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What to expect working as a Surgeon in the NHS

  • July 01, 2020

Surgery is a complex specialty due to the broad variation between its surgical specialties. Because of the many options available within surgery, it can offer a demanding and challenging career. It is important to note that surgery is a very competitive area of medicine and thus in order to secure the best career opportunities for yourself, we would always advise the MRCS/FRCS route to GMC Registration.
 

What can I choose to specialize in?

Surgery comprises ten main specialties within the NHS, most of which have further options for sub-specialisations embedded with them. The following table aims to outline each of the 10 specialties and their own sub-specialty branches of medicine –

Sub-Specialties

Cardiothoracic Surgery

  • Adult Cardiac Surgery
  • General Thoracic Surgery
  • Congenital Cardiac Surgery
  • Heart and Lung Transplant Surgery

General Surgery

  • Breast Surgery
  • Lower Gastrointestinal Surgery
  • Upper Gastrointestinal Surgery
  • Endocrine Surgery
  • Transplant Surgery – Renal/Hepatic/Pancreatic

Neurosurgery

  • Paediatric Neurosurgery
  • Neuro-Oncology
  • Functional Neurosurgery
  • Neurovascular Surgery
  • Traumatology
  • Skull-base Surgery
  • Spinal Surgery

Oral and Maxillofacial surgery

  • Head and Neck Cancer
  • Craniofacial Deformity and Orthognathic Surgery
  • Gland Surgery
  • Cleft Lip and Palate Surgery
  • Oral Medicine
  • Dentoalveolar Surgery
  • Aesthetic Facial Surgery
  • Jaw Joint problems and Facial Pain
  • Facial Skin Surgery
  • Academic Surgery

Otorhinolaryngology (ENT)

  • Otology
  • Rhinology
  • Laryngology
  • Head and Neck Surgery
  • Skull Base Surgery/Neurotology
  • Facial Plastics
  • Paediatric ENT

Paediatric Surgery

  • Urology
  • Neonatal Surgery
  • (Some Doctors may have an interest in Paediatric Orthopaedics, Paediatric Cardiothoracic and Paediatric Neuro, but they would be expected to go through Ortho, Cardio and Neuro Training Routes and then subspecialise in Paediatric Surgery)

Plastic Surgery

  • Paediatric Plastic Surgery
  • Hand Surgery
  • Congenital
  • Breast Surgery
  • Skin
  • Trauma
  • Cancer

Trauma and Orthopaedics

  • Site areas – Foot/Ankle, Shoulder/Elbow, Hand, Upper Limb, Pelvis
  • Joint Reconstruction
  • Orthopaedic Oncology
  • Paediatric Surgery
  • Spinal Surgery
  • Sports Injury Surgery
  • Complex Trauma Surgery

Urology

  • Endourology
  • Urological Oncology
  • Functional Urology
  • Andrology
  • Reconstructive Urology
  • Paediatric Urology

Vascular Surgery

Because this surgical specialty is new, there are no defined sub-specialties as yet.

What should I know?
 

1) Cardiothoracic Surgery

Cardiothoracic surgery is one of the most challenging and demanding areas of surgery. It's also highly competitive with a relatively small number of jobs. Some Cardiothoracic surgeons have a mixed practice across thoracic and adult cardiac but the majority within the NHS specialise in one of these areas. As a Cardiothoracic surgeon you will work closely with cardiologists, oncologists and anaesthesiologists, and have close professional relationships with other non-medical staff such as perfusionists, intensive care staff and operating department personnel.
 

2) General Surgery

General surgery is one of the two largest surgical specialties in the UK (the other being trauma and orthopaedics) employing 31% of the country’s consultant surgeons. The defining feature of general surgeons is that they have a wide range of knowledge and skills to deal with all kinds of surgical emergencies, with an emphasis on acute abdominal problems. They also carry out a large number of elective operations. General surgeons work in smaller hospitals as well as larger teaching hospitals. There are greater opportunities for increased specialisation within large hospitals and specialist units. As a General surgeon you will work with patients of all ages, from babies and children to elderly people.
 

3) Neurosurgery

Neurosurgery is a very challenging surgical specialty where techniques and technologies are constantly developing. Your working day is going to be long – with early starts and late finishes all part of the job. Although surgery is your main responsibility, you will also be evaluating patients in outpatients’ clinics and emergency departments and attending ward rounds. Neurosurgeons are usually based in large regional centres usually attached to teaching hospitals. Most of these are in or near major cities. There are 34 neurosurgical units in the UK.

4) Oral & Maxillofacial Surgery

The specialty of oral and maxillofacial surgery is unique in requiring a dual qualification in medicine and dentistry, followed by a comprehensive general and specialist surgical training. Patients can span all ages, but young people aged 15-25 and older people aged 65 plus often predominate. The on call demand is less than other surgical specialties

5) Otorhinolaryngology (ENT)

There are around 1476 ENT surgeons working in the NHS, making them one of the biggest surgical specialty within the NHS and this is largely down to the very broad range of skills they cover. ENT has possibly the widest range of operations of any speciality from major head & neck procedures with flaps & complex reconstructions to microsurgery on the ear. Unlike most other surgeons, ENT specialists also act as physicians spending a high proportion of their time running out patient clinics and managing conditions non-operatively through prescribing medicines rather than undertaking surgery. On call demand within ENT surgery is not as high as that required in oth er surgical specialties, making it easier to achieve a good work-life balance.

6) Paediatric Surgery

Where other specialties are concerned with a particular technique or area of the body, paediatric surgery is the only surgical specialty that is defined by the patient’s age rather than by a specific condition. The majority of specialised children’s surgery is performed in specific children’s hospitals, or in paediatric surgical units within larger hospitals. There are 29 such centres across the UK, staffed by approximately 338 paediatric surgeons. In these settings, teams of health professionals led by consultant paediatric surgeons provide the necessary services to diagnose, treat and support the rehabilitation of children with various ailments.  Surgery may be planned or emergency. Much of the clinical workload involves children operated on as day-cases. In comparison to other surgical specialties the amount of emergency surgery is relatively low. Consultant paediatric surgeons generally participate in on call rotas of between one in four and one in seven, to include nights and weekends

7) Plastic Surgery

Reconstructive procedures are the mainstay of nearly all plastic surgeons’ work: covering all aspects of wound healing and reconstruction after congenital, acquired and traumatic problems, with aesthetic surgery playing a smaller but important part in their working week. Most consultants will specialise in a particular area, although nearly all take part in on-call rota dealing with emergency admissions. Plastic surgeons have a busy emergency workload of soft tissue and limb injuries as well as burns. Emergency plastic surgery also supports the work of other surgeons, dealing with complex wounds from accidents or after other surgical procedures.

8) Trauma and Orthopaedics

Trauma can range from low energy fractures (often in elderly patients) to multiple injuries such as those caused by a road traffic accident. Bone and joint infection can also require emergency admission and treatment. T&O surgeons work with patients of all ages from babies to elderly people. T&O surgeons generally spend about 40% of their time operating, and the remainder in outpatient clinics, the emergency department and assessing/monitoring patients before and after surgery. It is important to note that there is more on call work for T&O surgery in comparison to other surgical specialties. Most, but not all orthopaedic surgeons take part in on call rotas to cover the trauma workload. The frequency of on call varies from 1 in 6 to 1 in 12-15 depending on the size of the unit. On call workload will be more intense in bigger units and in designated major trauma centres.

9) Urology

Urological conditions are relatively common and account for up to 10% of all GP consultations and up to 20% of all acute hospital referrals. Most urological surgery is elective and urological emergencies are relatively rare. But dealing with acute kidney infections, urinary retention and trauma to the urinary tract can also occasionally be part of a day’s work. You might perform two or three operations during an average half-day in theatre, and see up to eight patients in a morning or afternoon outpatients’ clinic.

10)  Vascular Surgery

As a Vascular Surgeon around 40-50% of your surgical work is likely to be emergency surgery and the remainder elective work. When not performing surgery, vascular surgeons undertake a mixture of ward rounds and outpatient clinics. Outpatient and minor interventions may be provided on hospital sites away from the main vascular unit. When you are not working as duty surgeon you could expect to work on an on call basis to deal with emergency cases about one in every six nights/weekends.
 

Where will I be working?

Most surgical work takes place within hospital settings and as well as performing operations, surgeons will also undertake ward rounds, outpatient clinics, administrative duties and teaching. Surgeons have a hugely important role within Emergency and Trauma Departments however dependent on the specific surgical subspecialty, you may be expected to work within separate units, specialized centres or differential departments/hospitals.
 

Relocating to the UK

If you are an international Surgeon who would like to relocate to the UK , email your CV to [email protected] and we can support you in securing an NHS post and on your relocation journey to the UK. Please note, Surgery is an extremely competitive field and thus NHS Trusts are fairly successful with their own recruitment processes. With this in mind, BDI Resourcing mostly specialize in Consultant Surgery positions but we can certainly keep your CV on file should an appropriate NHS position arise.

Are you a member of our Facebook group? When you join IMG Advisor, you join a community of doctors all looking to relocate to the UK and join the NHS. We post a series of blogs and vlogs to the group each day. We will also be on hand to answer all of your relocation queries.

Subscribe to our YouTube channel! We have over 60 videos covering everything you need to know about relocating to the UK and joining the NHS.

Listen to BDI Resourcing on the go with IMG Advisor the Podcast! You can listen to us on Apple Podcasts, Spotify, Stitcher and Buzzsprout. We have a number of episodes with tips and advice on relocating to the UK and the routes you can take to achieve this.

Finally, we have just launched our new Instagram, so if you are a member, feel free to follow us to view our posts and IGTV: @bdiresourcing
 

References:

Health Careers. 2020. Surgery. [online] Available at: <https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/surgery> [Accessed 23 June 2020].

Royal College of Surgeons. 2020. General Surgery — Royal College Of Surgeons. [online] Available at: <https://www.rcseng.ac.uk/news-and-events/media-centre/media-background-briefings-and-statistics/general-surgery/> [Accessed 23 June 2020].

Royal College of Surgeons. 2020. Plastic And Reconstructive — Royal College Of Surgeons. [online] Available at: <https://www.rcseng.ac.uk/news-and-events/media-centre/media-background-briefings-and-statistics/plastic-and-reconstructive/> [Accessed 23 June 2020].

Royal College of Surgeons. 2020. Ear, Nose & Throat (ENT) — Royal College Of Surgeons. [online] Available at: <https://www.rcseng.ac.uk/news-and-events/media-centre/media-background-briefings-and-statistics/ear-nose-and-throat/> [Accessed 23 June 2020].

 
 

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