When I got my fellowship there was a five minute period where I thought I was the bees knees. Professors and super senior staff within the trust I worked with started greeting me in corridors. SLT peers congratulated me on my achievements. I had just appeared in a TV documentary on brain injury and a couple of people at conferences recognised me from that. I wondered whether I was kind of hovering on the top rungs of my clinical career ladder- I had made it. I’d written a book, been on TV and gotten the precious funding I needed for my PhD.
Around this time I remember a good friend subtlety suggesting that I might feel very different once I’d started uni- that it might be challenging being at the bottom of the pile. Shortly after I started another SLT PhD colleague described the dawning realisation that the PhD is actually the very bottom of the ladder – of realising that she knew nothing really.
I can’t say I felt quite like that- I actually felt quite valued. I feel that people in my department genuinely respect my clinical experience. I also realised that I had jumped from one ladder (my clinical SLT ladder) to another (the academic ladder) and that although they stand close to one another they don’t necessarily intertwine. I realised that in general PhD students are at the beginning of their academic careers. That I knew little of academia, of research methods and statistics and that it was only fair that I stood on this bottom rung. I also realised that for me it wasn’t really about the classic career ladder. The NIHR understands this conundrum and is endeavouring to find another route for clinical academics, firstly by paying them a salary to do research that has impact. They are supporting clinicians to explore a research idea that truly belongs to them and advocating that this be linked to their clinical work. But NIHR funding is not that easy to get.
Having been to a number of talks on career pathways recently I have been pondering where I fit. The last talk I went to suggested the importance of going to a different academic organisation for a post-doc position, and further post-docs beyond that. This assumes one has the means to move around. And how does one maintain the clinical skills and link in all this? Does having a clinical role part time along side an academic role really work? With one foot on both ladders? I would like to think it does. I know some clinical academics who have made this work. Can I make this work for me? Perhaps it is the last question that is the most important – no matter what ladder I am on and where – can I make this work for me?
I am sensing a theme this month…. off the back of my last post (working and studying overseas) I have decided it might be nice to consider the other side of this discussion. Now if I were writing this blog as a piece of qualitative research I would need to qualify it with the following statement (or something similar): As a British citizen who has done most of my growing up, living, working and studying in the UK I am of course rather biased in favour of living and studying here. However, I do feel I can take a somewhat balanced view as someone who was brought up with a German father (he lives half the year in Berlin and uses the health service there when he needs to, plus my sisters both did a year of university in Germany ). Also I lived in Melbourne Australia for 5 years and completed my Masters of there (see my last blog post). Having declared my biases I feel I can now continue.
I completed my undergraduate degree at UCL in London. We were the first year to pay our degree fees – although at the 11th hour the NHS stepped in and started funding the medical subjects (how amazing is the NHS!). Yet with a predominantly white female middle class cohort we didn’t necessarily reflect the types of patients we see in clinical settings. Some of the people who most need the support of health professionals, such as SLTs, are often male (at least half if not more) or from lower socioeconomic backgrounds . Luckily the NHS continue to pay these fees (for now) thus ensuring a more balanced work force. My first point of simply this- that this amazing relationship between NHS England and the Higher Educational Institutions means that there is slightly more diversity in the health professional population at present. We have mature students with life experience, people from ethnically and socio-economically diverse backgrounds. And more males (although of course this gender diversity isn’t dependent on the fees being paid!!).
I started work in the NHS as a fresh faced 22 year old in east London. One of my favourite things about the NHS is that every patient I saw was provided with the same opportunities. The NHS is developed and delivered on the principles of population health. Treatments are chosen and delivered based on what works for the majority of the population. This scientific approach ensures a rigorous and thorough approach to delivering healthcare to everyone across the UK. If this does not work then the next most likely approach is chosen, then again the next most likely. Symptoms are treated as evidence that point toward the cause and the solution. These are the methods that have been used to success within the NHS for the last 70 years
Unfortunately when there are not adequate finances to deliver the NHS services to everyone involved then some services may be deemed less of a priority- for example speech and language therapy for people with dementia. This can result in inequitable services across the UK. Advocating for these services, demonstrating the value that these services can have for individuals, their families and the communities they live in may be key to ensuring the longevity of the nations NHS services. Demonstrating that speech and language therapists can improve communication, conversation, relationships and potentially a persons ability to live independently for longer has implications for reducing the financial burden on the community as our population ages. This seems a suitable gift from a speech and language therapist on the NHS’s birthday.