RECENTLY, in the wake of R U OK Day and World Suicide Prevention Day, I spent some time thinking of my friends and colleagues facing unprecedented career challenges and seemingly impossible choices. After a conversation with a coworker, I began thinking about my own experience in the early part of this decade, when I found myself working away from home and in a setting that I was not enjoying.
I had recently returned from studying a master’s degree in the United Kingdom and was therefore out of sync with the Australian recruitment cycle. I had applied far and wide for hospital medical officer jobs but found very few vacancies. Eager to return to clinical medicine, I accepted one such short term opening and moved from England to Northern Australia.
I quickly found myself isolated from my family, friends and support network. Unhappy in my job and my environment, I could feel my capacity for empathy failing; I was becoming a worse doctor because of it. Then, a member of my family suddenly became very unwell – it was time to return home. I completed my rotation and moved back to Melbourne.
Upon arriving in Melbourne, I again struggled to find rotations and jobs appropriate for my desired career path. I have written before about the dangers of experience-based discrimination, and so was wary of taking up the wrong opportunity. I felt like I was at a dead end. Although I had embarked on my master’s degree to develop as a doctor, it felt like time “out of the system” had crippled my clinical career. Paradoxically, opportunities abounded in paramedical fields such as biotechnology. I began seriously considering leaving medicine.
On the advice of some friends and colleagues, I met with a doctor to discuss a potential career change. Although the doctor’s intentions were good, their response could not have been less helpful. Rather than counsel me through my various options, they admonished me, lecturing me about the investment that the government had made in my education. According to the doctor, I had an obligation to spend the rest of my life working in the Australian health care system, irrespective of personal enjoyment or fulfillment. I left that meeting with a deep sense of shame that I was considering the move. Shortly afterwards, my PhD funding came through and that discussion passed into memory.
Then, a couple of weeks ago, I asked the following question on Twitter:
For those junior doctors forced out of Australian medicine due to the #trainingcrisis, what would your advice be? Move to a different country to practise medicine or change industries? Where or what?
While some of the responses were constructive, and most seemed well intentioned, I was disappointed with some as they reminded me of the conversation I had 5 or so years ago. Many of the comments advocated changing specialties or moving to the bush. These will be terrific options for some and were undoubtedly put forward by those who love their area of specialisation or locality and want others to share in their experience. But a lack of rural training opportunities and the arduous eligibility criteria for training programs mean that these options, even when individually appealing, are far from simple or universally appropriate.
Furthermore, for those already heavily invested in one field of medicine, the suggestion that they change is confronting. This is particularly true in the absence of any recognition of prior training or guarantee of success the second time around. My medical school classmates will shortly enter their 10th year of practice since graduation. Almost all have dedicated the past decade to work as doctors in training. Most have sat multiple postgraduate exams, and a handful has postgraduate degrees, including PhDs. Some are consultants. Many are still searching for training positions. If I were to suggest to the consultants, who in many cases have done the same number of years of service and the same amount of exams as the aspiring trainees, that they change specialties, I would likely face a very hostile reception. Why would we expect a different response from similarly dedicated, but still aspiring, trainees?
We can wish all we want that the system would not encourage or allow such prolonged commitment without the prospect of career advancement – and I have long advocated for wide-ranging training reform – but the reality is that many doctors in training are facing this predicament. Unfortunately, there is little by way of support or counsel helping them to navigate through this all too common turbulence. Sadly, burnt out trainees are sometimes thrown on the scrapheap, or blamed for their passionate dedication to the “wrong specialty”. It is therefore not surprising that some choose to leave medicine. Disappointingly, many of those I have spoken to report a similar sense of judgement or reproach from their peers that I myself experienced.
I believe that there are initiatives that could be adopted to give far more support to doctors considering a transition – either to a new field or away from clinical medicine altogether. For example, the establishment of a publicly available, exhaustive national training registry would go a long way in helping juniors identify areas of trainee shortages. This could have the added benefit of redistributing doctors to areas of need. Alternatively, enabling those who have made an extended commitment to a specialty to transition with some recognition for the time served, such as a membership qualification, would provide much needed acknowledgement of their contribution and skill.
But we also must be realistic and acknowledge that some doctors will prefer to walk away from medicine or try their luck overseas. As a profession, I feel that we have a responsibility to support these doctors, not admonish them, if and when they make that decision.
As the training crisis leads to a greater and greater number of doctors facing the tough choice to leave medicine, we would all be wise to show our colleagues compassion, understanding and empathy. Shaming these doctors into a career in medicine is a sure-fire recipe for disaster.
Dr Tim Lindsay is an Australian doctor and PhD student in the MRC Epidemiology Unit, at the University of Cambridge, UK, supported by the Cambridge Commonwealth Trust.
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.