I spend a lot of my time traveling. Hence, I write a lot about my travels. But every once in a while, I figure I should talk about the realities of living abroad. And with that, the realities of working abroad. So, this post is dedicated to describing my experience of working as an MRI Radiographer in England and comparing it to that of Nova Scotia.

Work-Life Balance

First thing’s first: my work-life balance has tremendously improved since moving here. For my first while here, I kept getting asked, ‘Do you even work over there?‘ and ‘How much vacation time do you get?!’… Because it seemed as though all I was doing was gallivanting around the UK and Europe. I took full advantage of my flexible work schedule and plenty of vacation time and visited 13 different countries in my first year in England.

So how do I do it? Well, to be frank, I work for a private company that treats me pretty good. My contract is for 36 hours per week and I work twelve-hour shifts, so I only need to do three shifts per week. I also get all bank holidays off and have 28 days of paid annual leave. And my schedule is flexible – I can request to work three days in a row, have eight days off, and then do another three days in a row, which gives me a full week off without even needing to take any annual leave.

Now, this isn’t the case for all sites at my company. I just happen to be incredibly lucky and work with a pretty small, fantastic team who are always willing to help each other out however they can. I also work at a static site, so I don’t have to worry about spending lots of time traveling around like I would if I worked on the mobile units. Although, they essentially get paid to travel around so maybe that wouldn’t be so bad either...

Compared to Nova Scotia… I could be working for seven days straight, have a day off, work another three or four, then have a long weekend and that was considered a good rotation. I’d be switched from an evening shift to a day shift the night before, or vice versa. I worked 8-hour shifts during the week and 12-hour shifts on the weekend, just to really mess with my system – honestly, getting through to 8pm when you’re used to leaving work at 2 or 3pm is a battle. I mean, it wasn’t always like that, a lot of weeks I just did my five 8-hour shifts Monday-Friday, and all was swell in that sense.

But I chose to work at a very busy hospital, the only place that does cardiac scans in the Atlantic provinces, the only site to do a lot of specialty stuff for the province, and worked in research there as well, doing shifts completely on my own without another MRI Tech or assistant. So yes, it was hectic, but I gained so much knowledge and experience there, and the days often flew by because we were so busy. We scanned every type of patient possible; inpatients and ICUs to traumas and outpatients, pre- and post-operative, radiation therapy planning, you name it. You never knew what you were going to get walking in to work; you might end up squeezing nine inpatients into your almost-full outpatient list. If anything, it was a job full of excitement.

In my early days as a newly qualified X-Ray Tech, training to be an MRI Tech, I worked at a smaller site which was an entirely different experience. The department was open Monday to Friday, 0630-1630. You either worked the early shift (0630-1430) or the “late” shift (0830-1630). They had one inpatient slot every day, which often was filled with outpatients on the day because we simply didn’t have any inpatients to scan. The scans were all pretty straightforward as well – the complicated stuff was sent to the other site I worked at. So, it totally depends which site you work at as to what your work-life balance will be, but (I believe) at every MRI site in NS, you start off at 15 days of vacation per year and (I think) almost every site does 8 hour shifts as well, so Notts still wins the work-life balance battle with the four days off a week and 28 vacation days plus holidays.

It’s also worth mentioning that at my current site, being responsible for the urgent, cancer query, two-week-wait cases means we do a lot of the same scans over and over: prostates, rectums, livers, brain tumour follow ups, that sorta thing. We don’t scan inpatients at all anymore, so no arrangements with wards or waiting forever for porters. Our 3T scanner is dedicated to all the routine, non-contrast kind of scans like spines, knees, shoulders, hips, mainly MSK stuff with the odd brain scan thrown in there. So my days are pretty chilled-out, straightforward and well-organized. AKA, I’m a bit bored now but it’s great if you’ve got kids or are just happy doing what you know without too many challenges or curveballs.

Qualifications and Membership Fees

This is a bit of an interesting topic for me. In Canada, you need to complete an accredited MRI course and pass the Canadian Association of Medical Radiation Technologists (CAMRT) MRI certification exam to be a qualified MRI Technologist. In the UK, there is no exam, you simply need to meet the Health and Care Professions Council (HCPC) requirements for working as a radiographer here. This means you must successfully complete an approved programme in diagnostic radiography, which could mean a degree course (3-4 years) or a postgraduate programme (usually up to two years). But no MRI-specific course necessary.

Once you gain HCPC registration, you have to pay the renewal fee (£180 paid in a lump sum or in multiple payments) every two years to uphold your registration. Simple, easy, relatively cheap, and I can claim that cost back through my employer, so really, it doesn’t cost me anything. In NS, I had CAMRT dues as well as NSAMRT (now the Nova Scotia College of Medical Imaging and Radiation Therapy Professionals – NSCMIRTP) dues to pay each year. The CAMRT annual fee is $225 and the NSCMIRTP annual fee is $450, making the total annual cost just to work as an MRI Technologist in NS quite high.

Because I completed my training in Canada and worked in MRI for three years before moving to the UK, I had experience before applying for Health and Care Professions Council (HCPC) registration and jobs here. But two of the radiographers I’ve worked with over the last three and a half years had no previous MRI experience whatsoever before working with us, so we trained them ourselves. We do have a competency booklet which all radiographers must complete to ensure we actually know what we’re doing though, so don’t worry, there are some practices in place to make sure people are qualified to run MRI scanners.

InHealth itself offers a range of training and development opportunities, including an advanced MRI course and an Emerging Talent Programme, aimed at radiographers who want to specialise in MRI. Ultimately, it’s completely up to the individual if they want to undergo any extra training or not. This has resulted in me working with a very wide variety of radiographers with a range of training here – my team lead and I are the only two out of eight of radiographers at my site who have a post graduate certificate in MRI. A lot of the knowledge radiographers have here is solely based on their work experience and how keen they are to actually complete any CPD. That said, every site I’ve ever worked at had a pretty diverse set of people with different experiences and abilities, so I can’t fault the system here.

Meanwhile in NS, I was 8 months into my MRI course before I even entered an MRI unit, and could never dream of being hired in MRI without spending countless hours studying and stressing about and anxiously awaiting the results of the $900 certification exam first. So yeah, the qualifications necessary in the two countries are vastly different.

Wages and All Things Pay Related

One huge difference I noticed when moving here: getting paid monthly instead of bi-weekly – it is much harder to budget. So here, I get paid once a month, on the 28th day of the month. Except for around Christmas, when I usually get paid just before Christmas thanks to the bank holidays, and then not again for 5 weeks until the 28th of January rolls around.

I also have a salary, rather than an hourly wage. In NS, I received evening and weekend pay rates on top of my regular hourly wage, but here I simply get an extra £50 per weekend shift. My overtime hours are paid at time and a third, whereas in NS I would receive time and a half, or I could bank the hours to use as time off.

Another difference: my pay here was negotiated during the interview process… At home, your pay rate is based on your experience/hours put in. Here, I can ask for a raise. No such chance in NS. I can’t actually decide which is better, though… It’s nice that in NS I didn’t have to awkwardly request and negotiate a raise, I just automatically got a wage increase once I clocked so many hours. But at the same time, it’s rewarding when you put in extra effort here (i.e., complete a postgraduate certificate or management course, take on more tasks, go above and beyond, etc.) and it actually gets noticed, appreciated and recognized with a raise. Every place has its pros and cons.

But back to pay in the UK. For healthcare professionals in the public sector (NHS), their salaries are regulated by the table in the Agenda For Change, where pay rates consist of nine pay bands. In the private sector, pays are managed by the institution and therefore can be negotiated, but typically follow these bands as well. The majority of radiographers will fall into the Band 5, 6, or 7 categories with a very select few in the 8a role. To explain:

• Band 5 radiographers are typically newly qualified with little experience (roughly £25-30k)
• Band 6 are experienced radiographers (~£31-38k) and
• Band 7 to 8a are advanced radiographers and management roles (~£39-51k).

As a radiographer with six years of experience in MRI and a post graduate certificate, I qualify as a Senior MRI Radiographer and land in the Band 6 slot.

If you live in London or close to London, you may also qualify for high-cost area supplements – in Inner London, this is 20% of your basic salary. You can also receive a company car or payment for using your car to travel in if you work for mobile sites.

Finding and Getting a Job

Diagnostic radiographers are on the shortage occupation list here (useful for visa applications, but that’s a different post 😉 ). Which means there are tonnes of jobs for us here – InHealth alone has 80 MRI scanners in the UK and employs 300 MRI radiographers. Unlike in Nova Scotia, where there are ten MRI scanners in the whole province, the city of Nottingham currently has something like 14 MRI scanners… So there’s more MRI jobs in Nottingham alone than there is in all of my home province.

Note: to compare cities a bit, the city of Nottingham has a population of about 333 000, where Halifax’s is about 359 000. However, the county of Nottinghamshire (2160km²) has a population of 828 200 and Halifax Regional Municipality 414 000, in an area of 5,490 km² which is approximately 10% of the total land area of Nova Scotia. So, the county of Notts is less than half the size of HRM, but with double the amount of people.

You can look for current radiographer vacancies in the NHS at healthcareers.nhs.uk , jobs.nhs.uk or nhsjobs.com or for private roles, sites like indeed.co.uk , reed.co.uk or even a search on LinkedIn will bring up lots of results. Like I said, there’s a lot of MRI radiographer jobs in this country. The top private healthcare companies providing MRI here are: InHealth Group , Nuffield Health , BMI Healthcare , Spire Healthcare , Ramsay Health Care , and Alliance Medical.

When I was applying for jobs with private companies (back in December of 2016), I applied directly through the companies’ websites. So for example, I went onto InHealth’s website on their radiography jobs page and uploaded my CV there. I received a confirmation email shortly after, and then 5 days after that I received another email from one of InHealth’s talent acquisition partners informing me they were distributing my CV to a few sites. Very quickly (within about 6 hours actually) afterward, they emailed me again to say they’d had very positive feedback from a couple of sites and asked for my availability for Skype interviews. So in less than five days, I had already managed to get two interviews lined up for InHealth, along with a few others; two other private companies and two NHS positions. Have I mentioned the lack of MRI radiographers here?

MRI Interviews

The interviews I had for MRI jobs in the UK compared to MRI jobs in NS were not even comparable. In NS, they ask you a lot of generic interview questions… the ‘Describe your strengths and weaknesses‘ and ‘How would you deal with a conflict with a co-worker?‘ type, with a few very basic MRI questions thrown in like ‘How do you manage a claustrophobic patient?‘ and ‘Explain the basics of an MRI as you would to a patient‘.

In the UK though, there was none of that faff. It was mostly technical questions: I had anatomy questions, MRI physics questions, was asked to describe an MRI scan from start to finish including what sequences and why… It was an interview which actually tested my knowledge and capability to do the job. Which makes so much sense; I can’t believe I’ve never had interview questions like that before.

I also had my first interviews via Skype when applying for jobs in the UK. Obviously with NS being so small and me being there, I went in and met with the interviewers personally. Since I was still in NS when applying for jobs in the UK, I had to do all of my interviews via the internet.

I had two lined up, one right after the other and kept rehearsing answers in my head while anxiously awaiting the Skype ringtone. 15 minutes after the interview was due to start, I began panicking. Then I got an email saying they couldn’t get their Skype to work and could I do an over the phone interview instead? So my very first interview was over the phone. It was a bit awkward; the technical questions rather than generic questions threw me off and made me ramble a lot, and the connection wasn’t great so the sound kept cutting out and I had to repeat myself and ask them to repeat themselves a lot too.

I thought I did horribly. I felt so overwhelmed and stressed out, thinking I had flopped the first interview and if they were all like that, there was no way I would ever get a job in the UK… I had gone totally off the deep end. Then, just ten minutes after we finished the interview, they called me back and offered me the job. I immediately thought, ‘Jesus, how desperate are these people??’ but almost accepted it out of pure excitement for my first offer of a job in the UK. I didn’t; I reeled myself back in and said I had a few more interviews and would let them know.

My second interview that morning also had technical issues. This time, they couldn’t find me on Skype and by the time they emailed me and I gave them my Skype details again, they didn’t have time that day to do the interview. So we rescheduled it and the video interview actually worked, although the connection was so horrible the two interviewers were just two blurs – I could barely tell that one was a woman and one was a man. It took a while, thanks to said poor connection, but I got through it (with a lot more confidence than the first one thanks to having more time to prepare for the technical questions) and was also offered that job afterward. Have I mentioned how badly they need radiographers in this country? 😉

Continuing Professional Development

CPD is the way in which registrants continue to learn and develop throughout their careers so they keep their skills and knowledge up to date and are able to practise safely and effectively.

https://www.hcpc-uk.org/cpd/

The HCPC website has all the information needed on CPD here.

Carrying out CPD is a requirement for you to keep your registration, so it’s a good idea to not only participate in CPD activities, but to also keep a portfolio in case you’re one of the 2.5 percent of radiography registrants randomly selected to submit your CPD profile for the CPD audit each renewal.

When I worked in Nova Scotia, I found it could be quite challenging to attend any live events as it was difficult to find the time off to do it, or receive any funding to attend paid courses. Have I mentioned how lucky I am to be working three 12 hour shifts a week?

My employer here is pretty gracious with this – if I find any courses that appear interesting and relevant to my role, I can claim it back as education/CPD (within reason, of course). So I’ve been able to attend the UK Imaging and Oncology (UKIO) congress, the British Institute of Radiology (BIR) annual congress, a cardiac study day in London, a gynaecology course, a preliminary clinical education course, and I’ve even completed a level 3 management course thanks to support from my employer.

In addition to this, the Society of Radiographers provides CPD support for its members, including courses, seminars, conferences and events. The British Institute of Radiology, which I get free membership to through my employer as well, hosts a wide range of CPD support here, a lot of which is done online now thanks to Covid-19. GE Healthcare (GE Cares) Philips and Siemens Healthineers also have plenty of interesting material to learn from on their sites. So there’s really no shortage of material to gain CPD from.

MRI Wait Times

The wait times for MRI scans also differ significantly here compared to NS.

In Nova Scotia, 90% of patients have their MRI scans within 295 days and 50% within 47 days. In England, the maximum waiting time for non-urgent, consultant-led treatments is 18 weeks (126 days) from the day your appointment is booked through the NHS e-Referral Service, or when the hospital or service receives your referral letter; or for suspected cancer, 2 weeks.

waittimes.novascotia.ca www.nhs.uk

At our site in Nottingham specifically, on our 1.5T scanner we are responsible for scanning the NHS two week wait cases (urgent/cancer queries), so the majority of our patients are scanned within 5 days of receiving the request on our system. On our 3T scanner, we scan only private patients (self-pay, medical-legal, insurance, etc.) and the turnaround time for these patients is very quick – our Vista Health patients can get same-day appointments with a report back within 3 working days.

Here in Nottingham, my patients always talk about how quickly they get their scans and rave about the lack of waiting they have to do – of course, this is mainly due to the nature of scans we do, but even when I first started here and we weren’t responsible for the urgent scans, our patients were waiting a maximum of 6 weeks for scans.

In NS, I constantly had to deal with patients complaining about how long they had to wait for their scans, but also the wards and doctors nagging us to get the scans done and asking us when their patients would get their MRIs. We simply didn’t have the capacity for the amount of MRI requests in NS. Only ten scanners for a population of nearly 1 million people, with only a few of those scanners running evenings and weekends, is just simply not enough.

The difference in wait times and types of patients we scan here completely changes the environment I work in and thus, my mood and mindset at work. That isn’t a UK-specific thing; the two sites I worked at in NS were almost the complete opposite of each other as well. But I’ve done a few extra shifts on the mobile units here in addition to my static site, and those patients were always quite pleasant too.

In general, I just feel a lot more respected here, from both patients and other healthcare professionals. But it’s very rare here that I get patients being even a bit ungrateful/rude/negative etc. Rather, we get patients who bring us candy and amazing treats like these handmade cookies…

No healthcare system is perfect, but I have to say the UK’s system of having both public and private health care works significantly better than Nova Scotia’s public healthcare system. I may be biased, working for a private healthcare company, but I’ve never understood the negativity associated with private healthcare. Yes, it gives better access to healthcare for those who can afford it, but this means it also grants better access to patients who can’t afford it – it frees up space for the public sector by giving the paying patient’s public healthcare space to someone else.

But that’s all I’ll say about that for now… that’s a whole other topic I could ramble about for days.

So, to sum up… my job here is great, with a fabulous work-life balance and I’ll never regret having made the move from public healthcare in Nova Scotia to working for a private company in the UK. Nowhere is perfect, but this place has been pretty dang good to me.