A Career in Medicine
BY DR NIKHIL VASAN
A career in medicine is a long road. It requires persistent dedication, leads you to experience intense highs and intense lows, and ultimately forms a part of your overall identity. It’s also a very unique time in history to become a doctor as the field is undergoing rapid cultural changes – it is prioritising fairness and wellbeing of staff more and more, becoming increasingly sub-specialised, and incorporating new technologies at incredible speeds.
And like other career pathways, you can’t know what it’s like on the inside until you’re actually there. 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.
Let me run you through the career progression of a doctor in the NSW health system.
CAREER PROGRESSION IN MEDICINE
- Year 1: You’ve graduated, congratulations! You’re now a hospital intern, or more formally, a Junior Medical Officer (JMO). This year is based on five rotations between various specialties, entrusts you with minimal decision-making regarding patient care, involves mostly paperwork and supporting other team members; but the whole time you’re watching and learning from your seniors about making clinical decisions yourself. Internship is a crucial year and its importance is underestimated by many. It provides a safe learning space where you learn to balance your job as a doctor with the rest of your life.
- Year 2: Hospital resident or Resident Medical Officer (RMO), similar to internship year, but now you have general medical registration, and you are expected to start making some independent decisions in relation 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 this year. The three ‘main types’ of senior job following residency are: an accredited registrar in a chosen specialty, unaccredited registrar in a chosen specialty, or senior resident (SRMO, sometimes also referred to as a hospital generalist).
- An accredited registrar is a position where a doctor has been accepted by a training college as part of a formal specialist training program (e.g. RACS, RACGP, RANZCP). These programs run anywhere from two years for GP training, to six years for most surgical training programs. As an accredited registrar, you will be immersed in your specialty and have the day-to-day responsibility for the welfare of patients under your team’s care and decision making for their basic treatment. However, the overarching care of your patients is still managed by your boss – the specialist consultant. As you progress in your training, the idea is you rely less and less on your consultant and start to blossom as your own independent soon-to-be specialist.
- Because of massive bottlenecks in organising and setting-up training positions these days, particularly in surgical specialties, new roles such as SRMO and unaccredited registrar have opened up, for people who have shown committed interest in a specialty but have been unable to secure an accredited training position, either due to being too junior, underperforming in the interview, or having an ‘insufficient’ CV. An unaccredited registrar is one such role, where, for all intents and purposes, you function as an accredited registrar, but your time simply doesn’t count towards your required formal training duration. The SRMO role is considered junior yet to an unaccredited registrar role with no formal commitment towards a particular specialty. The idea is that after a few years as an SRMO or unaccredited registrar, one’s clinical skills and CV will improve to the point that they will successfully get on to an accredited training program and work as an accredited registrar.
- Following completion of your specialty training program, you become a fellow of the specialist college! If you can find a job somewhere then you are now an independently practising specialist consultant. In a public hospital, you will lead a team of registrars, RMOs and JMOs. If you don’t get a job straight away, then you attach to a hospital department as a fellow (essentially a very senior level registrar role) until you find a consultant job. Many specialists choose to work in private practice. Consultants can also work as Visiting Medical Officers (VMOs) in various healthcare settings. Consultants are universally paid and treated very well.
The number of years it takes to get from graduating medical school to becoming a specialist is highly variable. Many GPs will become fully fledged specialists in their 5th year out. Most neurosurgeons become specialists in their 12th 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
Let me give you my five honest and unabashed insights into life as a doctor.
1. Being a doctor isn’t like in the TV shows.
There are many medical shows out there, and though they can be surprisingly good at depicting particular medical conditions and procedures, they 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 only Dr House can diagnose. Even major city hospital emergency departments only see around 3 out of 300 in a day who fit that 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 patients, understand and manage their expectations, and get them on board with your treatment plan. This is a lot more challenging than modern diagnosis and treatment, where often ordering a blood test or a scan is better than a doctor’s examination, and where treatment pathways rarely require intricate knowledge, but rather just require following hospital guidelines.
That being said, I continue to find building rapport with patients the most rewarding part of being a doctor. The ability to build a relationship with a patient, understand their situation and values, and construct a personalised plan can really turn someone’s life around and be an incredibly gratifying experience.
2. The hospital is a unique workplace.
There really is nowhere quite like it. It’s pure organised chaos. As a hospital doctor, there is unfortunately 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.
You have just sat down for lunch, and a patient’s condition rapidly deteriorates – 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 all 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, I find this 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 a hospital may not be right for you. That’s not to say don’t be a doctor – you may wish to go into GP training instead!
3. Know what makes your mind tick.
“What sort of doctor do you want to be?” If I had a dollar for every time I was asked that question in my early years, I wouldn’t need to work as either a doctor or a teacher. But I understand it – there are an almost overwhelmingly vast number of clinical pathways once you get your medical degree, and many more non-clinical fields of work.
You don’t need an answer straight away. Just because the person sitting next to you knows 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 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 what pathway I should pursue.
Consider the varied experiences that a doctor could have – 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 appraising articles to formulate a treatment algorithm which can be used by doctors in all hospitals. Which of those stands out to your mind 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. You will find, especially in high intensity and professional jobs like medicine, 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 which tell you what you actually enjoy, not what you should enjoy, and this is what you need to pay attention to in order to make the best decisions for yourself.
4. Medicine can form anywhere between 0% and 100% of your life.
No matter what field of medicine you go into, it will become such a large part of your life that it inevitably cements itself at least partly 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 which specialty you choose.
Doctors find it incredibly difficult to set boundaries. Many doctors don’t even know how to retire – they stop working only when they die. It’s probably 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 problem with this mentality is that if you aren’t wary of it, the medical field starts 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 career as a doctor, have a strong conviction 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 to 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 fundamentally not be compatible with you, and you should embrace that truth early on. You should never compromise your deepest values for your career.
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?
5. Ask yourself a difficult and profound question right now.
If you are a student reading this, 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 have to the above question is “I want to help people”. This is a bad answer. Medicine is not the only job 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” to help 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 you have which underlie this? These are vastly more important, because if you get into the workplace and realise that being a cardiologist is busy, competitive, and high stress, suddenly your fascination disintegrates, 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. 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 crumble. But if you do have one, it will only get stronger and take your career and sense of personal gratification to amazing heights.
