Table 3

Occupational perspective

SubthemeDetailsIllustrative quote
The junior doctor contract, role and workload
SalarySalary was unimportant to many of the F2s, to the extent that some did not even know how much they would be paid in their future roles. Others were hoping to have a higher salary, with opportunities for saving money. For many, a higher salary was a ‘nice bonus’ rather than a reason for going.‘I would say it’s an added bonus, I would say if they were going to say you will get paid the same as you are just now, I would still go.’ (P3)
Proposed changes to contracts in England**The proposed changes to junior doctor contracts in England had unsettled the F2s. They had mixed feelings about going away during a time of uncertainty, and concerns about what it might mean for them if they chose to return to the UK.‘I think if I worked down there [in England] I’d be totally disheartened and wouldn’t really want to continue. Sometimes I think I probably wouldn’t want to do this job if I was paid any less… And it’ll definitely change my perception if I come back and Scotland’s gone the same way, what will I do?’ (P2)
One of the F2s had considered applying to specialty training in England, but had decided instead to apply in Australia, partly as a result of the proposed changes to junior doctor contracts in England.‘I always wanted to work in London, so if I was applying for CMT1, I would have liked to have apply down South. [But] there was a lot of uncertainty and there’s still a lot of uncertainty now about what the contracts are going to be like. I think they have started releasing the provisional contracts now and they look terrible. You’ve been paid less and you’re working a lot more and you’re working one in two weekends. It didn’t seem like a good thing to trade rather than working somewhere where there is a good work life balance and sunshine and people appreciate what you do for a living in Australia - why would I want to move to England?’ (P12)
Labour intensityIn general, labour intensity was felt to be high in F2 posts, which was exacerbated by understaffing.‘We have a lot of staff shortages. Usually there’s only one of us on the ward. You feel like you’re fighting fires a lot of the time.’ (P1)
F2s had heard that the labour intensity in Australia and New Zealand was lower.‘From what I hear it’s meant to be slightly less intense particularly in A&E, as I read a few articles. People definitely say you are less stressed because you’ve just got more people on the shop floor.’ (P1)
Junior doctor skills
Transferability of skillsF2s described the development of transferable skills which would help them in their future jobs.‘I find now I’m less afraid of difficult conversations with families or patients. You have to be better at prioritisation and organising your time. Also trying to delegate to other people and knowing when it’s appropriate to call for senior help.’ (P1)
Some F2s did not feel adequately prepared to enter specialty training directly.‘When I see people go and start their CMT [core medical training], they cover CCU [the coronary care unit] and renal on their nightshift. It’s funny because at the moment I’m the one calling them about this abnormal ECG [electrocardiogram], but then you think, God, in four months’ time I’m the one who is getting called… that sounds awful. I think maybe I am just not quite ready to go into CMT yet.’ (P9)
Pursuit of career interests
Specific clinical job**Some F2s were going away for a specific clinical job, which they could not do in the UK.‘I only wanted to go to New Zealand if I was going to get a particular job in a particular department… I’ve got a registrar job as a haematologist out there… If I stayed here in the UK I would have had to just apply for CMT, and because haematology is a bit more of an unusual speciality, quite a lot of CMT trainees don’t even get to do any haematology, and I would only get to do four months of it anyway.’ (P9)
Further study and research**Some of the F2s planned to spend part of their time after F2 completing further study or research.‘I am spending the first three months doing a tropical medicine diploma…’ (P5)
Travel was seen as a potential way of building relationships for future research collaborations.‘I think it would probably be good for your career to have a wider experience, wider contacts, certainly academically bigger scope for collaboration.’ (P16)
Structure of training
Rigidity of training structure**Some of the F2s would like to have completed 1 year abroad, but planned to complete 2 years due to the inconsistencies between the British and Australasian year turnover.‘The Australian medical year starts in January whereas the British one starts in August it does mean that if you end up with say a 12 month job starting in January it would be difficult to come back within one year. So, one year may be two.’ (P1)
F2s who wanted to enter specialties with long run-through programmes were motivated to spend time away after F2, as it may be their last chance in a number of years.‘I want to do obstetrics and gynaecology. It’s run through for eight years, so it’s a long commitment and there will be no opportunity to go abroad at all during that. We’ll be contract free from August, so we can actually go away. It’s basically the only time.’ (P7)
Deferred entry schemes**Many of the F2s would have considered applying for deferred entry schemes, had they been available.‘I would have applied for CMT and GP and, you know, that would have meant that, A, it would be nice to know that you’ve got that certainty of having a job at the end of the year and, B, it would mean not having to come home at Christmas time for applications.’ (P8)
Choosing a specialty**Some of the F2s stated that their main reason for going abroad was that they had not decided which specialty they wished to apply for, or were not yet certain.‘Part of the reason why I’m taking a year out is I couldn’t decide between different specialities… I’m really buying myself a bit more time.’ (P1)
One of the F2s would like to have applied for a ‘broad based training’ scheme, rather than decide on a specialty at this stage.‘The broad based training that they had down South, it was never introduced in Scotland, but that had paediatrics, GP, medicine and stuff in it, and I considered that for a while, just to delay the decision-making process.’ (P5)
One of the F2s felt that she had decided too late on her specialty application, and wanted more time to appropriately build her CV.‘I maybe know what I want to do in the long-term but need to be more set on it. I had done my interview ages ago, and I wasn’t even ready for that at all. My CV wasn’t built up well enough either, I needed the extra few months to do it. And I’ll try and use the next two years to do that as well.’ (P2)
Conveyor belt/treadmill of training**Some of the F2s described feeling like they were on a ‘conveyor belt’ or ‘treadmill’ of training, and felt that post-F2 was a good opportunity to step off for a while.‘You are on this conveyor belt, you’re 17 and then you’ve signed up for life. I think, for me, it was just the last couple of years, you realise what you’ve actually committed to. If I commit to a training programme, that’s six years or so and after that you are looking at trying to get consultancy posts quite quickly. I would think on that kind of timescale you are thinking about family and mortgages… I don’t think you can really travel. This is an opportunity to go away for so long whilst still maintaining your clinical practice.’ (P6)
E-portfolio and WPBAs**The F2s felt that the e-portfolio was cumbersome to complete and too vague to be useful.‘If I can just not have to deal with any portfolio for two years I will be delighted. I think it just detracts so much from any enjoyment that you have… especially with the foundation e-portfolio because they have to design it so generically that some things that they want you to do can be incredibly difficult depending on the particular combination of jobs that you have.’ (P17)
Four-month rotations**One of the F2s described a dislike of short rotations and a desire to stay in one place for a longer period of time.‘I’m fed up of changing jobs every four months. I’m doing obs and gynae at the moment and I’m really enjoying it but it took me three months to start to feel like I was comfortable dealing with all the obstetric stuff and getting into the groove of going to theatre, and then I’m changing in less than a month.’ (P17)
The need to reapply and threat of relocation**One of the F2s described a dislike of the UK system in which it is necessary to reapply for jobs every 2 years, with a threat of relocation to another area of the UK.‘I actually think that I’m quite a scared person, and I don’t like changes. Even if you get into an ST1, you would have to compete again to get an ST3 position. What if you have to move across the country? It’s just so unstable, the life in Britain, I’d rather compete once, and get a job, and you’re just allowed to stay there for five years.’ (P14)
  • CV, curriculum vitae; F2, Foundation Year 2; F2s, foundation year two doctors; WPBA, workplace-based assessment.