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The ‘Gold Standard’

University physio courses in the UK, funded by the NHS (until recently), consistently drum the NHS methods, values and guidelines into the porous heads of eager students. It is the expectation that, once qualified, you follow the traditional “gold standard” route into the NHS. This being a junior rotational post, if you’re lucky enough snag one. Or, you break tradition and forge your own path.

Reality Sets In

When I decided to become a physio, I never envisaged myself working in a hospital inpatients setting. The idea of getting people in and out of bed, manually helping someone breathe in intensive care, the blood, the wounds, the toileting duties, just wasn’t for me.

I began training and I spent many months working in hospitals as part of my student placements. I thought, is this really what physio’s do?! Is this really what I’ve signed up for? I enjoyed it, but it was far from where I saw my future career. No, I had always imagined working in sports, treating acute injuries, rehabbing people post surgery, and working with people who chose to come to see me. My personal experiences of physio as a patient had always been in a private outpatient setting as a result of sports injuries or surgery. This is what had inspired me to become a physio. I was always adamant that this was the right route for me. However, I watched that vision get further out of reach as I got swept up in the wave of my classmates gearing up to take on the challenge of the NHS rotations, as we’d all pushed towards.

NHS Junior Rotations

As a slightly more mature graduate, I was torn between getting on with the career that I’d always wanted to do earlier without wasting time doing endless 6 month rotations in areas that didn’t interest me and that I would be unlikely to specialise in in the future or alternatively, doing the “right” thing – NHS rotations – ticking that box. Most fresh-faced physio graduates follow the NHS rotation pathway, which is considered the “norm”. We had just one one-hour talk on private practice as a career option throughout the entire two-year masters course. Just one. The rest was all geared towards the NHS. No wonder people are apprehensive about joining private practice straight away. It’s unknown. It’s different. They all have individual rules and regulations, guidelines, support systems. It’s a risk – and one that despite knowing private practice was where I wanted to end up in the long term, I was certainly concerned about whether taking such a risk immediately was the right thing to do. There’s also the FOMO element. Fear Of Missing Out. Fear of being left behind your classmates. Fear of being regarded as “less good” and “less skilful” by not completing the stepping-stone of rotations. Many prospective employers will only employ you if you have that golden ticket of NHS rotations on your CV. It’s certainly been a reason why I’ve been turned down for positions in the past. Does it really make a difference if you’ve spent two years in acute care in-patient settings if you’re applying for an outpatient MSK post? In my opinion, and in the opinion of many highly revered private physiotherapists, no.

Decision Time

With the tug towards private practice deep in my gut and my conflicting sensible head telling me to keep all options open and “tick that NHS box”, I weighed my options and decided to apply for both private and NHS jobs. Let fate lead me instead. I was put on the waiting list of a highly regarded NHS trust, was turned down by a few private practices for being too inexperienced (how can you get experience if no one will give you the opportunity?!), and not having the NHS on my CV (despite a variation of student placements). I was then offered a couple of jobs in private practice.

I chose to accept a job as a physiotherapist at Capital Physio because they offered me a good support structure, funding for post-graduate training, and the right environment for me refine my skills and learn from many highly skilled and respected practitioners. I loved the patients, the clinics, the team, the autonomy, the training opportunities, and I was finally getting stuck in and doing what I always wanted to do! A bonus of working in private outpatients is that most people who come to see you are generally more engaged with their treatment. They don’t arrive tearing their hair out with frustration because it’s been a long, slow road of referrals, GP appointments and fighting for space on a never-ending waiting list to finally get an appointment. This makes them a much more friendly bunch to work with, believe me. There is much more time and flexibility than within the NHS, so you have a great opportunity to practise and fine-tune your skills. And, despite not having a multi-disciplinary team around you, as you may do in a hospital, there are plenty of opportunities to liaise with other professionals. In particular, Capital Physio are fantastic at organising regularly training led by highly respected orthopaedic consultants, surgeons, and doctors. Many of these we continue to work with closely, treating their patients and referring ours on when physio is no longer the best option for them. So no huge disparity there.

A Spanner in the Works

A couple of months into my new job I had a phone call notifying me that a position had become available in the NHS and was mine if I so wanted. Torn between head and heart, having listened to multiple people’s advice and after a huge amount of deliberation and restless nights, I made the decision to go with what I “should” do and take the NHS job. That way, I thought, I could get the broad base of experience under my belt that so many people recommended, be able to add the prestigious NHS to my CV, and be comforted by the fact that it was the safe, familiar route to take. No harm to my career in the long-term and I would have the rest of my life to come back into private practice. The NHS was either now or never.

A Big Mistake

I knew on day one it wasn’t for me. The in-patient hospital atmosphere, the bureaucracy, the routine, the red tape. I found myself endlessly mobilising patients, writing discharge plans, preparing to sacrifice my evenings, weekends and public holidays while training to be on the on-call rota – all things I acknowledge as imperative to ensure the best possible patient care, however, just not for me or what I’d ever signed up to become a physio for. I considered grinning and bearing it for the next 6 months to see what the next rotation would have to offer, but I have to say the prospect was a long and not fulfilling one. I’d been lucky enough to see the other side of things, what private practice had to offer and how much I fitted in and enjoyed it. In terms of my long-term career, this wasn’t the area in which I saw myself working. I wasn’t progressing towards any of my personal career goals. I wasn’t working there because I wanted or chose to be. I was there because I, alongside a whole hoard of prospective employers, former classmates, other practising physios (most of whom had done their NHS junior rotations I note), thought I should be. What was the point? To please everybody else and tick boxes?! I lasted a matter of weeks and knew that I had to get back to private practice.

Back to What I Love

Luckily, Capital Physio had been fully supportive of my choice to accept the NHS role and offered me ongoing part time hours plus training. After leaving my NHS post within a few weeks, I was welcomed back to the Capital Physio team and couldn’t be more relieved. Despite the small shred of doubt and fear that perhaps I should have stuck it out, I can safely say that I know which area of physio I want to specialise in and what suits my practice, personality, and lifestyle best. Something I may not have known, and may always have wondered “what if” if I had not had this experience.

I am now happily getting on with planning and progressing in the career I’ve always wanted to do in private practice. I have broken free from the constraints of the NHS systems that threatened to divert me or hold me back. I certainly recognise the benefits of NHS junior rotations, particularly if you’re unsure of which area to specialise in, and to gain the breadth of experience and transferrable skills that rotations can equip you with. However, I also believe that this traditional route is not always the best direction for everyone.

Advice for New Graduates, Juniors, or Physio’s leaving the NHS

If  you know which area of physio you want to practice and you have an opportunity with a reputable private company that offers you a good support structure and learning opportunities – go for it! Having an open mind and diverting away from conformity to develop your clinical skills in an area that interests you will undoubtedly ensure you perform at your best. Ultimately, this will result in improved patient care, which, and at the end of the day, is what we are all working towards.

Article by: Sally Dixson – Chartered Physiotherapist at Capital Physio

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