slartibartfast

Locums or training? Things to think about.

12 posts in this topic

Even if the pay for locums has dropped, it's still pretty good.

But.. Complete your training. I left for very silly reasons, and regret it now.

Do things for the future you. The future you would want you to complete your training.

You can always do locums later.

Other choices:

Non training substantive posts - what's the point? If you're in a family, with kids, and are okay with living close to hand to mouth, with 46 weeks of work a year, then okay. If you're single, do locums. If in a family, complete training OR take the substantive post depending on your personality and the wishes of the other half. But also take steps to up your income, 50-70k a year substantive posts aren't enough money for today's living with having to put money down on a property, mortgage, and kiddies schooling (a lot want private schooling), and their expenses. Four flight tickets are a lot more expensive than one, more so during term time.

PAYE vs LTD company and IR35 issues:

Far better to take the Ltd Company plan and be disciplined with keeping accounts, and maybe do other income generating stuff and claim expenses for training and/or workshops.

IR35 seems to have gone after the people doing locums through a ltd company, in the same trust whilst still in a substantive post there. Or so I've heard. Far better to take the 0.001% chance of getting stuffed with IR35, than a 100% chance of getting stuffed with PAYE, self employed or tax avoidance.

I opted out of training. I had my reasons, but looking back they weren't good enough, and I regret it.
I opted out of Ltd Company, I had my reasons (IR35 being one) and went in for a tax avoidance scheme. I'm getting hammered for it now.
I opted out of tax avoidance, and went in for self employed because I didn't think I'd be disciplined enough with Ltd Co accounts. I regret it. Ltd Co and I could have just dissolved the company. I don't recommend it, but it is a massive safety net if things do go tits up.

We might think these are simple decisions, but the future You might have to work around decisions you make now.  

I wish someone had said these things to me a few years ago. If any of you have any questions, feel free to ask, and happy to answer them.

 

 

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i think you were not in a position to listen to anyone's advice then! correct me if I am wrong.

but I always liked your posts especially  'guarandamnteed' advises...

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With regards to IR35 as a limited company it's all about whether you are under direct supervision or control. If you are then you would lose if the government investigated you. The HMRC website says specifically for locum doctors:

The agency legislation applies only where workers are subject to, or to the right of, supervision, direction or control as to the manner in which they render their services. A doctor supplied by an agency to work in a hospital or nursing home is regarded as subject to such supervision, direction or control unless the post filled is that of a hospital consultant (see Bhadra v Ellam 60TC466). Agencies are therefore required to operate PAYE and deduct Class 1 NICs on the earnings of such doctors.

So if you're a locum doctor operating as a limited company who isn't a consultant you're taking a big risk

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Bro, you can find a gazillion things that will tell you not to take a certain option. Fear is a funny thing. 

Go ahead go for PAYE, and get your 3-4k a month. 

I'd go for Ltd Company, and take my chances with the 0.001% (or less) chance of getting IR35'd. 

Show me 1 person you know who has gotten IR35'd, and I'll show you 100% who've stuffed themselves with PAYE because of exaggerated fears and catastrophisation. 

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In addition, Bhadra was a bit of a numpty when he decided to represent himself in court.

What I'd like to know and confirm is whether he was working in his own trust and pocketing locum pay through the company.

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On 3/8/2016 at 15:21, slartibartfast said:


But.. Complete your training. I left for very silly reasons, and regret it now.
 

Can you expand on what your "silly reasons"  (in hindsight) were?

I just had a poor ARCP review (for not ticking all the boxes) and have been given a tough oncall rota ... every day I wonder why I just don't quit. Maybe I would see the poor rota and grief as silly reasons in hindsight, but at the time it seems very significant!

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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.



 

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TL;DR: Tick the boxes. Deal with the rota. Enjoy the journey. Complete training. 

Eyes on the prize. 

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I decided to do higher training after many years as locum staff grade. Really enjoyed locum lifestyle - pay, flexibility etc

Must admit I hate being back in training. Loathe portfolios, difficult consultants, WPBA that seem to be scored on whether someone likes you. I agree with your analogy that it's like a prison sentence! I just want to get cct and just do locum posts - either consultant or staff grade.

Slarti - I remember you making a big fuss of IR 35. I've never seen or heard anyone caught out by this. My accountant even stated that I was compliant with it. As for opting for tax avoidance scheme- what were you thinking?! Also I recall when you made the decision to quit training, posters encouraged you to stay on and complete

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Slarti is not hypomanic anymore and talking sense, didn't listen 5 yrs ago.

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On 15/03/2016 at 07:39, ianb78 said:

Slarti - I remember you making a big fuss of IR 35. I've never seen or heard anyone caught out by this. My accountant even stated that I was compliant with it. As for opting for tax avoidance scheme- what were you thinking?! Also I recall when you made the decision to quit training, posters encouraged you to stay on and complete

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. :) 
 





 

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very reflective post and thanks for sharing your experiences, slarti.

i can only hope that future is kind on all of us - poor psychiatrists..

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