Indemnity and the portfolio career

Indemnity and the portfolio career - The MDU

Doctors are increasingly ready to take on new challenges alongside their day-to-day practice. Dr Thom Petty explains how the MDU can support members who opt to pursue a portfolio career.

The concept of a portfolio career has been a slow-burner in medicine, perhaps because of the duration of medical training. But today's doctors are increasingly ready to follow the advice of influential US surgeon, writer and public health campaigner Dr Atul Gawande: "It turns out you can be a doctor and be almost anything else."

Thom Petty, former anaesthetist and now deputy head of underwriting at the MDU, reflects, "The profession's culture is changing and more doctors are breaking out of traditionally-defined specialties and pursuing varied careers. In some cases, their choice stems from existing interests, such as keen amateur athletes who diversify into sports medicine.

"Training in non-surgical cosmetic procedures such as dermal fillers is now more widely accessible so non-specialists are increasingly interested in working in this area. At the same time, patients themselves have become more proactive in researching treatment options online and selecting clinicians who meet their requirements, rather than waiting for a recommendation or GP referral."

Thom understands the drive to diversify. He qualified from the University of Edinburgh and, before joining the MDU, practised as an anaesthetic registrar in Bristol for over four years. Also an enthusiastic pianist and composer, he trained at the Royal Northern College of Music Junior School and more recently co-founded the Bristol Concert Series, a venture which promotes public performances by non-professional musicians.

In 2011, his long-standing interest in ethical and legal matters led him to join the MDU's claims team where he assisted members facing clinical negligence litigation. Thom is now deputy head of the MDU's underwriting team, where he assesses and advises on aspects of clinical risk associated with the work undertaken by members.

He speaks from experience when he says that evolving opportunities in the profession offer enhanced job satisfaction for doctors and greater choice for patients. But he warns, "At the same time there is inherent risk in expanding into new and often uncharted areas of practice.

"Take non-invasive cosmetic treatments, for example. On the surface, these may appear to be relatively innocuous procedures, but there are recognised risks and complications – such as intravascular injection of dermal fillers, nerve palsies, localised bleeding and haematoma. Doctors may also find that patients' expectations are extremely high and satisfaction with the end result can be very subjective. We have seen numerous complaints, complications and clinical negligence claims arising from these types of procedures."

Of course, there is no reason why a doctor who is trained, competent and who has taken the necessary risk management precautions cannot branch out into new ways of working but they must ensure they are appropriately indemnified. This is where Thom and his colleagues in the MDU underwriting team come in.

Thom stresses that the underwriting team has to strike a very careful balance. "Our duty is to support individual members who want to develop the scope of their practice, while not exposing the MDU's funds to unexpected financial risks, in the interests of the membership as a whole. The underwriting team assesses the clinical and indemnity risk presented by emerging and evolving specialties and the working arrangements of our members on an individual basis.

"These are often complex decisions but it's essential to adopt a balanced approach and agree to take on appropriately managed risks adequately reflected in any additional subscription levied."

Operating at the heart of the MDU, the underwriting team liaises with the advisory, claims and membership teams so that members who contact us about their indemnity requirements receive the best possible service. In many cases, Thom or one of his colleagues will speak directly to the members and they aim to give a response as quickly as possible.

Thom explains: "The job requires us all to think carefully because members' work circumstances are considered on a case-by-case basis. Before agreeing to extend the benefits of membership for a doctor wanting to undertake cosmetic work, for instance, we ask for evidence of the courses and training they have undertaken. The MDU has to evaluate and constantly reassess the risk that we accept on behalf of all our members and that means asking the right questions.

"As we are a mutual defence organisation owned by our members, we are careful to manage the new and existing risks to which members' funds are exposed. For example, while the MDU may indemnify members from claims arising from patients who are elite, professional athletes, we took a view some years ago that the benefits of membership are unlikely to extend to claims from other third parties such as football clubs, agents or sponsors as this could potentially expose the mutual fund to claims for commercial losses running into tens of millions of pounds, which would not be in the interests of the generality of our members."

Online consultation services are another developing area, he says. "There are a number of factors we look at when assessing potential risks associated with providing online clinical services, including the location of the patients (who may not be UK-based), the range of services provided and the qualifications and experience of the clinical team involved."

Thom also points out that doctors who want to expand their scope of practice must remember their responsibilities to patients. "Even if the types of treatment they are providing are also available from non-clinicians, it's important to ensure that doctors still fulfil their obligations as outlined by the GMC, especially when it comes to areas such as record-keeping, confidentiality, follow-up, continuing professional development and the consent process."

In his two years at the MDU, Thom has seen the popularity of portfolio medical careers among GPs and hospital doctors gain momentum and he believes the trend will continue as doctors take advantage of the opportunities provided under commissioning, as well as the growing possibilities offered by new technology.

"In the end, it's all about balance," he concludes. "Doctors should be able to enjoy a rich and varied medical career, providing they continue to meet the GMC's professional standards. It's the MDU's role to support our members, while safeguarding the interests of the organisation and our wider membership."

Previous article Next article

This page was correct at publication on . Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.