Life After The Foundation Programme (Good Things Come To Those Who Wait)

As of last Friday, I have completed the (form-filling parts and educational requirements of the) Foundation Programme.

Do you remember when I was just starting it? It was five minutes ago. Yet, here I am, ePortfolio all ticked off and six weeks of acute medicine away from being not quite so much of a baby doctor anymore.

With the improbable but still very looming prospect of Life After Foundation, I’ve been committing what is probably a grave sin. I’ve been telling my FY1s about what happens come autumn when they sit down with intimidatingly long job application forms and start to be bombarded with well meaning careers advice. I’ve been saying that the thing to remember is, if they are offered a job that they do not want, they are under no obligation to take it.

You are not told this.

I did not realise it myself until a few months ago, and it blew my mind when I did.

You see, applying for FY1 jobs, fresh out of medical school and/or still suffocating underneath a pile of finals revision, we did have a bit of an obligation to take what we were given and be grateful for it. We had provisional registration with the GMC, and to achieve full registration (and so be employable as doctors) we were required to complete our allocated FY1 jobs. No questions. No arguments. Bags packed and off to Shetland, if Shetland was where the UKFPO believed your destiny to lie. I was given precisely the job I wanted and within reasonable driving distance of the city I wanted to be in, but others did not have such good fortune. After working for two years in a job that was allocated by that kind of system, you do find when the two years are over that it’s played a few tricks on the mind. It was a lingering bit of that mentality that led to me saying things like, “Well, I’d like to be able to live in Glasgow, obviously, and that’s what I’ve applied for, but I’ll have to go wherever I’m sent.”

A lot of people do take the first job they’re offered, of course. Like me in FY1, some people are offered the training post they want or the location they want or a one-way ticket to Australia, and I am thrilled for them. And I’ll grant that there’s something to be said for not going too far in the other direction; after all, quite aside from the rest of it, the bottom line is that you need to be able to pay rent in August.

In February, I learned that I did not have a place on the Core Medical Training programme in Scotland.

(An aside for the non-medics and the non-Brits. CMT is the next step for a person who wants to be a hospital doctor in a medical specialty. Where the Foundation Programme theoretically included a little bit of everything, this is the stage where I’d drop things like surgery, paediatrics, GP, etcetera. There are equivalent programmes although of varying lengths for folk who do want to be surgeons or GPs or paediatricians. If you’re familiar with the North American system, whether legitimately or because of Gray’s Anatomy, this part is a bit like a residency in internal medicine.)

The offers for CMT in my region were released on a Tuesday afternoon in early February. On that particular Tuesday, I was in the middle of my Advanced Life Support course. It was also the Tuesday that I was due to collect a new car, my old one having died a final death on the hard shoulder of the M74 in the rain at the end of the previous week. It was also Equal Marriage Day in Scotland. It was a week of mixed emotions. But the offers for CMT are released by text message, and let me tell you there are few more crushing ways to learn of one’s imminent unemployment than to be the only person in a room full of your peers to not get that text message.

The good news was I was not considered unappointable by the good people who had interviewed me. A pleasant surprise, considering I’d forgotten the word for amiodarone in the middle of my interview.  I was merely quite far down on a reasonably lengthy list. So, you wait for good news to come to the people whose applications to CMT were a second choice or who had expressed an initial preference to work somewhere else in Scotland. The automatic next step is to go into the second round of applications, where the jobs that are left over are opened up to people who haven’t got one in their first choice of region. I expressed my intention to do this and even had a bit of a poke on the CMT website. Scotland was oversubscribed and so my options in Round 2 would be restricted to England and Wales. In my head, I was saying, “But I don’t want to go to England!” (Sorry, England.)

Eventually, I nudged high enough on the Scottish waiting list to be offered a job in the North.

Aberdeen, Inverness, and places where a 3G signal goes to die.

By that time, I had had a good talk with an excellent friend. She had sliced through my mad panic to remind me that with GMC registration comes decisions and options and not taking that which is foisted upon you. I had started to look into some of those options — fixed-term staff jobs and clinical teaching positions and locum work, and my well-worn and fatalistic mantra of “well, I’ll have to go where they send me” had been abandoned and deservedly so. I had stopped muttering about England and I spent perhaps five minutes considering the job Oop North — not an indictment of Aberdeen but an abiding love of Glasgow, this dear green place with my beautiful city that adopted me with joy and contains my home and my community and my life, where, once I’d been reminded that I could choose, I was never going to not choose.

(I was angry and determined when I came home from Synod. If I’d come home from Synod with the knowledge that I would soon leave my cathedral and the Diocese for a job two hundred miles away, I’d have been inconsolable. It isn’t entirely about that, but it is a bit about that.)

I am in no hurry at all to be a consultant. Please, let me put off that terrifying day for as long as possible. I think that doing different things is good and that more experience is good. I’ve spent a lot of time on the scenic route, and I’ve never regretted taking it.

A couple of years ago, writing in InspiresI wrote this: “If I’ve learned anything in that decade and a half, it’s that being a doctor isn’t a being but a becoming. […] My journey hasn’t ended. I’ve only stopped to buld a cairn at the roadside, and when I get up, the horizon will have shifted and I’ll have settled new dreams and new responsibilities onto my back as I step back onto the path to continue a journey that may not have always taken me along the straightest or simplest of routes but that has been all the more worthwhile and memorable for it.”

Still true.

I’ll be reapplying to Core Medical Training this autumn with the hope of beginning it in August 2015. I’ll try not to forget the word for amiodarone this time.

In the meantime, I’ve accepted a job for the coming year as a clinical fellow in Haematology.

Not what I’d planned when I first thought about it a year ago. Not an option I knew was going to exist. But different and exciting and worthwhile. It might even be better than what I had planned. I’m looking forward to starting in August and I think it will be good for me



  1. I am totally unsure of whether amiodarone is an icecream or a place where Precious Ramotswe drinks red bush tea. It is plainly one or the other. I am even less sure of what is involved in a clinical fellowship in haematology is but it sounds a very exciting thing and I hope it is. I think that anybody who did not pick you first for team NHS is probably mad. Well, certainly mad.

    • You flatter me, Rosemary.

      I was a bag of nerves in the interview and it showed, and I came out knowing that it had gone badly. I know better what to expect for next year.

  2. You, Beth, have a steel core.
    We have all of this… incipient HYSTERIA in academia in the States, if you don’t get your position, if you don’t pass your Bar exams the first time, if you flunk a test in school, even — because things are so ridiculously set up there that people don’t seem to realize that they have options, even if the first exit isn’t where you get off the motorway…(and honestly, is that us, or is that academia in general, or an American thing, or a Western societal thing…?) And, taking our car analogy a bit further, you’ve taken the scenic route, indeed, for most of your academic career, and have shown the efficacy of “if at first you don’t first succeed, try another roundabout, and get off the OTHER exit.”

    It seems a small and obvious thing, but it truly is praiseworthy: well, you get up, you retest, you reschedule, and you keep driving. I’m impressed with your grit, and proud of you doing haematology, though we’ll hold our arms away from you and call you a sun-loving vampire behind your back, in any case. ;) (Incidentally, I don’t think we have amiodarone here. I’m sure we don’t. It’s a virulent disease, isn’t it? You get it from weasels, and it gives you rickets? Oh. We’re boring. We call it Lidocaine. I like the weasels and rickets better.)

    Joy in the journey: that’s where it’s at. Happy cairn-building.

    • Well, or else it’s a nice thing to call stubbornness. :)

      I do wonder if maybe I’m just wired to enjoy the meanderings. On Sunday… so, okay, you have to go with me a little bit on this being a metaphor, but you were the one who started with the roundabout thing. This past weekend the Chorus went to Dundee to record a CD and I undertook driving duties for a couple of people. On the way home, I missed the exit for the A9, blew straight past Perth, and was seeing signs for Dunfermline before I started to get suspicious that I might have gone a bit wrong. I wasn’t up for turning around on a B-road in the Black Hole of Nowhere, Fife if I didn’t have to. Kept going and cut across from Edinburgh. Not what I’d planned, but if it hadn’t happened I’d never have seen the light on the Firth of Forth on one of the most beautiful Sunday afternoons there’s been in a long time.

  3. Congratulations on your job as a clinical fellow. Have an awesome year, and I look forward to hearing about it on this blog :)

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