How things have changed in the NHS and UK in the past 7 years- an IMGs perspective.

Before I start, I wanted to let everyone know that this post is my personal opinion and should be taken as such. 
This will feel controversial however it is based on my experience and what I have observed. 
I am going to take it topic wise and explain everything in as much detail as I can. 

PAY 
When I came to the UK in 2016, my pay as a SHO was around 3,000 GBP per month after tax, pensions and NI deductions. 
At that time, interest rates were low and the cost of living was cheaper. 
Hence I could save more as a SHO. 
I used to locum and in 2017, as a SHO I was paid 55/hour as locum. This after tax deductions was around 35/hour - which comes out to be 400 per long day shift. 
I was able to save up for visa fees and relocation expenses when I started my core medical training ( in August 2017 - now replaced by IMT). Again, I was able to save up by locuming in CMT2 at 60/ hour and then moved to specialty training ( ST3) in August, 2019. 
The pandemic hit, prices dropped for a while but in 2021, the cost of living went sky high. 
https://commonslibrary.parliament.uk/cost-of-living-and-inflation/
Bills increased, interests increased, cost of utilities increased. 
My pay as a ST6 did increase but not enough to keep up with the high cost of living. 
Hence the locums I used to do before to save up were actually being used to now pay for the extremely high costs of living. 
We all felt it. There is no denying the fact that 

1. Your bills have gone up 

2. Shopping is more expensive 

3. Routine subscriptions/ finance deals have all gone up. 

This is why we are striking:
https://www.bma.org.uk/our-campaigns/junior-doctor-campaigns/pay/junior-doctors-strike-doctors-guide-to-industrial-action-2023

VISA FEES 
Luckily, the visa fees have come down now and we no longer have to pay international healthcare surcharge (IHS) on a work visa which is now called healthcare visa. 

The IHS was a rediculous charge by UKVI to use healthcare when we were working in the NHS on visas, paying taxes and national insurance. 
It has now been removed for IMGs who come to the UK on work visas. 

Unfortunately, for me all the money I saved from 2016 to 2019 went into the high visa fees so I was not able to take advantage of this. 

Also, I had to pay a huge amount for ILR and my British Citizenship ( which still remains extremely high). I have spent around 30 thousand GBP on visas and getting citizenship. 

HEALTHCARE 
There has been a massive decline. 
Here is how it used to be :
1. Patients in hospitals who were waiting for care homes were transferred immediately as soon as they were medically fit as there was enough funding and enough care home staff to sort this out. 

2. Hence there were more beds on wards for patients in ED

3. ED flowed very smoothly - there was a ' 4 hour breach' system whereby major concerns were raised when patients were not assessed, transferred to the relavent wards/ discharged within 4 hours. 

4. Ambulances were able to offload patients and get the next patients in the community. 

5. Because of this flow, patients who needed elective management ( day case procedures) were managed ASAP as there were beds on surgical and medical speciality wards. 

6. As a result, primary care ( GP surgeries ) were able to focus on patients in the community who could be managed by them and got the care they needed from secondary care ( ie NHS trusts) without waiting for long hence they did not develop any complications. 

7. Everything went smoothly - patients were well looked after, doctors felt they could make a massive difference and it was a pleaure to work in this system 

Then disaster struck! 
Now 

1. Lack of funding and lack of carers in care homes hence patients are waiting on the wards for ages for care home beds. 

2. Hence they take up beds on wards while waiting for care homes 

3. ED gets blocked as there are no free beds to transfer patients to 

4. Ambulances stay outside ED with patients in them /paramedics stay with patients in ED corridors till they have a bed/seat/chair/anything they can sit/lie on. Hence patients in the community have to wait for paramedics for long. 

5. Because of lack of beds, elective cases cannot be performed. 

6. Hence cases which should be dealt with by secondary care are now dealt with primary care overburdening the primary care system which is not equipped to deal with the increasing pressure. 

7. It is a complete mess!!!! Everyone is burnt out and we have a mass exodus of doctors. Also, more and more doctors are going part time because of this. 

Evidence of the above :
1. Ask your bed/ site managers how many medically fit patients does the trust have of today. In my case, 20 to 25% of all inpatients are medically fit. The same number of patients are in ED waiting for beds. On a random day in one of the trusts I was working at , there were 100 patients on wards waiting for care homes, 80 patients waiting for beds in ED and 10 elective procedures were cancelled that day because of lack of beds. 

2. Have a look at your local ED - the waiting room is full, patients are sometimes queuing outside the ED doors ( in the rain at times) and the waiting time to see someone is more than 4 hours- this is to just have initial assessments. 

3. Go to your local stroke and cardiology ward - you will see how many delayed STEMIs, strokes they have. Delay in management causes more disability. More disabaility means even more pressure on the already breaking social care system 

4. Talk to your local GPs - do a taster day and see how many cases and what sort of cases they see. And how many times they have to expedite procedures, investigations in NHS trusts which should have happened weeks ago. 

5. See the actual waiting times for 2 week waits are - 2 WW are for ? cancers which need early investigations for early diagnosis for early treatment and remission. However the 2 WW is actually 2 MW ( 2 month wait) or even more. You can get this information by talking to your oncology teams. 

6. Talk to paramedics who are waiting to offload patients and have delays in getting to another unwell patient who could potentially die/ have life long disability if they are not treated early. 

7. Talk to your consultants - see how overworked they are. Look at your own colleagues - most of us are burnt out. The GMC surveys reflect this. See how many have gone part time. 

8. Look at how many consutlants and registrars you know from a few years ago - are they still working full time? Have they gone abroad? 

9. Have a look at vacancies - not just SHOs but now middle grade rotas and more worryingly, consultant rotas have significant gaps.

My experience:
1. As a relative of a loved one, we have had to wait for upto a year for routine appointments with specialities 

2. We have had to wait for up to 4 hours to be seen and then another 4 hours to be re-assessed after the initial treatment 

3. I had to go private for a consultation for a loved one due to the massive delays in the NHS ( more than one year wait) 

So, the pay is not good enough, the healthcare system has collapsed, cost of living has gone up - if things are so bad, why are you still here. 

I am a ST6 registrar and hence I am at the highest nodal point of pay before a consultant. Yet it is STILL not enough to sustain the same lifestyle we had 3 years ago. My bank account from my main salary is in negative 10 days before pay day. 

Hence, I have to locum. Luckily, I ask for and get higher rates ( 85 to 100 per hour) and because of my current situation ( ie passed all exams,  therefore I have no educational goals and can just work) , my annual income is boosted a bit. But this comes at an expense - the expense of not spending time with my family. In order to ensure I am able to read a bed time story to my daughter and pick and drop her at least 50% of the time, I take my annual leaves in advance and book study leaves, etc as soon as I get my rota. 

Is it worth it for you? 
It depends on where you are. Unfortunately when I was in my home country in 2014, I was not paid as a FY1 ( house officer) unless I worked in a small hospital 6 hours away from home and I was not paid as a year 1 post graduate resident ( equivalent to CT1/junior reg) as again I had to work away from where I lived and at that time, the pay was very low had I opted for these options. So instead of working and living in poverty like conditions, I instead worked literally 36 to 48 hours for 2 years without any pay but at least had a comfortable house with food on the table. This of course could not be sustained for long and hence at that point, I decided that moving to the UK would be a better idea. And no doubt, it was quite enjoyable and financially worth it back in 2016. 

However, in 2023 I am not a SHO and the economic siutation is not the same. 

So would I come here in 2023 as a SHO?

If I was not getting paid back home, yes I would. But like many others, I would look into getting out of here as soon as possible. I would start working as a SHO, work hard and locum, study for exams like USMLE, look into Australia, New Zealand for SHO posts and go wherever I would get the chance. 

I would have a different path if things were like this back in 2016. I would use this system as a stepping stone. 

Unfortunately, the NHS is a sinking ship. And we have reached a point where us clinicians cannot save it hence we are trying our best to save our selves - part time, locum on the side, etc. 

For new doctors:
Please strike! 
Use the NHS as a stepping stone if you feel it is not worth it. Try to make the jump early before you have a family as it becomes difficult. 

For doctors already settled here:
If you, like me have a school going child and feel this is home, conitnue striking! 
Ensure your colleagues strike as well. 

Understand that the SHO of today has the same salary as you had but with double the expenses. 
If you have been here as long as I have been, support your FY1s, SHOs and new registrar colleagues - talk to them, be kind to them and look after them. They will be the ones looking after us when we are patients. 

Look into going less than full time/ part time. It is the best thing ever. 
Know your worth ! Ask for escalated rates. 

Do not settle for less when you take a consultant post.

What has changed for me and what the future holds:

I will always be here. This is home for me. However I am not going to save the NHS- I will be a fool to think I can.

Instead, I am going to ensure that I get to spend the maximum time with my family - because at the end of the day, my daughter will not be proud of the awards her daddy got at the expense of staying away from home. She will remember the time we spent together - the time I dropped her to school and skipped with her, wore her purse for her when she was tired, danced with her in a grocery store and read her a bedtime story. And this is what matters to me the most. 

When I came here, I felt I will work in a busy trust, in a busy speciality and strive hard to make a difference - not any more. Now, I will go to work, come home and enjoy with my family.