My daughter has always paid for insurance, it’s taken as a condition of being in the BMA, and it’s a lot of money. She has always paid for courses and to sit exams. It costs a lot of money, often in the thousands, as GE correctly says. Although she’s currently living and practicing in New Zealand, she still has those costs, and after starting her training at eighteen, and starting practicing medicine at twenty four, at nearly forty one she is still doing courses, and paying for them. She currently works full time as a GP, she works extra shifts in ED (equivalent to our A+E) and she works from home for a private menopause clinic, which of course is paid much better than the public work she does. She is also currently taking an advanced course on managing the menopause. She is still studying. It never stops because all doctors must remain informed about all advances in medicine in their specialties.