A comparison of systems

So the vernal equinox came and went this week, and I have noted a bit of a change in myself, as well. Perhaps because I have also realized that I recently passed the half-way point of work at Christchurch Hospital. It has certainly gone by very quickly. Maybe it is a bit of subconscious self-evaluation, but the honeymoon phase is over, I have begun more to work on the necessary preparations for Sydney, and I have a sense of routine at work, which allows the mind to be on other things while completing tasks. Meanwhile I have noticed that I have not given Aunt Kath the description of work life here, as I told her I would. So I will start there and progress to other observations later.

Work is actually very nice. If I were to boil it down to two reasons, they would be that 1) the union has been strong here, and the registrars are the biggest beneficiaries, it seems; and 2) that I am appreciated there. The latter makes a huge difference. The two trainees here, those who are already designated to become plastic surgeons, are responsible for making sure that all the acute cases from the emergency department are taken care of. At times, that has meant that they were not able to participate in the elective cases they wanted. Most of these acute cases are hand surgery, or skin grafting of acute injuries. With the previous experience with burn intensive care and with the hand fellowship, I provided them a lot of relief to focus on the cases they want. Works out nice.

As for the conditions, it is much more civilized here. Much less of a sense of indentured servitude. Fewer hours, more respect, more vacation time, better pay. Kind of nice.

There is a tradeoff, however. This training scheme is based on the UK system, as are Canada's, Australia's, and a couple of others. The result is a much less direct pathway of matriculation. Basically you graduate from medical school without any clinical experience, so you are not expected to know what you want to do. You apply for positions as house officers, where you manage medications, make the changes discussed in rounds, chase down lab results, take care of the paperwork, including admissions and discharges. Through this experience, you learn about the specialty over about a four-month stretch, and the department gets to know about you. At the end of the run you move on to another specialty. And this rotational progression can be interminable.

The next step is to move from house officer to registrar. At the end of the year, or some year, you declare that you are moving from one role to the next and apply to a department to become employeed for the run of 12 weeks. And herein lies the greatest difference: even though you are taking call, doing the surgeries, attending lectures, giving presentations on the subject, you are not guaranteed to become one of those specialists. You get a better feel for what the field is like, get better pay, that is about it. And again, this process of going from one rotation to another may last one year, maybe several. It depends on when you are ready to apply to one specialty for final training and the fortune of getting accepted into a training slot.

And there are not many slots. For plastic surgery, for example, there are some ten positions in the country-- total. This year there was good timing and five spots were available. Some years, maybe only one.

So the downside is you have no idea how long your training will last. Worse, you may spend several years chasing a carrot that you will never reach. I would think that could be quite frustrating, demoralizing. But in the meanwhile, work can be rather pleasant, you have deeper pockets at an age when many are establishing families, or at the least want to be seein the world.
Pay is fair, resposibility low, and so for a doctor of the same age, these guys are incredibly cultured, well-traveled. But they still have a long road ahead of them before they reach independence.

In the end, which is more preferable? The jury is still out.