I have been thinking a lot about the blood, sweat, and tears I put into my surgical career cut short. There is a huge burden on junior doctors who wish to pursue a career in surgery, and we accept the costs because we have to in order to progress. As well as the emotional costs of looking after patients who may be extremely unwell or injured, there are huge financial costs to the training surgeon.
To begin with, I want to compare the medical and corporate worlds. When I speak to my friends in the corporate world, they are absolutely disgusted when they hear about how doctors are treated. Let’s call my corporate friend “Anna”, who is the same age as me and has the equivalent level of education and training.
When Anna works until late at night, her office provides food and gives her a cab voucher or reimburses her for the Uber ride home. When I stay until work late, I either miss out on dinner, or if any food outlets are still open, I pay for some takeaway. Then, I either drive myself home, or if I’m too tired to drive I sleep at the hospital. Not all hospitals provide on call rooms, so I sleep in a chair or spare hospital bed.
Anna gets an allowance from work to cover her rent. She also gets a “lifestyle allowance”, which she uses towards a gym membership. I’ve received neither benefit.
Here is where I see the biggest difference: courses and conferences. Anna gets paid to attend courses and conferences that will increase her knowledge, thus making her a more valuable and experienced member of her company. Flights and accommodation are also covered if the course or conference is interstate or international. Doctors have to pay for compulsory courses and the associated costs of attending them.
For surgical training, here are the compulsory courses, examinations and application fees I have had to pay in order to progress:
- Critical Literature Evaluation and Research (CLEAR)
- Care of the Critically Ill Surgical Patient (CCrISP)
- Australia & New Zealand Surgical Skills Education and Training (ASSET)
- Emergency Management of Severe Trauma (EMST plus its refresher)
- Annual “expression of interest” fee to the Royal Australasian College of Surgeons (RACS) to indicate my intention to apply for the training program
- The actual application fee to RACS
- The surgical sciences examination (which has become a pre-requisite to apply for the training program)
In addition, there are ‘optional’ courses and conferences that are highly recommended to strengthen your CV and therefore make you a stronger candidate (that they may as well be compulsory). For example, it is desirable for any candidate applying for the Plastic and Reconstructive Surgery program to have taken the ‘Emergency Management of Severe Burns’ course.
We also have equipment that we are expected to own in order to learn surgery. All Plastic Surgery registrars own a pair of loupes, which are magnifying glasses (2.5-3.5x magnification) that allow us to see small or thin structures such as blood vessels and nerves during hand surgery. Most of us also invest in a pair of surgical clogs, which make a difference when you are standing for long surgeries.
These costs add up to about $30,000. This is a huge monetary investment, especially for those registrars who may still be paying off any student loans, or may have young families to support. It might be worth it if doing all of these compulsory and suggested courses actually grants you a spot on the training program, but some registrars spend several years as a “service” or unaccredited registrar without any guarantee that they will ever “get onto the program”. Some never do.
Add to this the invisible costs of the stress, long hours, and abuse that many registrars experience and you can see why many become jaded or disenchanted by “the system”. When surgical registrars finally give up, as some do, they come to the realisation that RACS and their specialty society (such as the Australian Society of Plastic Surgeons) has not only taken their dream from them, but also their money, energy, passion, and time away from loved ones, hobbies, and other important life activities. What are we left with?
So, is it worth it? Many of us keep going because we think that it is. We think that eventually we will be accepted onto the training program, which will give us the external validation we have waited years for, and once we finish that program we will be independent, qualified consultant surgeons. By that time, most of us will be in our late thirties or early forties. Perhaps even older depending on when the surgical journey started.
I started medical school aged seventeen. I know that I spent most of my twenties studying and working. Do I want to turn forty and have the same sentiment towards my thirties? That is the question I have asked myself many a time.
My abrupt career road block has forced myself to ask these existential questions. Was what happened to me a blessing in disguise? It is certainly confronting to start a new career from scratch, but maybe the Universe has something more suitable for me, which will give me a greater sense of purpose than surgery has.
I will be following up this post on starting something else from scratch: my fitness.
Until then, take care.