Clinical Fellow vs Locum: Which Should I Choose?

If you’ve decided to take an F3 year, the two most common ways to do this are to either apply for fixed positions in a Trust, such as a clinical fellow or Trust Grade, or to pick up shifts as a locum. These are two different options in many ways, such as opportunities for career development, flexibility, pay, and supervision.

In this article, we’ll weigh up the pros and cons of clinical fellow and locum roles, and the main considerations you’ll need to make before choosing which path to take.

What are Clinical Fellow and Trust Grade Roles?

Clinical fellowships are non-training roles for a fixed term of usually 12 months. The job plan will be set out in the job description, but is often similar to the SHOs in training on the rota, usually covering a mixture of clinics, ward work, on call shifts, and other work, depending on the specialty. You will also get access to teaching and other sessions with the trainees that you're working with -in reality day-to-day life is not much different to your F2 year.

You may also come across research and teaching fellowships. Research fellowships tend to be more heavily involved in research than clinical work. These can sometimes contribute towards a qualification in research, like a Masters or PhD, depending on the role advertised. Teaching fellowships may be teaching only or mixed with a clinical role as well.

Trust Grade roles are similar, but typically will be a service provision-type post to fill a rota gap. Training opportunities may be limited. These are often for a year-long post but can sometimes be shorter.

You can find more information on these, and other non-training opportunities, in our article, Your F3 Options Explained.

What is Locuming?

As a locum you pick up shifts in hospitals, working either through the Staff Bank or via a locum agency. These may be for long blocks of up to three months, or more ad-hoc where you pick up shifts here and there. You are paid an hourly rate for the hours you work.

Which is Best for… Your CV?

If you want a variety of experience in different specialities you haven’t worked in before, then locuming might be the best option for you. However, you may not have long-term work in one place, so you need to be a bit more proactive in taking opportunities for CV building. See our article, Career Progression as a Locum, for tips on this.

If you want more experience in one specialty to tailor your CV, and get things like audits, research opportunities, or presentations, it may be an advantage to do a fixed position like a clinical fellowship/Trust Grade job instead, as you'll be in the same place for a while so you'll be able to take on bigger projects.

Which is Best for… Flexible Working?

Locuming is undoubtedly the better option for this. You can choose how often and when you work, so you can dictate your own work-life balance. The increase in salary also helps with this compared to the level of salary when working part-time in a fixed position.

In a fixed position, you'll be treated like a trainee, so you'll usually have on-call commitments and your annual leave requests must be approved by the rota coordinator. You’ll also have a notice period to work out if you plan to leave before the end of your contract.

Which is Best… Financially?

If you have fixed financial commitments, such as a mortgage, childcare, or particularly high monthly bills, then the most stable option to go for is a fixed position like a fellowship or trust grade job, as these will be paid at a similar rate to the other trainees on the rota.

Locum work is often much more lucrative in terms of hourly pay, but the pattern can be more variable. As a result of this, you may need to be more flexible in terms of location, your out of hours shifts, and even your specialty if you have fixed costs that need to be covered each month. For more information on this, see our article, How to Make a Living as a Full-Time Locum.

Which is Best for… Supervision and Learning Opportunities?

Usually a clinical fellow position will come with a clinical and educational supervisor, so you can get feedback on your progress. You’ll also usually be entitled to attend the same teaching sessions as the other trainees on the rota, and may get a study leave budget as well as time set aside in the rota for learning opportunities like shadowing in clinics. It’s worth checking your contract in advance to make sure that what you want is included.

If you’re a locum you’re very unlikely to get a supervisor, but you can still find opportunities to get feedback from senior colleagues. You won’t be entitled to a study budget, but if the workload allows during your shift then you may still be able to attend teaching sessions or clinics, or arrange to do this in your own time if the consultants are happy with it.

What Should You Do Next?

We'd advise that you speak to as many colleagues as possible who have done clinical fellowships and locuming in the past, to get a clear idea from them of what that would be like in the area you plan to work in.

For an extensive collection of tips, advice, and guidance, visit our F3 Resource Hub to ensure you can make the most of the experience during your own F3 year.

‍