slartibartfast

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About slartibartfast

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  1. I'm teaching junior doctors critical appraisal and would be grateful for advice on where I might be able to get past papers?
  2. This article seem's to echo some of the sentiments on this thread. What if All I Want is a Mediocre Life? https://nosidebar.com/mediocre-life/
  3. There's life lessons in all this. We want the easy answer and the easy life. But if we bleed a little bit, then we have much much more gain. I'm earning much less as consultant post IR35. But I won't ever go back to staff grade. Its like once you do staff grade, you can't go back to SHO work. But really, are our standards so low that we can't put up with some emotional discomfort? Most locum consultants outside IR35 are earning 3-4K a week. I'm so much more involved in developing the service than I was before. Before I was seeing just my OPC's, now I have an entire CMHT caseload to look after. Seriously, its not that difficult. Exams, consultant or AC paperwork, article 14, even getting children, a partner, home, stability are these fearful things for most people. But once you do them, you really that most of your fears were just that Fears, and you're much happier you put the work in to get to the other side. Doing the gym is an arseache, but getting the body is a beaut. Learning to lose arguments is an arseache, having a peaceful relationship is a beaut. Finish your training. Its just a year or three of difficulty. Then you have options opening up for AC and article 14. Sure, there is a whole strata of society that are okay with settling. Being fat, on medications, poor self care, dress poorly, dont' exercise, unfulfilling relationships, hate their job but stick on. The whole, hey I'm okay with how I am, why should I change. If thats you - then fair play. But c'mon, one life - why are people tapping out at the simplest hurdles? It's just a couple of years of a portfolio and exams?
  4. Fair play, my good man. Your reasoning seems solid, and if you think 50 year old you would think you made the right choice. Then nothing to really stop you. Keep us posted on how it goes. Godspeed!
  5. A lot of people, myself included, have passive income, step away from the rat race plans. It's not as easy as it sounds. Then again, there's very few emotions as expensive as regret. If you don't think you can stick it out for the MRCPsych, then don't. But understand that like we were in medschool, almost every single one of us considered quitting during exam time. I'd just like to point out that you had done some soul searching, wanted to quit locums to do exams, you have hit upon a very expected roadblock - core training being a complete headache, and MRCPsych studies being a complete arseache. You've chosen a path, and come upon an expected roadblock. But I might be getting it wrong, we don't quit because we can't take it. We quit because the rationale isn't valid any longer. So if you're quitting because you cant take it, then not the best decision. If you're quitting because your initial rationale isn't valid any longer, then fair play. But what you are signing up for is deciding to work in private, outside IR35, or in back of beyond places, and being 50 years old, without exams and having newly qualified consultants throwing their weight around telling you what to do. Me, I'd definitely definitely be feeling a whole lot worse if I didn't have my exams. I can probably deal with being 50 and not a consultant, but 50 and without exams. I don't think I could have done it. Maybe it's silly, maybe I'm asian, but that degree is pretty darned important for me and myself image and self esteem. I'd suggest sucking it in for a year, getting your exams and going for whatever makes you happy. BECAUSE if you are a consultant, odds on, that's what you will do for the rest of your life. Same ol same ol day in day out. Not being a consultant, gives you that self esteem hole that you look to fill in other ways. That would actually go a much longer way to feed your authentic self. Also, we have to recognise, like Daniel Kahneman said, the separation between our two selves, the experiencing self and the remembering self. And often, its' our remembering self that is responsible for the majority of our emotions. My experiencing self might have had a terrible time in medschool, my remembering self just remembers I stuck it out, got my degree, and am financially set for life in a well respected career. What will your 50 year old self remember and want you to do? Because that's who your real master is supposed to be. Not the person reading this, who will completely change even in a couple of months in terms of values, goals and priorities, but the guy who you look at in the mirror every day for the next few decades. TL:DR; leaving core training because you can't hack it isnt a good reason. Leaving because you don't think you need the exams, is a pretty good reason. I'd suggest working for another year, getting the exams. There's very few things more expensive than regret. Basically make a decision that the 50 year old you would thank you for.
  6. This really isn't a surprise. We all knew consultant salaries were 4-4.5k post tax when we first came to the UK. There's two ways I can see this. One, is that 4-4.5K is actually 99.84 percentile of highest salaries on the face of the planet. It's more than enough money to live well with. That's solid food, clothing, rental income, with enough set aside for leisure and saving. It's still enough to pay for a flash car, a great pad, and solid holidays during the 6 weeks you're allowed. If you have children, it is a lot tighter, but schooling is free, healthcare is taken care of, and if you cut corners, there's still enough for childcare expenses and a tiny amount to save. Pretty much EVERYBODY else on this forum (outside of locum/IR35) subsists on that much. The other side, is it isn't enough for a Lifestyle. There's little leeway to save money especially if you have children, or they are in private schooling. It's hard work paying for a mortgage on a 8-900K London property. A few weekend section 12's, DOLS, private work, and prudence with money and that's taken care of. Court work, and private consultations can net you hundreds of pounds extra a week for not muc Most NHS consultants do a little work on the side. You can also earn But c'mon, there are SHO's who leave core training with a couple of houses in the kitty. -- If you still feel it isnt enough... I felt the same way as you did. I got my consultant post, IR 35 rules, and thought whoa, I can't do this for the rest of my life? I can't afford a flash car in London, or a downpayment or mortgage on a house. But a friend of mine said that isn't true. All his locum consultant colleagues are earning 4K a week! And that seems about right. 80 quid an hour with 40 hours a week, plus a 16 hour on call works out to 4500 a week. Keeping solid accounts, finding non IR35 jobs can greatly increase that take home pay. Private work can greatly increase that. Working in boondock territory like small town Scottish towns, or Northern Ireland can give you £130 hourly rates. That's over £30k a month pre-tax! There's also private practice. Traveling out of the UK - Oz locum consultants earn $2000 a day. Private practice can bank a whole lot more. -- The issue here, like with most other things where there is a difference between claims and possessions, isn't a lack of resources, but a lack of resourcefulness. You Knew substantive consultant payrates would be 4-4.5K when you first came to the UK. How much did you prepare for that? How much have you saved? How much is your money working for you? Have you made private work plans since? Have you looked into budgeting? Have you streamlined expenses? My intuition is you wrote this post. Worried about finances. Are still worried about finances, but have done little about it. If you have (and others in the same boat reading this), and I'm more than happy to be proven wrong, then great! -- Look around you - most consultants earn in the 99.9% almost. Forget 1%, this is 0.1% territory. Most consultants have nice cars, flash houses, and live in a reasonable amount of style. If you want more, you have to work to get more. And there are more than enough options. The good stuff in life is on the other side of FEAR. The comfort zone is where the really uncomfortable stuff happens. Your level of happiness or unhappiness is determined by a simple formula. You think your life is better than it's supposed to be - great life. Worse than it is supposed to be- misery. You can easily think 4-4.5k, all this hard work, woe is me. Or phew, lucky me to be 0.1% of population in a brain dead piss easy job like a NHS consultant. Sure, it's more difficult than a SHO or SpR post, but not exactly the most taxing job in the world. I'm in a reasonably difficult central London locum consultant post that has been impossible to fill substantively in years. My stress level is pretty much zero as the only consultant in a busy 570 patient, central London, old age CMHT and I work like a dog, and I'm doing a lot more than just my 9-5, and doing a shedload of extra work to develop the service, and keep managers happy with their KPIs and stuff. And I'm IR35 capped to boot. Sure, I'm meditating for 20 minutes twice a day to get there, but it's not a big ask. Every single day gives me incredible joy and fulfilment. Find another job that pays you 4-4.5K with the ease and hours of consultant pay. I'd be fascinated to find out! -- TL:DR; You always knew consultant salaries would be 4-4.5k It's still 0.1% level income, and more than enough to live a more than decent lifestyle. Pretty much every other consultant manages a decent enough living and lifestyle with this salary. Every single SHO, nurse, secretary or social work colleague would be thrilled with your salary - all of them manage a lifestyle, savings, and have managed to buy, or have bought London properties too. You can always do private work to massively supplement income. Locum consultants earn £4000 a week on average. Boondock territory Scotland Northern Ireland jobs can gross £30k a month easy. Find another job that pays you 4-4.5k that's as easy as a normal consultant job. The problem isn't a lack of resources, but a lack of resourcefulness.
  7. I had a patient come in today. 80 year old lady with dementia who was flirting outrageously with me. Her daughter was there, and I said that speaking to patients (like her and others) gave me great joy, and was the highlight of my job. I've often said told patients when they say it's a difficult job, that dealing with patients is the nicest part of the job. Listen, if you want to make trouble for the consultant you probably can. But I'd see it as harmless banter, and let it slide. Sure, personal emails and You make me happy is probably crossing boundaries. But there's bigger sins. We're all out there trying to do our best for patients, and looks like he's someone who cares and not someone who's looking to sleep with his patient or do something completely out of line. Pick your fights, pick your grouses, pick when you want to make a stand. Make sure it's worth it, and not hassling a doctor, possibly unnecessarily using up precious resources for something that on face value looks like an innocent rapport building statement.
  8. Finish your training. This is a no brainer. I wish someone kicked my ass when I left training. All I needed to hear was, training is like prison time. It's designed to be a pain in the butt. Sure, everything else before and after is too. But you rarely feel the burn as much as during training. Just realise that pretty much everyone around you is going through the same thing you are. The people who leave, get stuck in dead end staff grade posts for the rest of their lives. And hitting AC, and CESR hurdles as they realise their mistake after leaving training. The people who stay get into consultant posts, and hey, thing's aren't much better, and the workload is much more than SpR/Staff Grade and SHO combined. But options open up. Private, locum, international work etc etc.
  9. Hi, I was wondering if a group of peeps wanted to get together to sort out an AC application peer group for accountability and sharing ideas, and tips. We could do it on a whatsapp group.
  10. Great advice, Ian.
  11. Hi, I'm about to start my first consultant post and was wondering if there are any books (or resources) on being a consultant psychiatrist and what it entails/what's expected? Thanks!
  12. I'm hoping this discussion will turn into a solution focused one. I have a fair few thoughts and thought bullet pointing them might be better than rambling on. 1. I've used tax avoidance scheme(s) in the past (Sanzar, Garraway and Winchester) and HMRC is coming down hard on these. The companies have closed up, and have set up alternate schemes. I was actually passed on from Sanzar to the others, and the same people run them all. HUGE tax bill to deal with. 2. In view of the above, I'd suggest due diligence with umbrella schemes (EFTs were legal, and other tax loopholes were closed 7 years in retrospect! (Google BN66 and Montpelier). 3. I doubt IR35 can be legal. Simply because you can't pay PAYE and say it's limited company, but you're still an employee without any perks. So it' sgood to hear of people following this up with unions (who are always ever so helpful *rollseyes*) and others. 4. Its being left to individual trust to determine IR35 and I think locum's will go hell for leather for the ones that don't go with the IR35 shtick. 5. If the goverment continues to fuck me about, I'm leaving for Oz or somewhere else. My Oz consultant bud was getting 2000 AUD a day for locum work. It's not all about money, but when the rest of the system is getting buggered like all get out too, hard cash can ease the pain a fair bit. Basically, be careful with umbrellas. Due diligence, hopefully people coming up with solutions here. Doubt it's legal but lets watch it play out - illegal or unconstitutional can pass along very peacefully where money saving is concerned.
  13. I still don't feel IR35 isn't compliant with medical locum contracts. You're a smart guy, if your accountant said it was compliant, you'd know exactly how and why it was compliant. I'm guessing you don't. I took tax avoidance because it was legal, and I thought everybody else was doing it. From politicians, to footballers to other contractors. Better than Ltd Co tax hassles, and got more money up front than anything else. Looking back, it seems I should have also taken into account that every single tax avoidance scheme person would get audited by HMRC. I think the right option would have been to do Ltd Company, and just pray. When I made a decision to quit, I did make a decision to stay on. My training scheme directors asked me to stay on, my work colleagues asked me to stay on, and I did agree to stay on. But felt with every single passing day that I was making the wrong choice, after about a couple of month of this, and speaking to a friend whose advice I trust, I thought now or never. Looking back I think I'd want myself to have gone the Ltd Co. route, but still haven't done that. And looking back I think I would have wanted to finish training, but can't see myself working through every single day feeling I had made the wrong choice, and haven't pulled consultant psych trigger even five years down the line. So regrets notwithstanding, obviously I'm still not completely convinced myself. The only thing that will give me my answers is Time.
  14. TL;DR: Tick the boxes. Deal with the rota. Enjoy the journey. Complete training. Eyes on the prize.
  15. At the end of the day, you have to look at training as a kind of prison sentence. 3-6 years of dealing with a LOT of BS. After that you're sailing. Sure a lot of BS to deal with for the rest of your life, but really a walk in the park. You'll have far far bigger problems in life than a tough on call rota. True story. The UK is a place that does not really want good doctors, who get along with patients, care about patients, etc etc. They want people who toe the line, and tick the boxes. Tick boxes and you can get away with murder. Even after all that Harold Shipman runaround, the best they could come up with was a tick box exercise that Harold Shipman himself would have sailed through. My 'silly reasons'. I didn't really want to work as a consultant as I felt most of them I saw had a haunted look. Med students had that light in their eyes, HO's a little less, SHO's even less, SpR's almost minimal and Consultants just looked haunted, resigned and tired. With the substantive salaries the system takes away 11 months of your pay (From January to June - I work for the government (30-40% income tax, 11% NI, and council tax)(conservative estimate here) July-mid September - I work for the bank (2.5 months salary is a very conservative estimate for a normal mortgage) two weeks in September for my pension (two weeks salary is a conservative estimate for a years pension) Oct-mid nov - i)GMC (medical registration), BMA (doctors union), MDU (defence union), RCPSYCH (royal college registrations) all circa 400 quid on average ii)car/motorcycle insurance, gas, tax, loan iii)utilities i.e. gas, electricity, water, broadband, tv, cable, phone Last two weeks in nov - to pay for 6 weeks of holiday. so at the end of the day, I found I had 45 minutes of my daily income that I could actually decide where to spend. I thought the patients will be exactly the same 5, 10, 15 and 20 years down the line. Nobody wanted to help the patients, care for them, or even speak to them like human beings - it was (is?) just risk management. Get them safe enough to be out in the community on their own, and out of trouble and job done. Didn't want to do the agent of social control thingie. Just one consultant of all the dozens I've worked with over the years has spoken to patients in a remotely psychological manner, or done any form of talking therapy in ward rounds or otherwise. It's just brain dead have meds, reduce risk, go home management. The best outcome for a lot of patients is pot noodles and a couple of hours voluntary work a week. Felt like one of the bad guys. Read the four hour work week, and thought get to time, freedom and mobility. So everything I own fits into a little more than a suitcase, and a backpack and I've had 3-4 years of holiday these past 5-6 years. If I didn't like a job, I could just leave it, and have a choice of 3 jobs to start the following Monday. If I worked consultant, I might have to stay in one place, and get pressured for a substantive post, but staff grade was freer and easier to get posts. Didn't think disorganised me would keep up with all the boxes that had to be ticked as a consultant. CPA's, meetings, training, supervision, service development, portfolio, appraisals, etc etc. Seemed to me the bar was much lower for staff grades and what was expected of them, and I'd only be earning 10 quid less an hour than a consultant. Now a locum consultant (even with salary caps) is earning as much as 5 years ago, but a staff grade's pay has reduced by 20 quid an hour. So 90% pay taken away, patients not really cared for, no real change in patients apart from getting them from unwell to a stage where they couldn't do any damage in the community, losing a part of me every passing year, the haunted look of consultants, feeling ticked off with training, and on and on and on.. the math just didn't add up. NOW: Still feel people don't care about patients apart from a risk management POV, still feel patients don't change years down the line. I now have that resigned, haunted, nothing can really affect me look that I saw the consultants have. But it's the best job in the world and I think it's a gift from God, that I'm able to be in that room helping people at the most difficult times in their life. I really really enjoy the job, dealing with patients and colleagues. The patients need the medications, its' the best of a bad deal. And we save lives every single day of our working week. Hundreds and thousands over the course of a lifetime. Maybe not save, but we do reduce risk and make the world a safer place, and help people at the most difficult time in their lives. So yeah, lots of reasons, I feel they were 'silly' because when you want to do something, even if on impulse, you will draw up a whole story why it makes sense. But at the end, current Me is paying for a lot of the 'sins' of the old me's. I'm stuck in middle grade posts, when complete numptys from training are working consultant posts. Whatever is happening. You can deal with it. Think of it as doing time, 3 years and you're out. And yes, tick those boxes, that's all you have to do. Forget about all the rest. Attendance. CBT. Audit. Reflective practice. etc. Trust me, those tick boxes will continue for as long as you work in psychiatry or in medicine. Or anywhere else in the UK, or a Caucasian country. Finish your training, see it as doing Time, and call the shots in terms of the job you want, where you want to work, which country, which hours etc etc after you get the CCT. Anything else is a choice the future You might not appreciate.