Frontline medicine

HARDLY a week goes by without fresh media reports on the activities of Britain’s armed forces abroad.

Troops can find themselves deployed to any number of far-flung destinations from war zones in Iraq and Afghanistan to bases in Germany, Cyprus or Brunei. And wherever they are posted, GPs and other medical officers will follow to care for military personnel and their families. Despite the sometimes harrowing reports from conflict zones, the Army, Royal Navy and Royal Air Force still attract strong interest from doctors wishing to pursue military careers.

For many, the appeal is clear. Working as a military GP – or 'medical officer' – offers challenges and opportunities that an ordinary practitioner might never experience, whether it’s sports and adventure training, working on board a submarine, jumping out of helicopters or practising medicine under extreme pressure in conflict zones.

Life can be unpredictable for military doctors who are expected to go wherever they are needed. Some medical officers will provide medical support to troops on the frontline and therefore must master the same basic military skills and tactics, such as map reading, basic fieldcraft and how and when to fire their personal weapon. They must also be prepared to follow orders which may mean personal wishes and ambitions cannot always be accommodated.

Life as a military GP also means working with a different type of patient from civilian practice. These are largely young, fit men – with few elderly patients. There are a number of Army and RAF medical centres who also care for soldiers’ dependents, and in some instances GPs in the military enjoy a higher doctor-to-patient ratio.

Entry and training

There is demand for GPs in all three services with most doctors entering through cadetships that offer sponsorship usually during the final three years of their medical degree. The army and navy only take fully trained GPs as direct entry post-graduate applicants but graduates can also join the RAF either at the end of F2 (before specialist training) or once they have completed ST. Some fully qualified GPs are eligible for a 'Golden Hello' when entering the military, with the RAF and the Army offering an incentive worth £50,000.

The retention rate for military GPs is generally slightly lower than the NHS because of family ties and because pay does not match the highest NHS GP salaries – although it is above average. The forces also offer competitive allowances and pension schemes and a structured career path that mirrors the civilian route.

Prior military experience is not required as all three forces provide officer training for new entrants, but it’s advisable to have a good level of fitness before applying. Medical officers are also expected to have strong leadership skills and motivation.

RAF

Direct entrants undergo the 11-week Special Entrant and Re-Entrant (SERE) officer training course at the RAF College Cranwell in Lincolnshire. RAF GPs have a varied career and you could serve in a station medical centre or in a field hospital in Afghanistan. You may even have the opportunity to work as part of the Aeromedical Evacuation Team flying on board one of the aircraft returning casualties to the UK.

As a station medical officer, you’ll provide primary care for personnel and sometimes their families. You’ll be treating a wide variety of people – from pilots who have to deal with the pressures of fast-jet missions, to RAF Regiment Gunners who must be fit to work under extreme pressure. Medical officers are normally deployed on operations (such as Afghanistan) for four-month deployments, usually every 18 to 24 months.

Qualified GPs must join before their 55th birthday and pay varies depending on your seniority and specialty. The usual length of service starts at six years. Find out more at raf.mod.uk/careers.

Army

Qualified GPs attend the Professionally Qualified Officer (PQO) course at the Royal Military Academy Sandhurst. The course is based directly on the Regular Commissioning Course and is aimed towards officers who hold professional qualifications such as doctors, nurses, dentists, physiotherapists, vets, lawyers and chaplains. The course lasts for ten weeks and is focused towards officership, command and leadership with military training in both the field and the classroom.

Following the PQO course the officers from the Army Medical Services will then complete their Entry Officers Course at the Defence Medical Services Training Centre in Hampshire. The course lasts three weeks and builds on the information which was taught on the PQO course and is geared towards operational medical planning and support.

Finally, army doctors complete a 10-14 week postgraduate medical officers course which specifically prepares them to become a military doctor. This includes input from the consultant advisors within the Army and provides training on battlefield advanced trauma and life support, as well as teaching doctors the principles of delivering medical care under austere conditions with limited resources.

GPs then serve as regimental medical officers caring for soldiers and their families in military practices in the UK and abroad. Many accompany their regiments on tours of duty for up to six months every two to three years, but this can be more frequent. As with the other forces, there are many opportunities for travel and adventure training as well as the prospect of short notice emergency situations anywhere in the world. Service starts at six years and qualified doctors must join before their 55th birthday. Visit www.armyjobs.mod.uk

Royal Navy

Qualified doctors enter the navy on a short commission of three to six years. The job is open to men and women although only men can serve as medical officers in the Submarine Service. Unlike in other forces, navy GP practices in the UK don’t cater for families, so GPs tend to do two days in a navy practice and three days in a general one.

Medical officers are part of the navy’s senior management team, making it a wide-ranging and challenging role. GPs can practise on shore, on board ships or submarines, fly in helicopters or even earn the coveted green beret of a Royal Marines Commando.

Applicants must be under 54 and Medical Officers (Submariner) need full British citizenship. For more information visit royalnavy.mod.uk/careers

Part-time

For doctors who are unsure about committing fully to an armed forces career, roles are available in the Territorial Army, RAF Reserves and Royal Navy Reserves. These roles can usually fit around your main medical career and involve regular training sessions throughout the year, including weekend stays and usually a fortnight-long training camp each year.

Q&A

Squadron Leader Cat Davison, GP with the RAF, based at Tactical Medical Wing on the Deployable Aeromedical Response Team

•What attracted you to a career as a military GP?
I was attracted by the excitement of being paid to travel. I knew early on in my career that I didn’t want to qualify as a GP and do the same job for 30 years! I researched the Royal Air Force and discovered I could apply to be sponsored through university. I joined in the fourth year of my medical degree on the RAF medical cadetship scheme and completed my training through the RAF in 2008.

• What do you enjoy most about the job?
The variety of the job. I work as a GP all around the world, in different environments, with many different people and cultures. Last year I worked in the UK in a medical centre, Cyprus on the rugby pitch, USA and Jordan in the desert and Belize in the jungle.

• Are there any downsides?
If you’re in a long term or serious relationship, the separation can be a challenge. You need an understanding partner! You also need to be flexible and happy with change. A detachment or tour abroad you thought was six months can suddenly be brought forward but you adapt and use your colleagues to help.

• What do you find most challenging?
We as military doctors maintain the high standards of care expected in a local UK hospital. Working in austere or hostile environments without the benefit of traditional facilities and maintaining a standard of care can be a challenge, although lateral thinking and team work play a huge part.

• What about the role has most surprised you?
The wide variety of locations and sub-specialisations within the GP career stream. GPs are supported to pursue interests in areas such as aviation medicine (opportunities to undertake a diploma), sports medicine, public health and occupational medicine (a diploma or further study to become a consultant). No two RAF GPs have the same skill sets. We have all done GP training, but as we progress we have all found an interest and been encouraged to study further.

• What is your most memorable experience so far?
There are many from the last five years in full time uniform. Although filling a tooth with a DIY dental kit in the middle of the desert followed that day by assisting a vet operating on a military dog, rates highly.

• What advice would you give to a trainee GP considering a career in the armed forces?
Go for it and find out about the job. You only live once and what have you got to lose from a phone call and then a chat with an RAF GP to find out more?

Joanne Curran is associate editor of GPST