Intended for healthcare professionals


Careers advice for doctors

BMJ 1996; 313 doi: (Published 06 July 1996) Cite this as: BMJ 1996;313:3
  1. Douglas Carnall,
  2. Richard Smith
  1. Editor, Career Focus BMJ, London WC1H 9JR
  2. Editor BMJ, London WC1H 9JR

    BMJ provides a new source of information

    Although unemployment among doctors is rare, many doctors express dissatisfaction with their work. This mismatch between expectation and reality may in part be due to doctors not receiving adequate advice on their careers. This week we launch a new section in the BMJ designed to respond to this lack. Career Focus, as the new section is known, will be published each week in the classified advertising supplements and will help keep doctors abreast of the many possible avenues that their working lives may follow.

    The one thing we know for sure about the NHS of the future is that it will be different from now. Last month the British Association of Medical Managers (BAMM) gathered together a team of hospital doctors and managers to play a game designed to simulate future careers in the NHS, creating an NHS very different from the present one. BMJ readers may be sceptical about learning from games–and so, at the beginning, were many of those who played. But by the end most players were convinced of the game's value–and disturbed by what they discovered.

    The main finding was that the NHS is an inflexible employer at a time when flexibility is important. The work itself demands flexibility, and many of those working in the NHS want it too. But because the players were poorly advised and insufficiently aware of how the early decisions and the many vicissitudes that affect every career can have profound later consequences, many players in the NHS game ended up “in the wrong place.” They felt that they had failed in an NHS intolerant of failure, offering no support, and no routes backwards or forwards. The players agreed that the game reflected reality and showed the need for radical rethinking of work and career patterns within the NHS.

    Students enter real life medical schools with a complex pattern of motivations, generated in part by unrealistic portrayals of the profession in the media. The students then do not use their university careers service before graduation, instead relying on their experience of the specialties as a student to guide their choice of career.1 The continuing dominance of hospital specialists over undergraduate training imprints a narrow set of values on students, often including the perception that career choices outside the specialties are for failures. After graduation, early work experience is poorly supervised and has limited educational value. It is often undertaken with only the vaguest of long term career plans.2

    For those more advanced in their careers, or involved in the recruitment of doctors, the many changes in specialist training,3 in the working styles of consultants,4 and in primary care5 mean that it is vital to stay abreast of employment changes. The world of work is changing rapidly, with increases in part time working, job sharing, teleworking, and flexible working.6 The NHS has been slow to change but will have to catch up.

    Although many sources seek to inform medical postgraduates of the choices available to them at each stage in their career, seeking them out may be difficult. Local institutions have specialty clinical tutors who are responsible for advising doctors in training; there are postgraduate tutors, deans, and advisers, but there is no coherent structure or source of information for doctors in training,particularly if it is apparent that a sideways move into another specialty or even another profession might be the right course.

    The diversity of sources of information means that overloaded doctors may not benefit fully from any of them. The BMJ's classified supplement is the definitive source of recruitment advertising in Britain and a logical place to publish not only career information but material that will assist in obtaining the self knowledge necessary for personal and professional development.


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