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A leap into the unknown—working overseas
  1. I D Wacogne
  1. Ian Wacogne is a consultant in general paediatrics, Birmingham Children’s Hospital, UK; ian.wacogne{at}

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Like most of these things, the opportunity to work for a year in Brisbane came about by chance, one in a series, in a lifetime filled with lucky circumstances.

I had already decided, with my wife, to take six months of unpaid leave in order to see a bit of the world. More about this another time. The chance to work in Brisbane came up and we rapidly combined it with our travel plans. It is usually hard for doctors working in a March/September system to fit in with doctors working in a January/January system without upsetting someone. Our plans for time out to travel gave us much needed flexibility to reconcile this.

Part of me would have liked to work in the developing world, but for complicated personal reasons this was not possible. So, the question arises: What is the point of working in another developed country? Will the experience be significantly different from staying at home? To try to address this valid point, I set myself some goals and some questions that I wanted to try to answer by the end of my time in Australia. I’ve had varying success.

Firstly I wanted to get a feel for which of the problems with NHS are the consequence of it being the NHS, and which are common to any health monolith. Clearly I only have an n of 2, but I do have a better feel for what we do because that is what we’ve always done, and I’ve seen some of the problems we share with Australia solved in different ways.

Secondly I was keen to experience some branches of paediatrics my region or country couldn’t offer me— or could only offer me with greater commitment than I could give in a five year training programme. Thus, I’ve had short periods of experience in paediatric intensive care, with fixed wing and helicopter retrieval, in oncology, and in rural and (extremely) remote paediatrics. I’ve also been the Chief Resident, a role which isn’t currently found in any hospital in the UK.

And thirdly I wanted to find out more about some of the specific issues I’ve written about here—the 40 hour week, obesity, teenage smoking, aboriginal health, and so on.

What are the down sides of working overseas?

Well, there are conflicting messages about the amount of time that will be counted towards your CCST when you spend time out of rotation. At various times I was told anything between one and two years of my total two years working overseas. The postgraduate deans are currently under pressure to move SpRs through the system, and so now there is a trend to include more out of programme time. I’d have to be honest and say that the issue didn’t really worry me greatly; so I might be a consultant for a year less in the grand scheme of things—where’s the hurry? Oddly enough the Royal Australasian College of Physicians allows up to six of the total seven training years spent outside Australia. This causes a little anxiety among some senior members, who argue that this isn’t really an Australian training at all. There must be some happy—although entirely arbitrary—middle ground. Unless the supervising body had confused training with service, of course ...


It’s been expensive too. Oh, I’ve earned loads, but being on the other side of the world from your usual home gives you a different perspective. It would rude to go all that way and not see the place properly, wouldn’t it? It does, however, leave my pension in a terrible mess.

Lastly the stresses involved in dealing with a whole different set of regulating bodies—from immigration, through registration, to colleges, and the health monoliths themselves—can be huge. We got married a few months before leaving for Australia, and I can honestly say—with no disrespect to the institution—that the wedding was a breeze compared with the rest of it.

At the end of it all, in answering the question “Was it worth it?” I would have to say yes, emphatically and without hesitation.

A few tips for anyone considering anything similar. Firstly don’t underestimate the disruption and cost. Do the old backpackers’ technique for estimation of expenses: work out how much you’ll need, and then double it. If you are used to backpacking, then double it again. Secondly, establish and use clear lines of communication. Get an account with a telecom company offering cheap phone calls to wherever you are going. Follow up post; send items by international registered mail if they are at all important, and make a polite phone call after two weeks if you’ve heard nothing. Email can make this easier, but people have varying levels of ability with this tool, and you need to remain contactable.

Lastly, if you think you would like to do it, then you should. I doubt very much you will regret it.