Apologies that it’s been a while since I’ve added to this blog. I’ve been rather swamped with some highs and lows of the job! I thought I’d talk a bit about choosing a specialisation in medicine and why I decided to add in academia.

For many medical students the initial hurdle of finally being a doctor is daunting enough. In the UK though, that feeling is quickly swamped by the realisation that on top of just becoming a doctor, you need to choose a specialisation. This is no mean feat. The choice is huge and has knock on effects for your general life too. So I thought I’d tell you about my career pathway and then give some top tips for choosing a specialty and why academic medicine is so great!

My Career Path

Most doctors in the UK follow the following pathway:

• Graduate after 5 or 6 years of undergraduate medicine
• Start Foundation Years– 2 years of general rotations in medicine, surgery, GP etc and after the first of these years, become fully registered (as opposed to being on a sort of “probation” year) with the General Medical Council (GMC).
• At the end of FY2, choose (and apply for) a (general) specialisation– either broadly medical (hospital), surgical or GP. Some specialties have what’s called “run-through” training where the trainee is on that pathway to specialisation as soon as they have finished FY2. Most specialties require 2-3 interim years within the broad specialty. So in becoming a specialist in Infectious Diseases/ Medical Microbiology, 2 years of Core Medical Training is required first where I would rotate through different medical specialties while I work towards exams to be registered with the Royal College of Physicians.
• Then apply to and hopefully start your actual specialisation pathway for a further approximately 5 years before passing more exams to become a specialist in that field, ie, a consultant.

My path was slightly different.

The end of FY2 and the start of choosing a specialisation is a natural break in the career pathway of many postgraduate doctors. I had known from my first trip to Zambia that I had an interest in global health and I did an extra undergradutae year to gain a BSc degree in International Health (what’s known as an intercalated degree). However, I thoroughly enjoyed my intensive care placement during my Foundation Years and I had done some academic studies that I had enjoyed too. I felt a little lost. So I decided to aim to make my career suitable for a job with Médecins Sans Frontières and noticed that they recommended a Diploma in Tropical Medicine and Hygiene. I spent my year out of a training pathway doing this course, working in Emergency Medicine to pay for it and travelling.

During that year I hit on the idea of doing Intensive Care Medicine (ICM) with Infectious Diseases but as yet this pathway didn’t exist. I mistakenly chose to do core years in a pathway which didn’t enable me to then go into infectious diseases as well as ICM and wouldn’t allow me to swap without repeating several years (Acute Care Common Stem Anaesthesia). I also realised that getting into academia with this route would be tricky and nearly impossible and I had enjoyed both specialties partly for their academic presence. Having been considering academia for a long time, I quit and applied to a pathway that allowed me to do ID with academia called an Academic Clinical Fellowship (ACF) with the National Institute for Health Research (NIHR).

As you may now understand, all these pathways are a confusing mine-field for even doctors! And that’s after you’ve chosen your specialty!! This is the rest of your life you’re talking about and it’s a big decision. With that in mind I have signed up recently to talk to FY2 doctors and I thought I’d share some of that thought pattern with yourselves. Here goes:

Advice for Choosing a Specialisation

1. Are you medical or surgical? Broadly speaking this is usually the easiest question to answer first. Many foundation trainees find they become increasingly sure of their answer during these years. Once you’ve worked that piece of the puzzle out, think of the options within those broad categories.
2. Do a SWOT analysis: SWOT stands for Strengths, Weaknesses (things about yourself), Opportunities and Threats (things that are external to yourself that can help or hinder you). Working out what your skills and likes and dislikes are is a great way of focusing your mind and working out what you might want to specialise in.
3. Look at people in your chosen field: The program Scrubs hit on something when they made stereotypes of the different specialities in the medical field. Stereotypes can be unhelpful but they often start for a reason and many specialties are prone to certain ‘cultures’ within them. For example, sit with enough ID folk and you’ll find most of us are well travelled, love the fascination and detective work needed for complex cases and often dress a bit like ‘hippies’ (not hard and fast but there is definitely a certain trend). Work out where your personality lies. None of this is exclusive obviously, but it can be helpful.
4. Aim to use your taster days: there is a great scheme when you can take taster days in a specialty. It’s a great idea and often fails in practice because we’re too understaffed to make it work. But do your best to have a go at getting this in.
5. Take a year out but use it effectively: I don’t much hold with taking a year out and not planning it as it doesn’t always help in the long term. Having said that many people elected to ‘just go to Australia’ and see what happens. Many were very happy… Either way, I’d still recommend planning your time to make the most of the opportunity. You could, for example, collect a list of specialties you’d like to shadow and then locum in your spare time in those specialties or arrange shadowing opportunities and taster days that way.
6. Don’t be afraid to make mistakes- things are changing: I have had a bit of rough time at the hands of the confusing medical pathways and red tape. This is changing though- the GMC and the Academy of Medical Sciences are trying to make training pathways more flexible as they’ve realised how miserable being ‘stuck’ has made us. The flipside is that some core training has been extended, largely I suspect to cover the shop floor for longer and create ‘sub-consultant’ levels (ie, paid less to do more). Either way, I’m still a believer that hard work and determination will get you where you want to be when you’ve finally worked it out. Furthermore, I have learnt many skills I otherwise wouldn’t have and had more opportunity as a result. Flipside is that many of my friends are now consultants or nearly consultants.
7. Consider academia at least in some capacity: this opens up SO many avenues for you. It’s not easy but it also comes with a flexible work schedule for your academic blocks and enables you to be more self directed from an earlier time in your career. Furthermore, doing academia means you tend to read and learn more about your specialty. The best way to start getting a foot in the door is to talk to academics in the specialty you’re considering and ask to help with a project for example, during your foundation years. If you are more sure of your specialism, an ACF is also a great idea and it comes with run-through training (ie, you don’t need to apply for specialty training if you get your ACF from Core Training years). If you are a medical student, consider an academic foundation job.
8. Look at the consultant job and the future for that specialty: I have done a lot of emergency medicine and there is a big recruitment drive into this frankly brilliant specialty. But honestly, it still doesn’t yet come with a fantastic work-life balance and my husband found my work schedule more difficult than I did! Life balance has become more important for me over time and likely will for you. So don’t just ask a consultant what they think of the job now but also how they see it going. A 24/7 consultant presence is increasingly the case in Emergency Departments. As much as I loved the job, that wasn’t something I thought I’d be happy with in the future.
9. Don’t get put off by people saying it’s a competitive specialty: I am happiest in my general life when my work life also makes me happy. Competition is only tricky when you’re forcing yourself to do things you don’t love but still have to work hard at. So if you enjoy that specialty then go for it- someone has to get the job and why shouldn’t it be you?
10. Aim for a specialty that you will love forever: It’s taken me a long time to say I wholeheartedly LOVE my job. Don’t take so long. Don’t waste your time but looking at things that for whatever misguided reason you THINK you should do. Do what you WANT to do. If that turns out not to be in the medical field then go back to the SWOT analysis. Honestly though, life is too short to feel guilty about not doing the job your favourite consultant wanted you to do/people thought you’d do/is short staffed/your parents thought would be good. Just look for what you love getting out of bed for in the morning. If it takes you more than one year out to find it, so be it. If it means staying in Australia, your NHS colleagues won’t blame you. Just do what you love.

I hope this helps in some way. If you have any questions remember that you can contact me through instagram or comment on this article. Let me know if there’s anything else that would be helpful.