SHO and career progression to consultant

Xeyn wrote: »

Like I said I can only speak personally from a surgical perspective but from speaking to colleagues it's not that much different in other specialities.
Despite being in recognised training posts, the Irish system has deskilled me from when I arrived a number of years ago. Every surgical consultant I have spoken with agrees that the training is far too long and is currently broken. My last consultant who u got on very well with actively encouraged me to 'look out for myself' by leaving the country to get better training.

Can i ask your opinion on the new run through type surgical training programme that they've introduced? I've heard that they might not even stick with it now although it does at least sound like an improvement on the old system. Realistically do you see any improvement in terms of the structure or delivery of surgical training? or would you completely advise any intern/ final med against doing surgical training in Ireland?

IrishSkyBoxer wrote: »

You have a very good chance of being kicked out of the surgical scheme after 18 months. 18 months wasted post intern year. What are you meant to do then? Go back and apply for GP and cut your losses. There is now the issue of people doing phds etc before commencing training as a means to ensure they proceed through the scheme (as opposed to people doing phd and research at the end of spr). This "run through " nonsense is snake oil. There is no run through.

I wouldn't recommend anyone trains in this country. Unless you fancy being a professional lifelong reg and locuming

I've heard alright of there being too many people applying for a particular speciality on the speciality training scheme, so that being the case it isn't really a run through scheme at all as you say. It has however only been up and running a few years so I'd be intersted in knowing if trainees do end up in this no mans land after being kicked off the scheme. I'd be interested in hearing the experiences of people on the scheme as to what practically speaking the scheme is like.

I hear good things about Anaesthetics though:P

They've changed the run through program so many times in its less than 2 year history it beggars belief. It's very clear they don't know what they are doing and have been told by a couple of members on the board that there is so much conflicting politics, nepotism etc going on that it's really hindering the program. Basically a lot of the younger consultants are waiting for the 'old guard' to retire so they can actually make some progress.

I wouldn't advise someone to definitely look elsewhere for training but Ireland has one of the only systems in the modern world where there is a good chance you won't advance in the career you wish to.
The training is not the best but is certainly not the worst either.
You can work your ass of for nothing in the surgical speciality or you can advance relatively smoothly (albeit slowly) - that's not true of most first world countries surgical training.
So if you have good personal skills, a good graduate cv, the willingness to work very hard and a strong desire to work in the public system in Ireland then staying and training here is not a bad option. If you want to have a better chance of getting to consultancy in your chosen speciality in surgery (and usually quicker) and don't mind working as a consultant overseas (at least for a while) then I would advise leaving - especially if your looking for a very competitive speciality like plastics etc.

The surgical run through program is very much in its guinea pig years and I don't trust the rcsi surgical training as far as I can throw the lot if them. Many trainees who had genuine concerns about being on either side of the transition were essentially hushed and told 'everything will be grand'.
As for speaking to trainees who have been left in limbo from the new system- there aren't any as far as I'm aware as the first lot haven't even reached the 18/24 month mark.

Bottom line- both surgical training and the health system in general have an unknown future currently. No one can say you won't get exactly what you want if you stay here - you certainly can, but you'll have a better chance elsewhere.

In my time, long ago, the first Irish consultants from our med school year that I heard about were all in anesthesia. Psychiatry was fairly quick too and nearly everybody made it. General surgery was the worst - a Via Dolorosa for some of the most talented people I have ever met. Many of them ended up in general practice, casualty and ENT and they were probably the lucky ones.

I was drifting around Ireland trying to do pathology and went to Canada because I had no other options. Three years later I was fully qualified. The standard of training over here was far more intense and comprehensive than in Ireland. Service always took second place to learning whereas the opposite was the case at home.

I notice among the Canadian locals that the specialties in demand now are the high income/low patient contact numbers like dermatology, ophthalmology and radiology. General surgery is dying over here - too much call, responsibility and not enough pay.

whadabouchasir wrote: »

Thanks for your insight. Just a few questions if you'll humour me.How does working in the canadian health system compare to the irish one as a consultant? And how easy is it for irish docs to get on residency programmes over there?

On a more general note why do people think its the case that getting a consultant post in surgery is so much more difficult than other specialities?

I only ever worked as a locum consultant in Ireland a few years ago so I really can't answer for the contemporary Irish end.

We are staff physicians here with lower status than the consultants used to have in Ireland in the olden days. The medical workforce is cylindrical rather than pyramidal so nearly everybody who wants one gets a 'consultant' post. Training takes a lot less time - 5-6 yrs in most specialties from med school graduation and 2 yrs for general practice - and jobs are usually easy to get afterwards. I'd say work is pretty similar. The pay looks great at first but most doctors finance their own pensions and disability insurance and there is no lump sum at the end of the rainbow. We are easier to fire. Many remote hospitals here have no junior doctors at all so call is tough out there and many foreigners end up working in such places.

It used to be fairly easy to get in to do a residency but I think these days you would be up against stiff competition from all over the world for the few posts given to foreigners. It would be easier in less popular specialties like psychiatry or pathology. Fellowships are also easier to get. Each province makes up its own rules on who is eligible to apply for work at post-resident level.

Orthopedic surgery was having a hard time filling its posts a few years ago because of a glut of these guys on the market. So you could keep your eye out for residency posts that have become less popular. Most residency programs require you to have already done all the Canadian qualifying exams.

General surgery is innately difficult. The field is enormous and patients' expectations are through the roof. Mistakes are often easy to detect unlike many other fields of medicine I could mention. Most younger doctors here prefer something more specialised, more akin to dentistry, in the city with lots of support, senior colleagues to call, junior doctors to help and a nice call rota. But it's not difficult to get a job here in it, especially in rural settings. At home in Ireland, there were far more applicants for surgical jobs in my time and training took way too long. The best surgeons were often the senior registrars.

One classmate of mine, outstanding in every way, took nearly ten years longer than I did to get a consultant post in surgery in Ireland. When he was doing interviews near the end, he found out that one of his close friends, a fellow senior reg, was bad-mouthing him to the powers that be. That's how mean it can get.

If you could stand the actual work each day, psychiatry is a very good bet for ultimate consultant success. All my buddies who did it ended up as consultants in Ireland. They didn't kill themselves working either.