Dealing with the costs of being a junior doctorBMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e5939 (Published 12 September 2012) Cite this as: BMJ 2012;345:e5939
- Usman Ahmed, specialty trainee year 3, trauma and orthopaedics1,
- Shahbaz Malik, specialty trainee year 3, trauma and orthopaedics2,
- Yasmin Akram, specialty trainee year 3, public health3
- 1Royal Orthopaedic Hospital, Birmingham, UK
- 2Queen Elizabeth Hospital, Birmingham, UK
- 3NHS Birmingham and Solihull, UK
- Correspondence to: U Ahmed
Usman Ahmed and colleagues consider the costs of postgraduate medical training and how to minimise their impact
As medical school fees and loans continue to rise, an increasing number of doctors are now beginning their working life under a burden of heavy debt. In addition, because continuing education and training are mandatory for clinical progression, moving beyond deciding what jobs to apply for and filling in the relevant forms on their e-portfolio mean extra costs in courses and exam fees. As you progress, the cost of courses and subscriptions continues to rise.
Medical training is expensive—a 2007 report by the Associations of Surgeons in Training showed that the total cost of surgical training, from medical school to completion of training, is over £400 000.1 Of this sum the trainee personally funds almost a third.
After finals and the elation of graduation comes the challenge of foundation year 1 training. Dealing with this first step into working life can be a huge distraction, and professional bodies have probably already taken your details and started charging you for their services.
Take, for example, your General Medical Council (GMC) subscription. The fee
to register provisionally as a foundation year 1 doctor is £95, but this will soon increase to an annual retention fee of £390 for full registration and a licence to practise.2 Organisations that offer professional indemnity insurance, such as the Medical Protection Society and the Medical Defence Union, charge premiums that increase annually in keeping with your increased experience. The BMA has a graded subscription scheme that starts at £109 for a foundation year 1 doctor but increases to £425 for full subscription by the time you have been in the job for seven years.3
As you progress through foundation training and specialty training, you will become familiar with a professional college, such as the Royal College of Physicians or the Royal College of Surgeons, and specialty groups, such as the British Orthopaedic Association or the British Society of Rheumatology. Specialty trainees need to pay fees to these organisations for membership examinations, many of which comprise several parts that are charged for separately, or for courses, access to journals, and research funding, which are necessary tools for developing your career.
A foundation year 1 doctor is likely to have a total annual subscription bill of about £350 (GMC, BMA, and the medical defence organisations), whereas a year 3 specialty trainee in trauma and orthopaedics, for example, may have an annual bill of about £1250 (GMC, BMA, the medical defence organisations, the Royal College of Surgeons, and the British Orthopaedic Association).
Once we start adding in the costs of courses, some of which are mandatory, annual costs can rise further. The person specification for surgical specialty trainee year 3 posts states the following items are essential for all applicants:
Full registration with the General Medical Council—£390
Completion of membership of the Royal College of Surgeons qualification (A and B)—£1295
Completion of core surgical competences (mandatory intercollegiate surgical curriculum programme for two years)—£300
Advanced trauma life support course—£550-600
Care of the critically ill surgical patient course—£550-790
Basic surgical skills course—£500-710
Straight away the cost of your application is around £4000. Given the levels of competition for surgical training posts, further courses are desirable but can work out quite expensive too, such as the AO Foundation’s fracture management course, which costs around £1000.
Also, don’t forget travel and accommodation for jobs and for courses. Most training posts require rotation through several hospitals, and courses can be held at sites across the country.
What help can you get from your employer?
When starting a job, make sure that you look at all policy documents related to expenses, and also consult the deanery’s policies. Study budgets are often available to trainees. Although these are often limited (roughly £600 but sometimes less if the deanery or trust dips into the budget for those weekly half day sessions that they may organise), these can help cover course fees and related expenses.
In addition, many trusts operate on split sites, and travel between them could entitle you to travel expenses. If you are employed by a new deanery during your rotations, you may be able to claim additional mileage expenses to cover the distance you have to travel in addition to your regular commute. If you are appointed to a trust that has several sites, ask your department which will be your base site. Any travelling between sites can be claimed for per mile.
If you are moving to a different deanery to take up a post (box 1), check your eligibility for relocation and removal expenses. Trusts or deaneries can support you with legal fees and stamp duty if you buy property close to your new hospital.
Box 1: Case studies
Arun Ahluwalia, specialty trainee year 2 in public health, NHS Birmingham and Solihull
After graduation I had more than £20 000 of student loans to pay back—it would have been more but for the invaluable NHS bursary in years 5 and 6. Thankfully, my foundation year 1 placement was at my local hospital, so I lived with my parents and immediately started saving. I quickly learnt that reclaiming tax on GMC or BMA fees, and using my study budget for courses, was essential in helping money stretch further. I am currently on an unbanded post, which makes saving extra money for things like a house deposit that much more difficult. I have to think more carefully about what I’m spending money on.
Saba Usmani, foundation year 2 in emergency medicine, East Surrey Hospital
As a foundation year 1 doctor I was assigned to a job that meant I had to move across the country. I have a young child so my husband had to take some time off work during relocation, resulting in a substantial impact on our finances. Accommodation costs, in addition to other living expenses, were quite a struggle. On top of that the GMC fee had to be paid right when we were in the middle of making arrangements to start moving back across the country so I could start a new post, which added to the strain.
What help can you get from HMRC?
Organisations such as the GMC, BMA, the Medical Defence Union, the Medical Protection Society, the royal colleges, and some specialty groups, such as the British Orthopaedic Association and the British Society for Rheumatology, are on HM Revenue and Customs’ list of organisations for which subscriptions are eligible for a tax refund.4
You can claim back tax from HMRC on subscriptions for up to seven years after the cost was incurred, but keep good records and receipts—you never know when HMRC will want to see proof and demand seven years’ worth of records.
The costs for anything educational such as courses and exams cannot be claimed back from the HMRC, as these expenses are not perceived to be necessary to do your job. With revalidation becoming mandatory for doctors, however, there may soon be scope to argue that exams and courses are necessary expenses, not only for doctors to do their job but also to allow them to revalidate and keep their job.
Doctors who have additional sources of income, such as from being locums or from property, probably have an accountant or do their own tax returns. It is important to bear in mind that you should also declare any money you receive from completing cremation forms and insurance forms for patients. Doctors who have no additional income beyond their hospital salary do not need to file a tax return unless the HMRC requests it or they meet the criteria on the HMRC website.5
Being smart with money
Being a doctor is a rewarding career in itself, but the pay slips at the end of the month certainly add to the feel good factor of helping people. Progression towards your career goals requires an investment of a lot of time and large sums of money, but keeping an eye on your finances and making the most of sources of financial support or reimbursement can mean a little more spending money (box 2).
Box 2: Money saving tips
Get organised: You don’t need any fancy software to manage your money and plan for expenses—a simple desktop spreadsheet with month and year down the side and recipient (such as GMC, BMA) across the top will do. Fill in the table with outgoings and extend this table to accommodate your routine expenses such as rent, bills, and groceries.
Familiarise yourself with your deanery and trust policies on travel expenses, relocation and removal expenses, and study budgets: Some deaneries operate a system where one trust takes the lead in dealing with all expenses, even if you move hospitals during your training. It is important to know the system in your area, as sometimes trusts or deaneries put time limits on when you can claim for expenses, and not knowing how things work at your organisation could mean you miss the window.
Consider getting an accountant: There are plenty of accounting services that will sort out all your tax affairs for you, for a fee that will range from very modest to disturbingly high, depending on your requirements. Fees for a basic tax return start at £75, and hiring an accountant may be a worthwhile expense if you’re likely to get a refund from HMRC. The fee you pay the accountant is also tax deductible.
Keep receipts: If you don’t have receipts, then get them. The BMA, royal colleges, and medical defence organisations usually provide receipts on request, so if you are going to make any claims make sure that you have receipts for everything.
Talk to a financial adviser: Other financial arrangements, such as private pensions, may also be eligible for a tax refund. Contact a financial adviser to find out what you may be entitled to.
Plan ahead: Keep an eye on how you envisage your career and other plans progressing. Knowing what to expect will ensure that you can keep your finances organised in real time.
Stay honest: Leave the scandals for excessive expenses claims to the politicians.
Competing interests: None declared.