There are great things about A&E – the variety, the people, the cohesive team. There are terrible things, like the rota, and not finding out what happens to people, and the rota. My 900 hours in A&E is coming to an end and I need to start thinking about making a decision (although I have another 6 months in another A&E department, in 6 months time. My concern comes down to work-life balance – it’s easy enough in medicine to slip away from your non-medical friends and into a quicksand of work without having that work take up every other weekend and 5 evenings out of 7. I’ve contemplated a number of ‘plans for life’ based on avoiding this:

Plan Number 1 – Don’t do A&E.
Do acute medicine instead! Sure, you get the dreaded job of the Medical Registrar, (although secretly I kind of want that challenge) but your rota is much better, you don’t have to deal with anywhere near so many drunks, and you are still free of day-long medical ward rounds. You get a bit longer with your patients, and although you often work later into the evening you’re compensated for this by doing fewer days at work. However, 99% of your work is the same 20 presentations, and there aren’t quite so many jobs out there as ED (but not far off). It is less exciting, and there’s no trauma and fewer practical hands-on odds’n’ends. I am currently on a training programme that supports either this or ED as options.

Plan Number 2 – Try and wrangle LTFT training because they’re desperate.
Less than full time training lets you reduce the hours you do but in order to qualify, you need to provide a good reason, like being a single parent or being the sole carer for someone. I’m neither of those, but wonder if their desperation for A&E doctors is such that they will allow someone to reduce their hours for purely selfish reasons, so I can have a life. This means that training will take longer and I would be paid less overall, but I would have more time for escapism. I suspect that this is not truly an option outside of my wishful thinking. Pity.

Plan Number 3 – Choose Life.
The shortage of A&E registrars is widespread and severe. Once I complete my core training, I could work as a registrar locum for a time. Perhaps I could do a couple of years working 6-9 months locum and then the rest traveling or similar. That, or arrange only to do shifts around my social life. The life benefits of this are tempting – time off, no e-portfolio, no dealing with the bureaucratic bullshit of the training system. The negatives are a lack of progression in both training and pay. Ultimately, the lack of a career may well crush this option to dust but that doesn’t mean it’s not tempting for at least a year or two.

Plan Number 4 – The Gamble.
Gamble with my life. The workload in A&E is unsustainable and must improve or the specialty will end. In five years, will the rotas be better? Will work/life balance have been improved, or the service be better funded, or there be more direct admissions without needing to go through A&E? What about in ten years? Can I take that risk? Should I, when there is a chance that things may not just stay the same but get worse?

Plan Number 5 – Procrastinate more.
My current plan of choice. I have taken up a 3-year training programme (ACCS) and luckily, the first year is 6 months of acute medicine and 6 months of A&E. Depending on which I choose, there are exams I need to complete (so I can’t wait too long) but I can certainly sit on my hands a little longer and think. No need to make a decision at all is wonderful…but nothing lasts forever.

Thoughts and discussion welcome, and indeed requested!

Metal dice

Plan number 6?


2 responses to “Plans

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