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The best days

of your life?

Dr Matthew Kiln, a doctor

at two large schools, explains what the job entails

The amount of work that is required from the school doctor will depend on many factors within the school itself.

Here are a few examples.

· Boarding schools under current regulations have to have a school doctor/school medical officer and also tend to have a greater amount of work than day schools. The actual numbers of boarders will also usually be reflected in an increased workload.

The number of boarders in a school varies from 10s to well over 1,000, which then means it is virtually a full-time position in term time.

· Qualities and experience of the nursing staff, and boarding house staff as applicable. As we all know, some nurses feel reassured after having their diagnosis and management confirmed by a doctor, even if they had got it all correct in the first place.

· The needs and views of the school bursar/headteacher and sports staff.

· Pupil numbers, boarders as well as day pupils. Although day pupils (because they still have their own local GPs) tend to present a much smaller workload, this depends a bit on the sports played, and other activities within the school ­ rugby and football for instance sometimes mean more sports injuries to sort out.

· Dealing with members of staff who have recurrent and/or poor sickness record. Some of whom may have to retire early on sickness grounds.

However, every school will be unique in its requirements from the doctor and many day schools get by quite well without one.

How do you get a job as

a school doctor?

There is no set procedure for this, most of it is by chance.

When I joined a large south London general practice 18 years ago I was asked if I would like to become a school doctor to a large boys' boarding school.

I did not have to apply for the job and just accepted it because it sounded like something a little bit different.

A few years after that when a well-respected local doctor retired, I was asked to take over his position as the school medical officer to another school he had looked after. Being a medical officer to more than one large school is rather unusual, but I find it quite helpful, in that when I learn good things from one I can adapt it for the other!

In the current climate of more work being required from GPs (mostly consisting of rather daft paperwork), I find it hard to believe that anyone would wish to look for any additional work, but if you still do after reading this, then because school medical officer jobs do not become vacant very often, it might be sensible to approach an established school and see

if you can talk about what you could

do for them.

You will need to discuss payments depending upon the amount of work you plan to do as part of this.

I really can't advise you on payment. The Medical Officer of Schools Association does have a suggested payment, but this is only really of any help in schools that consist of mainly boarders.

Both of my schools disregard the MOSA guidelines, and actually pay

better rates. This was achieved by sensible, respectful negotiation.

Good things about being a

school doctor

· You may be lucky and get a fee reduction if you send your children to the school you work in. But this not always the case, it took me 10 years to persuade my main school to do this!

· It is often quite different to 'normal' general practice work. Almost all of the people you see are young and generally fit.

Schoolchildren when they are happy and content at school can be quite cheering when compared with some of the patients one commonly sees in the surgery.

· A significant amount of the work is dealing with sports injuries, and advising on sports medicine.

· The money. This can be a bit mixed. When I started, the rate of pay for what one did was quite good and offered a reasonable reward.

Nowadays, with increasing demands elsewhere, and the promise of better earnings for achieving quality points, the rate of pay is becoming less of a bonus that it used to be.

If I did not still get quite a lot of job satisfaction I would probably give it up because the financial rewards are really not worth the extra work anymore.

· Gets you out of the surgery sometimes, to places where nobody can find you.

Possible disadvantages of

being a school doctor

· Coping with the additional work, and the occasional large amount of additional work such as an outbreak of food poisoning.

· Dealing with situations where no one can give you any advice worth listening to for your situation. For example, during the SARS outbreak I contacted the local health promotion department, national infectious disease advisers (Colindale) and also Medical Officers

of Schools Association for advice and guidance on boarding pupils returning from Hong Kong and China, at the start of the outbreak.

The official advice was correct for

individual persons or families, but could not be extrapolated to schools that had 80-200 boarders returning from that area.

· Pay may not be as good as you can get for other work.

· You may need training or more importantly experience of trauma, orthopaedics and/or sports medicine. I did a diploma course in sports medicine on becoming a school doctor.

· You need to have a good working knowledge of health and safety at work.

· Sometimes parents can be clearly doing the wrong thing for their children. Often you can help, or rather assist, the school nurse, teachers or school counsellor in sorting things out.

However, sometimes there is nothing you can do to allow the parents to see that their approach to parenthood is part, or occasionally most, of the problem that their child is dealing with.

This can be frustrating as in the situation when both parents are far too devoted to their work.

· If you earn a reasonable amount, make sure you have adequate medical defence cover.

Generally speaking, once school medical officers have been in a position for a while you may get rewarded with perhaps a greater amount of respect than you might deserve.

Your opinion may also be valued in more areas than those that are strictly medical.

Matthew Kiln is a GP in

south-east London


Our practice has just taken on a new practice manager.

I thought the last one was brilliant but this one is in my view hopeless ­ but all the other partners seem to like her. I feel I may have to leave the practice over this as I can't face what I see as gross inefficiencies going on around me. What should I do?

Dear Doctor,

Don't rush to leave just yet! You don't say how long the new manager has been there and it does take a while to settle into anyone else's shoes and she may have other strengths you have yet to notice. You don't mention whether or not you have raised this issue formally at a practice meeting (or with each partner individually if the manager is at the meeting).

If you feel you must 'do' something consider the following:

· bone up a bit on employment law and maybe gain some new 'management' skills yourself in order to manage the manager (as it may be the previous one was very self-motivated and organised ­ this one may need some help)

· choose one area of inefficiency that you feel is of top priority and bring this to the attention of your partners formally at a partner meeting; but don't do this in an accusatory way, and be sure to offer solutions

· ensure the use of proper management techniques yourself; if the manager is to have an appraisal make sure clear goals are set for her

· keep a list of all the problems you see arising that you view as admin or managerial.

The way coaching could help is to ensure you don't blow a fuse over this, that you develop a plan for improving things or a plan to prove the manager must go using proper management/legal methods ­ or if all fails, to help you to identify a partnership with values closer to your own.

Dr Sonia Hutton-Taylor

is the founder of Medical Forum Career Management which provides e-mail career coaching

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