Switching medical specialties: is it feasible?

Of all the professions, medicine has one of the most rigid career pathways; it can feel like a conveyor belt that you can’t get off. But what if, during or after your training, you decide you’ve chosen the wrong specialty? Are you stuck with what you started, or is it feasible to switch horses midstream?

Around 10% of residents in the Australian system do choose to switch their specialty each year, so the answer is that it’s certainly possible. But it’s not a decision to be taken lightly, as it could involve up to three years of supplementary training.

It’s not uncommon for those in training to feel unsuited to their specialty, leaving them stressed and sometimes like they may want to leave medicine altogether. A discipline might end up being a poor match for the person’s core skills or might jar with his or her personal preferences. Registrars embarking on a career in pathology might find that they miss the patient contact and pine for the hospital wards; or alternatively a registrar in general practice might find the constant personal contact too emotionally draining.

But no decision should be made about switching specialties without considerable reflection and consultation with colleagues. Often, doctors might think they’re unhappy with a specialty when in fact other issues are at play: difficulties with a particular colleague, a desire to work part-time instead of full-time, an overly long commute or even problems at home.

“You need to look at what’s really going on in your life to see if there are ways of resolving your problems without retraining.” says Dr Caroline Elton, a UK-based psychologist and medical careers advisor.

Dr Elton says doctors finding themselves at a career crossroads should go through a “career planning process”, whereby they carry out a self-assessment to identify their interests, skills and abilities and to decide what is really important to them.

They should then look at what specialties best match their skills and priorities, learn more about them and plan what to do to be able to work in them.

Here are a few tips for doctors who find themselves wondering whether they’re in the right specialty:

Be aware that taking a step sideways will inevitably also mean taking a small step backwards:
Be proactive and seek advice from as many people as possible, both within the specialty in which you are already training, and in the one to which you’re think of switching. Don’t feel that it will be considered a black mark against you if you ask for support in leaving a specialty. Such support is crucial;
Find out as much as possible about the preferred specialty, particularly what the eventual job entails rather than just what you go through in training;
If you are still unclear about the way ahead, consider a dual training pathway;
For consultants, switching specialties is likely to be considerably harder and involve a major upheaval; be prepared to lose the protection of your consultant contract;

Source: BMJ Careers

Visit the AMA Career Advice Hub for useful information across the whole medical-life journey as well as Career Counselling Service resources. For one-on-one assistance, contact Christine Brill at careers@ama.com.au .

Click here to sign up to the doctorportal jobs board.

[Correspondence] NHS manifesto: the missing piece of the puzzle

The NHS Manifesto published in The Lancet by Nigel Crisp and colleagues (Dec 10, 2016, e24)1 is a broadly compelling one, and yet it mirrors an error made by National Health Service (NHS) England’s Five Year Forward View2 in calling for a major transformation of the UK’s largest public service without acknowledging the importance of public engagement in those plans. To be sure, Crisp and colleagues1 call for services to be made patient-centred, and for patients and carers to be engaged “in decision making and care”.

IMGs: are the options narrowing?

In the light of recent visa reforms and new calls to stem the flow of overseas doctors, international medical graduates (IMGs) may soon find it tougher to work in Australia, and harder to get permanent residency if they do.

Last April the government announced the scrapping of the 457 foreign worker visa system, to be replaced with a more restrictive two-year visa that doesn’t allow for eventual permanent residency. This potentially leaves some international medical students uncertain about their future and their ability to work in Australia after they finish their degree.

A second visa class, focused on strategic, long-term skills gaps, will have a four-year limit and will require higher standards for English language proficiency as well as mandatory labour market testing.

Months on, the details remain somewhat murky and the impact on IMGs unclear, but the AMA was advised recently that the mandatory requirement for labour market testing will include doctors.

This is likely to narrow the job options for IMGs, particularly as the government has also announced a provision of $93 million in incentives for agencies to recruit Australian doctors over foreign-trained ones.

For the moment, all medical specialties are listed in the new visa arrangement, but it’s far from clear how IMGs currently in Australia on a 457 visa might be affected should the list of approved occupations change in the future.

The Department of Health has previously recommended the removal of all medical specialties from the list of skilled occupations eligible for working visas, a position that the AMA supports.

Assistant Health Minister Dr David Gillespie has described the influx of overseas-trained doctors as “unsustainable” and is planning to curb the flow while at the same time making it easier for locally-trained medical students and junior doctors to do their training in rural locations.

Meanwhile, the RACGP is also calling for the government to stem the influx of IMGs, and has published a position statement to define the role of the rural GP. The College says many of the doctors working in rural and regional Australia do not have the appropriate skills, qualifications or support, and it calls for a new national rural generalist pathway.

RACGP President Dr Bastian Seidel said Australia should stop spending money attracting overseas-trained doctors and focus on training local graduates to care for rural patients, who are typically older and have more chronic conditions such as heart disease.

“We’ve imported doctors from overseas and just literally left them alone with minimal support in rural areas and we know that hasn’t really worked,” he told AAP.

It is estimated that Australia will have a doctor oversupply of 7000 by 2030, although there remains a significant shortfall in rural communities.

Are you an international medical graduate? The AMA website provides a range of resources for IMGs. Looking for the right job? Visit Doctorportal for our comprehensive jobs listings, updated daily.

[Series] Levers for addressing medical underuse and overuse: achieving high-value health care

The preceding papers in this Series have outlined how underuse and overuse of health-care services occur within a complex system of health-care production, with a multiplicity of causes. Because poor care is ubiquitous and has considerable consequences for the health and wellbeing of billions of people around the world, remedying this problem is a morally and politically urgent task. Universal health coverage is a key step towards achieving the right care. Therefore, full consideration of potential levers of change must include an upstream perspective—ie, an understanding of the system-level factors that drive overuse and underuse, as well as the various incentives at work during a clinical encounter.

[Series] Evidence for overuse of medical services around the world

Overuse, which is defined as the provision of medical services that are more likely to cause harm than good, is a pervasive problem. Direct measurement of overuse through documentation of delivery of inappropriate services is challenging given the difficulty of defining appropriate care for patients with individual preferences and needs; overuse can also be measured indirectly through examination of unwarranted geographical variations in prevalence of procedures and care intensity. Despite the challenges, the high prevalence of overuse is well documented in high-income countries across a wide range of services and is increasingly recognised in low-income countries.

[Series] Evidence for underuse of effective medical services around the world

Underuse—the failure to use effective and affordable medical interventions—is common and responsible for substantial suffering, disability, and loss of life worldwide. Underuse occurs at every point along the treatment continuum, from populations lacking access to health care to inadequate supply of medical resources and labour, slow or partial uptake of innovations, and patients not accessing or declining them. The extent of underuse for different interventions varies by country, and is documented in countries of high, middle, and low-income, and across different types of health-care systems, payment models, and health services.

[Comment] Account for primary health care when indexing access and quality

It is well established that primary care leads to better health outcomes, lower costs, and greater equity in health,1 and an important part of a country’s development should be the strengthening of primary health-care services. This way, the health care provided will be comprehensive and people-centred, for all ages and stages of life, incorporating and coordinating health promotion, prevention, acute and chronic care management activities, to deliver equitable access and safe high-quality care.

[Comment] Addressing overuse and underuse around the world

The benefits of modern medical care have advanced the health of populations around the world, but with better health has come rising health-care spending. Not surprisingly, there is global interest in optimising the delivery of health services, exemplified by the universal health coverage (UHC) and waste in research campaigns.1,2 Comparatively neglected is a central paradox that afflicts high-income countries (HICs) and low-income and middle-income countries (LMICs) alike: the failure to deliver needed services alongside the continuing delivery of unnecessary services.

[Comment] From universal health coverage to right care for health

Achieving universal health coverage is the most important means to advance health and wellbeing during the next decade. Too many countries—and not only in low-income or middle-income settings—do not have a health system that provides “access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all”, as described in Sustainable Development Goal 3.8.1

[Comment] Avoiding overuse—the next quality frontier

As nations move toward universal health coverage (UHC), the stakes on quality of care rise. The poorest people in the world can least afford poor quality health care. They do not have the resources to repair the damage when care goes wrong, their development requires a healthy workforce, and money wasted on ineffective or harmful care is money denied to other essential services. Poor quality care damages wealthy nations, too. Few high-income countries have the political will to increase tax rates, and therefore government investments reflect zero sum choices—what public health care gets, public schools and public housing lose.