Seeking - and finding - that ‘something else’

Dr Paul Cooper explains his life-changing decision to up sticks and take a job in idyllic Orkney

“As you grow old, you lose interest in sex, your friends drift away and your children often ignore you. There are other advantages of course, but these are the outstanding ones,” noted politician Richard Needham. But what do you do about work?

You might be the departmental sage, offering your experience to anyone who asks. You’ve climbed as much of the greasy pole locally and/or nationally as you want or are able, and can use your wisdom as influence with colleagues and your organisation.

Or not, as the case may be.

Having done what you are doing for more than 20 years, you need to do something else. You might take up fly-fishing, playing the clarinet or learn Esperanto. Of course, these things aren’t mutually exclusive – none, or all, of them could apply.

In my case, my wife is an enthusiastic knitter/spinner/weaver and as a result Orkney became a regular holiday destination. On one visit I struck up a conversation in the pub with a local anaesthetist. Several months later, I was being interviewed for my third consultant post.

I went from a multi-site Trust with 25-plus anaesthetic colleagues to a Health Board where the total hospital consultant complement is 12.

Now I’m an obstetric, ENT, eyes, dental, gynae, trauma, and paediatric anaesthetist and, when required, neonatal resuscitator, major trauma stabiliser and ad-hoc intensivist.

Balfour hospital, with 49 beds, serves a population of about 22,000, with another 150,000-plus cruise-liner passengers and holidaymakers between March and October. And as the nearest “big” hospital is more than 200 miles away, we are the first port of call for anything that needs secondary care.

My “something else” is breeding sheep – a flock of Borerays, Britain’s rarest breed. I’ve learned about lambing, drenching and rooing. I can go on about fibre staple length and crimp.

I’ve built and repaired drystone walls, drained and filled ponds and burns, seen the Northern Lights and built a polycrub (a wind-resistant cross between a polytunnel and a greenhouse).

I’ve come to veterinary medicine late in life. Toxaemia of pregnancy in sheep isn’t the same as the human condition. Obstetrics which I learned all those years ago hanging round labour wards doesn’t really help with lambing. Coamoxiclav is used to treat “jointill” (septic arthritis in lambs). With injections in sheep, you don’t just think about hitting other anatomical things.

In many ways the day job in Orkney is also “something else”.

Programmed activities aren’t a good way to reflect unpredictable daytime work with frequent on-call and variable out-of-hours workload. Regardless of the hospital size, there are essential administrative roles and the individual burden can be higher than in bigger set-ups. And it’s not straightforward to reflect all these demands in a job plan framework designed for largely predictable workload in bigger units.

The management approach to problems needs to be different as well. Clinical and management structures are very flat. It’s easy to get to see the CEO, MD or relevant admin person and the hospital managers’ office (we have just the one) is just along the corridor.

There is a different perspective on maintaining staffing and a safe rota when you live cheek-by-jowl with patients who may be your friends and neighbours and are very dependent on the service you provide. The nearest alternative is several hours and a flight away.

A 1-in-3 rota can restrict what you can do when on-call. But the journey to work takes 14-16 minutes – there are no permanent traffic lights in Orkney – regardless of time of day or night. Unless you get stuck behind a tractor.

Parking is close and free, so popping in to sort something doesn’t take long. Night-time disturbance isn’t frequent. Air ambulance retrievals, though, can mean being on-site for six to eight hours with the patient awaiting their arrival, or longer when we are stormbound.

Recruitment in Scotland, and in the north in particular, is difficult, with many posts vacant for more than six months and heavy use of locums. Terms and conditions are the same as “down south” – ie anywhere south of Wick – with the addition of a Distant Isles allowance, which is currently £1,194 per year for Orkney.

Travel to Orkney can be expensive – £300-400 per person from London. But that can be offset by much more affordable housing, while goods and services that don’t have to be transported here are relatively cheap.

We have no waiting list initiatives or private practice opportunities, though, if that is your thing.

We also don’t have an LNC (yet). But getting the views of your substantive colleagues – as of January that meant six of us – isn’t difficult. Issues can easily be raised, if not solved, by going and banging on someone’s door.