How to plan your post CCT fellowship. With Shilpa Ojha

[00:00:00] Mat: Welcome to Doctors at Work. My name is Mat Daniel and this podcast is about doctors’ careers. Today I’m interviewing Shilpa Ojha and we’re talking about post CCT fellowships. Shilpa tells me what to think about when you’re planning your fellowship, how to decide and how to make it all happen. Her top tips are to be really clear on what you want from the fellowship, and to start planning well in advance.

I hope it’s useful. Welcome

Shilpa. Tell me a little bit about yourself.

[00:00:42] Shilpa: Thanks for having me, Mat. I’m Shilpa. I’m a paediatric ENT at Alder Hey Children’s Hospital in Liverpool currently. My ENT journey started as a core trainee in London. I then went on to complete my registrar training seven and completed a paediatric ENT fellowship at Starship Children’s Hospital in Auckland.

[00:01:02] Mat: Tell me about your fellowship

[00:01:02] Shilpa: I just returned from Starship Children’s Hospital in Auckland, which is the only tertiary paediatric hospital in the whole country. as you can imagine, it was quite a busy but exciting fellowship. I was there with one other fellow mainly doing general paediatric ENT cases, but also a mix of complex airway cases.

And I always wanted to work in Australia and New Zealand and a fellowship is a great way to get exposure to this kind of different healthcare system. It was quite busy with a lot of service provision as well and managing the registrars and essentially, I was allowed to be almost the junior consultant in the department.

Running the show is to speak, but yeah, I had a great time. Also managed to do a lot of traveling around New Zealand and Australia. I’d highly recommend it.

[00:01:52] Mat: Sounds like a great experience. What were the reasons that you did the fellowship in the first place?

[00:01:58] Shilpa: Personally, I had fantastic training in Severn with mentors such as Mike Saunders and Julian Gaskins.

I had quite significant exposure to paediatric ENT but I still wanted to do some more complex airway cases and to build up my further experience. And as I mentioned, I always wanted to go to Australia and New Zealand. Also, having an Australian husband meant it would be a great year. To spend with family and travel and get to meet everyone on the other side of the world.

So for me, the NZ fellowship was highly recommended. As I mentioned, it’s the only tertiary level paediatric hospital, which meant you see a huge range of pathology and you get all the operating, which is great Also, for me, all of my mentors have done fellowships abroad and they always talk about it in a positive light and felt that it was invaluable experience with an exponential learning curve.

And I definitely felt having done the fellowship, I felt ready to become a consultant and it, for my own self confidence and experience, it was great.

[00:02:59] Mat: Tell me a little bit more about this idea that you wanted to travel. Why would you want to travel? Why would you do a fellowship abroad versus one in UK?

What’s the difference?

[00:03:09] Shilpa: I think there are fantastic fellowships UK and there’s also benefits from going abroad. I think it’s down to personal choice and gaps in your experience and what you really feel you want to gain from your fellowship. I think the positives from going abroad, you get to experience a new healthcare system.

You get to see and learn different practices, maybe take surgical techniques or things you’ve learned back home. It’s an opportunity to network, to meet people you may never have met before otherwise, and work with leaders in their field. Such as, in, in New Zealand Colin Barber is considered one of the godfathers of paediatric ENT, it was great to have him in the department and work with him.

I’d also previously done a research fellowship in Boston, I had some idea of what it takes to move your life abroad and start and work in a new department. I already had some idea of that and working in a different healthcare system. And then I guess the positives about staying in the UK, it’s a system you’re familiar with, the NHS, family and friends are here. Don’t discount that, that’s quite a big part of your, life. Financially, I’d say you’re probably better off being in the UK, now that all my bills have come through from being abroad for the year. It was, it may be, If you’re thinking of staying in the UK or taking up a consultant job in the UK, often it’s quite good practice to get a fellowship in that centre.

It’s almost like a year long job interview, to speak. And there’s many paediatric E& T centres here in the UK that do offer great fellowships, such as Alder Hey, for example, the Evelina, Great Ormond Street, just to mention a few. I think those are the positives on either side.

[00:04:52] Mat: And if somebody were to come and ask you and say, HIL I’m undecided, what do you think I should do? Should I go abroad or should I stay in UK? What would you tell them?

[00:05:01] Shilpa: I think it depends a lot on what you’re hoping to gain from the fellowship.do you have that experience already?

Is there something super specialist that do you want to go to Cincinnati and do. Lots of airway reconstructions, for example, or do you need to do cochlear implant fellowships, for example? Do you have you not had that experience in your training number one number two? Is it something that you and your family or your partner or whoever is in your life want to do?

Don’t forget it’s a big change for your other half as well and children as well uprooting them and moving them abroad And I guess it’s, yeah, I think those are the main things, and mainly it’s the experience, and I think training is long in the UK, and a lot of people, won’t have gaps, they’ll go straight from ST3 to ST8,this is the first opportunity to be like, do something completely different, experience a new system, get abroad, and also, travel and see a different country.

[00:06:01] Mat: you’re saying that it’s about the individual person and what they specifically want out of the fellowship and of course everybody’s going to have. slightly different things, we might all think that it’s all the same, but the reality is that different people will have different requirements, and then there’s that whole family and the rest of the life piece that also needs to fall into place.

[00:06:23] Shilpa: And I think the other thing to say Now having been back and in my consultant job, you won’t necessarily end up in a job where you get to do exactly your subspecialist interests, you might have to branch out. A fellowship can be a good way and getting a broader experience or also that subspecialist experience.

So I don’t think there’s a right or wrong answer versus the UK versus abroad. And I know that training is changing in the UK to try and encourage more UK fellowships. What I will say is that the abroad fellowships are, from my experience, very competitive. You need to be applying or thinking about it two to three years in advance.

So it also depends on timing where you’re at in your training.

[00:07:06] Mat: How did you manage to secure the fellowship?

[00:07:10] Shilpa: It was a lot of work. I’ll be honest. I initially was thinking Australia purely for kind of personal reasons. And also I’ve gone to a lot of conferences and met, teams from Perth and Brisbane and had a really great experience with both of them.

So I think in ST6. I went and took two weeks of annual leave and went and visited multiple centres. I didn’t spend long, maybe a day or two in each department, but I actually think that face to face time is invaluable. They get to know you you’re going to be working with them for a year.

They want to know if you’re like a dependable, normal person, essentially. I think that was a big help. Then, I think COVID hit. ’cause of that, my training got extended slightly, which meant I’d missed some of the deadlines for some of the Australian fellowships. Then I had to think what next?

So New Zealand, I haven’t actually visited but my colleague ed Toll, he’s was appointed as one of the consultants there. I think thanks to him, he put in a great recommendation for me. And I applied on an open platform with everybody else and the interview went well, and then I got the job without having visited, but yeah.

[00:08:16] Mat: Yeah, and you said the centres that you visited how did you, how did you know where the fellowships are in the first place?

[00:08:23] Shilpa: It’s difficult. At that time, it was very much kind of word of mouth and speaking to like people who’d already gone on fellowships or speaking to my mentors and seeing what they had done.

And it was, Mike Saunders highly recommended the Starship Fellowship to me, which is essentially why I went for it in the end. Because he knew what Experience I was perhaps lacking in what, he thinks would make me a better consultant at the end. I cold emailed a lot of departments.

That information I think now will be available on the BAPO website through BAPO Juniors. I think that’ll be great platform to access more information on fellowships and it’s something that we’re working on. But yeah, very much, it was word of mouth. It wasn’t widely advertised and I’m probably.

I’m still not aware of all the fellowships that happen globally. I don’t think there’s any way to find out. Sometimes they put adverts out on the AOT forum for the UK ones. That’s probably why I know that.

[00:09:17] Mat: I guess it’s it depends on which specialty or subspecialty people are working in and it’ll be different for different areas.

Okay, you manage by word of mouth or on the internet, you find out whether these fellowships existed. And then what you just, you, you emailed people and what did you say?

[00:09:34] Shilpa: I just emailed people, I sent them a short blurb about myself and, what my interest is. I attached a CV that was up to date as well and just said, gave them some dates that I’m planning to be in the country and what would work for them.

And just was flexible. But I think what really helped me is I think as a trainee, it’s really easy to get focused on kind of the clinical practice and the research, but actually it’s really important to network and attend courses and conferences and meet people. Particularly, if you’re thinking about fellowships and you need to start this early, I’d say, I’d already met most of them at ST4, ST5 level. I was a familiar face, to speak. I think that hopefully helped.

[00:10:18] Mat: people you’ve met at various ENT or subspecialty conferences, the people that are the fellowship directors. You would have seen them speak and then what you’d introduce yourself to them

[00:10:29] Shilpa:

Yeah, just introduce or often It’s just socially just having a drink with them after the conference. It’s not a formal process and I think for paediatric ENT in particular, it’s quite a small world often they already know about you or know of your mentors or know of your referees. I would say, yeah, I’m not quite sure what the case is and other subspecialties, but I think AT& T definitely, ESPO is a great way to meet, consultants from Europe and America and Australia and New Zealand, I would say.

[00:10:58] Mat: Okay. And how easy was it to organize to come and shadow for a day? Was there hospital paperwork or did you just turn up?

[00:11:06] Shilpa: I just turned up. I did have to self fund. There wasn’t any, and I had to, I used my, annual leave and took it out of my own time to go. yeah, it’s a slightly costly affair.

I tied it in with a holiday to New Zealand anyway. I thought one. halfway around the world, I might as well stop and visit some centres, but I appreciate that can’t, isn’t possible for everybody. Even if you can’t visit, I suggest just touching base and, having a Zoom call or speaking on the phone or finding out when they’re next in the same conference that you might be attending.

I think that’s enough, really.

[00:11:40] Mat: Okay that’s quite a good idea because you could, if you’re planning this two or three years in advance, you could say, Are you going to be in such and such a conference and then you arrange to meet them there? That sort of sounds like a win in terms of traveling and costs.

You said that you’ve actually done two fellowships abroad. you’re probably the world authority on, on, on moving abroad for a fellowship. What do you need to take into account if you’re going to move your life to a different country?

[00:12:30] Shilpa: Oh it’s a lot. I think these is probably the biggest issue. I went to Boston fairly early on in my training, pre court training, actually. that was a pure research fellowship. Again, I did send a cold email to the department and I think, the stars aligned and I managed to get a job there in the end.

But again, I had to fly out for a visit. Meet them, send my CV, and then all the paperwork, I think, takes about nine to ten months, wherever you’re going. The visa paperwork for New Zealand, you have to get all your documents notarized. You then have to sign up with the medical council and that can take about three to four months.

And then HR can be quite challenging. I ended up doing a lot of it myself.it meant I got my visa through a month. Before I was about to fly, which was quite stressful other things to mention, which I didn’t realize until I spoke to other fellows is if you’re bringing a partner or a spouse, particularly in Australia, if they come on your visa, they’re only allowed to work for 20 hours a week, which, I think one of my colleagues, his wife’s a lawyer, she couldn’t work as a lawyer.

She had to she ended up doing parties for children. Just because that was that would be within the time allocation. She had a great time, but it’s just things to think about. My husband, for example, even though he’s Australian and has an Australian passport, he thought he could walk into a New Zealand job and he couldn’t.

They were very strict on him having some New Zealand experience. Yeah, I think things like that, just be aware, look into kind of the visa issues for your other half, to speak. What else? I think finances. I think I underestimated financially how much your fellowship costs. Some fellowships, you get grants, you’re not paid, you’re paid from the UK.

For example, I know Otology has the TWJ and the Graham Fraser fellowships. I did get paid, I got paid quite nicely actually comparative to SDA’s salary. However, I didn’t realise about cost of living, for example. I’d say Auckland’s probably on par with London in terms of cost of living, and also my other half didn’t work for four months.

So I hadn’t factored that in. It’s just things to think about,

[00:14:46] Mat: and what about furniture or accommodation?

[00:14:50] Shilpa: Oh, we were initially thinking we were gonna… make the move abroad and not come back. we put all our stuff in shipping. I think my stuff’s seen more of the world than I have actually.

It’s just sailed around the world. It’s coming back next week. I’m not looking at the bill for that, but yeah, I think if you’re planning to come home, I’d suggest you leave your stuff in storage or with family or friends. I did. I sold my car before I went and then I didn’t realize coming back because I’ve been abroad for a year.

You’re invalidated for finance and cars. For example, even though you can show them your consultant contract, they’re like, you’ve been abroad, it affects your credit rating, it’s all these things I have no idea about. I would say until you’re 100 percent sure that you’re definitely moving abroad and you think you’re going to be back in the UK, leave your stuff here, leave your car here.

Find some friends who’ll take some of your stuff. My flat I let out furnish, which at least I’m grateful for, I didn’t have to take everything with me. But yeah, those are my top tips.

[00:15:56] Mat: what was it like to settle into a completely different system?

[00:16:00] Shilpa: I was lucky in that they had previous fellows from the UK.

And I think their last three appointments had been UK consultants and two of which I knew. Actually they were really good. I was inducted gently into the department. My colleague, Sheneen, was the other fellow. She’d already been there for four months, she was great in showing me the ropes and telling me how the department ran.

So actually, I was quite lucky in that respect. Starship was quite well set up and they had a whole induction pack for the fellows. There’s challenges of kind of a different healthcare system completely. Also like the cultural differences health equity is quite a big thing in Starship.

And, working with the indigenous and Māori populations as well. And just the trust in kind of Western healthcare may not be there. I thought that was quite an interesting challenge with some of the patients. But yeah, and I think it’s just, then, it’s like any new job that you suddenly come, nobody knows you.

Everyone’s trying to suss you out for the first couple of months, and then you can get the ball rolling. And I think the more senior you are and the more you come into a senior position, it gets harder to try and do that, to establish your footing.

[00:17:07] Mat: I guess the expectations are much higher, aren’t they?

If you turn up as an SHO, people expect very little of you, whereas, as a fellow as you almost consultant level, or at least we expect more of ourselves, even if other people don’t.

[00:17:21] Shilpa: And it’s really difficult to change practice, I think, until you’ve been there for a while. say for example, I know they have their own way of doing things or, they don’t follow set guidelines and procedures that were quite, protocol here at the NHS.

So I think that was quite a big adjustment. To say, actually the consultants will do what they feel is best with their experience, which isn’t the wrong thing. But I think just or trying to change attitudes and the way things are done. I think my leaving gift was making an on call bag for the SHOs and registrar.

I was just stuffed with kit because they’ve never had one. And I was just like. You’re running across two hospitals. How do you not have everything in a bag? I don’t understand it, but little things like that

[00:18:08] Mat: And what about social life? You move to a different country. Okay, you have your husband with you But how did you integrate into the New Zealand life outside the work

[00:18:17] Shilpa: My interview question for fellowship when they were asking, do you have any questions? My question was, what’s your social life like? Do you socialize quite well as a department? Cause I’m a pretty social person and I think, I don’t want to move halfway across the world and be sat in my flat after work.

So I was lucky. They were really lovely. The department, super social. They organize regular. dinners and drinks and I actually felt really part of the team, which was nice. And even outside of that, the nursing staff were great and made friends with a lot of the anaesthetists and juniors.

But yeah, I think you have to, I’m quite social. I can imagine for someone a bit more introverted, it can be difficult. You really have to put yourself out there and make an effort and really get to know people. That can be quite daunting. And then my husband, because he went back to Australia for a job.

So we ended up doing long distance anyway.it was a lot, it was a lot of socializing, alone. But I really enjoyed it. And I’ve made some friends for life, I think.

[00:19:16] Mat: Okay. And then maybe my final question, what would be your top tips for somebody who’s thinking of doing a fellowship?

[00:19:23] Shilpa: I would say show interest early particularly if you’re thinking of going abroad. I think most fellowships you need to apply at least two years in advance and show your interest before. See if you can visit figure out what you want to gain, what your gaps in your experience are plan early, especially financially, and I guess enjoy yourself. Make the most of being abroad.

[00:19:47] Mat: Wonderful. Thank you very much, Shilpa.