all).
The job of a medical registrar is very stressful.
I find it less stressful than my core medical training for the following reasons
1. I am in a specialty now. I was always worried about which specialty I would go for for training in my CMT.
2. I have passed my exams. MRCP exams can be quite stressful.
3. Finances - I had to do a few locums to save up for visa extension fees which is no longer applicable as I have a visa for a few years now.
The medical registrar cannot bring any improvement and is just stuck in the system.
This is not true. As a medical registrar , I am :
1. The associate college tutor - My role is to improve training for IMT trainees and I have given a few suggestions to improve this. I have been listened to and those changes are being implemented as well.
2. I have raised concerns which have been sorted before there was a serious incident.
3. I have ensured that we have minimum staffing on my ward. I managed this by encouraging juniors to exception report and encouraged consultants to fill the exception reports in. Things improved within a few weeks!
4. I am liaising with the directorate to improve patient flow - by meeting the directors in person and feeding any suggestions back to the respective managers.
5. I arrange regular PACES sessions with MRCP examiners in my trust and sometimes even agree to carry the on call SHOs bleeps whilst they are practicing with the MRCP examiners. They feel more supported and this way.
I am passionate about improving training, patient flow and staff morale. And the management is fully on board with me.
No one respects the medical registrar!
Again, this is not true. We are at the forefront of the hospital when we are on call. We know the problems and our solutions, if implemented can improve patient flow and patient care. Hence, all consultants and the management respects us, listens to us and asks for our suggestions.
Who are the ones who suffer then?
The life of a medical registrar is not a bed of roses. We have issues too. I have mentioned some here after hearing this from my fellow registrars ( with solutions - which they implemented and then improved their training this way.
With every problem, there is a solution.
TRAINEE REGISTRARS WHO ARE PROCEDURE BASED:
Being unable to do procedures due to lack of time/ no space in the procedure room.
This is an issue in busy wards like Gastroenterology ( where specialty trainees need a minimum number of scopes however there are other health professionals who need to get their requirements met as well like endoscopy nurses, gastro ACPs, non trainee registrars applying for consultant posts via CESR route). This can be very challenging especially if the ward is busy as well.
These are a few solutions which I have seen have worked:
1. The trainee registrars spoke to their supervisors about this first to see if they could be helped.
2. The trainee registrars then emailed the progamme directors (TPD)about this. They CC'd their supervisors in this email. They did this early in their rotations ( ie within 1 to 2 months)
3. The TPDs liaised with the trainee representatives and spoke to the trainees supervisor to reach an agreement.
4. The supervisor liaised with the rota team to ensure there was enough cover on the ward to ensure the trainees needs were met.
Solutions:
1. The trainee registrars have dedicated 'procedure days/clinics' on their rotas .
2. The rota team ensured that there was minimum staffing on the ward at all times ensuring that trainee registrars could meet their training needs ( procedures, clinics, seeing referrals).
But why would the supervisors want this to work? The trainee registrars are there just for a year and then move on.
We give feedback to the Health Education England, local deanery and GMC every year about the quality of our training and if there were any issues. We are encouraged to raise any concerns with our supervisors earlier ( and if they do not help, with the trainee reps and TPD). If there are major concerns and there is consistency in those concerns, the can possibly loose all trainees next year - ie, the deanery will not include this trust in the hospitals trainees are supposed to be rotated in. This has happened in the past and the deanery is very strict about this.
So what? Even if the hospital does not have any trainees, it can still function on the basis of consultants and non trainees.
The quality of patient care deteriorates. Trainees are more dedicated, motivated ( mainly by force as they have annual assessments and ARCPs and they need to be good). Plus they want to have a very good portfolio as they know they have a certain number of years to become a consultant.
I am not saying that non trainees are bad, it is just that trainees are more motivated ( by force) to deliver better patient care.
Hence the hospitals want to have trainees. They can improve patient care by doing QIPs, presenting in national conferences, giving good feedback about their training in that trust so that more trainees ( and hence more staff) join it in the future.
TRAINEE REGISTRARS WHO ARE STUCK IN A HORRIBLE TRUST:
Not all NHS hospitals are amazing. These are the people who can be obstructive
1. Supervisors
Raise concerns to your TPD and trainee reps early! They are very good and so sort things out.
2. Management
Raise issues! If the on call is understaffed, email the rota team, CC the consultant on call. Mention 'patient safety', 'risk of serious incidents', 'staff stress'.
If nothing works, escalate to the guardian of safe working. They are appointed in the trust to feedback to the relevant teams anonymously if there are any concerns and they are excellent at their job.
3. Fellow registrars
Not everyone thinks alike. You do not need to agree however you do not need to get into arguments either. Remember, they are your fellow consultant colleagues in a few years and you, as a consultant will always need their assistance ( and vice versa) - good connections always help.
4. SHOs and foundation trainees.
They are usually very good however some may not be interested in working. Sit with them, talk to them, ask them what is bothering them. We have all been there when we have lost interest and there is always a reason. And we have always seen that one amazing registrar/consultant talk sense to us- be that amazing registrar!
TRAINEE REGISTRARS WHO ARE MOVING TO A NEW TRUST EVERY YEAR
This can be a problem especially if you have bought a house, have family (especially with kids who are going to nursery/school) and have settled in a city in that deanery.
The best thing of working in a training post is that you will not be relocated far - all hospitals in my deanery ( except 1) are within an hours drive of each other.
What if I am rotated into that city which is far away?
You can let your TPD know ( early) that you would like to work in a particular area and (s)he will see if you can be adjusted accordingly. But you must talk to your TPD ASAP and the earlier you inform him/her, the more chances you will have to not be relocated to that city which too far away from your base city.
IMG REGISTRARS WHO HAVE NOT GONE THROUGH THE TRAINING ROUTE :
This is for those IMG registrars who have not done CMT/IMT and have applied for ST3 training posts directly as their first job in the NHS. They find the e portofolio, new NHS system , cultural differences too overwhelming.
However if they work as a non trainee SHO for at least 12 months, they seem to do fine. I would still suggest that IMGs should do training SHO posts ( ie IMT) wherever possible.
Please read the relevant blog posts in the " guideline to registrar posts" section here:
http://omarsguidelines.blogspot.com/
To summarize,
I am thoroughly enjoying my job as a medical registrar. I love my on calls, working on the ward and getting involved in projects to improve the morale and training of all health care professionals. I do not regret this for even once.
I identify a problem, work towards a solution and then ensure that the solution is implemented - I am very grateful to be in a position in which I can improve things.
Dedicated to the amazing team of healthcare professionals in Scarborough District Hospital (from the amazing nurses to the passionate directorate) - who have made me love my job.
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