The resident medical officer
BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7466.s105 (Published 11 September 2004) Cite this as: BMJ 2004;329:s105
Abstract
Ever wondered what it's like to be a resident medical officer in a private hospital? Khurshid Ghani, Paul Hadway, and Ken Anson think it's a useful experience with time to study on the job
In some countries the resident medical officer (RMO) is a junior doctor in medical training. In the United Kingdom, however, the RMO is usually a resident doctor in a private hospital. There are more than 250 private hospitals in the United Kingdom and in these hospitals the RMO plays an important role, providing vital emergency medical cover.
RMOs seem to be another “lost tribe” of doctors; not much is said or written about them despite the fact that there are at least 500 in the United Kingdom. We are currently working as RMOs in private hospitals in south east England. We were used to the hierarchical structure of the National Health Service (NHS) and knew very little about the role of the junior doctor in the private sector before starting our posts. We hope this article can provide an insight into the world of the RMO and guide those doctors who may be considering applying for such a post.
Who works as an RMO?
Traditionally, private hospitals have recruited RMOs from the few junior doctors who opt to do research or demonstrate anatomy at medical school. The job offers the security of a regular income while giving you the freedom to work towards a research degree or study for postgraduate exams (box 1).
In the past decade, with the expansion in independent health care and medical research, RMO positions have been increasingly linked with research positions in NHS departments. In this set up, the researcher receives a basic salary on condition that he or she spends at least one day of the week at the private hospital. Both of our research positions in urology are arranged in this manner.
Box 1: Advantages and disadvantages of working as an RMO
Advantages
Low level of stress at work
Broad spectrum of specialties
Improves presentation skills with consultants
Good standard of living quarters
Regular work (v seeking locums)
Time to study at work
Introduction to private practice
Membership of private healthcare plan
Disadvantages
No formal clinical training
Can lack excitement of acute medicine
Don't fit in with NHS doctors
No chance to learn practical skills
Occasional loneliness and boredom
Drop in salary
No NHS pension plan
More recently, because of the shortage of doctors, private hospitals have started to recruit from overseas, especially from South Africa, Zimbabwe, India, and Pakistan. These young doctors are recruited by agencies abroad, tempted by the good money and easy introduction to clinical medicine in the United Kingdom.
Stopgap or vocation?
The other group of doctors working as RMOs are those who have failed, and are holding out for, their preferred position in the NHS (usually a specialist registrar post) and have decided to work as an RMO for six months or so. As the post has free time during and after work, it allows them to finish off projects and write papers (always a sticking point for some candidates), without the stress and high work levels found in an NHS post. There are also some doctors who do RMO work as a vocation. They are career RMOs, who enjoy the level of work, are accustomed to the life, and usually pursue other ventures in their time off—such as the arts, travelling, music, and so on.
The role of the RMO
The responsibilities range from that of a house officer to a registrar. There may be one or two RMOs on duty during the day, but only one will cover the night. You are required to remain on site at all times in case of a cardiac arrest. The essential duties are to deal with any emergency that may arise, and to recognise and report to the consultant in charge any deterioration in the clinical condition of patients. A certain level of clinical experience and proficiency is expected, ALS/ATLS (advanced life support/advanced trauma life support) is essential, and a postgraduate qualification is desirable.
Good support
The work itself varies depending on the size of the hospital. You have to rely on all your basic medical knowledge—you can see patients across all medical and surgical specialties. Most hospitals will have a high dependency unit that you will be expected to cover (only a few private hospitals have intensive care units). The wards are generally well organised and nursing staff are extremely helpful in filling out phlebotomy and x ray forms at the request of consultants. Most hospitals will have a phlebotomy service, and as the consultant usually orders investigations, there is less of the running around so common in the NHS.⇓
Working conditions
Most posts will contract you to work between 24-48 hours per week with the remainder of the week free for research and personal projects. Certain hospitals require residents to be on duty for a whole week, alternating with 2-3 weeks off. With the introduction of the European Working Time Directive, these working patterns are likely to disappear. The hospital should allow annual leave and most will make a contribution towards course fees. Being the resident troubleshooter means it is mandatory for you to complete ALS and paediatric advanced life support (PALS) courses before starting; the hospital will ensure that you attend these courses on their behalf. Regarding medical insurance, the hospital covers the RMO for all work carried out on duty; therefore extra medical protection is not required.
Box 2: A consultant's perspective
Many consultants with academic interests depend on the RMO post to help fund clinical research within the NHS. The RMOs employed via this route are motivated individuals, keen to complete their research before returning to the NHS. Sadly, too much time spent as an RMO with no research/audit projects completed can be detrimental for career advancement.
Having been an RMO myself, I can attest to the potential for boredom but equally I found the time to be rewarding. I became involved in the clinical work and was able to achieve my research aims. The opportunity to meet many different consultants is useful and the post provides a valuable insight into the machinations of private practice, which can be useful later in your career. If taking up a post my advice is simple—enjoy the relatively stress-free environment but beware of complacency. Ensure you complete your projects in the time available and try to move on quickly. Use the job as a stepping stone to your next NHS appointment. Good luck.
Box 3: A day in the life of an RMO
The day to day bulk of the work consists of checking on patients, prescribing medication, and finetuning your intravenous cannula skills. You are not expected to do ward rounds. As most patients are elective admissions, you are only called to see them if there is a clinical concern or the consultant specifically requests your help.
Occasionally there will be a patient to clerk, who is usually an emergency admission. As for clinics, because patients pay to see a consultant, you do not consult with patients. Some hospitals may ask you to assist consultants in theatre, although technically speaking if this happens you should expect an assistant's fee from the surgeon. On the whole, the patients are not as acutely ill as they are in the NHS, the work is pretty stress free, and nights are very rarely interrupted.
Accommodation
The living quarters are generally of a high standard, with a computer with internet access. If you are lucky your meals are complimentary. During the day there will be periods when you hardly get interrupted, and this is the ideal time to get some reading or writing done. Beware: if you lack self discipline, you can find that you spend this time watching satellite films or sports instead.
Pay
The pay is at the level the candidate was at during their previous NHS post. So if you were a senior house officer (SHO) IV going into the job, that is the pay level you would receive, which would increase to level V after one year (as it would in the NHS). The pay is a basic salary, which includes on-calls. There may be the opportunity to do locum work at the same hospital, which can allow doctors to increase the salary by a further £5000 to £10 000 per annum (rate of pay per hour £20 to £25).⇓
Further information
Independent Resident Medical Officers Association (IRMOA—gri48{at}dial.pipex.com)
Time to settle in
It is always a good idea to speak to existing RMOs to get a feel for what you'll be expected to do. Is the hospital failing to provide some of the basics that we have just listed? If so, indicate that a happy RMO is better than a disgruntled one. It takes time to get used to the non-NHS working practices. The most important thing to remember is that communication with a patient's consultant is vital. If you have any doubts about a patient's further management, call the consultant. From our experience consultants are keen to be kept informed. You may even learn something new (box 2). Of course, the senior sister or charge nurse has seen and done it all before, and she or he should be the first port of call when you find yourself needing help.
Dealing with boredom
This post could be your longest appointment in a single institution until you become a consultant, especially if you are working towards a higher degree. This low level intensity work has the potential to lead to boredom and frustration at times. The important thing is to integrate your work with the rest of the staff and build a team spirit at an early stage. This will enable you to enjoy your work, and at the end of your tenure you may find that you have become so attached to the place (and the three course meals) that leaving may become harder than you think.