Choosing a medical specialty

ONE of the hardest decisions in your career begins at foundation level, which is when you have to start thinking about which specialty to pursue. Anecdotally, about half of foundation doctors have a good idea early on; the other half are very much influenced by their experience.

There are over 60 specialties and over 30 subspecialties to consider after foundation training. If you know which specialties you prefer, you may be able to opt for particular foundation or core programmes which will assist your career decision. Other trainees are more influenced by geography, i.e. they want to stay in a particular region and will consider a range of specialties in order to fulfil that aim.

Factors in making a decision

When choosing a specialty it is important to take into consideration who you are: your personality, likes and dislikes, abilities, interests, ambitions, aptitudes, cognitive processes, limitations and task-management skills. What makes you unique? You need to consider the specialty’s requirements, conditions of success, advantages and disadvantages, financial and personal compensations, prospects and opportunities for further career and educational development. You should be realistic about the relative strength of your application; some specialties are very oversubscribed.

All specialties require completion of an application form. Domains are usually (but not always) marked at the shortlisting stage, and if you don’t get many marks at this stage you may not get an interview no matter how good a clinician you are. Most doctors cannot gauge the relative strength of their application, but if you look at the national application form you should be able to work out whether you can gain marks in any or all of the domains. Additional degrees, postgraduate exams, presentations, publications and teaching or audit experience can provide the basis for enough marks at the shortlisting stage to get an interview for a very popular specialty. You should investigate the competition ratios, but bear in mind that this data isn’t historical and does not necessarily reflect future competition – indeed the mere act of making this information available can change applicant behaviour!

If you have decided on a career as a physician, the first step is relatively simple because there are only two main training routes. You should apply for either core medical training or acute care common stem (acute medicine) training. Entry is at core training level 1 (CT1) and the training lasts for two to three years. Both routes open up access to about 30 medical specialties which commence training at specialty training 3 (ST3). This ST3 training lasts four to five years and can sometimes lead to subspecialty training (for example, as a gastroenterologist you could specialise further in hepatology). Visit www.rcplondon.ac.uk/medical-careers to find out more about the different physician specialties.

You may not know that there are a handful of ST3 specialties which accept trainees from other core training programmes. For example, palliative medicine can take trainees from general practice, and dermatology from paediatric core training. There are also opportunities for trainees from surgery, anaesthetics, emergency medicine and psychiatry to enter some ST3 specialties. Additionally, some non-physician training programmes, such as intensive care medicine, are available to physician trainees.

What are your aspirations?

You need to decide where you want to be in five or 10 years’ time, professionally and personally. Do you want to have time with your children, family and friends or time to travel? Where do you place your ideas of contentment or fulfilment? Is this through an ultimate career success or peak, or in achieving a work–life balance?

Many factors can alter your aspirations at any stage of your career. Personal factors include relationships and your sense of self. But there are also organisational/ governmental factors (such as new laws coming into effect that may change how certain work is done) and economic issues (financial security and career progression).

Get experience

During clinical placements at student and foundation levels, you will experience a number of specialties, and the real-life medical situations you encounter can influence your view. These placements are vital in providing a taste of life in a certain specialty; you should make the most of these and try to experience as many as you can. As a student, you can consider volunteering or undertaking elective work at a hospital to gain more experience. As a foundation or core doctor you can arrange ‘taster’ sessions in a specialty which is not already part of your rotation. Do ensure that your decision is objective and not solely based on how much you like the consultant and their team; objectively consider how you felt about that specialty.

Personality

Something else to take into consideration is your personality. Although this should not be the only factor, you need to have an understanding of yourself and how you behave in situations. How you process and communicate information, focus attention, in what environments you like to work and how you solve problems are all crucial when weighing up what specialty would suit you. Are you a hands-on practical person, or do you like to think about detail and solve complex problems? Can you deal with uncertainty and complex/busy situations or do you prefer a more ordered approach with time to think?

Many of the medical specialties require a mixture of attributes because of the varied and variable nature of work as a physician. Deaneries and foundation schools often provide personality and learning styles testing through their careers department, as well as detailed specialty descriptions.

Having second thoughts

If you find yourself in the position where you doubt whether you are in the right specialty, there are still opportunities for change. Quite a few specialties recognise that trainees who move from one training path to another bring with them useful skills – for example undertaking core medical training before moving into radiology or general practice, or undertaking general practice before entering physician training. However, the more changes you make, the longer your overall training pathway becomes. Your decision-making capabilities may be also questioned by selectors.

You could consider a fixed-term post, either in the UK or abroad, to gain experience in particular specialties. This will help you validate your decision about the specialty you want to pursue next. This is also relevant if you are having trouble choosing your first specialty. Quite a few foundation doctors step off the career ladder before entering specialty training in order to experience different specialties and different healthcare systems, and the experience gained is usually very useful.

Liz Berkin is a consultant cardiologist and clinical lead for specialty recruitment at RCP London Article adapted from How to choose a specialty – originally published as an RCP Insight on the Royal College of Physicians website

Points to consider in choosing a specialty

• Patient contact – will you have time to develop patient relationships or would you prefer to see many patients in a day? What kind of patients do you want to treat, i.e. do demographics play a role in your decision?

• Training schedule and time taken to reach consultant level – how long do you want to train for, how many hours are required and once you are a consultant what hours do you want to work?

• How competitive is the specialty selection process? Do you have the knowledge and skill base to get selected? (See http://specialtytraining.hee.nhs.uk for details of specialty entry)

• Career progression – how far can you go in each specialty and how far do you want to career-climb?

• Stress management – how do you cope with haste/stress? Would you prefer time to think things over? For example could you work in the high-pressure environment of acute or emergency medicine?

• Do you like to work by yourself or in a team?

• Do you like research? Data and analysis?

• Do you like problem solving or straightforward care practices – structured work?

• Do you like to teach others, speak to groups?