How to plan your FY3

FY3 refers to time spent out of training after completing the foundation programme i.e. the year after FY2. In this article, we hope to give you an overview of the process of planning your F3, highlighting important resources to help you get started. As this is the article our audience has asked for most, we appreciate any comments, questions or feedback!

Given over 70% of junior doctors take time out after completing the foundation programme, FY3 and beyond has become the norm. It is a great opportunity to take a break or to develop yourself.

Five things you could do during your FY3

  1. Relax: Have a career break to prioritise yourself/family/friends/hobbies/travel
  2. Earn: Use locums to pay off debts or earn money for future expenses (e.g. weddings, house)
  3. Work: Trust grade job or Clinical fellow post +/- further qualifications such as a postgraduate certificate or masters
  4. Develop: Develop your portfolio and/or skills for future jobs
  5. Explore: Consider working abroad or alternative careers

The above list covers some of the potential opportunities available during your FY3. You can mix and match these to suit what you need. There is no need for you to start your FY3 with any concrete plan of how you’re going to spend the time. As doctors, we are so used to having “control & structure” due to medical school followed by a regimental foundation programme, that we can find it scary or overwhelming to have such freedom over our time and work (but this is a good thing!).

How long should I take out?

You might immediately assume the FY3 needs to be an entire year. However, some specialties will have February intake e.g. ACCS/Anaesthetics, GP or Psychiatry. Many like to spend the first 6 months building their portfolio, doing a fellowship job or locums followed by travel and enjoying themselves for the remainder. This fits nicely with the timeline of specialty applications which are usually completed by around February or March.

Are there downsides to an FY3?

Always consider whether it is the right time for you to take time out of training. Depending on what you want to do with the year, family or personal commitments may not allow you to make the most of the year. Also, you might want a few more years of experience as a doctor to make the most of the time out if you’re looking to do something with more responsibility.

The main disadvantage of an FY3 is that it isn’t part of any formal training programme. You, therefore, do not get a guaranteed salary, study leave, study budget, relocation expenses and annual leave. You are in charge of your own training and employment and you can’t use these experiences (typically) to shorten the time spent doing any future core or run-through training programme. Given you’re not formally in training, you are responsible for organising your own appraisal and finding evidence of your professional development.

This isn’t always the case though! If you are doing a fellowship or applying for a fixed-term job – you may be able to negotiate some or all of the above.

How do I organise an appraisal? Do I need one?

The GMC states that all doctors should annually practice appraisal, but revalidation is only every 5 years. Essentially, the GMC wants you to evidence that you’re worthy of keeping your license because you are continuing to develop.

You need to find an appraiser or “designated body” which is the trust, agency or company for which you’re working. You will need to keep a log of continuing professional development (CPD) which includes your objectives for the year (personal development plan) and how you achieved this. Additionally, you should include evidence of QI activity, feedback from colleagues, compliments & complaints. MedAll has an excellent guide which explains this in more detail and has an awesome platform to keep track of most of this activity for free!

How can I decide what I want to do?

The rest of this article talks about the main possibilities and provides information & resources for each of them. Ultimately the decision is yours, but most doctors spend the time doing either locums and/or clinical fellow jobs. The former helps you earn & the latter provides you with structured time to develop your portfolio for specialty applications.

The following three questions can help you make a decision

  1. What am I hoping to get out of my FY3?
  2. What am I thinking about doing in the future?
  3. Do I want structure & employment benefits?

It is helpful to prioritise your motivations for taking an FY3 rather than do what everyone does for the sake of it. Some are keen to use the time to prepare their application for a competitive specialty by maximising portfolio points. Some people thrive on an unstructured year where they can flexibly work/travel and others prefer the rigidity of a specific job and team with the benefits of annual, parental or sick leave.

Only you know whether you want to use the time to relax, earn, work, develop or explore.

Relax with a career break

It is completely fine to spend the time taking a break and addressing your mental wellbeing and enjoyment – this is vitally important and financially, through locums, you can earn far more than your usual salary doing less than 25% of the work! You can then follow this up with a more structured plan only if you want!

Do not be worried about being penalised in future applications for not having a productive FY3. With the sheer number of people taking an FY3, the interview panel cannot afford to penalise what is already a diminishing pool of applicants. If anything, panels will look favourably on those who have had time to self-reflect and develop their priorities as these are applicants who are far less likely to drop out of the training programme later on! All you need is to explain what you used the time for and why it was helpful to you.

If you’re thinking to travel, it is important to plan travelling early. You must choose the right season for appropriate weather and lower cost. Booking early also may get you cheaper tickets or accommodation, and provide you with time to plan going with friends & family. Finally, remember to plan around interviews if you’re thinking of applying to specialty training during your FY3. They tend to be in January to March and you might be only given a few days of notice!

Earn with our top tips for locums

This is by far the most popular because you get to choose your working hours & the pay is incredibly attractive. You will usually earn about £35 to £45 per hour but this might be higher if booked last minute, if more unsociable hours or if negotiated with the hospital. As this pay ends up about three or four times your usual salary – you only need to work 2-3 days per week to make your FY2 salary. You can also choose the jobs you take to vary the experience you get.

The major disadvantages are that you have no fixed salary and the jobs tend to be all service rather than aimed to train you. If you’re unable to work for any reason, you don’t get paid. Also, locums might be in hospitals you are unfamiliar with or which are significantly short staffed which can be quite stressful. Finally, your shifts might get cancelled last minute which is incredibly irritating when it happens.

To combat this, I recommend you join the hospital bank so you’re regularly doing locums at the same hospital. As a result, you often build relationships with your supervisors, feel you are more familiar with the hospital and can provide continuity of care for patients. However, by doing this you limit yourself to only shifts they can offer and hence I recommend also signing up to a locum service like Messly to further supplement your earnings.

Work in a trust grade job or clinical fellow post

Trust Grade Job

A trust grade job is essentially like doing an FY2 job again, but perhaps in a new specialty. Essentially, trust grade jobs are created when GMC-approved posts are left unfilled and so hospitals need to recruit someone to fill them – typically an FY3 or international medical graduate. These posts are also known as LAT or LAS posts – locum appointment for training or service. The former is meant to be more similar to FY2 as there are opportunities for educational activities. The latter is a pure service job where you fill gaps in the rota in a way that is more consistent and cheaper for the hospital than a locum. Overall, these jobs tend to provide less training and educational activities when compared to FY2 – but you might be able to negotiate extra time in clinics/theatre or for them to pay towards courses/exams/qualifications. You may also be able to negotiate the salary. You can find these jobs on NHS jobs, BMJ jobs & Indeed.

Clinical Fellow Post

There are many types of fellowship jobs with different levels of clinical & academic activity. They might be more orientated to research, quality improvement, and education. To incentivise you to apply, they may also offer you time out and cover the costs of additional qualifications such as post-graduate certificates or masters.

They vary in the time you spend on clinical activity, but typically you are not part of the on call rota and hence the pay can be poor and sometimes worse than your FY2 salary. To make up for this, you can do a few locums during your time out.

Some of these jobs can be very competitive because of the benefits they provide and if they’re in a major city with excellent experience in a competitive specialty. If you’re thinking of applying for a clinical fellow job, it is very important to plan very early. Some jobs are advertised as early as December of your FY2. You therefore should look out for these early on and get your documents ready well in advance. This includes certificates, DBS, immunisation records, indemnity and references. You can find these posts on NHS jobs, BMJ jobs & Indeed or simply by searching “Clinical Fellow” on Google.

You should also contact various departments you know as they may internally advertise these first and/or be willing to create one. Many often find it easier to return to previous hospitals where they’ve worked asking them for any jobs that may become available. It also becomes easier to negotiate what you would like included (e.g. courses, exams etc.), your contract and your pay. Beware that some clinical fellow jobs may be on an outdated junior doctor contract because this works out cheaper for them to employ you.

Develop your portfolio and/or skills

Whatever you’re doing for your FY3, alongside it you may wish to develop your portfolio and/or skills. Simply doing a job isn’t enough – specialty applications require involvement in teaching, QI, presentations, prizes, leadership, courses, publications and exams. You don’t necessarily need to be based in a hospital to engage in these activities and the extra free time may give you more of an opportunity to focus on these aspects. I’ve written an entire article on how to maximise your points for specialty applications which is well worth a read!

Explore working abroad or alternative careers

Many doctors are very keen to work abroad or consider alternative careers but rarely actually end up doing this. Many tend to underestimate the work involved in planning these experiences. Nevertheless, these opportunities remain very attractive given increasing burnout and pay cuts. Whilst leaving the NHS long-term may be something you’re strongly considering, the reality is that whilst over 70% take time out after FY2, within 5 years over 90% return back to working in the NHS. Whatever the statistics say, you should do whatever is right for you and even if you end up disliking the experience, it is better to have tried and failed than never having tried at all.

Working Abroad

Before deciding to work abroad, ensure you consider that you may need additional exams, indemnity, and professional registration – these things can be very costly! Additionally, you may need to get used to another language, culture or being further away from friends and/or family. There are plenty of organisations that can help you find these jobs:

Alternative Careers

Getting into alternative careers can be really stressful and need to be planned well in advance. Rather than being a doctor where generally you’re always likely to have a stable job, the same isn’t true for roles outside of the NHS. They require dedication, research, and you’ll need to network and apply for jobs and may need to move frequently. Many startups are likely to fail and how much you earn may vary significantly as a result. However, you can always supplement your income with locums to make up for this.

Some options within this space include medical startups, working for charities as a doctor, medical educationalist or being a medical expert in media. You could also choose to completely leave medicine and use your skills in finance or other careers by applying to graduate programmes.

It simply isn’t possible to list all of the resources and positions available as they change as often as weekly. It is therefore important to check out dedicated resources for this.

References & Resources

  • Our favourite resource is Messly for their locum service & F3 resource hub which is by far the best collection of resources
  • We love MedAll’s tool for creating an account to keep appraisal documents
  • RCP London & The MSAG describes personal stories of FY3s
  • Hostel World offered our favourite top tips before travelling the world
  • Thames Valley HEE offered an excellent resource to frame career dilemmas
  • The GMC has provided their analysis on why people take FY3s and the benefits of them

Written by Dr Akash Doshi (ST4 in Endocrinology & Diabetes)

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