Spotlight: Working abroad

More doctors are jumping ship to work abroad but uncharted waters present new risks, argues Sara Williams

Last year, suitcase in one hand and passport in the other, Dr Alex Naylor, a trainee from Leeds, walked through the doors of Heathrow Airport to check in for his one-way flight to Sydney to work at Westmead Hospital. But, a year on, was his quest for fortune and glory in vain? “My main reason for leaving was for a sense of adventure. Leaving F2, I didn’t feel ready to throw myself into a particular field; I wanted to gain further experience in anaesthetics and ICU.

"I made the right decision. The pressures of work don’t feel as demanding as they were in the UK; you feel more of a team player, rather than a nameless drone. I have found working in the emergency department incredibly fulfilling; no four-hour waiting times, so you feel like a doctor, not just a triaging system. There will always be a place in my heart for England, but giving up the work, weather and the country would be hard.”

Thinking ahead is the key to organising a successful trip

Alex is not alone. Although the Department of Health (DH) doesn’t collate official figures, the GMC has issued 2,480 Certificates of Good Standing so far this year, which is a standard requirement before embarking on clinical work in most countries, and is an indication of how many doctors are going to work abroad. Dr Clare Fellingham moved to New Zealand in 2007 because she was frustrated with the MMC "fiasco”. She has since moved and currently works in Perth in Western Australia.

“When I was a third year SHO in a busy DGH in the Home Counties, I realised that nothing fazed me anymore; I felt like I was working on autopilot. I moved to the Antipodes and found jobs that are without parallel in the UK. You could run a base hospital, work in a clinic 1,000km from the nearest tertiary referral centre, cruise with the flying doctors, act up a grade, make real life and death decisions, and gain infinite clinical skills and life experience.”

Thinking ahead

Clare left the UK confident that she could achieve her dreams of working as a foreign doctor, but she now knows only too well the number of boxes she had to tick to realise them. From expensive medicals to police checks, it can take a long time to secure a ticket to work in another country. Thinking ahead is the key to organising a successful trip – getting important factors like travel insurance, flights, vaccinations and professional indemnity sorted early will help avoid problems at the last minute.

What indemnity is needed?

Before practising it is vital to protect yourself: new countries mean new risks. Having a patient’s best interests at heart will not always protect that patient from harm. Likewise the best intentions will not always protect a doctor from human error and professional scrutiny. This is why having indemnity and access to 24-hour medicolegal advice is vital.

Junior doctors must be alive to the ever-increasing risks of clinical practice

NHS indemnity is limited to clinical negligence claims arising from NHS hospital care and the claim is made against the trust. It is essential for all doctors to have additional professional protection for the other medicolegal risks that can arise from practice. The NHS scheme does not extend to doctors working abroad, who will therefore need to make their own arrangements to ensure that they have adequate protection in place.

Dr Pallavi Bradshaw, MPS Medicolegal Adviser, says that junior doctors must be alive to the ever-increasing risks of clinical practice. “Doctors travelling abroad should be alert to the current legal and ethical climate within a particular country. Being aware and managing these risks will safeguard you for the future.

“Without a doubt, patients should be protected, but equally, we believe, so should doctors. MPS’s role is to protect the interests of members when concerns are raised about their practice, in any form – claim, complaint, medical council investigation. It is a common misconception that MPS deals mostly with clinical negligence claims. This kind of work represents only about 20% of our caseload.”

How should you inform MPS if you want to work overseas?

If you plan to work overseas you must contact the MPS membership helpline on 0845 718 7187, or email us well in advance of your trip, to ensure that you have appropriate indemnity arrangements. This is particularly important because some countries – for example, Australia and Germany – have made it a requirement that all healthcare practitioners have insurance-based indemnity, as discretionary indemnity is not recognised in these areas. MPS is the world’s largest mutual medical protection organisation working internationally, operating in more than 40 countries. If you are planning to work overseas you may well be able to continue your membership with us.

For practice in Australia, MPS has a reciprocal agreement with MIPS (an Australian insurance company) to arrange cover for non-Australian resident MPS members intending to work in Australia in state indemnified hospitals. When you contact the membership helpline to work in Australia, please provide them with the following information:

• your UK address and telephone number
• email address 
• Australian address and telephone number 
• Australian work address 
• dates of practice.

Good Samaritan acts

MPS’s protection entitles members to request assistance with medicolegal problems arising from Good Samaritan acts in any part of the world. This is where a doctor provides medical assistance outside their usual clinical employment or work environment in a bona fide medical emergency, such as when passing a roadside accident, emergencies at public events and on aeroplanes.

Where to go?

The Antipodes is a mecca for graduates from all trades, but Clare Fellingham argues that a lot can be gained from exploring faraway places. “It depends on who you are, your seniority, your outlook on life and your breadth of experience, but if you really want to, go for a far off land and get a great experience.”