You are reaching the end of your VTS and about to be launched into the world as a newly-qualified GP. You are more up to date on clinical knowledge and guidelines than ever before and looking forward to no longer being ‘the registrar’. What happens next?
When I finished training, it was straightforward. You worked as a locum for a bit, or got a salaried post, but the aim was to be a partner. More money, control over your practice, the chance to own the building, higher status – what’s not to like? Only those with significant other commitments were seeking out a career as a non-principal.
Things are changing. Year on year cuts in practice funding mean that many partners have seen their drawings fall drastically in the last few years, some now earning less than the salaried GPs that they employ. Each year something gets added to the contract, and what is sold as 'new money' often turns out to have been recycled from elsewhere. Extended hours is the current sword of Damocles hanging over the profession – will practices have to open 12 hours a day, 7 days a week?
There are five main career options for most GPs, or combining them can lead to a varied and satisfying career as a 'portfolio GP'.
Despite my negativity so far, many partners are happy. If you are a cohesive team, you will enjoy the continuity of care, both professionally and from a business point of view. A savvy practice manager, good admin team and a switched-on CCG can help to protect against uncertainties and for many, being in control and able to shape the practice over years or decades is still an attractive proposition.
In theory this is great – you get to do the clinical work that you trained for, with none of the administrative or business hassles of partnership.
Many salaried GPs value it as a job with 'edges' - you work your set sessions and when the patients are seen, you go home. It is not your problem if the boiler breaks or the receptionist calls in sick. The downside is that you are an employee and as with any job, you may have a good or bad employer.
Many practices value their salaried GPs, give them a proper contract and support their career aspirations. Others may see them as just a cheap pair of hands to be worked into the ground until they leave, for another sucker to take their place.
The key to being a happy salaried GP is having a proper contract - with your previous NHS service recognised - and a defined working week, both in terms of numbers of sessions and what is in each session. There’s nothing wrong with taking an interest in the running of the practice – this is often how salaried jobs morph into partnerships – but it needs to be give and take on both sides.
Probably the ultimate in being your own boss. No partners, no employer, you work when you want to. Got children at school? Work term times only. Can’t stand Fridays? Always have a long weekend.
But with this freedom comes insecurity. No paid annual, maternity, paternity or sick leave. No automatic pension or PAYE – you have to keep track of it yourself. If you don’t work, you don’t get paid. Basically, all the benefits and downsides of running your own small business. For some it is the perfect career plan, for others it’s just too unstable.
Out-of-hours work can be ideal for parents – if one of you works in the day, and one evenings and weekends, you may be able to get away without expensive childcare (though you might never see each other).
Like being salaried, it is a purely clinical job, usually with no management responsibilities. However, there is minimal continuity of care - the patients you see more than once are likely to be the out-of-hours 'frequent flyers', although some out-of-hours doctors will get to know terminally ill patients who are dying at home. Defence union premiums are higher, as this is seen to be risky work.
Non-GP work may be clinical or non-clinical. Clinical assistant posts in secondary care give the opportunity to become an expert in an area – but are usually very poorly paid. You might decide to be a trainer or appraiser, work for the deanery, get elected to your LMC – the list is endless.
In the 10 years since finishing my VTS I have been a salaried GP, done three clinical assistant posts, taught, written for magazines, edited e-learning modules, worked as a locum, given careers advice and held posts for the CCG and deanery.
With another 30 years until I retire, who knows what will come next? Whatever you decide to do, research it carefully, take professional advice if you need it and have fun.
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