Intended for healthcare professionals


Why doctors need to prepare for their return before going to work abroad

BMJ 2016; 355 doi: (Published 05 October 2016) Cite this as: BMJ 2016;355:i5175
  1. Harry Dean, core surgical trainee
  1. Severn deanery
  1. harrydean{at}


Australia and New Zealand may seem enticing but junior doctors need to think carefully before quitting the UK, says Harry Dean, who worked as a non-training surgical registrar at Dunedin Hospital in New Zealand

The number of junior doctors reported to be considering working in Australia or New Zealand has increased substantially over recent years, with the current industrial unrest likely to add to this number.123 The decision to work abroad is not to be undertaken lightly, however, and doctors who do so may battle with uncertainty about returning home.

The number of posts available to UK doctors has dwindled over the past 20 years. You will need to fully commit to the process of getting a position abroad—and stick with it. Offers can come late and opportunities can arise and evolve throughout the application process. Research your travel plans, visa requirements, and medical body registration well in advance.

Reasons for going

Why you want to go is the single most important question to ask yourself. Clarifying your objectives will help you with decisions further down the track.

Many doctors heading abroad are uncertain about their choice of future specialty or whether to enter higher training. Working overseas is a great opportunity to reflect on your options and to pursue a more rounded training path. However, if you can complete an exam and some courses before you go, it will make re-entering UK training a lot easier.

What to expect

Australasian team structures often do not have the same middle grade doctors as the UK and so you may need to decide whether to continue at a “house surgeon” level (foundation to junior SHO equivalent) or to step up to a non-training registrar post. There are generally more junior jobs available but these will not give you the same opportunities or privileges (or pressures) as a registrar post.

Hospitals in Australia and New Zealand are renowned for paying doctors better than in the UK. Yet, while some jobs—such as general practice and some emergency medicine posts—provide a greater work/life balance, be aware that other posts have long and demanding hours.4

Saturday ward rounds are routine, on-calls abundant, and zero days conspicuously absent. This is offset, however, by a number of perks such as generous study budgets and free food, as well as a sense of being valued in a way that has disappeared from UK training.

Coming back

Many doctors who go abroad will spend much time thinking about whether to return. This is a very individual process. When I went to New Zealand I had always planned to come back: England is my home and I have an—arguably misplaced—sense of loyalty to the system that trained me and to the NHS.

If you are thinking about staying abroad to train bear in mind that the majority of training schemes in Australasia are “run through” and will require you to commit to around five years. In practice, the application system is also heavily dependent on your references and commitment to training and it will probably take you an extra couple of years to develop and demonstrate these in that country.

It is also difficult to get clinical experience from abroad accredited to UK training unless you have already agreed this, so think carefully about what grade you will need to apply at and where the bottlenecks are in your chosen specialty.

Certain specialties mark applicants according to how many years experience they have had since qualification. Therefore you will need to continue to progress your CV and academic achievements if you wish to remain competitive.

The majority of those I know who left for the antipodes after foundation training have now returned. Having been back for just over a year myself, I still miss New Zealand and I am certain that taking time out from training to work abroad was the best decision I have ever made. It has given me a fresh perspective on how I value aspects of both my professional and my personal life. Although many of my peers are now further ahead in their careers, it was a very positive experience and has undoubtedly made me a stronger clinician.


  • I have read and understood the BMJ policy on declaration of interests and declare that I have no competing interests.