“What do you want to specialise in?” “What kind of doctor are you planning to be?” “Do you want to be insert specialty of the doctor asking?”
Since starting my foundation training as a resident doctor in the UK, I am asked these questions on an almost daily basis, by my seniors, my peers and my non-medic friends. And, well, honestly, I’m not quite sure what especially I want to do, but here’s what I’ve realised 4 months into being a doctor:
Choosing a medical specialty is a complex and multifaceted decision that shapes a doctor's entire career. Recent data from the Association of American Medical Colleges highlights that personal interest and content of specialty are the most influential factors for medical students when selecting their career path1. This aligns with my own experiences and reflections as I navigate through my foundation training.
Being a doctor is not my whole life
Although being a doctor is a big part of my life and identity, working as a doctor has made me realise how easy it is to make this profession into your whole identity. Excelling professionally is exciting and I have many ambitious career aspirations, but I have equally many aspirations outside of my working life. Whilst I enjoy a challenge and I’m not afraid of hard work, I’ve come to see that no amount of respectability or external recognition is worth sacrificing personal well-being, family time, and the ability to pursue interests outside of medicine. Specialties that allow flexibility in working hours and provide a sustainable career path have become much more appealing to me now.
This realization aligns with a growing trend in the medical profession. Work-life balance is increasingly recognized as crucial for physician well-being and career satisfaction. Specialties such as Family Medicine, Dermatology, and Psychiatry are often cited as offering better work-life balance2. This shift in perspective is vital for maintaining long-term career satisfaction and preventing burnout.
Less ward time
I am one of the few medics (it seems) that enjoys ward rounds and clinics, however I don’t see myself enjoying them for the rest of my career if they are a daily occurrence. I’ve realised that I would like to pursue a specialty that doesn’t rely too heavy on long, repetitive ward rounds and inpatient care, but rather offers a balance of ward and clinic time, with a large emphasis on non-clinical duties.
This preference for varied clinical experiences is common among many junior doctors. Specialties like Dermatology, Radiology, and certain surgical subspecialties often provide a mix of clinical duties, balancing ward rounds with outpatient clinics and procedural work2.This diversity can lead to greater job satisfaction and prevent monotony in daily practice.
Examples of specialties with...
Lots of ward time: Internal Medicine, General Surgery, Cardiology, Respiratory Medicine
Some ward time: Dermatology, Obstetrics and Gynaecology, Emergency Medicine
Minimal ward time: Radiology, Pathology, Microbiology/Infectious Diseases
No ward time: Nuclear Medicine, Pharmaceutical Medicine
Teaching and education
I’ve found a lot of satisfaction in mentoring and teaching med students, educating patients, and engaging in developing educational materials. I’m gravitating toward specialties that provide ample opportunities for academic involvement and where education and research are integral parts of the specialty, alongside clinical work.
The field of medical education is expanding, with increasing opportunities for doctors to incorporate teaching into their careers. Many medical schools and healthcare institutions are developing dedicated pathways that combine clinical practice with educational responsibilities3. This trend recognizes the critical role of teaching in advancing medical knowledge and improving patient care.
Looking at my future
I’ve found that looking at senior doctors (particularly registrars and consultants) in a particular specialty is the best way to gather an idea of whether I would enjoy it. Actually seeing what their day-to-day looks like and whether they are fulfilled and have a good balance has been incredibly enlightening. There are certain groups of doctors that seem to always be stressed and over-worked, despite loving certain aspects of the job. If I don’t see myself doing what they do daily, I won’t be following in their footsteps.
This approach of observing and learning from senior colleagues is supported by research. Role model influence is consistently ranked as one of the top three factors influencing specialty choice among medical graduates1. It provides valuable insights into the long-term career trajectory and lifestyle associated with different specialties.
Clinical-Academic Career
The boundaries between pure clinical work and academic research are becoming increasingly blurred. Many modern medical careers offer integrated pathways that allow simultaneous progression in clinical skills and research capabilities. I need to love both clinical work and research in order to sustain a fulfilling and impactful career. If one area doesn’t excite me as much as the other, it’s unlikely I’ll thrive in a role that demands both in equal measure. So I’m on a mission for the specialty that combines the 2 for me!
The integration of clinical practice and research is becoming increasingly common in modern medical careers. Many specialties now offer integrated pathways that allow simultaneous progression in clinical skills and research capabilities4. This trend is particularly evident in fields like Immunology, Pathology, and certain subspecialties of Internal Medicine.
Examples of specialties that typically have…
Heavy focus on academia: Clinical Pharmacology and Therapeutics, Immunology, Medical Oncology, Endocrinology
Some focus on academia: Cardiology, Neurology, Respiratory Medicine
Minimal focus on academia: Emergency Medicine, General Practice, Anaesthetics
Emerging Trends in Healthcare Specialties
The medical landscape is rapidly changing, influenced by technological innovations, demographic shifts, and evolving healthcare needs. Specialties that demonstrate adaptability and embrace interdisciplinary approaches are likely to offer the most dynamic and fulfilling career opportunities.
Other considerations
Opportunities for private practice, potential for innovation and technological advancements in the field, and the ability to make a significant impact on patient outcomes are also factors I'm considering. Additionally, I'm thinking about the long-term career prospects and how different specialties might evolve with changes in healthcare delivery and technology.
These considerations reflect the complex decision-making process involved in choosing a medical specialty. Factors such as income expectations, future family plans, and the competitiveness of specialties also play significant roles for many medical graduates1.The evolving healthcare landscape, influenced by technological innovations and changing patient needs, adds another layer of complexity to this decision.
Specific specialties + my thoughts
Urology
What attracts me: Urology is an interesting field that combines surgical skills with medical knowledge. It offers a variety of procedures and the opportunity to work with cutting-edge technology. The potential for innovation in minimally invasive surgeries is exciting
Drawbacks: The surgical lifestyle can be demanding, and there's potential for a toxic work environment in some settings. The on-call schedule might be challenging for maintaining work-life balance.
Endocrinology
What attracts me: Endocrinology is intellectually stimulating with its complex hormonal systems. It offers diverse sub-specialties like fertility, general endocrinology, obesity, diabetes, and lipid metabolism. There's good potential for private practice and a mix of both acute and chronic patient care.
Drawbacks: The prospect of being a medical registrar is daunting, given the intense workload and responsibility. The specialty might involve less procedural work compared to surgical fields.
Rheumatology
What attracts me: Rheumatology offers interesting cases and the opportunity to manage complex, chronic conditions. There's potential for private practice and a good balance of clinic and ward work. The field is evolving with new biological therapies, offering exciting research opportunities.
Drawbacks: Similar to endocrinology, it requires medical registrar training, which can be challenging. Some conditions can be frustrating to treat due to their chronic nature.
General Practice
What attracts me: GP offers excellent work-life balance and the opportunity to build long-term relationships with patients. It provides a varied caseload and the flexibility to pursue special interests within primary care.
Drawbacks: There might be less opportunity for complex procedures or hospital-based work. The high patient volume and time constraints per consultation could be challenging.
Obstetrics and Gynaecology
What attracts me: This specialty offers a unique blend of medicine and surgery, along with the joy of being involved in childbirth. It provides opportunities for both acute and elective work, and there's potential for subspecialization.
Drawbacks: The on-call schedule can be demanding, and the medicolegal risks are high. Achieving work-life balance might be challenging, especially in the early years of training.
Dermatology
What attracts me: Dermatology offers a good work-life balance and interesting cases. There's significant potential for private practice and aesthetic work. The visual nature of the specialty appeals to me, and there are opportunities for procedural work.
Drawbacks: It's highly competitive to enter, and the training pathway can be lengthy. There might be less variety in day-to-day work compared to some other specialties.
Immunology/Pathology
What attracts me: These fields offer strong research opportunities and less ward-based work. They're at the forefront of medical advancements and provide a deep understanding of disease processes.
Drawbacks: There's less patient contact, which might not suit my interest in teaching and patient education. The work can be isolating compared to more clinical specialties.
Although I've only completed my first rotation of F1, the learning and reflection has been EXPONENTIAL and is helping me so much in deciding my next steps. I've realized that my preferences align with several key factors identified in research on specialty choice among UK medical students
References:
Comments