Career Focus

Choosing your career

BMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7048.2a (Published 06 July 1996) Cite this as: BMJ 1996;313:S2a-7048

Welcome…

… to the newest section of the BMJ, Career Focus. The pages have been added to the classified supplement to give added value to all reader's of the BMJ, many of whom, our research tells us, get it for the jobs first, and for the main section second.

We also hope that the information will Iure doctors who have attained a stable career back to the classified section, for information about management, recruitment, courses, and continuing medical education.

Each week we will publish two pages of information that will help doctors to develop their careers. Besides features on career related topics, there will be news and information on events that effect doctors' careers. We plan to revisit many of the “How to do it” topics, using entirely new authors, and as much evidence as possible, and shine a light amidst the darkness of rumour, gossip, and individual preferment that so often characterises doctor's current experience of career advancement in Britain today.

The articles will be written by a range of individuals with an interest in doctors' careers. Presidents of royal colleges have a point of view, as does the youngest medical student: we hope that we will get the balance right. If you think we have not please do let me know at the address given on this page. which should also be used to send suggestions, questions, and letters. Submissions for the pages are welcome, and, if accepted, will enable you to discover how well doctors are paid in comparison to journalists. I look forward to being at your service.

Douglas Carnall

Editor, Career Focus

How do you decide what career path to take? Dr Patricia Scriven, an associate adviser in flexible training in West Midlands region, outlines a pragmatic approach to job selection.

A medical degree can open many doors, not only those to a conventional career in one of a wide range of medical specialties. Medical graduates can also pursue careers allied to medicine, together with many that are open to all graduates (see list).

Possible careers for medical graduates

  1. Conventional careers within medicine where a medical degree is essential:

    • General pract

    • Hospital specialties

      • direct links with patients, eg medicine, surgery

      • service support for frontline services, eg anaesthetics, radiology,

      • laboratory support, eg pathology, biochemistry

    • Public health - purchaser-provider advice

    • Postgraduate education/ administration

    • World Health Organisation and related international organisations

  2. Conventional careers within medicine where a medical degree is desirable

    • University teaching posts in related sciences

    • Management of clinical directorates, etc.

  3. Related sciences where a medical degree is desirable

    • Drug companies - research

    • Health Science companies

  4. Law -particularly medicolegal issues

  5. All careers in industry, administration, local government where an ordinary university degree opens up opportunities

  6. Media - knowledge of medicine may provide a starting point, eg reporting medical advances:

    • Journalism

    • Television/radio

  7. Politics - skills acquired during a university education are necessary, eg ability to argue lucidly, influence others, etc

    • Local

    • National

The acquisition of a medical degree not only qualifies the holder for preregistration experience, but also demonstrates academic ability, knowledge of health issues and perseverance.

Practising medicine demands many skills common to all professionals such as problem solving, prioritising tasks, and delegation. They are rarely taught formally, but learning them by observing others is essential for all good doctors.

But are you a good doctor? Most doctors worry about whether medicine is right for them, and if are they right for medicine. At school most doctors would have received careers advice. This is usually based on personality, preferences and academic ability. It would be wise to repeat the taking of such formal careers advice and take time to reflect and assess what is important at various stages in a career. The demands of work in the health service may not allow much time for reflection, but it is nonetheless vital that doctors think about what they wish to do next, and where they might be going. A bad decision could hamper; or even ruin, a career.

In industry psychological profiling and psychometric assessment are extensively used by companies keen to appoint the right person and by candidates who want to assess their strengths and weaknesses, but their effectiveness within medicine is unproved. More practically, career intentions can be assessed by analysing personal priorities and likes and dislikes.

Personal priorities Most doctors are motivated by a dedication to helping others. This ideal is particularly important to students, but as other demands increase it may become less important.

Nevertheless, most branches of medicine satisfy this desire, often in abundance.

Intellectual challenge can be very important Boredom can lead to lack of enthusiasm. Usually progress through the training grade ensures that new techniques and challenges are encountered and interest is maintained. Relatively few doctors become “burnt out” at an early age. Once a career grade is reached, the possibility of burn out is greater, but there are nevertheless usually plenty of further challenges. These often include taking on managerial responsibilities and involvement with postgraduate education.

Financial rewards are comparatively generous for doctors. The opportunities for earning immense wealth are few, but most doctors are comfortably off and can afford the usual trappings of success - large car, big house, and good holidays - at some stage.

Life outside medicine can be neglected by a dedicated few. Most doctors can change the balance between work and other interests at various stages of their careers. Some may choose to work flexibly (part time) while children are growing up for example. At career grade start and finish times can usually be tailored to an individual's needs.

Ask yourself these questions

Meeting people - Were you fascinated by the variety of people you met and the way they reacted to stress? Did you find you enjoyed helping them? If your answers are yes, then you should choose careers where you always meet people. Good communication skills will be needed.

Expertise - Did you find that you were particularly pleased when you performed a difficult examination or task well? An example might be intravenous cannulation or assisting in theatre. If this is so, a career which demands technical expertise may be very suitable.

Problem solving - Perhaps you were involved in looking after a particular patient with lots of problems that appeared insoluble. After a period of reflection, were you able to think how to solve these? If so, you may want a career that requires an analytical mind, with time to think things over

Stressful situations - Were you able to think calmly and rationally and react quickly and appropriately, even under extremely stressful conditions? This is a valued ability in any specialty but particularly the acute ones.

Leadership - Are you a natural leader? Can you motivate others? How do you work in a team: do you always have to lead, or can you also be a good team player? It is essential that you can work with others in medicine and related specialties, but some careers may demand this more than others.

Teaching - Do you like knowing your subject well and explaining it to others? Can you give a good lecture or teach in a small group? Most posts in medicine involve teaching, but you may want to choose a career where teaching is a major part.

Management and organisation - You may have discovered that you were good at working with others involved in the team looking after the patients. You may have enjoyed organising, deciding who does what or discussing how to improve services. Again a career where this is a major component should be chosen

Disadvantages

Although all these elements contribute to medicine being a satisfying career for many doctors, there are some major disadvantages.

Stress is encountered by all doctors and is commonly listed as a reason for disliking or abandoning medicine. Strategies to reduce stress include discussing the problem with colleagues or confidential stress counsellors (available in most regions and now nationally through the BMA's stress counselling service). Increasing experience may allow doctors to learn how to cope and may reduce stress in difficult situations as these are likely to have been encountered before.

Fatigue should be less of a problem nowadays, in theory at least. The “New Deal” has reduced actual working hours in most specialties, but working hours are still long for full time trainees.

So is medicine right for you? If on balance the perceived advantages outweigh disadvantages then the answer should be yes. Analysing previous posts using the questions listed on this page can be helpful in deciding this.

The categories are not exhaustive, but may give you a starting point. Careers in medicine may need all these qualities - they are not mutually exclusive.

Finally, seek advice about other careers. Watch others in different specialties and ask whether they like their job and if it would suit you. Does it provide many of the characteristics you have identified as being enjoyable aspects of work for you?

Discussion with your educational adviser should include careers advice. Further information can be obtained from the various college tutors in your hospital, including the general practice tutor. Within your region the postgraduate dean and associate deans are also available for further careers advice.

At each stage in their career, whether within or outside medicine, all doctors should think hard about what they want to do. They need to consider which tasks they enjoy and whether a proposed career needs these preferred abilities. Careers advice is always useful. A short term job in a promising specialty or chosen career can be tried out to see whether it is suitable before a final decision is made and several jobs may be needed before such a decision can be reached.

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