Choosing a careerBMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7193.2 (Published 08 May 1999) Cite this as: BMJ 1999;318:S2-7193
Medicine is an ecosystem with a wide diversity of habitats. John Bache considers the factors to consider as you look for your niche.
Few qualifications can result in such a wide range of career choices as a medical degree, but how do you decide on your final career? Is it right to enter medical school wanting to be a neurosurgeon and refusing to consider any other possibility? Should you dedicate your life to paediatrics because of one tremendously enthusiastic consultant? Equally, should you eliminate radiology because of a particularly uninspiring consultant? Do you enjoy all specialties but drift fairly aimlessly from one post to another? Do you feel like a square peg in a round hole? What factors should you consider when making your choice?
Each individual must find a unique answer to these questions, but some general comments may be useful. Remember that one man's meat is another man's poison. We are all individuals, with our own strengths and weaknesses and our own likes and dislikes. The world would be a boring place if it were otherwise.
Medicine is a broad church …
Medicine and its sub-specialties
Accident and emergency medicine
Surgery and its sub-specialties
Care of the elderly
Care of the elderly
Obstetrics and gynaecology
Psychiatry and its sub-specialties
Radiology and its sub-specialties
Public health medicine
Voluntary service overseas
Find out what you enjoy
This must be the most important factor. Do not be seduced, actively or passively, into a specialty that you do not enjoy. Medicine is hard work and, in general, the more enthusiasm you put in, the more enjoyment you receive. But medicine should always be fun. When you go home, you should feel that you have enjoyed your day and provided a useful service to those who have needed your help. Some doctors thrive on stress, others prefer a quieter life. Most enjoy contact with patients, but some prefer the scientific challenges of medicine, including laboratory work. Some enjoy the intellectual stimulation of academic medicine and research, while others prefer the challenges of daily clinical practice. Whatever your requirements, this profession will have a place for you to flourish: you simply have to find it.
Some specialties are easier to enter than others, for a variety of reasons. Job prospects are sometimes notoriously difficult to predict, particularly in certain specialties, and the popularity of some disciplines varies in an almost random manner. Be realistic in terms of likely opportunities and of your own abilities.
Obtaining a specialist registrar post makes it very likely that you will become a consultant in the fullness of time, although some specialties are badly out of balance in terms of numbers of posts. Despite a general reduction in junior doctors' hours, training in certain specialties inevitably involves a large out of hours commitment; for other specialties, the out of hours commitment is much less. Ask yourself whether you cope well with examinations, because some specialties have more difficult and more frequent examinations than others. The length of training also varies between specialties.
Environment and location
Decide whether you prefer working in a hospital or in the community. If you want to live in the country and not have to travel into a city every day, consider general practice or a post in a district general hospital. Working in a big city has advantages and disadvantages, and these need to be considered before you make your final choice of career. You may wish to work abroad, temporarily or permanently. If so, you need to decide where you want to work and ascertain what examinations are necessary.
Glamour and status
Some jobs sound glamorous and carry a certain prestige, both among the general public and other members of the profession. Paediatric cardiac surgery sounds good, doesn't it? But glamour and status are fickle and can change dramatically. Again, do not be seduced.
Variety and excitement
Every job has its share of tedium, but some have more variety than others. Accident and emergency medicine is possibly the least predictable of all the specialties. As you become more senior, you may wish to expand your role, possibly by undertaking research, managerial work, examining, committee work, postgraduate education, college work, or medicopolitical work. The opportunities are there if you seek them.
Research and academe
Some doctors enjoy the academic aspects of medicine and thrive at grand rounds and journal clubs. Many derive great pleasure from teaching undergraduates and postgraduates. Research is enjoyed by some doctors but leaves others cold. You may or may not wish to consider a post which offers opportunities for research.
If you enjoy working with children consider, for example, a career in paediatrics, general practice, or accident and emergency medicine. As a physician or a general surgeon in a teaching hospital (or even in a district general hospital), you may never come into contact with children on a professional basis.
Some specialists are obviously likely to be called in frequently, and this can certainly disrupt your family life. A partner who is not from the world of medicine may well find it difficult to accept that you cannot guarantee to be home for an evening meal with the children. “Is it essential to take two cars to the restaurant, in case you are called into the hospital? No one else has to do that.” Other specialists work mainly office hours, with little or no commitments at nights or at weekends or bank holidays. Both women and men may wish to train flexibly or work part time as consultants or general practitioners. This is certainly more accepted than was once the case and is becoming easier, but those working less than full time still sometimes perceive themselves to be less valued members of the workforce.
Surely you are not so naive as to believe that all consultants and general practitioners earn the same amount? Some specialties attract enormous amounts of private practice. Others have a large number of distinction awards. Finance may not be a particularly important consideration when you are 25 years old, but you are likely to have children and they can be very costly. The luxuries of life (cars, houses, hobbies, and holidays) can also be expensive. Money cannot bring happiness, but it can bring comfort.
Getting further advice
There are several sources of advice, such as the colleges and faculties, postgraduate deans, postgraduate tutors, regional advisors, and college advisors. Probably the best advice, however, will be obtained from those who are already established in the specialties that you are considering. They will be pleased to tell you all the advantages and disadvantages of their particular posts and will also direct you to the most appropriate sources of further information.
The final decision is one of the most important you will ever take and can make the difference between 30 years of enjoyment and 30 years of drudgery. Think carefully before you decide.