The Year I Went From Six Figures To Zero - Part Three

The one where Louise gets to the point

Previously, in this financial life story:

• The one with the photo of a consultant surgeon’s payslip:

  The Year I Went From Six Figures To Zero - Part One

• The one with the surgical training years and pretty shoes:

  The Year I Went From Six Figures To Zero - Part Two

So what’s it really like to earn six figures then lose your job?

Well, we made it to the dénouement of this tale. Thanks for sticking with me, I do so appreciate you being here. Today, we’re coming to the crunch, as we pick up the story at the end of my long and winding path through surgical training.

I was awarded a certificate of completion of training (CCT) and named on the GMC’s specialist register as a paediatric surgeon in February 2022. That was a big day. An expensive one, too, as the congratulatory email arrived with a £489 administrative fee. It was a good feeling, to get to the end of 16.5 years of postgraduate training; 21.5 years including my time at medical school: more than half my lifetime in pursuit of this goal. I thought I’d made it; that now things would begin to fall into place, I’d be able to settle, and the ‘life’ that I’d been putting aside while I focussed on getting over the next hurdle, could begin.

Of course, things are never as straightforward as that.

- The Year I Went From Six Figures To Zero, Part Two

Uncertainty had been a universal theme throughout my career, and by the time I completed training it had taken quite a toll on my emotional health. I’ve written previously about the insecure nature of medical careers with their years of rotational, fixed-term posts. I also faced prolonged uncertainty about exactly when (or even if) my training would end.

My training programme, certifying me as a fully independent consultant surgeon was due to end in 2020. A complicated pregnancy with my daughter led to some delay, then as for most plans around the world that year, any hopes I’d had of opportunities to perform my final procedures for sign off were derailed entirely by the pandemic. In my third trimester of pregnancy at the time of the first lockdown, I stayed at work long beyond much of the published advice recommended, in hope that achieving sign off would allow me to make more concrete plans for my return post-maternity leave. The decision was ultimately taken out of my hands at the end of March, and I was sent home to isolate until my daughter was delivered in May.

In the months following my daughter’s birth, a constellation of postnatal changes alongside the pandemic-enforced isolation and health anxieties that plagued much of the population, and the persistent pressure I felt to ‘have a plan’ work-wise were the catalyst for a period of significant depression; in retrospect, probably also an autistic burnout. I was acutely aware that my training programme would end as soon as my final couple of procedures were signed off, and though it was not possible to predict when that would happen, the final signature on an assessment form would set off a six month timer¹, after which, if I hadn’t found another job, I would be unemployed. Fear of change has been a recurring challenge for me, but here I faced not just the possibility of change, but its imminent certainty.

It is increasingly common, especially in surgical specialties, to undertake a fellowship post after CCT to gain additional niche skills and present as a more attractive candidate for consultant posts. I had sought opportunity to request time out of my training programme to gain experience in trauma surgery earlier in my career, but with an intention to include this work in my consultant practice, I decided to apply for a competitive, nationally appointed programme for this post-CCT period. While I knew that this decision meant that I would effectively be a trainee for an extra year with my salary therefore remaining on the registrar pay scale, I would have an unmissable opportunity to work with some of the UK’s leading experts in major trauma. Perhaps even more vital for my particular circumstances, the placement was based in my local hospital trust, so I greeted my appointment as much with relief as delight.

Fellowship 2022-2023

Base pay £53k | Total pay £74k + regular locum shifts | Attitude to money: Balancing act

I began my year of fellowship in February 2022. Because of the quirks of rotas and pay bandings², despite now being a fully trained surgeon, my pay was less than it had been in my trainee post. Fortunately, there were many opportunities to do extra shifts, and as I was now qualified to take up these shifts at consultant grade as well as registrar grade, I was able to make up the shortfall.

I committed myself to learning as much as I possible could during this year. The work was as busy as it was challenging, but ever varied, and my confidence in managing a trauma call or resuscitative surgery increased exponentially as my experience grew. My leadership capabilities expanded and my responsibilities broadened, in time becoming the Major Trauma Centre lead for paediatric trauma. I travelled to South Africa to study under world renowned trauma specialists and to Portland, Oregon to present my research work. These incredible opportunities did not come cheap, though, each requiring >£2000 of personal expense despite a study budget funding a small portion.

My ID badge for the Pediatric Trauma Society meeting 2022

Specialising in major trauma was unusual for a paediatric surgeon. Significant torso trauma requiring surgery is fortunately much rarer in children than it is in adults, but this means that many surgeons who exclusively treat children have limited experience in the trauma sphere. My own decision to follow this path was made years earlier when I’d looked after a teenager with a stab injury, and my consultant at the time admitted to being out of their depth (we called in an adult team and the patient recovered well). Through a combination of wanting to see as much as I could, feeling a duty to fill vacant shifts whenever feasible, and, yes, a desire to earn the extra pay that was attached to these additional hours, I spent so long at work that I saw little of my own family, often leaving before they awoke in the morning and arriving home after the children’s bedtime (if at all). I was focussing so heavily on trying to ‘prove myself’ at work that I missed much of my children’s early years. Reflecting now, I think that my main drive was to prove myself worthy of a future permanent consultant post, with a hope that I could finally feel secure and settled. Ultimately, this was not to be. What I had neglected to take into account then was that most precious and irreplaceable resource in existence: time.

Unemployment [1] February - April 2023

Base pay £0 | Total pay £0 | Attitude to money: Frugal

Towards the end of fellowship, without a consultant job lined up and with no possibility of any jobs local to my home region in the foreseeable future, I was worried. Worried that I might not be able to find work in the specialty I’d spent so long training for, and worried that if I did find work, it was extremely unlikely that it would be within a commutable distance of home. Feeling close to crisis at this point, I did two things. First, I arranged an appointment for ADHD assessment. The revelation that there might be something more going on was slow to arrive, but when the pieces finally fell into place I decided that while I would never be able to change what anyone else thought of me, I might be able to change how I understand myself and interact with the world. I don’t think that it was much of a surprise to anyone that I received a diagnosis. The awareness and validation that that diagnosis brought gave me enough self-compassion to recognise that while the career I’d long dreamed of in the centre where I’d trained, was no longer going to be possible, that I still had useful knowledge and skills. The second thing I did then, with that little bit of newfound confidence, was to reach out to the National Children’s Major Trauma Forum to explore any possible opportunities across the UK for a paediatric surgeon with specialist trauma training. It was heartening to be met by a lot of interest, but converting interest to a business case for a consultant job is no mean feat in today’s NHS.

The end of my contract rolled around rapidly, and with no extension offered, after more than 16 years of continuous employment within the NHS, half of which had been in the very same hospital, I became unemployed. I was not eligible for NHS redundancy pay, because this had been a fixed term specific training post; my employment simply ended.

In that six week period of unemployment, my primary emotion was shame - in my perceived lack of contribution to the household - in a way that felt very different to my time on unpaid maternity leave. When I was offered a consultant post at a hospital in a city I’d never before visited and would be a two-hour-on-a-good-day commute, as challenging as I recognised that would be, I jumped at the chance.

Consultant April 2023 - July 2024

Base pay £102k | Total pay £106k | Attitude to money: Make it stretch

This time last year, my annual salary in my post as an NHS consultant surgeon was £105,539 ( ~$133k). The basic salary for a 40 hour working week was £102,465 per year, with a 3% supplement for being on call 1:10. Take home monthly pay after taxes, pension contributions, and the fee to park at work (let’s not forget that), was around £4.5k (~$5.6k).

- The Year I Went From Six Figures To Zero, Part One

In April 2023, in the middle of a resident doctor strike, I walked into a shiny new hospital with a shiny new ID badge bearing the title ‘Locum Consultant ’. I still can’t decide if I was more terrified or excited.

My exact start date was up in the air until just a few days prior. Keen as I was to get started, the necessary admin to move to a new hospital trust takes time to process within the creaking bureaucracy of the NHS. My employment contract mandated residence within a 15 mile radius of the campus. My home being located 109 miles away, I spent a weekend viewing rental properties in my work city and - like a student going to university for the first time - a day shopping for all of the accoutrements necessary to survive in an acceptable degree of comfort for those months that I would spend living away from my family.

The rent for my two bedroom (so that my husband and children could visit) flat on the edge of the city centre was £1250 per month, with another £100 monthly for a car parking space and £250 for bills (electricity, water, council tax, internet). Once these additional expenses were accounted for, my pay packet stretched just enough to cover my share of the bills at home. I considered this year of running two homes an investment. A locum consultant post is often considered an extended job interview. It is increasingly uncommon for surgeons to be appointed to a substantive post without having worked as a locum in that particular department first, such is the perceived risk of an ‘unknown quantity’ disrupting department harmony (even in departments where the existent harmony is akin to a choir of wailing cats). I hoped that, should I eventually be appointed to a permanent post, relocation would then be a viable option and I would, at last, be able to settle and release the uncertainty that had plagued so many years of my life. Of course, if you read the first part of this tale, or even the title of this one, you will know that things didn’t quite work out like that.

In June 2024, two locum consultant vacancies were advertised in the department where I worked. My own fixed term contract was due to expire in July. The problem was, there were two other locum consultants employed in the same department. Colleagues of mine. Friends, even. Three locum consultants. And from July, only two jobs. It was therefore inevitable that at least one of us would be left out in the cold. Whether the decision came down to my performance over the year or simply on the day of the interview, I’ll never know, but I was unfortunately unsuccessful. With just three weeks remaining on my contract, I was faced with packing up my life in my work city, giving notice on my flat, and moving home, unemployed for a second time.

On 2nd July, 2024 my fixed term contract of employment ended. For the rest of 2024, I earned zero.

Now, that is not the entire story, because as those in the UK may recall, there were a series of NHS strike actions across 2023-24 as a result of an industrial dispute between doctors and the government. When resident doctors were on strike, consultants necessarily ‘stepped down’ to cover their shifts, to maintain safe emergency cover for our patients. Because this work was extra-contractual and largely unattractive to many doctors with a degree of unresolved trauma from our own junior years, we were paid much more than our usual hourly pay, with rates of up to £269 per hour. My final shifts as a consultant happened to fall during one such strike period. I had volunteered to work the night shifts in the knowledge that, with no active vacancies in my specialty in the UK, I may not have an income for some time. The approximately £13,000 I earned during this set of nights covered the first few months of my mortgage payments in that second half of 2024. Since then, I’ve been using savings to cover the shortfall.

- The Year I Went From Six Figures To Zero, Part One

Unemployment [2] July 2024 - present

Base pay £0 | Total pay £0 | Attitude to money: Careful, but free

To recap my financial position as described in this essay series:

Eight months into this period of unemployment, I have no income. I am fortunate to have some savings which, along with my husband’s salary, are allowing us to continue to meet our financial commitments at least for now. Though I made an active decision not to pursue any further posts in surgery as discussed in my earlier essays, I have spent many months researching and applying for alternative careers, and upskilling along the way, so far to no avail. Importantly though, I have learned to slow down. To rest. To play. To be with my still-small children. To appreciate the little things in life. To write!

Soon, I will need to make the decision to either spend several hundred more pounds on appraisal and revalidation requirements to maintain my licence to practice as a doctor in the UK, or to give it up. The personal expenses shouldered by doctors are considerable, and though they can be offset against taxes, they remain a significant burden. This is not a decision I can rush, though my heart is telling me it’s probably time to allow this door to close gently behind me.

What’s next? I’m still not entirely sure. After two decades pursuing one increasingly niche career, it’s very difficult to contemplate starting again at the bottom of a different ladder. I think that there have been many times over the years where I have felt unhappy at work, but trapped by the feeling of ‘I have no idea what else I could do’, as well as to a certain extent trapped by the salary. I got into the mindset of needing to keep earning as much as possible, but I hadn’t realised that many of the expenses I was spending the salary on would disappear along with the job. Living in one home again, without international courses or conferences to pay for, with no commute, no work clothes, no professional fees has cut down our spending requirements enormously. There are things³ I would like to be able to spend more freely on, certainly, and I do want to contribute to the family finances again, but I have learned to take my time over this and take the next right step mindfully.

At my writing desk today!

I feel immensely grateful to have discovered my creative self in this period of pause. I am free to dream of all that could be. I am also realising that do not need to spend money to be happy. I am finding joy in a dance party with my children; in a writing circle with friends; in the sight of new crocuses peeping through the grass. The opportunity to express myself in essays and poetry has brought fresh meaning to my experience of this one precious life, and I thank each of you reading for this gift of your time. With Spring just around the corner, like those flowers not yet awoken from their wintry rest, my future dreams are just beginning to bud. I hope that you will stick with me to see them bloom.

Louise x

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1. Health Education England Period of Grace guidance states:

“Once a doctor has been entered on the specialist register they are able to take up a substantive, fixed term or honorary consultant post in the NHS. Although trainees are able to apply for Consultant posts up to six months before their anticipated CCT/CESR(CP) date, not all are either able to do this or are successful in their applications. The Period of Grace enables doctors who have completed training and not yet obtained a Consultant post to continue in the Specialty Registrar grade contract for a time limited period whilst they find employment, usually in a consultant level post.”

2. As per the terms of the 2002 junior doctor contract, pay was made up of a basic salary for a 40 hour work week, and an additional ‘banding’ supplement to account for the unsociable nature of a significant proportion of our work, and additional rostered hours over 40. In most of my posts, the banding was set at 40-50%, making my total pay 1.4-1.5x the basic salary for the seniority grade. Post 2016, the terms of the contract changed, though I remained on old contract pay under transitional rules, while still in training. (From The Year I Went From Six Figures To Zero, Part Two)

3. ‘Things’ like gifts for the children, yarn, pretty notebooks, fabric, candles, yarn, more notebooks, and more yarn.