Choosing your speciality
Where do I begin?
Choosing a speciality is one of the most important, and perhaps also one of the most difficult, decisions you will face in your medical career. Once made, however, it clarifies your subsequent pathway and allows you to focus on appropriate positions, reducing the time spent in unnecessary jobs.
The decision is complicated by the limited flexibility in medical practice. This does not favour major changes of career pathways once you are established in a specialty: successful career U-turns are currently unusual.
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The initial decision to enter medicine may have been heavily influenced by your family or school. Specialisation, however, is a very personal matter as it has substantial impact on the rest of your life.
Some take up medicine with a specialty in mind. While it is essential that such a decision is fully examined and supported by your undergraduate experiences, it does allow you, from an early stage, to make the most appropriate preparations for your career. Most decide their specialty during their undergraduate years, after experiencing many specialties and choosing the one that best fits their aspirations. This allows discussion with career advisors and the choice of a foundation programme that provides appropriate experience for your chosen speciality.
At the latest, the specialty should be chosen early in the foundation programme, so that job applications can be made and a career plan prepared for at least the next one or two years.
A common problem is that you enjoy too many specialties and are spoilt for choice. In this case, start by excluding specialities that you would not consider, and lean towards those providing the greatest opportunity for entry and progression. Take into account the factors discussed in the following paragraphs. Develop a personal checklist of 'for and against', and accept that the problem may be complex and multi-factorial.
Factors influencing career choice
1. You must understand what a chosen specialty involves and decide whether this is what you would enjoy doing. Your understanding is increased by watching how doctors work within the specialty, and from full discussion with colleagues at all levels and with members of other disciplines. Close involvement is provided by working within the specialty or undertaking a short 'taster' during your foundation programme.
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2. Consider whether your aptitudes, both mental and physical, match the requirements of a specialty. The pace of activities in acute areas can be stressful, last for prolonged periods and involve unsocial hours. Although every doctor is expected to keep up-to-date and be in charge of their personal development, some have to maintain sustained in-depth knowledge of a field, both for practice and research in these areas. Physical requirement and technical skills have to be considered in a number of specialties.
3. Life outside medicine - although working hours are regulated, they may still markedly impact on family life, children's schooling, holidays and other extra-curricular activities. The location of your employment influences all these factors and part-time employment may be desirable for your chosen lifestyle. The NHS has a set salary structure but many specialties have opportunities for additional payments and private practice, while part-time employment may substantially reduce financial rewards.
4. The most important factor in life is your motivation and this can often compensate and overcome disadvantages in other areas. A lack of motivation for a speciality produces a lack of drive and initiative, and loss of personal satisfaction and status. Your choice, therefore, should provide realistic and achievable expectations to ensure a happy and satisfactory career.
Once you've chosen...
Once you have chosen the speciality, go for it 'warts and all'. It is helpful to have a respected mentor in the field. This person may have already influenced your initial choice and their ongoing dialogue and advice is a valuable asset. One word of caution, such a relationship can be severely strained if advice is ignored, therefore, try to anticipate any such event and have reasonable alternatives thought out prior to any such discussion.
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How can this site help?
The 'specialities' sections of this site are written by practicing clinicians from each speciality. They have not been given a rigid template but have been asked to develop the above strands, and to:
• give a description of their specialty, what it involves, the likely and possible changes, the make-up of their specialist team, the amount of patient involvement, a typical working week, the opportunities for part-time employment and typical income streams.
• consider opportunities within the specialty, current and future, and the numbers and vacancies, current and predicted, over the next decade, and their location.
• define the entry requirements, the competition, the training programme - its length, the number of trainees within the system and proposed or possible changing work pattern.
• discuss the exit qualifications, rate of progress and promotion, and the career pathways.
• list the professional bodies, societies, websites and where to look for additional information.
While expecting enthusiastic bias from the authors, they have also been asked to consider potential difficulties, together with the rewards and hang-ups of practice within their specialty.
Professor John Lumley
Last updated 25/12/06
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