Leave core training and become a lone wolf locum

11 posts in this topic

I'm thinking of leaving core training in order to return to staff grade/specialty doctor locum work. Prior to core training I worked as a specialty doctor which was productive, both clinically and financially. I decided to go into core training in order to knock off exams, however I've becomed disillusioned by the process and its impacted my enthusiasm somewhat

I was happier as a staff grade in a locum capacity and had a work life balance that allowed me to earn enough money to fund side ventures and build up a deposit for a home more rapidly (something important in these times given the way property prices are rising). However, I'm literally shackled in core training and now living pay cheque to pay cheque like a bum. 

I don't care about status at work, I care about self-esteem and status in life and I feel that going back to staff grade will give me the freedom and balance to earn enough (through phases of heavy 9-5 plus out of hours locuming, followed by relaxed routine 9-5 locuming) while feeling happier and productive.

I know that most are hell bent on consultancy and will explain the array of earning potential and private opportunities as a consultant, but some staff grade pay is not far off from the average NHS consultant without the kafkaeque headaches that come with it.

I know most will tell me to persevere with exams but I'm completely depleated of energy and would prefer to be a workhorse as long as it allows me to do the things I enjoy outside of work as I value life status over work titles.

A friend of mine left training and focused on locuming and worked all hours that god sent in a 5 months on 1 month off pattern. He kept this up for a few years and saved up enough to buy 3 houses. He rents out 2 and lives in one and has reduced his locum work to part time (increasing his hours according to need). He may not be a consultant today with 'work status' but he has security, life status and passive income that affords him some degree of control over his life. Whereas his consultant colleagues have no passive income.

I suppose I'm inspired to do the same as I felt I could achieve this when I was a staff grade. I know that IR35 has stifled locums to some extent but relative to core training you're still better off by the numbers it seems.

Thoughts please? 

Edited by Oneiros

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Oneiros you remind me of me. You're quite right there's hardly anyone here who thinks like this.. most feel that anything short of being a consultant is absolute failure.  It almost seems like a taboo subject to talk about within training.  I also couldn't care less about status and would rather have work-life balance.

I'm in a different position to you in that I (reluctantly) went  in higher training.  I did this out of insecurity really.. just to exhaust all the training and give myself maximum options. But if I were back in core-training personally wouldn't be able to hack it and would probably go into locuming again.

You've sort of answered your own questions to be honest. You clearly know all of the pro's and cons.  For me the IR35 thing was huge.. it seemed to be the difference between earning an ok wage in a job with little job security to a mega salary where you're on more than consultants.. and because of the salary there was job security because effectively you could not work for 3 months of the year and still earn a great wage.  The IR35 thing swayed me to go into ST4.  But now it seems like positions outside of IR35 are popping up again in the private sector so that might be the way to go.

If you ever wanna discuss PM me.. I feel very much the same way as you do about all of this.


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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. 


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. 

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I don't derive myself esteem externally from 'work status'.

Id rather work as a staff grade and use the opportunities available to make a bit more money and establish ways of making passive income so that by the time I'm 50 I'm not working as a doctor anymore.

Its a risk like anything in life, but the transition into core training feels like a mistake (I intend to do exams as a staff grade anyway but on my terms and at my pace).

As a core trainee all I do is live pay cheque to pay cheque, no time to go out and form relationships and all my free time is spent documenting when I eat shit and piss on the eportfolio and I'm fed up of it. 

One day I'll be a dead man and the moment before I pass on I won't remember studying like a robot and doing eportfolio. But I may remember the risks I took and the other experiences I was able to achieve because of those risks taken.



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8 hours ago, Oneiros said:


One day I'll be a dead man and the moment before I pass on I won't remember studying like a robot and doing eportfolio. But I may remember the risks I took and the other experiences I was able to achieve because of those risks taken.



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. 


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IMHO if you derive your self image and self esteem from a degree, exam or job title then that's a sign of a bigger problem. Be happy with who you are first and all the rest flows from there. Omeiros make your decision based on what you want out of life. Life is too short.

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On 8/21/2017 at 11:09, Oneiros said:

Hi Oneiros



Hi Oneiros

Great to read your post. I've been a staff grade for 4 years now, and over that time I have come to the conclusion that my work-life balance is so perfect that I don't need the extra money that being a consultant would give me, let alone the stress of it. For me, money only gets you a certain degree of happiness and as I get the same money as a locum doing 22 hours a week as I did being an SHO doing 48 hours a week, the extra time I gain to live my life not concerned with work is something money cannot buy.  

Your decision will be guided by what you value in life and want from it. I'm not after status in life, so being a consultant for that reason does not appeal.  I like to learn as I work and I do not want to stagnate in my knowledge, skills or interest in psychiatry. I find that my current work provides me ample opportunities to progress in a way that is valuable to me an individual; a willingness to work towards creating your own way of working, and not relying on the "formula" of conventional training will help you to create work that is a perfect fit for you.

From the tone of your emails and the information that you have provided I feel as if you have answered your own questions. The following sentence particularly made me feel as if you know what you want but maybe feel as if you should do something other than what you want: "As a core trainee all I do is live pay cheque to pay cheque, no time to go out and form relationships and all my free time is spent documenting when I eat shit and piss on the eportfolio and I'm fed up of it". 

Would be great to hear from you!





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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? 

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Yes, I think you're right that there are lessons in all of this.

I think for anyone of us to make the right decision for ourselves and our unique situations in life we really have to know what we want out of life overall and how it will all fit together for us.  For example, a given individual may decide that based on what they know about their own strengths and weaknesses and preferences in life, they may decide that working  as a staff grade may be the trade off they are willing to pay if they want to ensure they have more time and energy to be with their family or to devote to interests outside of psychiatry etc.

Another person may juggle the demands of being a consultant better and wouldn't feel that it impacts on family dynamics or other aspects of life.

I believe that each person has to make that judgement for themselves as they are the only person who knows how they want all the different facets of life to balance against each other. 

I agree that if you really want something that requires such effort, its absolutely worth putting that effort in and striving for your desired outcome.

That way, having got through a period of hard work, you will be happier for many more years to come.  For some,  it may well be that "fears" are holding them back, and once they overcome these fears and complete their training they are glad they have done so.

However, I do not feel this is the case for everyone.  

If one is doubting whether the hard work is worth, it suggests to me that they do not think the reward would be worth it.  I believe the majority of us at this stage in our careers have enough insight and wisdom to make an accurate personal judgement on this.  Paying more attention to that judgement and less attention to external representations of what constitutes success may help all of us to find the course of action that suits us as individuals.

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I've really enjoyed reading this thread.

Oneiros, do you have an update on what you did?


Your opinions really resonated with me as I too think of leaving core training. 


I spent a year locuming around the country in 2018 and I initially found the instability unsettling, but then grew to love the freedom of choosing where I work, when I work, and how much time off I had. The pay was great (for someone who just finished FY2). But I thought I wanted to enter training so I did, and it was in a city I thought I loved but I didn't. And just as you described it Oneiros, I feel "shackled" to training, but also to a location. I've looked into IDT but I don't meet the criteria.


I'd love to know what decision you made and how you feel about it now. 


I sometimes feel like leaving and returning to training, but I think that is not allowed. I'd love it to be more flexible, but I think that would damage the quality of training. In all fairness, I wish I'd never started training, if I put it off for only a few more years maybe I'd be ready for the shackles.


Best wishes,



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