Career options for older GEM doctor?

pc11

Hi, I'm about to start GEM. The thing is I'm older (>40) and hence will have a short career which means shorter time to repay debt, less chance to progress to the higher ranks, less career earnings, and less time to accumulate pensions and so on.

• Is there any chance I could eventually reach consultant given my age? It seems unlikely to me.
  
• If I become a hospital doctor, will I be forced to retire at 65? I have read that for new entrants to the HSE, 65 is now the minimum retirement age, not the mandatory age - is that right?
  
• Even if the HSE made me retire, couldn't I work privately as long as I wanted?
  
• If I go the GP route, presumably I'll be self-employed or employed by a practice eventually, and I can work for as long as I want?
  
• If I did my full training to be eligible to become a consultant, do I need to wait for a hospital consultant post to come up or can I just set up privately as a consultant?

I'm worried that my options will be limited, and I'll be forced to have a short career, especially if I'm in the hospital system.

Any advice or thoughts?

Agnieszka_88

I can only answer the retirement age question: the EU is pushing for mandatory retirement for surgeons at the age of 65-67. Other hospital doctors would be allowed to work for as long as they wanted, provided that their health would allow it. Theoretically, they could be forced out if it was decided that they can't work effectively any more, even if they felt otherwise.
As for working in a private practice, the number of patients would probably decide for you.

Personally, I think it will be hard for you (and anyone staring over 35, really) to reach consultant level, but I suppose it will all depend on what you'll decide to specialise in.

ThatDrGuy

You really shouldn't be asking randomers on the internet this if your just about to start GEM. So many clueless people have signed up for medical courses without a notion of what their working conditions and futures will be like. Find someone actually working in the field you want to go into and investigate. In my opinion it is lunacy. Working 80 hour weeks in your 50's ? Being savaged by debt for the next decade? Being passed over again and again for training places to bright young things 20 years your junior ? Realistically speaking you haven't a snowballs chance in hell of getting a consultancy post in practically any specialty. That's even if you could get on a training scheme and if you factor in the long PHDs and fellowships most consultants have these days you might not even be qualified to compete for a post before retirement age. If you are dead set on it - GP route might be an option but GP training schemes can be just a competitive and GP training is no walk in the park either. Once qualified you have no guarantee of income. Abroad is an option if you can uproot but still count on taking a long time. You really need advice on this.

pc11

ThatDrGuy wrote: »

You really shouldn't be asking randomers on the internet this if your just about to start GEM. So many clueless people have signed up for medical courses without a notion of what their working conditions and futures will be like. Find someone actually working in the field you want to go into and investigate. In my opinion it is lunacy. Working 80 hour weeks in your 50's ? Being savaged by debt for the next decade? Being passed over again and again for training places to bright young things 20 years your junior ? Realistically speaking you haven't a snowballs chance in hell of getting a consultancy post in practically any specialty. That's even if you could get on a training scheme and if you factor in the long PHDs and fellowships most consultants have these days you might not even be qualified to compete for a post before retirement age. If you are dead set on it - GP route might be an option but GP training schemes can be just a competitive and GP training is no walk in the park either. Once qualified you have no guarantee of income. Abroad is an option if you can uproot but still count on taking a long time. You really need advice on this.

Well, I have always been resigned to the fact that making consultant is unlikely and I have to accept that, and I could well be quite happy doing GP. I just want to understand all the options. And I don't know what field I want to be in yet. If I had someone better to ask, I would ask them.

As for the long hours, my age and the debt, I'm painfully aware of these, believe me. They are huge barriers and they certainly worry me, but then I can't do much about them.

My 50s would be even longer if I stay stuck in my current career, frankly.

Ok, let's take the difficulties as a given, what about the specific questions I asked, do you have any info on the retirement thing for start?

EDIT: According to this: http://www.hse.ie/eng/staff/Benefits_Services/Pension_Management/Current_Employees'_Pension_Scheme_Members/ for new hires the following applies:

A minimum retirement age of 65 years
No compulsory retirement age (subject to suitability and health requirements).
A minimum of 2 years’ service is required for eligibility for benefits (no minimum service is required however for death in service benefit).

EDIT 2: your post was really unnecessarily harsh IMO. I'm far from alone in going the GEM route, we're aware it's very difficult, and it's illogical to tell someone they should ask questions and then criticise them for so doing. I'm pretty sure the questions I asked are ones that most young med students have even though of, so I actually could be ahead of many. Nonetheless, thanks for your input.

Vorsprung

pc11 wrote: »

• Is there any chance I could eventually reach consultant given my age? It seems unlikely to me.
  
• If I become a hospital doctor, will I be forced to retire at 65? I have read that for new entrants to the HSE, 65 is now the minimum retirement age, not the mandatory age - is that right?
  
• Even if the HSE made me retire, couldn't I work privately as long as I wanted?
  
• If I go the GP route, presumably I'll be self-employed or employed by a practice eventually, and I can work for as long as I want?
  
• If I did my full training to be eligible to become a consultant, do I need to wait for a hospital consultant post to come up or can I just set up privately as a consultant?

I'm worried that my options will be limited, and I'll be forced to have a short career, especially if I'm in the hospital system.

Any advice or thoughts?

While it might be possible you reach consultant level depending on your career path, I think it's highly unlikely, for the reasons outlined above. You could certainly work privately, but that would most likely mean going abroad for a period of time.

If you attempt the GP route (not easy from personal experience), you could have a good career; you're unlikely to be self employed in the years after finishing GP training (and you're probably 10 or so years away from that point anyway), instead you'd probably end up doing sessional work for other established practices.

If you did all your training, you could set up as a consultant by yourself but you'd often need access to procedure space (depends on the speciality I guess). Certainly possible.

While I wish you all the best, I really wish you'd asked these questions of someone/anyone long before!

pc11

Vorsprung wrote: »

While it might be possible you reach consultant level depending on your career path, I think it's highly unlikely, for the reasons outlined above. You could certainly work privately, but that would most likely mean going abroad for a period of time.

If you attempt the GP route (not easy from personal experience), you could have a good career; you're unlikely to be self employed in the years after finishing GP training (and you're probably 10 or so years away from that point anyway), instead you'd probably end up doing sessional work for other established practices.

If you did all your training, you could set up as a consultant by yourself but you'd often need access to procedure space (depends on the speciality I guess). Certainly possible.

While I wish you all the best, I really wish you'd asked these questions of someone/anyone long before!

Thanks Vorsprung, that's helpful. I had been mostly thinking of GP anyway, and I've always understood that reaching consultant was unlikely as most doctors can't make it, and that was ok actually, but I recently wondered about the hospital route and wanted to understand it better.

To be honest, the main question was the HSE retirement age thing, the rest were just add-ons.

Let me ask another question, if I went the hospital doctor route, do I understand there is no way to later be semi-retired and just be a 'country GP' without actually qualifying as a GP, no matter what experience/qualification I might gain in hospital?

As for asking earlier, well I've been pretty active here and elsewhere for a long time asking and answering questions so I haven't been holding back, and I can't say I've seen most of these questions raised so I'm clearly not alone in finding these non-obvious. Or maybe everyone knew all the above and I'm really dumb, but I'm willing to bet these haven't even occurred to most young med students.

Do you really think many med students have even thought to research retirement age and pensions?? Most middle-aged people I know have no idea about these, let alone young uns.

Agnieszka_88

pc11 wrote: »

Let me ask another question, if I went the hospital doctor route, do I understand there is no way to later be semi-retired and just be a 'country GP' without actually qualifying as a GP, no matter what experience/qualification I might gain in hospital?

I think the "retired army surgeon turned country doctor" thing ended sometime at the beginning of the last century, you have to have training to call yourself a GP. You can work as an advisor to other doctors, but this only makes sense in big research/educational centres, doable only if you have published a lot.

pc11 wrote: »

I'm willing to bet these haven't even occurred to most young med students.

I've tried to research these things a long time ago (will be over 30 when I start GEM), but I agree with pc11. Even some people entering GEM seem to have this "it will all work out in end" attitude, not everyone worries about retirement age and possible career routes - discussing these things openly cannot harm. It's clear that you've thought about it for a while now and are going in with your eyes wide open, I see no harm in seeking further information when you've already decided that you're going back to school no matter what.
Also, a personal observation: from combing through this forum and some English GEM forums, it seems to me like being a mature medicine student meets with more discouragement in Ireland. Could it be because of the differences in further training or is it simply because work conditions in Ireland are so much worse? (is there really such a difference?)

Vorsprung

pc11 wrote: »

Let me ask another question, if I went the hospital doctor route, do I understand there is no way to later be semi-retired and just be a 'country GP' without actually qualifying as a GP, no matter what experience/qualification I might gain in hospital?

If you want to call yourself a GP, you have to be on the specialist register, and you will need to do formal GP training to get on it (4 years here, 3 in the UK). You can conceivably set up as an independent practitioner but I haven't really come across that outside of the odd random cosmetic clinic.

pc11 wrote: »

As for asking earlier, well I've been pretty active here and elsewhere for a long time asking and answering questions so I haven't been holding back, and I can't say I've seen most of these questions raised so I'm clearly not alone in finding these non-obvious. Or maybe everyone knew all the above and I'm really dumb, but I'm willing to bet these haven't even occurred to most young med students.

In fairness you have been fairly active, sorry I didn't mean to suggest otherwise. But given that you are presumably giving up a lot in your 40s to take on this new challenge (and big balls to you for doing so), I'd have expected you to have had the answers to these questions well before now.

pc11 wrote: »

Do you really think many med students have even thought to research retirement age and pensions?? Most middle-aged people I know have no idea about these, let alone young uns.

Medical student or not, I don't think most people under the age of 25 have thought about retirement or pensions.

pc11

Vorsprung wrote: »

Medical student or not, I don't think most people under the age of 25 have thought about retirement or pensions.

Exactly. From my experience, few people even up to 50 have done so in much detail. That's not to excuse it, but it's petty typical.

Ok, ideally I should know every question and answer long ago, but that's not realistic when I've spent the last year working, doing GAMSAT, saving, budgeting, dealing with banks, agonising over whether to do this at all and all the rest. And trust me, agonise I have done. I am terrified of the challenge of medicine, the long hours, the pressure, the starting again from scratch, the debt. It keeps me awake at night. I am petrified I am making the wrong decision. And yet, it's been on my mind for years, and I can't think of anything else I want to do now.

So, did you investigate retirement and pensions before med school?

Vorsprung

pc11 wrote: »

Exactly. From my experience, few people even up to 50 have done so in much detail. That's not to excuse it, but it's petty typical.

Did you investigate retirement and pensions before med school?

No, but if you had shares in companies that produced bottom shelf beers I contributed to your pension.

I am slightly worried that it might be typical that people in their 50s don't know how they're going to source their income in 15 years!

Vorsprung

pc11 wrote: »

Ok, ideally I should know every question and answer long ago, but that's not realistic when I've spent the last year working, doing GAMSAT, saving, budgeting, dealing with banks, agonising over whether to do this at all and all the rest. And trust me, agonise I have done. I am terrified of the challenge of medicine, the long hours, the pressure, the starting again from scratch, the debt. It keeps me awake at night. I am petrified I am making the wrong decision. And yet, it's been on my mind for years, and I can't think of anything else I want to do now.

Well look, it's your call and the very best of luck with it. I have a friend in a not dissimilar position to you (she's 30 odd) starting GEM next week (different college to you). She has been talking about doing medicine since we were teenagers, she had the points but decided against it in the end. Long story short, she's moved countries, quit her decent job and moved back in with her parents.

I'm not sure I could do it, but as I said, kudos to those who do it!

pc11

Vorsprung wrote: »

Well look, it's your call and the very best of luck with it. I have a friend in a not dissimilar position to you (she's 30 odd) starting GEM next week (different college to you). She has been talking about doing medicine since we were teenagers, she had the points but decided against it in the end. Long story short, she's moved countries, quit her decent job and moved back in with her parents.

I'm not sure I could do it, but as I said, kudos to those who do it!

Well, here's the thing. I'm in a terrible workplace that I've come to hate, and I'm fed up with the whole profession I'm in. It hurts my very soul every day I'm there. As hard as medicine is, how hard is it to spend years in something you hate? (rhetorical question!)

ThatDrGuy

It's kind of horrifying that colleges will just take your money and give you no advice and guidance on these issues. There really should be someone you can sit down with who knows about the Irish system that can talk you through the pros and cons of it. Or at least a mechanism that allows potential students to shadow doctors about their day so they can see what the job entails. About 100% of my class's knowledge of hospital medicine environment came from ER. If you haven't experienced it, it's very hard to convey what it's like. You might be trading one soul destroying job for another. There are only a handful of my class left in medicine in this country - the vast majority have gotten the hell out and never looked back ( myself included ). At the other end of the meat grinder you have far too many students who are utterly unprepared for the reality of the job driven by romaticised notions of what they think medicine is. I don't want to tread on anyone's dreams but the cautionary principle is very important here. I've met more than a few post grads whose bitterness makes a life long cynic like me seem like a care-bear in comparison. Having said that I've seen some take to it like a duck to water somehow rising above the chaos in ways I never could. Best of luck anyway.

pc11

ThatDrGuy wrote: »

It's kind of horrifying that colleges will just take your money and give you no advice and guidance on these issues. There really should be someone you can sit down with who knows about the Irish system that can talk you through the pros and cons of it. Or at least a mechanism that allows potential students to shadow doctors about their day so they can see what the job entails. About 100% of my class's knowledge of hospital medicine environment came from ER. If you haven't experienced it, it's very hard to convey what it's like. You might be trading one soul destroying job for another. There are only a handful of my class left in medicine in this country - the vast majority have gotten the hell out and never looked back ( myself included ). At the other end of the meat grinder you have far too many students who are utterly unprepared for the reality of the job driven by romaticised notions of what they think medicine is. I don't want to tread on anyone's dreams but the cautionary principle is very important here. I've met more than a few post grads whose bitterness makes a life long cynic like me seem like a care-bear in comparison. Having said that I've seen some take to it like a duck to water somehow rising above the chaos in ways I never could. Best of luck anyway.

I don't disagree with any of that, and I'm satisfied that my expectations are more realistic than that. When I say above that I'm scared, I really am, That's why I'm here talking about it.

Where have you gone to now? How is it there? I don't rule out leaving either.

What is the single biggest negative you felt about medicine? Is it the Irish system specifically?

Anthony16

ThatDrGuy wrote: »

It's kind of horrifying that colleges will just take your money and give you no advice and guidance on these issues. There really should be someone you can sit down with who knows about the Irish system that can talk you through the pros and cons of it. Or at least a mechanism that allows potential students to shadow doctors about their day so they can see what the job entails. About 100% of my class's knowledge of hospital medicine environment came from ER. If you haven't experienced it, it's very hard to convey what it's like. You might be trading one soul destroying job for another. There are only a handful of my class left in medicine in this country - the vast majority have gotten the hell out and never looked back ( myself included ). At the other end of the meat grinder you have far too many students who are utterly unprepared for the reality of the job driven by romaticised notions of what they think medicine is. I don't want to tread on anyone's dreams but the cautionary principle is very important here. I've met more than a few post grads whose bitterness makes a life long cynic like me seem like a care-bear in comparison. Having said that I've seen some take to it like a duck to water somehow rising above the chaos in ways I never could. Best of luck anyway.

Very good post.

Ihaveanopinion

pc11 wrote: »

Hi, I'm about to start GEM. The thing is I'm older (>40) and hence will have a short career which means shorter time to repay debt, less chance to progress to the higher ranks, less career earnings, and less time to accumulate pensions and so on.

• Is there any chance I could eventually reach consultant given my age? It seems unlikely to me.
  
• If I become a hospital doctor, will I be forced to retire at 65? I have read that for new entrants to the HSE, 65 is now the minimum retirement age, not the mandatory age - is that right?
  
• Even if the HSE made me retire, couldn't I work privately as long as I wanted?
  
• If I go the GP route, presumably I'll be self-employed or employed by a practice eventually, and I can work for as long as I want?
  
• If I did my full training to be eligible to become a consultant, do I need to wait for a hospital consultant post to come up or can I just set up privately as a consultant?

I'm worried that my options will be limited, and I'll be forced to have a short career, especially if I'm in the hospital system.

Any advice or thoughts?

I know of someone the year ahead of me who qualified as an Intern in his 50s, mind you he was financially independent at that stage. He went down the hospital medical route. I'm not sure how far we went in his post graduate training but I know he got a job as a Staff Grade Registrar. It doesn't really exist in Ireland officially - but it does. This is a permanent hospital job where you work nominally under a Consultant or service, but work reasonably independently. The few I have come across in Ireland are all well paid and the people are pretty happy.

To get to Consultant level would be possible but if it came to an interview for hospital jobs, I feel it would be a challenge for you because your short career may play against you - unless you are a very strong academic.

GP is a reasonable goal but again, you may come across an age bias at interviews. To practice as an independent GP, you need to complete a formal training programme. You can do locum work until the cows come home without formal post graduate qualifications. But I would think that would be a very unsatisfactory result for you

RobFowl

Ihaveanopinion wrote: »

GP is a reasonable goal but again, you may come across an age bias at interviews. To practice as an independent GP, you need to complete a formal training programme. You can do locum work until the cows come home without formal post graduate qualifications. But I would think that would be a very unsatisfactory result for you

FTR you cannot work as a GP without training anymore as the MPS (not 100% sure about Medisec) will no longer insure you (they continue to insure those who were already working in this role).

Ihaveanopinion

RobFowl wrote: »

FTR you cannot work as a GP without training anymore as the MPS (not 100% sure about Medisec) will no longer insure you (they continue to insure those who were already working in this role).

Apologies - I meant Hospital Locums - not GP Locums

polydactyl

As a doctor I can tell you the reality is GP is really your only feasible option. Once you qualify you have a mandatory 1 year as intern. For hospital route you then apply and interview for the schemes you are interested in med, surg, Paeds, psych, GP etc gettibg on these can be tough but should be grand no matter the age. After 2 years as an SHO provided you have completed all the necessary post grad exams you can apply for the relevant SpR scheme and here is where your age will be a factor. Providesd you have managed all your exams in the two prev years which many don't these schemes are all very. Competitive and to be honest if they can train a 27 year old versus a 40 something I think it will come into play. If you do get it then that's 5 more years SpR after which while eligible to be a consultant you won't get employed without a post grad MD/PhD and or a fellowship which all add two to three more years on. So in reality if you are 40+ already starting and it's another 10 yr to any speciality after grad you will be mid 50s at least applying for consultant posts going up against mid 30 something's who can give back 30 years to the service.


In summary GP your only realistic option. Sorry but likely true. You could be a career reg but j suspect that would be deeply deeply unfulfilling and the hours and pay for the hours would get you in the end.

drzhivago

polydactyl wrote: »

As a doctor I can tell you the reality is GP is really your only feasible option. Once you qualify you have a mandatory 1 year as intern. For hospital route you then apply and interview for the schemes you are interested in med, surg, Paeds, psych, GP etc gettibg on these can be tough but should be grand no matter the age. After 2 years as an SHO provided you have completed all the necessary post grad exams you can apply for the relevant SpR scheme and here is where your age will be a factor. Providesd you have managed all your exams in the two prev years which many don't these schemes are all very. Competitive and to be honest if they can train a 27 year old versus a 40 something I think it will come into play. If you do get it then that's 5 more years SpR after which while eligible to be a consultant you won't get employed without a post grad MD/PhD and or a fellowship which all add two to three more years on. So in reality if you are 40+ already starting and it's another 10 yr to any speciality after grad you will be mid 50s at least applying for consultant posts going up against mid 30 something's who can give back 30 years to the service.


In summary GP your only realistic option. Sorry but likely true. You could be a career reg but j suspect that would be deeply deeply unfulfilling and the hours and pay for the hours would get you in the end.

Disagree that GPis the only option but it is most

• Why are you doing this, what was it that attracted you to this change at this point in your life
• Do you like the idea of a different educational challenger or is there somedriving force telling you to be a doctor (of some kind)
• What kind of doctor do you want to be multiple options exist here
• Have you sondiered joining ARMY after graduation, they have a medical staff contingent and for those eraly years of career pay is significantly greater than working as junior doctor in hospitals
• What other skills do you have from your current job (even if you dont like them) that may be transferrable (even if you dont see it others will) into a career in medicine eg Logistics and complex chain management ( Clinical Ed / Non clinical Public Healh) ; Legal ( Clinical - Pathology/Forenisc Pathology / Police Surgeon NON Clinical - forensic Legal medicine/risk Management / MPS Medical Advisor) ; Significant Literary and editorship Skills ( Clinical ; Lead Investigator/Grant Writer for Clincial trials Groups like ICORG NON CLINICAL- ACADEMIC - Course director in University Sector/Module Writer/Text Book Author /Web Site Editor / Medical Journalist)
• HAve you considered teaching ie Undergrad / Post Grad as there are careers available on those tracks
• HAve you considered aacdemic - there are SPR schemes available for people to become Clinican Scientists (if you already hae a head start from current life that could be a good transition)
• Have you a head for Business - Medical Advisor to Pharmaceutical Companies who need medics to train their reps/approve materials/speak to Gp groups etc
• HAve you considerd setting up sevice in career advice - as you can see there is a lot out there that is not publciised regarding where people can slot in to a work life which does not look like the typical work pattern for a doctro when you ae looking from a medical student perspective

likely option for you to finish training and get on specialist register in shortest period of time but other things to consider are


UCD are planning an event I think titled "the road Less Travelled" to highlight to students some of the options available in careers they would not see in their undergrad experiences to give them a flavour of the who why and what expedition medicine or event medicine, disaster medicine , pharmaceutical medicine etc is all about


Without asking many personal questions other matters to consider are

• FAmily situation - this can be very difficult when doing junior rdoctor rotations, I lived away from own wife and children for 4 years during my junior doctor days and that was not easy
• Own health situation - is your personal health up to the stresses of the rotating noght shifts, believe me when I say taht is soemthing for younger people and i have seen many struggle with taht eleemnt of it
• Cn you do anything with your current profession while a student, anything to keep some cash flowing as the life change from beinga working eprson having money in pocket to student living hand to month and counting pennies is a very difficult transition back
• Life Insurance - essential if you have dependents and you may need to talk to broker about levels of cover based on chanegd crcumstances
• Personal debt levels - Bank loans will not be easy to get unless have equity ie home, banks also not ken on lending to GEM students anymore because they realsie the jobs are not automaic on graduation and thye cant call ina debt on someone wheo has emigrated to UK to continu their career

Hope not all doom and gloom there are many options out there

Realistically though from outset traditional hospital medicine is probably not for you if the Goal is to remain in ireland, average age at appointment to consultant post is 42 and that is for people who graduated at 23 or 24 so a 17 or 18 year track post graduation with a good few of those years spent abroad
If you are 60+ at the point where you are eligible to apply it will be difficult but not impossible to get a job, they cant age discriminate against you but the interview processes are flawed enough to allow bias

pc11

drzhivago wrote: »

Disagree that GPis the only option but it is most

• Why are you doing this, what was it that attracted you to this change at this point in your life
• Do you like the idea of a different educational challenger or is there somedriving force telling you to be a doctor (of some kind)
• What kind of doctor do you want to be multiple options exist here
• Have you sondiered joining ARMY after graduation, they have a medical staff contingent and for those eraly years of career pay is significantly greater than working as junior doctor in hospitals
• What other skills do you have from your current job (even if you dont like them) that may be transferrable (even if you dont see it others will) into a career in medicine eg Logistics and complex chain management ( Clinical Ed / Non clinical Public Healh) ; Legal ( Clinical - Pathology/Forenisc Pathology / Police Surgeon NON Clinical - forensic Legal medicine/risk Management / MPS Medical Advisor) ; Significant Literary and editorship Skills ( Clinical ; Lead Investigator/Grant Writer for Clincial trials Groups like ICORG NON CLINICAL- ACADEMIC - Course director in University Sector/Module Writer/Text Book Author /Web Site Editor / Medical Journalist)
• HAve you considered teaching ie Undergrad / Post Grad as there are careers available on those tracks
• HAve you considered aacdemic - there are SPR schemes available for people to become Clinican Scientists (if you already hae a head start from current life that could be a good transition)
• Have you a head for Business - Medical Advisor to Pharmaceutical Companies who need medics to train their reps/approve materials/speak to Gp groups etc
• HAve you considerd setting up sevice in career advice - as you can see there is a lot out there that is not publciised regarding where people can slot in to a work life which does not look like the typical work pattern for a doctro when you ae looking from a medical student perspective

likely option for you to finish training and get on specialist register in shortest period of time but other things to consider are


UCD are planning an event I think titled "the road Less Travelled" to highlight to students some of the options available in careers they would not see in their undergrad experiences to give them a flavour of the who why and what expedition medicine or event medicine, disaster medicine , pharmaceutical medicine etc is all about


Without asking many personal questions other matters to consider are

• FAmily situation - this can be very difficult when doing junior rdoctor rotations, I lived away from own wife and children for 4 years during my junior doctor days and that was not easy
• Own health situation - is your personal health up to the stresses of the rotating noght shifts, believe me when I say taht is soemthing for younger people and i have seen many struggle with taht eleemnt of it
• Cn you do anything with your current profession while a student, anything to keep some cash flowing as the life change from beinga working eprson having money in pocket to student living hand to month and counting pennies is a very difficult transition back
• Life Insurance - essential if you have dependents and you may need to talk to broker about levels of cover based on chanegd crcumstances
• Personal debt levels - Bank loans will not be easy to get unless have equity ie home, banks also not ken on lending to GEM students anymore because they realsie the jobs are not automaic on graduation and thye cant call ina debt on someone wheo has emigrated to UK to continu their career

Hope not all doom and gloom there are many options out there

Realistically though from outset traditional hospital medicine is probably not for you if the Goal is to remain in ireland, average age at appointment to consultant post is 42 and that is for people who graduated at 23 or 24 so a 17 or 18 year track post graduation with a good few of those years spent abroad
If you are 60+ at the point where you are eligible to apply it will be difficult but not impossible to get a job, they cant age discriminate against you but the interview processes are flawed enough to allow bias

Thanks for a very thoughtful post. I can say that I have very carefully considered most of the personal/financial considerations you mentioned and they are in hand. I won't get in to answering all your questions as it would take too long, but I will take them as questions for me to consider.

As regards the career options, yes, I have considered some of those options and some were new to me. One of the reasons I would consider doing GEM is for the wide range of careers for doctors, you're right that it's not simply hospital vs GP for sure.

To be honest, my original post may been poorly phrased. My main question was really about retirement ages and pensions in the HSE. I am more likely to do GP, I just was curious to know more about the hospital route and how long one could work there. I know well that making consultant is unlikely, and I've always known this and it's ok.

Thanks again.

drzhivago

pc11 wrote: »

Thanks for a very thoughtful post. I can say that I have very carefully considered most of the personal/financial considerations you mentioned and they are in hand. I won't get in to answering all your questions as it would take too long, but I will take them as questions for me to consider.

As regards the career options, yes, I have considered some of those options and some were new to me. One of the reasons I would consider doing GEM is for the wide range of careers for doctors, you're right that it's not simply hospital vs GP for sure.

To be honest, my original post may been poorly phrased. My main question was really about retirement ages and pensions in the HSE. I am more likely to do GP, I just was curious to know more about the hospital route and how long one could work there. I know well that making consultant is unlikely, and I've always known this and it's ok.

Thanks again.

Apologies I now see all the spelling errors, trying to type quickly back from on call in hospital pre taking kids to sport

Watch for that UCD careers event, it will be aimed at undergrads and early year post grads who may be unaware of those and many other specific options and also people who are looking for something completely differenet and thinking of not finishing the degree because they cant see themselves working like the people they meet in hospitals every day

90% of medicine happens outside hospitals yet 90% of your training is focussed inside them, gives a poor balance really

GP is only one option dont just focus on that it is also very competitive which can mena it takes a few years to get on the scheme

Public Health another area to consider, wide career options in that
Occupational medicine
Sports and Exercise Medicine, something very new and would be able to do past 65
Mens health clinics growing area, not really a specialty but big area

Whatever you do best of luck, I have had more good days than bad but there are many days when i question why things are the way they are and our system is not conducive to those who ask such questions, if you find yourself in that boat get a different career path in medicine quickly

pc11

Ihaveanopinion wrote: »

Apologies - I meant Hospital Locums - not GP Locums

Can I clarify that? A qualified (or part-qualified?) GP could do locum work in hospital?

pc11

drzhivago wrote: »

Apologies I now see all the spelling errors, trying to type quickly back from on call in hospital pre taking kids to sport

Watch for that UCD careers event, it will be aimed at undergrads and early year post grads who may be unaware of those and many other specific options and also people who are looking for something completely differenet and thinking of not finishing the degree because they cant see themselves working like the people they meet in hospitals every day

90% of medicine happens outside hospitals yet 90% of your training is focussed inside them, gives a poor balance really

GP is only one option dont just focus on that it is also very competitive which can mena it takes a few years to get on the scheme

Public Health another area to consider, wide career options in that
Occupational medicine
Sports and Exercise Medicine, something very new and would be able to do past 65
Mens health clinics growing area, not really a specialty but big area

Whatever you do best of luck, I have had more good days than bad but there are many days when i question why things are the way they are and our system is not conducive to those who ask such questions, if you find yourself in that boat get a different career path in medicine quickly

I'm heading for RCSI but I'll watch out for it, thanks.

I did see this Facebook page specifically for diverse medical careers, it may be of use to people:
https://www.facebook.com/DiverseMedical

Tell me, what type of job/specialty are you in now? Would you choose differently if you went back in time?

pc11

polydactyl wrote: »

As a doctor I can tell you the reality is GP is really your only feasible option. Once you qualify you have a mandatory 1 year as intern. For hospital route you then apply and interview for the schemes you are interested in med, surg, Paeds, psych, GP etc gettibg on these can be tough but should be grand no matter the age. After 2 years as an SHO provided you have completed all the necessary post grad exams you can apply for the relevant SpR scheme and here is where your age will be a factor. Providesd you have managed all your exams in the two prev years which many don't these schemes are all very. Competitive and to be honest if they can train a 27 year old versus a 40 something I think it will come into play. If you do get it then that's 5 more years SpR after which while eligible to be a consultant you won't get employed without a post grad MD/PhD and or a fellowship which all add two to three more years on. So in reality if you are 40+ already starting and it's another 10 yr to any speciality after grad you will be mid 50s at least applying for consultant posts going up against mid 30 something's who can give back 30 years to the service.


In summary GP your only realistic option. Sorry but likely true. You could be a career reg but j suspect that would be deeply deeply unfulfilling and the hours and pay for the hours would get you in the end.

Thanks for that. I see that consultant is very unlikely alright. But, isn't it true that if I went through all the training that I could just be a private consultant? The path you describe there refers to HSE/hospital posts, right? So, it's an option to just work for yourself or in a private clinic I believe?

Not saying I would do that, just checking.

Also, it's not just SpR vs GP. As others have posted, there are other options. One of the attractions of medicine is there are a lot of career options. I have a very open mind where I could end up. I'm already a non-standard prospective doctor, so I have to be flexible and open really.

polydactyl

Absolutely there are other option outside of GP/ hospital I was just clarifying those two as that was what mainly seemed to be discussed earlier. As regards setting up as a private consultant then yes you could but again it depends on the area. If you want surgery you would need theatre etc and admission rights or there would really be no reason for a person to attend you obverse others. Other specialities like derm, psych etc yes of course you could. It's just difficult as most people find out about consultants from the hospitals they work in so it would be very difficult to just set up and make it a successful viable business quickly enough to make it a financially viable option.

Also anyone after intern year can do locums in the hospital at the appropriate grade etc but they are usually for a day/week/ month. Not long term as hospitals don't like paying locums long term

pc11

polydactyl wrote: »

Absolutely there are other option outside of GP/ hospital I was just clarifying those two as that was what mainly seemed to be discussed earlier. As regards setting up as a private consultant then yes you could but again it depends on the area. If you want surgery you would need theatre etc and admission rights or there would really be no reason for a person to attend you obverse others. Other specialities like derm, psych etc yes of course you could. It's just difficult as most people find out about consultants from the hospitals they work in so it would be very difficult to just set up and make it a successful viable business quickly enough to make it a financially viable option.

Also anyone after intern year can do locums in the hospital at the appropriate grade etc but they are usually for a day/week/ month. Not long term as hospitals don't like paying locums long term

How does it work with private clinics like the Sports Surgery Clinic or maybe the Hermitage? Are all the doctors there qualified as consultants? Are they employed by the clinic and they responded to vacancies or do they rent space from the clinic as sort of self-employed contractors?

Presumably in a place like that with theatres and imaging facilities they could be quite independent of the HSE if they so wished? I wonder how many of them also work in the HSE.

On the SSC's website, many are described as consultant, but not all. How does one end up in a place/job like that?

polydactyl

The doctors in the Hermitage who have clinics there and are listed as consultants are all fully trained either here or abroad. Consultants don't have any extra letters after their name but they are still fully finished SpR etc. many of them also do their public service in another hospital like Beaumont, Tallaght etc and this is extra. Same as the consultants in the sports clinic. All fully trained and most have public job also. The cardiologists are consultants as are the resp guys they have their cscst meaning they completed a specialist training programme. The only people who are not listed as consultants are the sports medicine physicians. That's because it's not a speciality you can do an SpR in. They are often GPs who did extensive additional training and research to become experts in their field or their speciality was internal medicine and their fellowship was in sports medicine.

They pay for the spaces and access and usually due to the fact that they see the demand in their public clinics and meet it. Honestly it's all very complicated and in the 10 plus years at least before you get to that stage at all it may all have changed

his_dudeness

To call yourself consultant in a medical sense, you will have to have a Certificate of Completion of (Specialist) Training (CC(S)T). You would then be on the Medical Councils General or Specialist Regsiter. I would suspect that all these forms are checked when these guys in the private clinics have either been hired as salaried staff posts or taken out private rooms there (both options would be available)

pc11

polydactyl wrote: »

The doctors in the Hermitage who have clinics there and are listed as consultants are all fully trained either here or abroad. Consultants don't have any extra letters after their name but they are still fully finished SpR etc. many of them also do their public service in another hospital like Beaumont, Tallaght etc and this is extra. Same as the consultants in the sports clinic. All fully trained and most have public job also. The cardiologists are consultants as are the resp guys they have their cscst meaning they completed a specialist training programme. The only people who are not listed as consultants are the sports medicine physicians. That's because it's not a speciality you can do an SpR in. They are often GPs who did extensive additional training and research to become experts in their field or their speciality was internal medicine and their fellowship was in sports medicine.

They pay for the spaces and access and usually due to the fact that they see the demand in their public clinics and meet it. Honestly it's all very complicated and in the 10 plus years at least before you get to that stage at all it may all have changed

Actually, sports medicine would definitely be on my list of possible paths. That's interesting that many of them might be GPs first.

Would it be a condition to have a room in a private clinic like these that they must have finished SpR training then? Is that a condition of the clinic or of the IMO/RCPI/etc? Is it impossible for a not quite finished SpR to set up on his own in some fashion?

Do you think if I found some doctors working in an area I was interested in that I could contact them and ask to do some kind of shadowing or experience with them during med school or during holidays?

Sorry if these are slightly silly questions, I haven't seen questions like these elsewhere. I'm grateful for your explanations.

TheKingslayer

The game is rigged, and unfortunately people are playing blindfolded with their hands tied behind their back.

There is no future in hopsital medicine in Ireland.

The majority of people in medicine have spent half their lives trying to get in, and then the second half trying to get out when they realise how ****ed the whole thing is. Over 50% of any graduating class will jump onto a GP training scheme just to escape the hell of the hospital, and this number will steadily rise as people who try and go the hospital route realise how futile it is.

The HSE have invented the most ingenious pyramid scheme in the history of the western world. Offer medicine to people desperate enough to get themselves into massive debts to do it (debts you will NEVER be able to re-pay if you stay in Ireland I might add). Then get people who are that little bit older - people entering their early 30s, with roots in Ireland, less inclined to emigrate due to family/girlfriend/kids/aging parents etc. Most of these people don't realise what they have let themselves in for until it is too late and they are in too much debt to turn back.

These people have been sold into servitude.

Your options as a person in his 50s are between none and limited.
GP is being decimated - the days of making 6 figures doing this are long gone. Watch and see the GP system become run by business-men who employ doctors for 40k a year max. These guys will no sfa about medicine and will constantly be on your case to spend less time in consults etc. The manager of the local LIDL will probably make more than you.

The loan - you will never be able to repay this.

The lucky few whose parents paid for their degree, or those who have a good degree to go back to (eg pharmacists) are the lucky ones - they have an escape.


You will be working 100 hours a week and getting paid for fifty. If you complain to your consultant about him not signing off on your hours, he will write you a bad reference, ring his pals to ensure you never get a job, or report you to the medical council.

Your options are the UK, Aus, or the US.

You have no option here. I implore anyone starting medicine (especially anyone in their late twenties and above) to turn back immediately.

This is not ER, or Grey's Anatomy. There is no ideals in this, it is just a job. There is no respect for this profession in this country.

polydactyl

pc11 wrote: »

Actually, sports medicine would definitely be on my list of possible paths. That's interesting that many of them might be GPs first.

Would it be a condition to have a room in a private clinic like these that they must have finished SpR training then? Is that a condition of the clinic or of the IMO/RCPI/etc? Is it impossible for a not quite finished SpR to set up on his own in some fashion?

Do you think if I found some doctors working in an area I was interested in that I could contact them and ask to do some kind of shadowing or experience with them during med school or during holidays?

Sorry if these are slightly silly questions, I haven't seen questions like these elsewhere. I'm grateful for your explanations.

I am afraid there is NO shortcut. As I have tried to explai. You have to complete some training programme either SpR or GP now to set up on your own. You need your certificate of completion and if you dont have it No insurance company would insure you as you just will not be trained enough until you finish your scheme or even more after that. No patient would attend you either if you we're only half trained. I am afraid it's 8-10-12 years no matter what after starting college. That's the only reality no matter what route you choose.

Shadowing would be no problem at all and I am sure could be easily arranged.

pc11

polydactyl wrote: »

I am afraid there is NO shortcut. As I have tried to explai. You have to complete some training programme either SpR or GP now to set up on your own. You need your certificate of completion and if you dont have it No insurance company would insure you as you just will not be trained enough until you finish your scheme or even more after that. No patient would attend you either if you we're only half trained. I am afraid it's 8-10-12 years no matter what after starting college. That's the only reality no matter what route you choose.

Shadowing would be no problem at all and I am sure could be easily arranged.

Great, thanks again. I wasn't really thinking of it as a shortcut, just trying to get my head around the system.

pc11

TheKingslayer wrote: »

The game is rigged, and unfortunately people are playing blindfolded with their hands tied behind their back.

There is no future in hopsital medicine in Ireland.

The majority of people in medicine have spent half their lives trying to get in, and then the second half trying to get out when they realise how ****ed the whole thing is. Over 50% of any graduating class will jump onto a GP training scheme just to escape the hell of the hospital, and this number will steadily rise as people who try and go the hospital route realise how futile it is.

The HSE have invented the most ingenious pyramid scheme in the history of the western world. Offer medicine to people desperate enough to get themselves into massive debts to do it (debts you will NEVER be able to re-pay if you stay in Ireland I might add). Then get people who are that little bit older - people entering their early 30s, with roots in Ireland, less inclined to emigrate due to family/girlfriend/kids/aging parents etc. Most of these people don't realise what they have let themselves in for until it is too late and they are in too much debt to turn back.

These people have been sold into servitude.

Your options as a person in his 50s are between none and limited.
GP is being decimated - the days of making 6 figures doing this are long gone. Watch and see the GP system become run by business-men who employ doctors for 40k a year max. These guys will no sfa about medicine and will constantly be on your case to spend less time in consults etc. The manager of the local LIDL will probably make more than you.

The loan - you will never be able to repay this.

The lucky few whose parents paid for their degree, or those who have a good degree to go back to (eg pharmacists) are the lucky ones - they have an escape.


You will be working 100 hours a week and getting paid for fifty. If you complain to your consultant about him not signing off on your hours, he will write you a bad reference, ring his pals to ensure you never get a job, or report you to the medical council.

Your options are the UK, Aus, or the US.

You have no option here. I implore anyone starting medicine (especially anyone in their late twenties and above) to turn back immediately.

This is not ER, or Grey's Anatomy. There is no ideals in this, it is just a job. There is no respect for this profession in this country.

You know what, I don't really disagree with you, and I'll consider going abroad if I have to.

But, I don't think this is ER or Grey's Anatomy, I'm not that stupid.

dissed doc

pc11 wrote: »

Actually, sports medicine would definitely be on my list of possible paths. That's interesting that many of them might be GPs first.

Would it be a condition to have a room in a private clinic like these that they must have finished SpR training then? Is that a condition of the clinic or of the IMO/RCPI/etc? Is it impossible for a not quite finished SpR to set up on his own in some fashion?

If you are qualified you can do what you like (like the people two years out of training doing botox that gets into the papers every now and then). You can see "Consulting Physician" business cards from people who have dropped out of training schemes in the UK sometimes. It happens. Only 10% of medical students actually are working as specialists long term (10 years out of college). Most people become GPs or stay as mid-level doctors (staff grade type level).

But, you will not be able to work as a specialist. The best option IMHO is skip the GP scheme, do SHO rotations for 2-3 years and then do GP locums for a few years before opening your own private only practice. That is actually not as uncommon as you think and much more financially viable than 10+ years in specialist training.

RobFowl

dissed doc wrote: »

The best option IMHO is skip the GP scheme, do SHO rotations for 2-3 years and then do GP locums for a few years before opening your own private only practice. That is actually not as uncommon as you think and much more financially viable than 10+ years in specialist training.

Not an option any more as insurers will no longer cover new entrants for GP work unless they are vocationally trained.

polydactyl

pc11 wrote: »

Great, thanks again. I wasn't really thinking of it as a shortcut, just trying to get my head around the system.

No worries. It is indeed complicated and not something you need to worry about yet

Vorsprung

Sports medicine got itself on the Medical Council list of specialities so those in the likes of the SSC are indeed consultants in sports/exercise medicine.

polydactyl

pc11 wrote: »

Great, thanks again. I wasn't really thinking of it as a shortcut, just trying to get my head around the system.

No worries. It is indeed complicated and not something you need to worry about yet

polydactyl

Vorsprung wrote: »

Sports medicine got itself on the Medical Council list of specialities so those in the likes of the SSC are indeed consultants in sports/exercise medicine.

Some of them are actually GPs however with additional post grad training and did not stay in the hospital system entirely

RobFowl

polydactyl wrote: »

Some of them are actually GPs however with additional post grad training and did not stay in the hospital system entirely

Quite correct relatively few practicing sports docs on the specialist register but I would expect this to change over the years as its a rapidly evolving speciality.

Vorsprung

Just had another quick look there, 5 SEPs on the SSC books (according to their website), and no-one with a GP qualification in their profile, nor history suggestive of having done GP training.

Are they doing GP on the side, shameful of their GP past or is it a bigger speciality than you're letting on?

RobFowl

Vorsprung wrote: »

Just had another quick look there, 5 SEPs on the SSC books (according to their website), and no-one with a GP qualification in their profile, nor history suggestive of having done GP training.

Are they doing GP on the side, shameful of their GP past or is it a bigger speciality than you're letting on?

2 at least are fully qualified GP's

Ihaveanopinion

Sports & Exercise Medicine is a slightly different speciality, in that there is not a formal training programme as yet. Those guys in Santry have done a combination of GP, Rheumatology, Orthopaedics and General Medicine. All have post graduate qualifications in one of the above. Most (if not all) have done fellowship training abroad in countries where they do have SEM as a speciality. To get on the specialist register for SEM, there was a grandfather type of thing, but now there is an exam, along with a bunch of criteria you have to meet.

There may be a programme in the future

polydactyl

Vorsprung wrote: »

Just had another quick look there, 5 SEPs on the SSC books (according to their website), and no-one with a GP qualification in their profile, nor history suggestive of having done GP training.

Are they doing GP on the side, shameful of their GP past or is it a bigger speciality than you're letting on?

You didn't look hard enough

Dr Franklyn Miller Member of the Royal College of General Practitioners, 2005

HeadPig

Since we're on the subject of GPs and I don't think this warrants a new thread I have a question: Can an Irish graduate do GP training in England and then return and practice as a GP here?

Vorsprung

Absolutely, a fair few do it that way.

Agnieszka_88

About training in England: is is better to go there straight after graduation and apply for a F1 scheme or to finish the intern year in Ireland and leave after?

RobFowl

Agnieszka_88 wrote: »

About training in England: is is better to go there straight after graduation and apply for a F1 scheme or to finish the intern year in Ireland and leave after?

Probably slightly easier to do it after graduation. The UK have Foundations years 1 and 2 as opposed to a 1 year internship here, suspect your'd be at a disadvantage competing against those with that if you did your intern year here.

HeadPig

RobFowl wrote: »

Probably slightly easier to do it after graduation. The UK have Foundations years 1 and 2 as opposed to a 1 year internship here, suspect your'd be at a disadvantage competing against those with that if you did your intern year here.

After internship, is that equivalent to finishing FY 1 & 2, or would one have to do FY 2 before applying to English GP schemes?

Agnieszka_88

HeadPig wrote: »

After internship, is that equivalent to finishing FY 1 & 2, or would one have to do FY 2 before applying to English GP schemes?

I've started digging after my last post and here is what I've found:
http://www.medicalcareers.nhs.uk/postgraduate_doctors/international_medical_graduate/article_for_british_or_eu_imgs.aspx

So basically, if someone did their intern year in Ireland, they could register with the GMC and wouldn't be eligible to apply for the "normal" Foundation Programme anymore. They'd need to apply for locum posts at foundation lever (and from what I've read on forums they're not easy to land) to get that FY2 experience. It all seems ridiculously complicated and kind of like a waste of time, because it seems like it can take two years to get enough "NHS experience" to be eligible for ST, so there is just no point in bothering with the Irish internship if you're certain about doing your ST in England.