What is a Clinical Fellow?
If you are a UK junior doctor considering an F3 Year, you may be hearing a lot of new terms that you don’t quite understand. From locum doctor, to trust grade, to clinical fellow, there are many work options open to you, and understanding what each one is is important to ensuring you chose the right role for you.
In this article, we’ll provide a detailed guide to working as a clinical fellow, covering topics including why clinical fellows are needed, where they work, how you can become one, how much money you could earn as a clinical fellow, and how this compares to a junior doctor’s salary. We’ll also weigh up the pros and cons of working as a clinical fellow, so you can get an understanding of whether a clinical fellowship would be a good fit for you.
We have a similar article called ‘What is a locum doctor’ where we explained everything you need to know about working as a locum doctor.
❓ What is a Clinical Fellow?
Clinical Fellows are substantive (contracted) doctors who work in a particular specialty or department and provide a mix of clinical support on top of other duties. These other duties usually include participation in research, audit, or quality improvement, teaching or education, simulation training, or other special interest activities.
They can be employed on a fixed-term (often 6 or 12 months) or permanent contract, that usually stipulates a particular divide between clinical and non-clinical time (i.e. 80% clinical, 20% special interest such as research or teaching).
Clinical Fellows can be junior doctors, or post-CCT doctors, but for the purpose of this article we will be exploring fellowships specifically for pre-CCT doctors.
Confusingly, the term Academic Clinical Fellowship (ACF) can refer to a national medical training programme that incorporates academic work into a typical training post but this is not what we are discussing in this article as it comes under the heading of a training role rather than a typical fellowship role.
❓ Where Can Clinical Fellows Work?
Most Clinical Fellows work within the NHS, at least for the clinical portion of their role. However, their non-clinical special interest work can involve working across other institutions including university, research, private health, or government departments.
The special interest part of the clinical fellowship role is what makes these roles so appealing. Whether you want to spend more time teaching medical students, working towards a research publication, learning how to be come a Simulation Trainer, practicing surgery, working with national health organistions or government bodies, or even studying for a PG certification or higher education degree, the opportunities are endless.
Generally, a full-time fellowship role will be split 80-20 (4 days per week of clinical work and 1 day per week of non-clinical work) however, this is variable and often negotiable.
❓ Who Can Work as a Clinical Fellow?
Anyone with a medical degree and full GMC registration can work as a Clinical Fellow, though most clinical fellowships require doctors to have completed both years of their foundation training as a minimum.
International Medical Graduates (IMG’s) on a Skilled Worker Visa (Formerly Ter 2) may be able to take on a fellowship role provided they meet the fellowship requirements (full GMC registration) and it complies with their visa requirements (i.e. a contracted role with minimum number of hours per week).
Some fellowship opportunities are restricted to applicants of a particular grade, for example the National Medical Director’s Clinical Fellowship stipulates that applicants must be pre-CCT in order to take up the role.
Sometimes, institutions use the terms Junior Clinical Fellow, Senior Clinical Fellow, and Advanced Clinical Fellow to distinguish between different grades of doctors in clinical fellowship roles but this is not a universally accepted rule.
❓ How Does the Clinical Work Vary Against a Training Role?
The clinical service provision is the same, so you'll see the same patients and be expected to have similar levels of clinical competence. Depending on the clinical environment you are working within, you may be expected to join in on ward rounds, leading clinics, participate in team meetings, perform surgery, or clerk patients. You may also be incorporated into on-call rotas meaning you could be expected to work nights and weekends at the same rate as the training doctors in the specialty.
Like training doctors, fellows have clinical and educational supervisors (the same person may perform both roles) and are generally invited to participate in the education and teaching programme alongside the other junior doctors. However, as they are not in a training role and therefore are not working towards an ARCP, they may not have the same requirements around attendance, CPD, and teaching that training doctors may have.
Like training doctors, Clinical Fellows typically get allocated a study budget and study leave as part of their contracted role, and can use this to attend conferences, courses, and exams like any other junior doctor.
❓ How To Find a Fellowship Role?
As the rate of junior doctors choosing to take time out of training programmes increases, the number of training and rota vacancies also increases. This can leave departments perilously understaffed, particularly in regions that are less popular to trainees.
Trusts facing the difficult task of ensuring that rota lines are filled with adequately trained staff have the choice of Trust Grade doctors, Clinical Fellows, or Locum doctors and usually their preference is to fill shifts in that order (lest expensive to the trust - most expensive to the trust). Substantive positions like Trust Grade and Clinical Fellowship roles offer more rota-security and predictability than Locum doctors and therefore are preferable to the Trust.
To junior doctors, Clinical Fellowships are generally preferable to Trust Grade as they are typically paid the same rate but a Fellowship offers a number of additional benefits that are not available to Trust Grade doctors. As a result, the number of fellowship roles on offer is increasing year on year, and NHS Trusts are usually open to creating more Fellowship roles if needed.
Some fellowships are more competitive than others and involve a lengthy application process and multiple interviews whereas other roles may have little to no competition or may even be created exclusively for you.
There are several different ways to find a fellowship role, if you want one.
👉 Nationally Advertised Roles
Some fellowships, particularly competitive or recurring fellowships, are advertised nationally on websites like NHS Jobs and indeed.com. Or, if a regional Trust is struggling to recruit locally, they may put out a national advertisement to attract new doctors to an underserved area.
👉 Locally Advertised Roles
Some hospitals are now advertising Clinical Fellowship opportunities to their current staff in order to retain junior doctors who have trained within the Trust. This may be done via email rounds from Medical HR, Medical Staffing, or Department Heads, or through posters put up in departments advertising opportunities.
👉 Create Your Own Role
Approaching a Trust’s Medical HR or even going to a specific department Head, you may be able to create a new fellowship role to specifically meet your needs/wants. If a department knows they will have an upcoming vacancy, and can find the budget and supervision support that would be needed to hire a clinical fellow, then they may be open to designing a new role.
You can read more about creating your own clinical fellowship here.
❓ How Much Are Clinical Fellows Paid?
Typically Clinical Fellows are paid according to the doctors equivalent training grade pay band, based on their last contracted role. This means that an F3 doctor would be paid an CT1 base salary of £40,257.
This becomes increasingly complex if a doctor has been out of training for several years or has done a series of fellowships. An F5 doctor who did substantive roles in their F3 and F4 years, may be able to negotiate CT3 pay (£51,017) but an F5 doctor who has been working as a locum may not be able to wrangle this.
Like trainees and Trust Grade doctors, Clinical Fellows also get additional compensation for out of hours work but some fellowship roles do not include any on-call work or anti-social shift work. Sometimes, you can negotiate out of an on-call rota prior to accepting the job if you specifically do not want to do out of hours work. You may also be able to negotiate a less-than-full-time contract.
🤔 The Pros and Cons of Clinical Fellowships
✅ Pros
🏋️♀️ Supervision - Clinical Fellows generally get allocated seniors for support and supervision where locum doctors and trust grade doctors often do not. This can provide reassurance that you are doing your work well, learning on the job, and can also create opportunities for CPD and mentorship.
🎓 Study leave and budget - Clinical fellows often have an allocated study budget and can spend this on conferences, courses, and exams without needing to spend out of pocket, whereas locum doctors and trust grade doctors generally don’t get this.
🥼 Specialty Experience - There are a wide variety of Clinical Fellowship roles available, often in specialties that are harder to access in your foundation years such as public health, palliative care, health management, microbiology, pathology, CAMHS and forensic psychiatry,, teaching and education etc. If you are considering a specialty application in one of these more niche specialties, or want to bolster your specialty application with more experience, then working as a Clinical Fellow is a great idea.
😷 Sick Pay and Rights - As a contracted employee, you are entitled to the same full set of rights as a trainee doctor. This includes sick pay, maternity leave and pay, and employee rights such as notice periods and rest breaks. Your substantive role will also contribute to your Reckonable Service or Continuous Service.
📅 Special Interests - As a Clinical Fellow, you’ll have more variety in your work. While trainees have to fit in their research and learning around their clinical work, Clinical Fellows usually have a pre-defined schedule that incorporates these interests so you get better balance of your working time. This may even include working remotely from home if your special interest allows it.
🏥 Location - Unlike training schemes, you can apply specifically for Clinical Fellowship roles in geographic regions that you want to work in, instead of applying for a national programme and then having to narrow down the places you want to work from there. This is a great option if geography is more important to you than the specific day-to-day job you do.
🏥 Combined Programme - When applying for specialty training, you may be eligible to reduce the length of the training programme if the clinical fellowship experience is relevant to that training. This will depend on the quality of the evidence you provide when applying for the specialty training programme, and it probably won’t reduce the training time by the length of time you did the fellowship but may contribute in some way.
❌ Cons
💰 Pay - Though you would earn the same base pay as a training role, you may take a pay cut compared to your F2 job if your fellowship role is 9-5 and doesn’t include an on-call component. There are certainly more lucrative opportunities for doctors out there, such as locuming.
💣 Risk - Some of these roles are highly competitive, and most involve an application and interview process. If you don’t apply in time, or are unsuccessful in your application you may find yourself without a job.
🏢Appraisal - Appraisals can be a major source of stress and anxiety for non-training doctors. This is usually because they are unfamiliar and confusing, not because they are particularly challenging. In reality, appraisals are much easier than an ARCP, place fewer demands on you, and are more flexible and personalised to your interests and career ambitions. You can learn more about appraisals here.
This article is part of a wider series of comprehensive guides and information to help doctors ensure their F3 year is a success. We cover everything from initial planning, options for moving abroad, help with finding work, and tips for making the most of the experience.
Click here to visit our F3 Resource Hub to explore the full list of guides and articles.
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