UK fellowships

With Dr Elie Matar, a Neurology Advanced Trainee, NHMRC postgraduate scholar and Clinical Lecturer with the University of Sydney, and Dr Abhijit Pal, a Medical Oncologist who is currently completing his fellowship at the Royal Marsden Hospital (Sutton), UK in the Drug Development Unit working on early phase clinical trials.

Introduction

A clinical fellowship is usually undertaken in the third year of specialty training after the completion of 2 core clinical training years in Australia. A fellowship can be undertaken either in Australia or overseas depending on the nature of the training program – for example in medical oncology (in 2018), trainees were asked to do 2 core years and 1 non-core year but other specialties such as cardiology and nephrology required 3 core training years. Overseas fellowships would usually be non-core training but check this with your college as there are exceptions. There are many factors to consider when thinking about a fellowship overseas including, where to go, who to contact and getting the job. This podcast explores these factors and looks at the highlights, challenges, logistics and discusses the wealth of experiences gained by throwing yourself into a new and different healthcare system on an overseas fellowship.

Elie Matar: Why did you choose to do a fellowship overseas?

Abhijit Pal: I had often heard of other doctors pursuing their fellowship overseas and wanted to experience the same opportunity to travel and immerse myself in a different healthcare system. This opportunity also allows you to gain exposure to different practices and larger research units. But a key reason was that my wife wanted to travel overseas and live in the UK for a year.

Elie Matar: What have been the positive aspects of your experience so far, was it what you expected?

Abhijit Pal: It has exceeded my expectations in that the amount of travel we have been able to accomplish in Europe has been phenomenal. There’s easy access to Germany, France, Italy and all these other countries we had hoped to visit. Professionally, it has been a fantastic experience as well. I have been able to be a part of multiple research projects and trained by some of the leaders in my field in Medical Oncology, which has been a great personal growth experience.

Elie Matar: What have been some of the challenges?

Abhijit Pal: The preparation required for an overseas fellowship can be very involved. A lot of preparation went into organising this fellowship in the year prior. Financially it is somewhat challenging with the realisation that Australian doctors get paid quite well compared to some other countries. In parts, I have found it quite stressful with simultaneously undertaking a part time PhD as well, however this was self-inflicted. All of these challenges are quite minor things when you consider the wealth of experience gained by being overseas and being in a large unit like the one I am currently working in.

Elie Matar: What was the preparation involved with organising your fellowship?

Abhijit Pal: I started preparation about 12 months prior to starting my fellowship. I had had a chat with doctors who had worked in this unit before, I then had a video interview, an informal interview and then I went to Chicago to one of the oncology conferences (ASCO) where I had a formal interview. After that I had to complete the job application. Following that process I organised the visa requirements and the overseas registration to the General Medical Council (GMC), the Australian Health Practitioner Regulation Agency (AHPRA) equivalent in the UK. Generally, people will say you need at least 6-12 months to organise a fellowship overseas.

Elie Matar: How did you manage to find the contact for the fellowship?

Abhijit Pal: One of the oncology fellows before me had been to the Drug Development Unit and I had always been interested in the idea of drug development, so I reached out to him. One day, I saw an email from the Medical Oncology Group of Australia (MOGA) advertising applications for fellows to this unit. It wasn’t that I knew anyone working in the unit or that any of my consultants knew anyone working in that unit; I simply sent an email to an advertisement and that’s where it all started.

Elie Matar: What are some of the practical hurdles people should be aware of that they may need to overcome?

Abhijit Pal: The first decision is, “Do I want to go on a fellowship overseas, or don’t I?” The next step, “Which country do I want to go too?” Usually Australians will go to either the US, Canada or the UK; US requires licensing examinations, Canada requires a weather change, UK requires GMC. This decision is usually guided by what centre you might like to go too. It could be a centre that does a sub-specialty of your choice, but this will depend on your interests. Once you have picked the country and the institution, the next challenge is to get a job there. How do you get a job? You need an interview. You may have worked with a consultant who knows someone at that unit and can put you in touch with them. You may just email someone, like I did, or you may have networked with someone. One of my best pieces of advice is to really reach out to people who have gone before you and they will have contacts they can put you in touch with. Once you have gotten the job you need to think about, your Australian training requirements. Accreditation needs to be sorted through your college which requires a supervisor back home and in your fellowship destination. This can take a bit of juggling but most of the time the colleges will accommodate. Another consideration, “Will it be pre-fellowship or post fellowship?”

Next step is to obtain overseas medical registration. This is different in countries with different stages. It is not simple and often requires fairly extensive fees and verification of documents. I had to go back to internship to obtain evidence that I had successfully completed it so it can be laborious. Then you need to think about the immigration requirements – visa, type of visa and length of stay. The visa needs to be processed before your date of arrival. Once arrived in the destination of choice there are some logistical challenges for example, getting a rental property and opening a bank account. In the UK there is a catch 22 where you cannot rent a property without an active UK bank account and you are not able to open a UK bank account without an active rental. It is a fairly long process, but it is definitely very possible and worthwhile.

Elie Matar: How did you navigate through that and find all the relevant information?

Abhijit Pal: I reached out for help at multiple points. There were some Australian fellows who had been to the unit before, so I talked to them through WhatsApp or email and they were very supportive. Most fellows who have been overseas are very happy to help and offer support. The international units that accept international fellows have done this time and time again, so they are very use to helping you. So, I had a lot of help from them as well.

Elie Matar: What have the hours, pay and logistics been like whilst on your fellowship?

Abhijit Pal: I am a trials fellow, so I work 9am – 5pm Monday-Friday. I don’t do any on-call shifts or after-hours work. I have imposed the extra research on myself, so my hours are worse, where I work after hours and on the weekend. As I am a trials fellow, I can’t speak for the NHS. In Australian terms my pay is about $75,000-$80,000, which is a pay cut from a PGY7 (post-graduate year) registrar in Australia. I do get 32 days of annual leave whereas in Australia I only get 20 days. I also get 15 days of study leave. Transitioning from Australia to the UK was very simple. UK doctors respect Australian doctors in that they are well trained, work hard and we find it very simple to integrate ourselves into their system.

Elie Matar: What is your main advice for those considering a fellowship overseas?

Abhijit Pal: Think about this as an option for you, your family and/or your partner. It’s an exciting option that is available to whatever specialty you are in. Experience what it is like to work in a different country with different populations and resources – this is invaluable to your future practice. Especially for physician trainees, the level of research opportunity is often quite different overseas compared to Australia. You will be exposed to a larger volume of patients and trials and research activity. The personal benefits of being able to travel widely and to take that year off the treadmill, I can’t explain how beneficial that will be as well. Doctor burnout is an endemic problem, where people are getting increasingly frustrated and tired with their work. Going overseas is a wonderful way of refreshing your interest in your specialty and to do some other things in your life as well. It is challenging to organise the overseas fellowship; I won’t dismiss that. My biggest tip is that networking is crucial. You need to know what jobs are available with centres and that information is not going to be displayed on any website. Talk to someone who has been overseas, talk to someone who have been in the unit or near the unit so you can work out what options are available. In the UK, word of mouth is quite crucial. Most people coming overseas on a fellowship are married, have children or are in a relationship – you often have someone else to think about. Planning is the only thing that matters, you can come overseas in any of these circumstances.