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Shadowing abroad - useful vs useless? What I learned from my internship in Barcelona

With junior doctors not being included in the recent announcement for a pay rise (which is actually a pay cut due to the rising cost of living) and the unresolved systemic issues that plague the NHS, it is no wonder that many young doctors and even medical students are considering alternative working conditions and increasingly, pivoting careers.

Travelling and pursuing a career as a doctor has always been my ultimate goal (despite many people who will tell you this is impossible). King's College London Surgical Society had an amazing opportunity to do a surgical placement in Barcelona so I obviously jumped at the chance to apply. After taking a year out to complete a research Master’s, I fell back in love with medicine! I chose OBGYN for its unique combination of medicine and surgery. Most of my time was spent in the operating theatre watching hysterectomies to remove cancers but I also got a chance to sit in on consultations and chat with the doctors about their lifestyle and the Spanish healthcare system.

An insight into the Spanish healthcare system

Spain consists of both private and public healthcare. Around 90% of the population uses the public healthcare system, which is called the Spanish National Health System (Sistema Nacional de Salud, SNS). However, it is quite decentralised in terms of service delivery and is organised at 3 levels: [1]

1. Central (Organización de la Administración Central)

Overseen by the Spanish Ministry of Health (Ministerio de Sanidad y Consumo) which develops the country’s health policy and oversees the national health budget.

2. Autonomous Community (Organización Autonómica)

Each of Spain's 17 Autonomous Communities (Comunidades Autónomas) is responsible for commissioning health services for the population in their specific region (similar to the UK’s Clinical Commissioning Groups).

3. Local (Áreas de Salud)

The "areas de salud" are responsible for the management of the health services offered at the level of the Autonomous Community and take into account specific factors of the people who live in that area including demography, geography, climate, socioeconomics, employment, epidemiology, and culture(s). The "areas de salud" are subdivided into even smaller units called "zonas basicas de salud”. Local management ensures the healthcare needs of the local population are being met.

Public healthcare is free for anyone living and working in Spain but can cover different services depending on what state or area you live in. Public health insurance in Spain is funded by Spanish social security payments, which are made by all employees and self-employed workers.

The average salary for a resident doctor (UK equivalent: junior doctor) is between €1000-1500 /month. The monthly salary of a family physician is from €2000 – 5000 [3]. Doctor salaries increase with each year of experience in Spain (residency is around 5 years long and doctors were quite shocked at how long our training pathways are in comparison, ~8+ years).

Wages are generally lower in Spain than in other EU countries but so are rent, food, and transportation. Most people in Barcelona lived in apartments and flats as opposed to houses (average rent price is around €300–700 a month). Food / eating out is relatively cheap and there are many decent public transport systems in the cities.

In Spain, life was lived outside and the weather was beautiful EVERY DAY. I'd finish hospital placement, cross the road and be on the beach (for more about what it takes to relocate to Spain as a doctor, buy the ebook!)

Exploring other countries’ healthcare systems is so important, especially if you are considering relocating at some point in your career. But aside from that, it’s easy to think there is only one right way to do things in medicine or that your country’s guidelines are the gold standard and that’s that. But, I encourage students to go and experience what other countries have to offer, the different patients they serve, the similarities and differences between the nature of their work and immerse yourself in new cultures and experiences! You will gain insights you can’t get through a screen. You’ll also make contacts abroad who can write you a letter of recommendation one day (especially for relocation). It’s also an interesting bonus to have on your CV that is likely to set you apart from others. It usually gets interviewers curious to know what you did and why!

Most importantly, it gives you a chance to use those experiences to bring forward new ideas and ways of doing things more efficiently, cost-effectively and safely which the NHS desperately needs.

Here are some of my tips for gaining experience abroad:

🥽 Be on the look out for opportunities. An example is the career-building page. of the site. If you haven't found anything, don’t be afraid to reach out to a doctor who may be able to host you for an experience. Use your network, whether it's a family member or a doctor you've met through LinkedIn, you never know if you don't try!

📝 try to tailor your CV / application to the specialty and country you want to visit. I recommend following the structure:

1 - What clinical experience do you want and why? Why are you interested in the specialty / country?

2 - What experience have you already had?

3 - Future plans and how this will give you an edge in your career going forward.

You can find a copy of the CV I submitted here.

💰 Finally, I recommend calculating your budget and getting organised as EARLY as possible. Is there any funding you can apply for or a charity you can travel with? Do they offer discounted student accommodation / food during your time there? Do you have all your necessary vaccinations and travel insurance? Book flights as early as possible!

[1] Health Management – Overview of the Spanish Healthcare System [2] Expatica – The Healthcare System in Spain

[3] – Spain

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