A few months ago, during the shortage of jobs for newly qualified GPs, I decided to exercise the international passport that a medical degree provides and sail around the Caribbean as a cruise ship doctor.
My time on the ship left me with fond, long-lasting memories, a host of new, diverse experiences, and feeling totally invigorated about medicine and the future opportunities it can bring.
The application process
I contacted the medical director of a cruise line recommended by a friend and was interviewed in London shortly after. They subsequently offered me a contract tailored to the dates of my availability. A standard contract is typically for four months.
After I accepted the position, I had to apply for a crew member US visa. To do this you need to be interviewed by the US embassy, so I would recommend sorting this out well in advance.
Applicants also need to have a health screen, including routine blood tests and an HIV test. The remaining administration was organised by the medical administration department.
The ship infirmary
Cruise ships carry between 3,500 and 5,000 crew members and guests. Smaller ships have one doctor and three nurses. Larger ships have two doctors (one senior, one junior) and four nurses.
The nurses are often very experienced, highly skilled and many have either A&E or ITU experience.
The infirmary typically consists of consultation rooms and a three-bed ward with facilities including a ventilator, monitoring facilities, CPAP and BiPAP machines, X-ray machines, blood processing equipment and a defibrillator. There are also minor surgery facilities and plastering equipment. The computer system is basic but functional.
The nature of the work is diverse and challenging. You act as GP to crew members and the A&E physician to everyone on the ship. If you are working on a two doctor ship, you are on-call every other day. You work 24 hours and then you have 24 hours off. On the working day, there is a morning and evening clinic, each lasting three hours, with 10–15 patients per clinic.
Cases range from coughs, colds and muscular strains to life-threatening acute medical emergencies. During my time, there were several major incidents including a diarrhoea outbreak – the dreaded norovirus – which meant we had to quarantine nearly 100 people.
There was a drowning during a shore excursion, witnessed by many guests and resulting in lots of people developing post-traumatic stress disorder. I was also sent on a rescue mission to pick up three stranded escaping Cubans whose boat had capsized in the middle of the ocean during hurricane season.
Medical events included thrombolysis in a patient with acute infarct, treatment of florid acute left ventricular failure, as well as several patients with seizures, cardiac arrests and numerous fractures.
Every clinical decision has to factor in the limitations of the ship. For example, whether an acutely unwell patient be managed until the next port or if we need to speed the ship up, turn it around, or get a helicopter evacuation.
Ship work and life
The title of ship’s doctor makes you one of the highest ranking officers on the ship, and this carries certain responsibilities. You are expected to behave and dress in a certain manner. All uniforms are provided.
The doctor also attends the captain’s weekly meeting and is introduced to all the guests at the weekly captain’s cocktail party. There is a very sociable atmosphere as that is the nature of the business. The doctor is provided with one of the most comfortable cabins on board and can access most areas on the ship.
The monthly salary is US$8,400 dollars per month tax-free for the junior physician and approximately US$10,000 for the senior physician. Other perks include free accommodation, food for your entire stay and substantial discounts around the ship.
My time on the ship provided me with great job satisfaction. It is an entirely novel concept to cohabit with your patients. However, they treat you with great respect because they recognise you are at their call 24/7. It is refreshing to live with people from so many different countries and cultures, all with different skills and expertise.
The main thing I have learnt from this experience is that GP vocational training provides an excellent foundation and skill mix that is easily transferable to other environments.
It was a timely reminder that there are many diverse and stimulating opportunities available outside of traditional general practice.
I have since slotted back into general practice, but from time to time reminisce about the ship leaving the dock with the backdrop of a beautiful Caribbean sunset and a cocktail in hand – such was ship life.
- Dr Mathukia is a GP principal in Ilford, Essex