By Ran Wei and Jenny Clements
In 2019, BOTA conducted a census of its members and found that 96% of the 590 trainees who completed the survey intended to undertake a subspecialty fellowship. The majority (69%) of respondents planned on either an international only (13%) or combination of a UK and international (56%) fellowship.
Many junior doctors take time out of training to work in Australasia after their Foundation and Core Surgical years in a bid to en-richen their CVs and life skills. They will have experienced the administrative headaches and financial heartache that precede the bounty of working abroad. In recent years, there has been an impressive conversion rate of core surgical trainees to T&O specialty trainees at national selection, such that fewer trainees experience ‘the overseas travel to work’ before getting their number.
97% of the trainees who responded to the BOTA census stated that they will be dedicating 6 to 24 months to attaining fellowship experience. Given that most trainees gravitate towards Australasia, it is
not surprising that most will want to spend more than six months working there after a long-distance move.
The recent COVID-19 pandemic resulted in temporary cessation of all elective activity both domestically and internationally. This has no doubt had a profound impact for those who were in the midst of their fellowships. Now that elective practice is starting to tentatively resume, the knock-on effect will undoubtedly be felt by those who are about to embark on their fellowships. In this article we aim to help trainees considering or planning on undertaking subspecialty fellowship experience in Australasia to tackle the common barriers.
Why do trainees go on fellowships?
In our 2019 census, BOTA sought to find out what motivates trainees to delay independent practice and undertake a post-CCT subspecialty fellowship. The most common answer to the question “what influences your decision to complete a fellowship?” was “competition for consultant posts / everyone
else is doing one”.
Most UK consultant job advertisements stipulate the need for prospective applicants
to have subspecialty fellowship experience. It is therefore unsurprising that trainees have responded by adopting post-CCT subspecialty fellowships as a mandatory stepping stone to consultant appointments. More recently, some consultant job adverts have also stipulated an additional requirement for a
stand-alone trauma fellowship. It is important for trainees to bear this emerging trend in mind when planning their fellowship year(s).
A surprising finding of the BOTA 2019 census was that 42% of trainees intended on undertaking a fellowship as a result of insufficient training in their subspecialty area of interest during their specialty training. It is possible that this statistic may improve with the new framework set out by the new T&O curriculum, but we will have to wait a few years to evaluate this. In the meantime, surgical exposure (cited by 72% of trainees in the census) will continue to remain the most important factor for trainees when choosing a fellowship.
It can be difficult to ascertain the likely surgical exposure (i.e. cutting time) of a fellowship job prior to an application. Apart from word of mouth, most trainees rely on either luck or an educated guess. Whilst there are some fellowship schemes such as the RCSEng Senior Clinical Fellowship Scheme1 that publish
the expected logbook numbers, there lacks a comprehensive and honest source of information when it comes to fellowship posts. BOTA are attempting to tackle this issue by investing in a new initiative that aims to help trainees become better informed prior to fellowship applications. At the end of 2019, we started work on www.fellowshipfinder.org.uk. It will take some years to mature but it is our hope that trainees will contribute their anonymised and honest reviews and surgical logbooks to an ever-growing database of domestic and international fellowships. After all, logbooks do not lie!
Preparing for an international fellowship
If you are considering an overseas fellowship it is essential that you start planning early. The need for this cannot be stressed enough. The latter part of your training will be fraught with exam pressures, acquiring CCT requirements and honing surgical skills. It would be prudent to note that competitive and even lesser known fellowships are often booked up two to three years in advance.
If you are considering Australasia, then check out the Australian and New Zealand Orthopaedic Association websites where many fellowships are listed2,3. There are often stipulations and a suggestion that local candidates will be preferred but don’t be put off. They do make exceptions and there may be last minute availability if prospective fellows pull out. Asides from the formal route, fellowships can also be arranged by word of mouth. State your intentions early and ask your consultant trainers, other registrars and use regional trainee meetings/websites to get ‘inside information’.
Be prepared for the 4am video interview (at least we are all now more experienced with video conferencing!). Do some research about the hospital and local region that you are applying for. If possible, ask if you can have the contact details of the person currently in the post to get some details on the day-to-day job, on-calls, expectations and locality. It is important to ensure that the fellowship will fit
your needs and expectations.
Once the job has been secured, start the admin/ paperwork early. It will take the good part of eight months to work your way through the mountain of forms and the necessary but lengthy email trails. If you want to reduce your stress, then start this process 12 months before your fellowship.
Finance is also an important consideration. You should ensure you set aside money for administrative costs as these are usually in the region of £1,500. The pay/income of fellowships can vary widely. If necessary, you will need to start saving early. After all, you will want to do more than just clinics and theatre lists when you are on the other side of the world.
Below are some important considerations if you intend on a fellowship in Australasia.
New Zealand or Australian Medical Council registration
This requires registration with Electronic Portfolio of International Credentials (EPIC) which is a long process and being granted full registration will often require a face to face interview once you have arrived in the country. They will also ask for a ‘letter of good standing’ from the GMC which can be obtained on the GMC website.
This takes time to obtain and will need the involvement of the relevant immigration bodies. You will find it much easier to get this when the relevant medial council has issued an ‘invitation to complete the process’.
It is highly recommended that you open an Australasian bank account and obtain a tax number before leaving the UK. This will ensure that there is no delay to your wages. You will struggle to obtain a tax number until you have a bank account. It is also much easier to open a bank account once a work
visa has been obtained.
This can often be a lengthy process. Ensure that you shop around for a Notary Public as the fees can
vary widely. Most hospitals will also ask for a police certificate (different from a DRB certificate) which can be requested via ACRO (Criminal Records Office) and takes a few weeks. Mandatory training and
occupational health checks will also apply. Most of this can also be done online before leaving the UK. It
can be useful to contact your own OH department before leaving to ask for a summary of the relevant
Unlike the UK, medical indemnity is not provided by the hospital but needs to be purchased independently. The cost can often be reclaimed from the health board you are working for. Again, a ‘letter of good standing’ will likely be needed from your current provider in the UK which takes a couple of weeks to organise.
All of the above are considerations surrounding the work aspect of your fellowship. You must also consider the ‘real life’ aspects as well. Single trip travel insurance should be considered as your normal travel insurance may not suffice and be sure to check what health care you are entitled to. In NZ, as a UK citizen with a work visa you should be entitled to full health care but be sure to check with your employer. You may need to organise accommodation, a form of transport and perhaps a school for your children prior to your arrival. It is therefore highly recommended that you get in touch with the incumbent fellow(s) as they are often a gold mine of advice. If you get lucky then you may be able to take over more than just their fellowship job. It is possible to secure accommodation, a set of wheels and even the odd surfboard through this avenue!
The current COVID-19 pandemic means that you must make several considerations when thinking about an international fellowship. From personal and family health, travel limitations and immigration restrictions through to government guidelines, quarantine requirements and the exposure of surgical
procedures if a country has limitations on elective practice. Not only do these add a layer of logistical complexity but never has careful consideration and research of all risks and potential ‘spanners in the work’ been so critical. Lastly, when you leave the UK for a prolonged period of time you will also need to consider what to do with your domestic baggage. Your GMC registration, UK medical indemnity and pensions will all be affected so make sure you don’t leave sorting these out until the last minute. Prior to leaving for your fellowship contact your supervisor to get a project set up. This will help you hit the ground running and will be especially important for those who intend on undertaking a six months fellowship. You should also utilise the knowledge of past/present fellows to gauge your boss’ scope of practice, kit preference and hobbies. You may find that spending a few more hours on the golf course might benefit your surgical training after all! In summary, overseas subspecialty fellowships can be a challenge to organise but remain highly desirable and rewarding. Most trainees start their applications for fellowships prior to the commencement of their FRCS exam year. Preparations for fellowships in Australasia can take in excess of eight months so start early. The current COVID-19 pandemic may render
international fellowships more logistically challenging to prepare for. When considering fellowships, it is often difficult to gauge the quality of surgical exposure. BOTA are therefore launching www.fellowshipfinder.org.uk in a bid to help trainees with this conundrum.
1. Royal College of Surgeons England (2020). RCS Senior Clinical Fellowship Scheme. Available at: https://www.rcseng.ac.uk/education-and-exams/accreditation/rcssenior-clinical-fellowship-scheme.
2. New Zealand Orthopaedic Association (2020). Fellowship Opportunities. Available at: https://nzoa.org.nz/fellowshipopportunities.
3. Australian Orthopaedic Association (2020). AOA Accredited Fellowships. Available at: https://www.aoa.org.au/orthopaedictraining/fellowshipsheader/aoa-accreditedfellowships.