What to do with a medical degree if you don't want to work in the NHS Part 1: considering your options

Authors: Adam Poole 

Publication date:  29 máj 2004

Most doctors never leave the NHS. But if you are toying with the idea of a career outside medicine, entrepreneur and former surgeon Adam Poole offers a two part guide to the process

Across the economy, career patterns have changed beyond all recognition. No more the “job for life”—arriving in one company after graduation and leaving 40 years later with a gold watch. Instead, the past three decades have witnessed the evolution of generation X employment.

Generation X

Generation X employment is about the development of transferable skills, which employees carry with them across different professions and sectors. Typically, the generation X employee moves jobs at least every two to three years. Periods in marketing, sales, analysis, e-commerce, teaching, and charity work (including spells abroad) are connected in a seemingly random way. A curriculum vitae is built not around specific skills but around general skills (such as management, creativity, team working, and use of resources) which could benefit another employer in a different sector.

The generation X employee doesn't have time in two or three years to become an expert in any one sector; instead he or she thinks laterally to identify common ground between past jobs and the next career move. This relies on a completely different philosophy from the old fashioned “see one, do one, teach one” approach. Generation X employees should be able to move into a new company “teaching one” from their first day.

Shift in medical opinion

Large corporations have been dealing in this brave new world of employment for a quarter of a century, and human resources specialists believe the range and diversity of careers have moved on even faster over the past decade as resistance to this style of building careers (from prospective employers) has softened. In medicine over the past five years we've seen the beginnings of a major shift in opinion about doctors' employment. When I qualified as a doctor in 1996 it was almost unheard of for “career minded” senior house officers (SHOs) to take off six or 12 months to work abroad and travel; now it is almost the norm. The suggestion that this harms careers is now laughable given the numbers that travel every year.

The government itself may become the catalyst for an extension of this quasi-generation X in medicine with the introduction of foundation programmes. By allowing SHOs to take time to consider different specialties, I believe they endorse a belief that travel, experience, and variety are good building blocks for medical careers. But travelling abroad for a year as an SHO is hardly using a medical degree outside medicine.

Beyond the mainstream

Most doctors never leave the NHS. The press may like to influence the debate on public services by implying a crisis of doctors fleeing the sinking ship, but this is largely fantasy. In the BMA's cohort study of doctors graduating in 1995, for instance, just 3% of the cohort (two men and 10 women) have left medicine as a career ( [Link] ). I have no criticism of doctors who develop diverse careers within the NHS, only of those who are so inflexible as to deny the existence of any other options. Most of my friends are doctors, and of my year group of about a 100 I know of only one other graduate who doesn't work for (or is not planning to return to) the NHS.

It is, I think, a function of intelligence to be inquisitive and consider options for careers. Obviously, it isn't new for doctors to pursue atypical careers. It is possible to move between different parts of the NHS, working in different specialties, and to move abroad, for a whole career. But the medical colleges make it extremely difficult to progress (upwards) in a career doing this.

Moving out of mainstream medicine into a different career altogether is a two stage process: stage 1 is to consider your options and stage 2 is to make the decision to change career. Stage 1 is actually the harder of the two. Careers advice within the NHS is improving, but it would be counterintuitive to provide in-house advice on non-NHS jobs. There isn't a book, a library, a website, or a biblical knowledge tree to provide the options. Careers advisers can be helpful, especially if they have worked with people in a similar situation. Their role is to help you sort your priorities, understand your personality and values, and thus to point you in the direction of potential career opportunities. The BMJ Careers advice zone ( [Link] ) also has some questions and advice about careers outside the NHS.

Stage 1: turning over stones in the garden

The information gathering stage is rather like the childhood game of turning over stones in a muddy garden to see if there are worms underneath. It is a question of not being afraid to start turning over stones. The stones are contacts, not necessarily ones that you have even met, who can provide you with information.

My own experience was that the most productive stone to turn over was in the form of a drug company representative. When I asked him if he knew any medical staff in his company who might be able to tell me about careers in the pharmaceutical industry, he phoned an in-house medic (whom he had never met either). The medic met me for lunch and provided the launch pad I needed for my first non-NHS job—an incredibly happy one at GlaxoSmithKline. While there, I learnt a huge amount about working in teams, organisational culture and motivation, and business. I worked across several different departments, including business development, respiratory medicine, and genetics research.

Be bold

But for every stone with a worm underneath, there are lots and lots that are wormless. If you want to know what your options are, you have to find many contacts and be willing to pick up the phone to total strangers to ask them about their jobs. Although to the introverted this might sound like torture, it actually isn't too bad. I have never encountered anyone who doesn't want to talk about their own career. Almost the opposite—people love talking about themselves and your phone call might well be their perfect excuse to avoid going to some really tedious team meeting.

You can make stage 1 run more smoothly by searching in the most likely places first. If you have thought about a career in the city you need to talk to some people who have made careers in the city. If it's medicolegal law, find yourself a medicolegal lawyer. If you want to be an entrepreneur, find an entrepreneur.

The reason that stage 1 is difficult is that the more people you talk to, the more complex the “how do I do it?” issue becomes. Many people believe that there is just one route to a job outside the NHS—like getting a specialist registrar post. Jobs are advertised, you prepare a curriculum vitae, and you go to an interview and sell yourself. That's sometimes true, but often jobs don't appear in the same way as they do in the NHS. Entry positions are often controlled by specialist headhunters, and jobs may not be advertised in places you might predict, if at all.


Most corporations (including city firms, drug companies, and blue chip employers) retain headhunters to help them with search and selection. Graduate level employees at big companies are normally recruited (by the companies themselves) at careers fairs; anything above this is usually outsourced. Headhunters are an integral part of the searching stage.

Headhunters aren't there primarily to help you. They are in the service of the employers and work solely for them. They keep what are incredibly lucrative contracts only by finding good candidates for vacant posts. And for their services they typically take a fee of a third of your first year's salary (if you stay in the job for six months or more). But they can operate only if they have high quality candidates to put forward to the employers, and therefore they can be a huge help to you.

The first service headhunters can provide is giving you an idea of what comes across their desks: types of jobs, salaries, what's entailed, and what kind of candidates are successful. They can put you forward for a job, and they can act as a go between and negotiate your salary, which can reduce tensions with your prospective employer even before you start work. The good thing is that because they are paid by the employers none of this costs you anything, except determination and time.

So it is a good idea to get in front of these individuals, with the caveat that they work for the employer and not for you. How do you find out which headhunter to talk to? One way is by phoning companies that seem to recruit doctors (for example, from advertisements in BMJ Careers) and more specifically by asking the worms under the stones.

Stage 2: handling criticism

When you have decided you like the sound of a specific option, the next stage is to find a job, get a job, and make a decision to move out of the NHS. It is at this stage that you will begin to talk to friends and family about your thoughts. Of course, friends react to situations differently, but the two reactions I have witnessed to my own career moves are absolutely typical. I was asked not, “Why did you decide to do your current job?” but, “Why did you leave the NHS?” The reason for this question is that—across society—there is still a perception that medicine is a vocation, like the priesthood. Once the decision has been made to become a doctor (at the age of 18) it really is still a job for life. Medicine—seen as the glamorous and respectable profession of helping others and selflessness—is not something you simply leave. And, underneath the question often lies a sneering “you couldn't cut it” type of reaction.

Deal with it

This reaction bothered me for a long time, so I sought to qualify and justify the decision, in sales speak, handling the objection even before it was raised. If you are serious about progressing to a career outside the NHS you have to be able to deal with this reaction: in researching this article every single ex-NHS doctor I spoke to had been subjected to it. It took me a long time to come to terms with the implied criticism of the decision I made, and the veiled contempt of some.

Once a doctor, always a doctor

The second problem is more trivial. Despite my continued protestations, my mother's friends still phone me to ask about their ailments or those of their grandchildren—and my mother doesn't like it if I just tell them to see their general practitioner. I really believe that many people continue the job for life vocational vision of doctors with a view that “but he's still a doctor really.”

The next article will consider the process that you will go through in being recruited for a role outside the NHS and the pros and cons of life in alternative careers.

Adam Poole director Career Edge Limited

Cite this as BMJ Careers ; doi: