My Life as an ICU Trainee in Australia
At Messly, we help young UK-based doctors find their dream jobs by providing guidance and insight into as many career options as possible, and that includes looking outside the NHS.
To give you a clear idea of what it’s like working in a hospital abroad, we recently spoke to a doctor who has successfully moved from the UK to Australia, currently in his third year of practicing medicine down under. In this interview, he shares his motivations for moving away, provides advice and tips for finding a job abroad, explains how the healthcare system there differs to the NHS, and much more. Read the full interview below to discover what life is like as an ICU trainee in Australia.
Where are you working now, at what grade, and at what is your specialty?
I’ve been out here in Australia for two and a half years. I came after F2, so I’m technically an F5 now. In my first year I was an ED Registrar in a rural hospital, then in my second year I worked in a tertiary ICU in a large state-capital hospital doing sub-speciality ICU.
The academic year has just started (as it runs from February to February here, rather than August to August) and I’ve just started as an ICU training registrar in a rural hospital.
Why did you decide to move out to work in Australia?
Originally I wanted to take a year out of training, earn a bit of cash for six months, then go travelling. I’d had a terrible time as an FY1 and FY2 in a dysfunctional hospital, and worked in a couple of departments with horrendous bullying issues, so there was no way I was going straight into training.
How did you find your job? What tips do you have for others who are job hunting in ANZ?
I chose to apply through the state recruitment websites. Each state has a website for recruitment (Western Australia is medjobsWA, for instance) so I found the jobs that looked appealing and applied from there.
I applied for roles in most states at first. I think I made about 20 applications in each year. I got a handful of interviews in my first two years, including one offer my first year (although I did cancel interviews after that first offer) and two offers in my second year. In my third year, my boss from my second year was friends with a boss at my current hospital and strongly suggested I go there.
The thing I’d say you need to watch out for is that, unless you're an Australian citizen, or a permanent resident in Australia, you’ll only be considered for a job if they’re unable to find a suitable Australian candidate. Therefore your chances of getting a neurosurgical registrar job in central Sydney, for example, are pretty much zero. ED or rotational SHO jobs are what most people end up doing when they come over here.
What are the interviews like?
Interviews are way more informal than the UK for the kinds of jobs you get as a PGY3. They’ll often be over the phone or on Skype, usually involving a clinical question or two, some general career progression questions, that kind of thing.
Equally important is the pre-interview, where you ideally visit the hospital or at least talk to the director on the phone. I’ve done that once and not gotten an offer but supposedly it can give you that edge. That's something I just didn’t know beforehand.
For my two second year offers I was pre-interviewed for both because I have a bit of a weird CV, and so both hospitals wanted to get a feel for what level they could slot me in at. I ended up following up with both of those because I was really interested in both, and I believe my enthusiasm persuaded the hospital to find a way to accommodate me. In the first year, the department was run by a Brit, and they were expecting Brits to apply to that job, so called me to sell themselves.
The other way to get a job is through locum agencies, although a disadvantage to that approach is that they sometimes have roles that have already been through state recruitment and not received much interest. You could also try directly contacting hospitals and asking if they have any vacancies.
What tips do you have for getting AHPRA registration and securing the necessary visa?
It’s a well-trodden path for UK and Irish graduates to get registered with AHPRA.
While you do technically need an offer of employment, and the hospital needs to fill out the relevant paperwork before you can actually apply for provisional registration, I’d get the ball rolling by looking through and starting to fill out the application for provisional registration so it’s ready when you need it. The application form is very long but reasonably straightforward. Be careful, too, because they’re very picky on things like using notaries.
For a visa, you’ll need a sponsorship number from the hospital. You can generally upload scans of everything, which is convenient. You’ll also need in principle approval from AHPRA to get the visa, but you can still start the process while waiting for that to speed things up.
If you plan on staying permanently in Australia, the single most important thing will be getting permanent residency as soon as possible after you get general registration. I had all my ducks in a row before that (specifically English test) so as to ensure that I could request an invitation ASAP. The rules keep changing so I wouldn’t hang about when it comes to that.
How did you settle in?
Australia has a tonne of immigrants, so most organisations have plenty of practice when it comes to welcoming newcomers. I set my bank account up while still in the UK and was able to pick up my debit card when I landed. I got things like Medicare, tax file number, a new local sim card, and so on within a couple days of landing. I even got a credit card with a $20,000 credit limit within a week.
A big positive is that most hospitals give you at least one week of accommodation when you arrive to help you find your feet, during which you can find a place to rent.
What was the hardest thing about moving out?
For me, missing my family is probably the hardest thing about living on the other side of the world, but you get used to it. We’re very fortunate today to have technology like Skype and WhatsApp, which are both very helpful for keeping in touch with things at home.
What are the main differences between your job in the UK compared to your job in Australia?
Here, you either come in as an SHO or Registrar (often called "junior reg").
SHO jobs are generally less responsible than the equivalent in the UK. Some places will expect you to discuss every patient you see in ED with a senior doctor.
If you’re a junior registrar it’s somewhere between SHO and registrar back in the UK. You’ll be expected to run a smaller emergency department overnight and deal with major traumas and the like. The big difference is the bosses will come in at the drop of a hat in many cases. I’ve had a world-renowned professor turn up to help me at 3am because there was a sick patient and I needed a hand.
How does your ICU job compare to working in the ICU or in critical care in the NHS?
The differences between ICUs within a country are far greater than between countries, as your ICU has to adapt to the hospital around it and the resources available.
Out here, the ED doctors tend to do much more than in the UK; they aren’t just a glorified triage service. They tube and line their own patients and tend to be pretty damn good resuscitationists. As a result, from an ICU perspective, their patients tend to be way better packaged and will often require a lot less work than they would back home. The downside to that of course is that you get less practice yourself.
Anaesthetists don’t go to METs or arrests, although if they’re around they’re usually nice enough to chip in. The only time I ever see them is when they’re returning a patient from theatres. As such, the ICU registrar is usually airway at the MET.
Med Regs (registrars in general) are way more junior. They can be PGY3 at the earliest, so may need more of a helping hand at MET calls depending on how confident and capable they are.
Australia has more money and more ICU beds than the UK, so they take far more soft admissions and no-hopers than would get into a British ICU. This means less demand for lines and intubations, so I do fewer of those here than back home.
Also, patients are generally much less sick. I’d say on my last shift more than half the patients wouldn’t have been admitted in the UK. It’s to the extent that I’ve had a few bosses strongly encourage me to do a post-qualification fellowship at one of the big London ICUs to get that kind of super sick patient experience.
What is the ICU training system like?
Most of the information about this is on the CICM website. There’s nothing like the specialty training system and deaneries, except in Queensland (other specialties have different systems).
Queensland has a rotational training scheme which, to my knowledge, sends their trainees to different hospitals like they would in the UK. Apparently they’re generally pretty good and flexible, so if you want to work in Brisbane or somewhere similar they’ll take that into consideration. Having said that, I have no personal experience. I don’t think their scheme has much to do with the college, so even if you quit you can continue with your training.
Outside of Queensland, you have to apply for a job every year or two depending on how long a contract you’re given. I believe most places will let you stay longer if you’re keen.
Each hospital is accredited for a defined amount of training time and one or more sub-specialties (neuro, trauma, cardio-thoracic). You also have to do some medicine, some anaesthetics, and you get a bit of elective time. You could theoretically finish it all in six years, but damn-near everyone takes longer. They’ll count time before you start (in med, anaesthetics, and elective) towards your training, even training in the UK.
How's the pay?
The pay is really good here. It’s much better than training in the NHS. My first year I worked in a poorly-paid state hospital and made about £75,000 working 38 hours per week. In my second year I made about £105,000 working 40 hours per week. This year, I expect to make a bit more.
How's the workload, and what's the culture like?
The workload is generally lower than in the UK. I don’t go home demoralised every day so that’s something. I generally have lunch and have time to drink and pee.
I’ve always had good experiences with my consultants and colleagues, but I’m sure others have had problems. The colleges do seem serious about trying to stamp out bullying and all that. They’ve actually stripped major hospitals of trainees for bullying issues.
And, of course, the lifestyle out here is great. Have you seen an Australian beach? It’s a first-world western country with good weather. Not really sure what else there is to say.
Are you happy with your rota?
I’ve done 8x10s in a fortnight and have also worked week on, week off schedules. I can’t say I have any complaints, and the lower hours almost guarantee better rotas.
I’ve generally found it pretty easy to get leave as well. I worked in one place that paid for locums when I took my leave. I spent 12 weeks overseas that year. I’ve got friends who were given instant bereavement leave when a parent died, which was pretty much indefinite as well, which is nice to know.
And finally, what tips do you have for other doctors who are thinking about making the move?
The paperwork is pretty straightforward, albeit a little tedious, but the move as a whole requires a fair bit of effort. If you’re looking into this because you want an adventure, I have nothing to say except good luck. You’ll love it.
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At Messly, we help doctors like you make your next move in healthcare. We're working with hospitals and clinics in Australia and New Zealand, helping doctors from the NHS find their dream roles in Australia and New Zealand. Discover more today by checking out current opportunities here.
This article is part of a wider series, supporting doctors like yourself with a comprehensive set of guides to ensure your F3 year is a success. These guides cover everything from initial planning, options for moving abroad, help with finding work, and tips for making the most of the experience. Click here to visit our F3 Resource Hub to explore the full list of guides and articles.
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