Medical officer in the Royal Air Force

Abstract

[...]the medical services have undergone a period of change and restructuring in order to meet the challenging demands of the future. The raison d'etre of the RAF consultant is to support the medical needs of the services in war. [...]special skills must be developed in parallel with the normal professional training programme.

Service doctors have lived through some interesting times recently. But the future is bright once more, argues Air Commodore David Rainford

The changes in the political arena of Europe since the Berlin Wall came down have allowed a reduction in the size of our armed forces. As a result the medical services have undergone a period of change and restructuring in order to meet the challenging demands of the future. The Royal Air Force has borne some of the most severe cuts, but has now settled down and is in a position once again to offer rewarding and satisfying careers in both primary and secondary care specialties.

Joining up

Doctors join the Royal Air Force (either as fully qualified direct entrants or following house jobs as a cadet) and undergo initial officer training for eight weeks at RAF Cranwell. Leadership qualities are assessed and developed by learning about the traditions and administration of the RAF which adjusts medical officers to their new responsibilities as officers. Instruction in service specific medical matters, aviation medicine and advanced trauma life support are followed by posting to an accredited GP training practice practice on an active flying station. A station medical officer is responsible not only for the general practice care of his patients, but also for the occupational needs of the workplace, particularly in the field of aviation medicine and for aspects of public health. The young medical officer will gain experience of Royal Air Force life and of the special needs of its personnel. During this period preparations are made for the future training needs of the individual.

The intake of medical officers is on average 15 per year from the cadetship scheme and 3-5 per year as direct entrant officers. Approximately 60% of entrants opt for general duties and the rest will enter hospital practice.

Training opportunities

Since April 1996 secondary care has been delivered to all of the services by the Defence Secondary Care Agency except in Germany where it is under the auspices of the Health Alliance. All single service hospitals have closed and been replaced by a single triservice core hospital, the Royal Hospital Haslar and three Ministry of Defence Hospital Units, one at Peterborough (predominantly RAF), one at Frimley Park (predominantly army) and one at Derriford (predominantly Royal Navy). There is also a hospital at Catterick in Yorkshire which provides psychiatric inpatient services and a Joint Services Rehabilitation Unit at RAF Headley Court near Epsom in Surrey. The facilities are fully integrated within the NHS and provide accredited training posts in most specialties to complement those provided at the core hospital. Royal Air Force consultants have their own firms and work alongside NHS colleagues as equal partners, joining in with all rotas and duty schedules.

Advantages and disadvantages of a career in the Royal Air Force

Advantages......

Finncial independence as a student

Guaranteed NHS equivalent training

National training number portability

Varied practice and excellent lifestyle

...... and disadvantages

Mobility

Careers for partners

Children's education

Limited private practice

In line with current NHS policy the delivery of secondary care and the provisions for training have been separated. The services medical training is supervised on a triservice basis by the Defence Medical Training Organisation. A defence medical postgraduate dean has full responsibility for medical officer training comparable to a regional postgraduate dean. All training is carried out in accord with Calman schedules and all specialist registrars are allocated national training numbers. Approval for consultant status is subject not only to the award of the appropriate certificate of completion of specialist training, but also a rigorous interview by the Armed Services Consultant Approval Board. This board is chaired by the president of the relevant royal college and voting members are civilian consultants contracted to the armed forces, ensuring that those approved are of the highest standard.

Individual training programmes are developed. Generally, senior house officer appointments will be either at Haslar or another service hospital and specialist registrar appointments split between the service secondary care facilities and teaching hospital posts.

The raison d'etre of the RAF consultant is to support the medical needs of the services in war. Therefore special skills must be developed in parallel with the normal professional training programme. All physicians will gain skills in intensive care techniques and all surgeons will receive multiskill training across specialties to broaden their experience and capabilities. Additionally, special training is given in nuclear, biological and chemical warfare. Consultants will expect to be detached occasionally from their hospital post to support national forces in the field; normally multinational peace keeping units or humanitarian aid missions. However, detachments provide both a chance to practise and consolidate skills vital in war and also some fascinating and rewarding medical experiences.

General practice

The Royal Air Force runs an excellent General Practice Vocational Training scheme (GPVT). The training schedule consists of 18 months in approved hospital appointments and 18 months in a training practice. Six months in the training practice is recognised by the Royal College of General Practitioners as occupational medicine training, hence the reduction in hospital appointments. Internal triservice and external NHS training courses are fully funded to enhance the training programme. Following accredited training, the medical officer will be awarded a certificate of prescribed or equivalent experience, permitting unrestricted work as a principal in general practice.

GPs are encouraged to take the MRCGP. A Diploma in Occupational Medicine course is run on a triservice basis to complete comprehensive training for the RAF medical officer.

For a young doctor on a six year commission, vocational training could be completed within three and a half years of entering full time service, allowing over two years' experience as a GP principal.

Occupational medicine

Occupational medicine training accords with Calman schedules and entry is competitive. First class training opportunities are provided in both general and specialist areas. The specialist registrar period of four years is supervised through the South Thames Region. Membership of the Faculty of Occupational Medicine must be gained, prior to consultant approval.

Aviation medicine, noise with hearing conservation, and radiation medicine are major specialist areas, but occupational physicians are encouraged to develop their own areas of interest relevant to Royal Air Force practice.

Public health medicine

There is only a small requirement for public health medical officers. However, those selected will follow Calman training schedules to recognised standards. Training is now triservice with modules in communicable disease control and in headquarters appointments. Training is given in all the core competencies and on completion medical officers will enjoy a fascinating consultant career in the very varied environment that the Royal Air Force provides. The range of activities varies from the investigation of outbreaks of communicable disease at home or overseas to advising on policy for prophylaxis or immunisation programmes for personnel deployed on military operations. Needs assessment of a highly mobile service population is also a major ongoing task.

Aviation medicine

Initial training in aviation medicine on joining the Royal Air Force prepares the medical officer for his or her new role. A certificate in aviation medicine is awarded by the Royal Air Force School of Aviation Medicine to successful candidates. Later in their careers, medical officers are encouraged to study the specialty by a distance learning course and then to attend the school for the six month Diploma in Aviation Medicine course. This is an international course with attendees from military and civil aviation throughout the world.

Aviation medicine provides medical advice on stations and some aspects of aircrew training. The development of equipment, operational and clinical support, teaching of medical officers and more complex areas of aircrew training is carried out by specialists in aviation medicine whose consultant career pathway involves scientific and academic training.

Terms of service

Admission to a career in the Royal Air Force medical branch, is either as a medical cadet while a student, or as a direct entrant. Medical students are eligible for consideration as a cadet after they have passed the 2nd MB examination. They are commissioned as officers and receive full pay and allowances, the Royal Air Force paying their tuition fees and education grant. On qualification, they are promoted and house appointments may be undertaken either within the NHS or a services hospital. Commitment on full registration is six years' service and promotion is awarded to flight lieutenant. Those who wish may subsequently apply for extension of their commission to a maximum of 14 years or transfer to a permanent commission, initially 16 years' service or to age 38 years whichever is the later. Full career commissions are to age 58 years for general duties medical officers and 65 years for specialists. Qualified medical practitioners up to the age of 39 years may apply for short service commissions.

Rank structure and promotion is being considered for rationalisation along with pay and pensions. Currently, promotion to squadron leader follows five years' service as a flight lieutenant and promotion to wing commander after a further eight. Thereafter, promotion to the higher ranks depends on career paths. All promotion is subject to achieving appropriate standards.

Conclusions

Practice in the Royal Air Force is varied and opportunities for training across a wide range of disciplines is excellent. Though in a changing world it would be naive to believe that no further change is to come, for those who choose it RAF medicine for even part of their medical life will be unlikely to regret it and are likely to be enriched by the experience.