Common Career Roadblocks for Doctors
Dr Ashe Coxon is a general practitioner, career development practitioner and director and founder of Medical Career Planning. Her team assists doctors and medical students to find true career-life happiness through gaining an understanding of ones self, values, interests, personality and skills.
It is currently ‘career season’ in the medical world, which means a lot of career planning, refreshing of CVs, interview preparation, many nervous doctors and a lot of career indecision!
The medical training system can be very complicated, complex, competitive and many doctors feel immense pressure to choose a pathway. Many doctors themselves are unaware that there are over 80 specialty areas they can train and work in.
It is not uncommon to speak with a medical student, or even a junior doctor, who has little awareness of the barriers to complete specialty training and many are unaware of the additional requirements and years of training that they need to complete after their medical degree.
Career counsellors, practitioners or coaches who are not aware of how the medical training system works can be forgiven for not understanding why ‘wanting to do that specialty = job’ and why May – July can be a difficult period for many doctors, and I will begin to try and explain.
Once medical students successfully graduate from medical school they are issued with their medical degree, but to gain full registration to practice as a doctor, they must satisfactorily complete an internship at an accredited hospital to gain General Registration from the Australian Health Practitioner Regulation Agency (AHPRA).
Roadblock #1 – The medical student who is putting in their internship preferences might find that their hospital and location of choice is a very in demand option, requiring the individual to move locations to find a role. In addition to this, certain hospitals may provide the opportunity to experience clinical areas of interest and others may not. For instance, certain hospitals may not provide an obstetric service and therefore the doctor will not be exposed to obstetrics during their work. This can lead to career indecision because ‘How do I decide if I want to be an obstetrician or not if I haven't had a chance to work in the area?’
Once general registration has been satisfied, the doctor can then work as a resident in the hospital system, essentially meaning that they rotate through different areas every 10 weeks and can sample a variety of rotations (Commonly 5 per year). For example, a second year resident may do a term in the Emergency Department, Pediatrics, Cardiology, General Surgery and Palliative Care. A doctor can continue to be a resident for as long as they wish to, however by their 3-4 year after graduation the majority of doctors would be considering what specialty that they wish to train in and would be attempting to get accepted into a training program.
To become a specialist in an area, for example - cardiologist, general practitioner, sexual health physician, and public heath physician - doctors need to be accepted onto a training program and work under supervision for 3 – 6 years. Once a doctor has successfully completed the training program, which commonly has a minimum of 3 exams often requiring an additional 6 – 12 months of preparation, they can then practice independently in their field they have trained in.
Seems easy doesn’t it? Just pick what you want to train in and go for it!
Unfortunately, many doctors experience several roadblocks throughout this process that career development practitioners working with doctors should be aware of.
Roadblock #2 – Getting accepted into a training program can be incredibly challenging, time consuming, expensive, difficult and there is no guarantee that a doctor will be successful. For instance, some training programs will only allow the doctor three attempts to be accepted and each attempt is commonly done yearly. It is also not uncommon to be rejected from the training program for a few years. Additionally, there are often multiple pre-requisites for training programs (certain courses or qualifications which can become expensive). Over this time, a doctor may start to question whether it is still the desired pathway for them.
Roadblock #3 - If after all of the applications and years of trying to get into a program they are not successful, they are then left trying to decide whether to pursue another training program. This program will inevitably have its own pre-requisites that the doctor must do. So, someone may have been attempting to be accepted into the orthopedics training program, but if they are unsuccessful they would have spent 3-4 years doing purely orthopedic related research programs, courses and training to make their CV competitive. Now they need to show their commitment to their new pathway.
Fortunately, this is not the common pathway as most doctors will eventually get accepted into their pathway of choice. But certainly for a few, they will either not be accepted or change their career intentions throughout this process and feel they need to ‘start again’. This is where they usually engage a career development practitioner who can be instrumental in assisting the transition.
The majority of clients that I see just cant decide what they wish to pursue as a career. As you can see, the training is lengthy, time consuming and expensive, so many doctors really want to be sure before they pursue a training program. The Medical Board of Australia recognises over 80 specialties that a doctor can specialise in and with only the ability to sample 5 rotations per year, it can leave doctors a) unaware of the options they have available and b) confused and conflicted that there may be ‘something out there’ that they haven’t sampled.
To assist them through their decision, the career practitioners at Medical Career Planning use a variety of practical exercises, reflective exercises and frameworks to assist in allowing the client to be aware of their own interests, skills, values and personality preferences. One of my main goals is to build awareness of all of the careers that a doctor can train in and ask if they can see themselves pursuing them.
Why is ‘Career Season’ Stressful?
Job applications for resident positions and training programs are commonly open June – August. This means that big decisions need to be made around what hospital they will try and train in, what training program they might apply for, does the hospital they get allocated to have the rotations that will be necessary to assist them onto a training program, and what areas should they try and work in if they don’t know what they want to do yet with their career!
As you can see, the lengthy process of application to training programs, successfully completing programs, exams (many people fail multiple exams in the process) and fellowship can take some doctors 10 – 20 years after their medical qualification.
Career satisfaction is hopefully still present, but for some they no longer enjoy the career that they have dedicated their professional years to and then seek career counselling on what to do now. This can be a disheartening and difficult position for the doctor and they will require a lot of support and career counselling to assist with finding contentment in their job or transition to new roles. A career development practitioner can play a HUGE role in these scenarios and can really make a difference in the career satisfaction for these doctors.
A Career Development Practitioners Role
So how can a career development practitioner, coach or counsellor assist doctors in this decision-making process?
Reflective based exercises on identifying areas of interest, skills, values and future life goals can be very useful, as well as advising the doctor to be aware of all of their options. The Medical Board of Australia has a comprehensive list of specialties and Medical Career Planning has a course outlining all specialties that a doctor can train in, skills required, general information about the field and brief descriptions around training and pre-requisites.
Picking a medical specialty is very similar to choosing a vocation, but the medical system has some intricacies that many are not aware of. Hopefully the above will assist you in continuing to support, counsel and coach doctors towards their eventual career of choice.