To commence a career in medicine is to start a journey down a long road. It requires persistent dedication, leads you to experience intense highs and intense lows, and ultimately forms part of your identity. It’s also a very unique time in history to become a doctor. The field is undergoing rapid cultural and technological changes, as equity and staff wellbeing are prioritised more and more, fields become increasingly sub-specialised, and new diagnostics and therapeutics are incorporated into practice at an incredible pace.
The saying goes that you can’t know what it’s like on the inside until you’re already there, and medicine is no exception. In this article, I’m going to take you through my insights into life as a doctor in the NSW medical system – things many of us wish we heard from people in the field when we were in Year 12, sweating over what to put on that all-important UAC application form. First, I’ll fill you in on the general career trajectory you can expect to have, from an intern fresh out of medical school to a senior consultant. And if you stick with me to the end, I’ll tell you what it’s really like to work as a doctor – the good, the bad, and the in-between – to dispel some of the mystery as you work out whether a medical career might be right for you.
Career Progression in Medicine
You’ve just graduated from four to six years of medical school. Congratulations! You’re now a hospital intern, or more formally, a Junior Medical Officer (JMO). This year, you’ll be undertaking five rotations between various specialties, including medicine, emergency, and surgery. Being a very junior doctor, you don’t make many patient care decisions yourself, and your job mostly involves filling out paperwork and supporting other team members with clinical tasks. At the same time, you’re watching and learning from your seniors about how to make safe and effective clinical decisions, in preparation for the next part of your career. Internship is a crucial year and its importance is underestimated by many. It provides a safe space where you learn to balance your job as a doctor with the rest of your life.
You’ve survived your intern year. Now, you’re a Resident Medical Officer (RMO). As a resident, you now have general medical registration, which means you’re expected to start making some independent decisions with regard to diagnosing conditions, initiating basic treatments, and ordering tests. You can stay a hospital resident for several years, but generally young doctors start gravitating towards a specialty of their choice around this time, so they apply for senior jobs around August or September of the resident year. At this point, depending on the career trajectory you want to follow and the outcome of your specialty training applications, there are three kinds of senior jobs you can move into: accredited registrar, unaccredited registrar, or senior resident (SRMO, aka hospital generalist).
An accredited registrar is a doctor who has been accepted onto a training program by a specialty college and is training towards becoming a consultant in that specialty. For example, surgical trainees are supervised by the Royal Australasian College of Surgeons (RACS), while general practice trainees are supervised by the Royal Australian College of General Practitioners (RACGP). What this means is that you work as a doctor in that specialty while making sure that you meet the learning and skills requirements mandated by your college (and passing all of your exams!). These programs run anywhere from two years for GP training, to six years for most surgical training programs. As an accredited registrar, you have the day-to-day responsibility for the welfare of patients under your team’s care and decision making for much of their treatment. However, the overarching care of your patients is still managed by your boss – the specialist consultant. As you progress in your training, you rely less and less on your consultant and start to blossom as a soon-to-be independent specialist.
However, the unfortunate truth is that there are massive bottlenecks in specialty training these days, with the number of applicants far outstripping the number of available positions in most specialties every year. Because of this, new roles such as SRMO and unaccredited registrar have been established. These are for doctors who have shown committed interest in a specialty but have been unable to secure an accredited training position due to being too junior, underperforming in the interview, or having an ‘insufficient’ CV. As an unaccredited registrar, you perform for all intents and purposes the same work as your accredited colleagues, but your time simply doesn’t count towards your required training duration. The SRMO role is more junior, with no formal commitment towards a particular specialty. The idea is that after a few years as an SRMO or unaccredited registrar, an applicant’s clinical skills and CV will improve to the point that they will be able to get on to the training program and work as an accredited registrar.
Following completion of your last specialty training exams, you become a fellow of the specialist college! If you can find a job somewhere, either in a public hospital or clinic or in a private setting, then you are now an independently practising specialist consultant. In a public hospital, you will lead a team of registrars, RMOs and JMOs as a staff specialist. It’s common for newly-minted consultants to attach to a hospital department as a fellow (essentially a very senior registrar) for a while before landing a staff specialist position. Many specialists choose to work in private practice. You can also work as a Visiting Medical Officer (VMO), which means you’re a private practitioner who also provides services in a public hospital.
Consultants are universally paid and treated very well, but as it’s hopefully clear, it takes a while to get to that level. The number of years it takes to become a specialist is highly variable. Many GPs will become fully fledged specialists in their fifth year out from medical school. Many neurosurgeons become specialists in their twelfth year out. But every year you are working, you are earning money, gaining invaluable experience, and becoming a better and better doctor.
Life in Medicine
Now that you know what’s in store in terms of your career trajectory, it’s time to focus in more deeply. Let me give you my five honest and unabashed insights into life as a doctor.
Being a doctor isn’t like on TV.
Medical shows can be surprisingly good at depicting particular medical conditions and procedures, but they almost universally fail to capture the reality of life as a doctor.
The truth is that most patients you encounter in your training years aren’t about to die, they’re not undergoing an incredibly complex surgery, and they don’t have a rare disease which can only be diagnosed by Dr Gregory House. Even major city hospital emergency departments would only see around 3 out of 300 in a day who come close to fitting such a description.
Most of your encounters will be with patients and families who are undergoing treatment or monitoring for a straightforward condition. Most view their interaction with you in an advisory sense, wishing to balance your recommendations against their own personal wishes, views and schedules.
The paramount skill of a modern doctor is to build rapport with your patients, understand and manage their expectations, and get them on board with your treatment plan. This human aspect of care is a lot more challenging than the technical or scientific side of diagnosis and treatment, where often a simple blood test or a scan will tell you more than your own physical examination of the patient, and where evidence-based treatment relies less on your own intricate knowledge of the disease than on your ability to follow hospital flowcharts and guidelines.
That being said, it’s precisely because of this challenge that I continue to find building rapport with patients the most rewarding part of being a doctor. Building a relationship with a patient, understanding their situation and values, and constructing a personalised plan can really turn someone’s life around and can be an incredibly gratifying experience.
The hospital is a unique environment.
There really is nowhere like it. It’s pure organised chaos. As a hospital doctor, there is no reliable structure to your day.
Believe me – I’ve tried to structure it! Ward rounds in the morning, reviewing medications and investigations before lunch, a clinic in the afternoon, ordering blood tests for the next morning before you leave for the day. That is never how it turns out.
Imagine you’ve just sat down for lunch after a gruelling overnight shift and morning round when a patient’s condition rapidly deteriorates – forget about your food, you simply must go and help. You have sorted out a complex discharge plan for a patient over the last few days, and suddenly you get a call from a family member giving you a detail that totally throws your plan into limbo. And let’s not forget the hospital itself – it’s always under pressure to keep patients moving through the system, from admission, to therapy, to discharge. And when that flow gets blocked up, guess who the pressure comes down on? You. Working in the hospital requires you to constantly reprioritise your tasks for the day. When people complain that doctors are always late… well, there’s a good reason for that!
This may sound daunting, but I think it really depends on your personality. For me, this is an incredibly stimulating part of being a doctor. No day is the same, and you never get trapped by a routine. Just when you think you are beginning to get your head around everything, the hospital finds a way to make you realise that you still have much to learn. If, like me, you can approach this chaos with enthusiasm and positivity, it’s sure to give you a level of excitement that is simply unattainable in any other field. Just be aware – if you are someone who relies on schedules and planning in advance, then working in the maelstrom of a public hospital may not be right for you. That’s not to say don’t be a doctor, but rather think about where you might like to end up. For example, you might like to go into a non-hospital-based specialty, like general practice, where you generally have far more control over your daily schedule and patient flow.
Know what makes your mind tick.
“What sort of doctor do you want to be?” If only I had a dollar for every time I was asked that question in my early years! But I understand it – there is an almost overwhelmingly vast number of pathways open to you once you get your medical degree, and many more non-clinical fields of work too.
Know that you don’t need to have an answer to this question straight away. Just because the person sitting next to you is convinced they want to be an orthopaedic surgeon when they’re 16 years old, doesn’t mean you should be discouraged from pursuing medicine just because you don’t know what you want to specialise in. Most find that what they think they want when they start medical school, or even when they start working, is not what they end up pursuing.
What I found very useful was to pay close attention to what sort of tasks, interactions and feedback my mind enjoyed, because that provided me with insight into the kind of pathway I should pursue.
Consider the varied experiences that you could have as a doctor – hearing someone tell you that you saved their life, the touch of a surgical instrument in your hand, problem solving a difficult set of competing patient issues, conducting chemical tests and viewing cells through microscopes, analysing the economics behind prioritisation and allocation of Medicare funds, collating and systematically appraising the literature to formulate a more effective treatment algorithm that can be used by doctors all over the world. Which of those stands out to you the most? Are you someone who prefers thinking, or doing? Do you prefer dealing with numbers, or with descriptions? Do you like repetition and perfection, or variety and nuance?
As you progress in the field, you will start to tally up experiences which give you a good feeling, and those that don’t. You must make a conscious effort to do this. For example, someone who enjoys reading and writing long, highly synthesised pieces of text may gravitate towards psychiatry. Someone who hates this might prefer surgery or anaesthetics.
Lastly – and this is advice applicable to all aspects of your life – pay attention to your gut. Especially in high intensity professions like medicine, you’ll find that people opine without invitation. They will tell you what you should do, and what you are capable of doing, and they may even tell you that some jobs are better than others. But in the end, it’s your gut feelings that tell you what you actually find meaningful and satisfying, and this is what you need to pay attention to in order to make the best decisions for yourself.
Medicine can take up 0 to 100% of your life – the choice is up to you.
No matter the field of medicine you go into, it will become such a large part of your life that it inevitably cements itself into your identity and personality. But the extent to which this occurs can vary greatly based on the type of person you are, how much you give yourself to it, and the specialty you go into.
I’ve noticed that most doctors find it incredibly difficult to set boundaries. Many doctors don’t even know how to retire – they stop working only when they die. I would posit that this is due to a combination of the nature of the work and the sort of people that go into medicine. It can be really hard to say, “I don’t think I’m the best person for that task”, or “I’m not in a position to assist with that right now”. The issue is that if you aren’t wary of it, your medical career can start to consume your entire being. I know a lot of my colleagues who wish they had a better balance, and they definitely could, but they just don’t know how.
Before you commit to medical school and a life as a doctor, start forming a strong idea of what you want your life to look like. Do you prefer to spread your time over hobbies, fitness and relationships? Do you want to go all in on one endeavour, and attain mastery over a field? Perhaps something in between? There is no correct answer; there is only your answer. And your answer, like mine, may change with time. You should be aware that depending on what you want your life to look like, certain specialty pathways will most likely not be compatible with you, and you should embrace that truth early on. You should never compromise your personal happiness, or your deepest values, for the sake of your job.
Be ready to set boundaries for yourself. Doctors are the backbone of the health system, and ultimately the body relies on the backbone to stand up straight and move forwards. All responsibilities will somehow end up finding their way to you, and sometimes it feels like you can’t really leave work or stop thinking about it, even when your shift comes to an end. Tell yourself early in your career that this is not the sort of doctor you will be, and that you will always look after yourself first. Because if you can’t look after yourself, how could you possibly look after anyone else?
Ask yourself a difficult and profound question right now.
If you’re a student, ask yourself right now – “why am I considering a career in medicine?” If you are a parent and your child is considering medicine, make sure to ask them after you read this.
Do you have an answer? Many don’t. And out of those who do, very few have a good answer.
The truth is, in order to survive and thrive in a field like medicine, you need to be able to confidently identify a strong motivator, and that motivator needs to be justified by your personality, life goals, and past experiences.
A common answer people give to the above question is “I want to help people”. This is a bad answer. Medicine is not the only profession where you get to help people, and you may find that if this is the only reason you are applying for medicine, this apparent passion for helping people fizzles very quickly in the face of the multitude of challenges involved with being a practising doctor.
Some people will say “I think the heart is fascinating, and I think it’s the most important organ, so I want to be a cardiologist”. All well and good, but what are the deep and personal convictions that underlie this? These are vastly more important. If you get into the workplace and realise that training and working as a cardiologist involves far more competition and stress than you bargained for, suddenly your fascination might well disintegrate, and you have no way forward.
Perhaps your motivator is supporting people who are very sick, or in their final days, and you have a goal to specialise in palliative care. Is this because you’ve been significantly impacted by a similar experience yourself? Do you feel strongly about a lack of that service in a particular community that you’ve seen first-hand, and you want to change that?
It is crucial to identify your motivators early and understand where they come from, and this is because you will draw upon them day in and day out in your work, to amplify the high points, to rationalise the low and to provide yourself with a blazing beacon to continuously aim towards. If you don’t have a strong personal backing for your motivator, and it’s something you’ve pulled out of thin air to justify your decision to become a doctor (or worse, it’s something that someone else has told you to think), then I assure you it will very quickly fall apart. But if you do have one, it will only get stronger, and it will take your career and sense of personal gratification to amazing heights.
