Intended for healthcare professionals


Taking a step sideways: switching specialty and revitalising my enthusiasm for medicine

BMJ 2016; 354 doi: (Published 25 August 2016) Cite this as: BMJ 2016;354:i4349
  1. Sarah Hillman, year 2 general practice specialty trainee
  1. Coventry and Warwickshire vocational training scheme
  1. sarahchillman{at}


Sarah Hillman describes how changing specialties has helped her to look to the future with enthusiasm

A year ago, I was a clinical lecturer in one of the country’s largest teaching hospitals. As such, I was in a position of relative privilege among junior doctors. But there was one problem—I was training in the wrong specialty and had been for the last eight years.

This conclusion didn’t appear to me as an epiphany. It emerged over years through a series of events and changes to my personal life. These meant that, a year ago, I had to make the single biggest decision of my life. I realised that the labour ward and theatre just weren’t the right place for me and that I was at my best consulting face to face.

I rang my husband on the way home. “I don’t think I want to do this anymore,” I told him. “I think I need to retrain.” I waited for a few seconds expecting a response of “everyone has bad days.” Instead I got, “Thank goodness you’ve realised. I wondered when you would. I just hoped it wouldn’t be in 10 years’ time when I had to pick up the fragments of some nervous breakdown.”

From that point on my perspective shifted. I could finally appreciate how difficult I had become at home, snapping at him and my young children. I spent a weekend crying, grieving for the career and identity that I was leaving behind, and scared of the uncertainty of following a new path.

Then I started to seek out people who could help. A quick look at the deanery website led swiftly to the local GP vocational training scheme (VTS) leads. I met with the training programme director of the local scheme who talked me through the application process and explained that I would be eligible for some reduction in training time under the accreditation of transferable competency framework.

I realised that continuing to pursue an academic path was incredibly important to me. I met with a senior academic in primary care who convinced me that my skills would not be lost, but transferable to the specialty.

The advice they gave me was helpful and supportive. Encouragingly many lead clinicians or GP academics I met had transferred from other specialties, giving me the mentorship and confidence to believe I could do the same.

The hardest part was telling senior clinicians who had invested so much time in me both clinically and academically that I was leaving, but without exception they were all wonderfully understanding.

I applied in the second round of recruitment, acutely aware that some schemes would be full for the following year. I sought advice from the General Practice National Recruitment Office (GPNRO) website and found this to be particularly helpful. On a couple of occasions I emailed the GPNRO directly and they always responded quickly.

Their website also allowed me to find out more about the process of application, and conversations with colleagues helped to elicit what would be involved at the specialty recruitment assessment stage (SRA, formally known as stage 2) where I undertook a computer based assessment consisting of clinical knowledge and situational judgment tests.

An email confirmed that I could proceed to the selection centre (formally known as stage 3) and I undertook the “interview” which tested my communication skills in difficult, but fair situations.

An anxious wait followed until an email confirmed that I had been successful in achieving a place on my chosen VTS scheme.

I have now completed six months of my VTS training and have surprised myself with how much I have enjoyed a flavour of psychiatry. Revitalised, I now look to the future with enthusiasm. The pressures of primary care are evident and I am under no illusions. This new career path will be a difficult one.

But a specialty that offers a chance to be a family’s first point of call through their life course, accompanied by geographical flexibility and the chance of a portfolio career, makes me wonder why I overlooked it the first time round. Although I may be just 1 in the 10 000 needed to recruit, I am determined to be a small part of the solution. Maybe the Royal College of General Practitioners should increase their three Rs to four: recruit, retain, return, and retrain.

If you are happy in your chosen specialty you probably stopped reading a while ago. If you are not, take a deep breath and take a step sideways, even if that also means taking a small step backwards.


  • Competing interests: I have read and understood the BMJ policy on declaration of interests and have no interests to declare.