Navigating medical careers & deciding on a specialty
Updated: Sep 29, 2020
One of the hardest decisions after graduating from medical school and beginning Foundation training (UK) is deciding on a specialty. With over 60 specialties and more than 30 subspecialties to consider, and with more unique specialties emerging as the years go on, it is a really tough choice. A lot of things can influence the decision you make about your medical specialty such as your personality, how much commitment you want to take on (e.g. shift hours, being 'on call'), your skill set and what you can imagine yourself doing every day in years to come!
Below is a summary of the tips that have helped me start to think about the specialty I may want to go into:
Research your options
Do a google search of the specialties you're interested in.
Look at the current list of all the specialties on the Medical Schools Council Specialties page
Read about doctors' stories, the types of training programmes each specialty requires, FAQs and much more on the Training & Careers section on each of the official Royal College pages for the specialties. A list can also be found here.
Personality and suitability
When choosing a specialty, it’s important to take into consideration who you are and what you like. Identify and reflect on your personality traits, abilities, limitations, interests and ambitions.
If you value technical skills, focused thinking and you like seeing an immediate outcome, you may want to look into surgery. Whereas, if you prefer to keep your knowledge broad and love to recognise patterns, work through cases and diagnose, radiology, internal medicine or general practice may be for you, where you have the chance to follow patient's stories all the way through.
Regardless of where your main strengths may lie and what specialty you choose, they all require a mixture of attributes and skills because of the varied nature of work as a doctor anyway. There are quite a few personality and learning style tests as well as detailed specialty descriptions. This is a great quiz that I completed recently: https://www.studentdoctor.net/schools/selector and it prompted me to think about my own skills and attributes that I hadn't considered before!
Speak to doctors in the field, listen to their stories, shadow them...
To get a better insight into what specialty might be for you, talk to the doctors who work within that field! Take the opportunity to ask doctors on your clinical placements WHY they chose their specialty, what an average day looks like for them and their favourite (and least favourite) aspects of the job. I also think it's great if you attend society events, conferences and careers days where doctors talk about their role (and the different responsibilities they have within that role), do grand rounds of interesting cases they've handled and describe their journeys into their specialties. You may be able to draw a lot of parallels to your own journey and make great contacts. Then, if you want, you could even ask to shadow them in your spare time and receive invaluable 1-1 support from a doctor in the field you want to go into and see what they do.
Join medical specialty societies
Have a look at the medical societies in your university and go to their events! They are great ways to get ahead and get exposure to the specialties you may be interested in EARLY. I recommend even starting from Year 1, as it can be quite tedious as this is your pre-clinical year and you will not have much clinical exposure and it can keep your motivation and excitement up. These societies may even have mentorship schemes which can facilitate you being partnered up with a doctor in the specialty you hope to pursue. I am currently part of Obstetrics & Gynaecology Society and Surgical Society which both run such schemes. I have also attended conferences run by my university's Plastic Surgery Society and Neurosurgery Society - my other current specialty interests!
Choose a specialty where you take joy in the BASICS
As students, we often seek out the interesting or exciting cases but you must love the most common patient interactions, since they will make up the bulk of your future specialty job! For example, whilst C-sections and major surgeries are exciting, most time spent in the operating room is realistically doing routine general surgery. For a lot of the medical specialties, the mainstays will be ward rounds and clinics - lots of patient interactions, history taking, diagnoses and follow-up testing. It is good to be realistic and figure out if you like the 'routine' parts of the specialty before jumping into a decision based on the rare and exciting things you may have seen.
Type of training
After successful completion of the Foundation programme you are then able to go on to training in a chosen specialty or general practice (GP) training. Length of training can also depend on lots of other things like whether you take time out e.g. Out of Programme Research (OOPR), an F3 year or if you train less than full-time (LTFT). There are also a few exams to take in order to become a Fellow of the respective Royal College and this could lengthen your training time too.
Specialty training is delivered in the following ways:
Run-through training programmes
These last from approximately 3 years for general practice and 5-8 years in other specialties. After completing your foundation years, you will apply to these programmes and if successful, become an ST1 (specialty trainee Year 1). This means you only have to apply to higher training once.
Examples include: Paediatrics, Obstetrics & Gynaecology, Ophthalmology, Radiology, Cardiothoracic surgery & Neurosurgery.
Uncoupled training (Core then higher specialty training programmes)
Uncoupled training is split into either 2 or 3 years of core training (where you become a CT1, CT2 etc.), before entering higher specialty training at ST3 level. With this path, entry to ST3 is a competitive process, which involves applying for a post, similar to what you did after completing your foundation years. Therefore, it is important to note that the application following core training is highly competitive and does not guarantee a specialty training post.
Examples include: Dermatology, Endocrinology, Gastroenterology, Infectious Diseases and Tropical Medicine, Rheumatology...
More specialties can be found here: https://www.st3recruitment.org.uk/specialties/overview
Acute Care Common Stem Training (ACCST)
A 3-year training programme that normally follows F2. It is the only core training programme for trainees wishing to enter higher specialty training in emergency medicine, and is an alternative core training programme for trainees wishing to enter higher specialty training in General Internal Medicine, Acute Internal Medicine or Anaesthesia. I believe this is due to the chronic shortage of doctors going into emergency medicine (so if this is a specialty you're currently interested in, we need you!)
For more information on specialty training read Health Education England's guidance application handbook.
More information on Royal College of Physicians website explaining postgraduate training
Think about how your specialty will change over time
Rapidly advancing technology and the use of Artificial Intelligence will have different effects on each specialty and are usually the buzzwords that provoke interesting debates on whether robots will 'take over' or not. Whatever specialty you hope to go into, think about its potential to change in the future. For example, telemedicine (communicating with patients and colleagues remotely) is becoming increasingly popular, especially in surgical care. Certain specialties such as pathology, radiology and lots of the surgical subspecialties use high-tech machinery such as imaging/scanning devices, assay testing and robotics for surgical procedures. When recruiting for these specialties, they will be looking for innovative young minds who can grasp technology quickly and are welcome to new technologies and opportunities to re-train in using these.
General Practice has also taken advantage of telemedicine during the pandemic - this could be a reality in the future where non-urgent appointments can be taken by your GP remotely via video conference call. With the increasing numbers of patients that GPs have to see, this is also a specialty that is a lot more stressful than people expect. Will appointment times reduce to even less than 10 mins? How comfortable would you feel diagnosing a patient over the phone? Are you a person who is willing to stay late/after hours if your clinics run over? Are you very organised/like routine?
Don't rush your decision
As cliche as it sounds, choosing a specialty must be done with your head and your heart! You have to love what you do but also consider the practical and financial aspects of the career. It is also important to remember that you do not have to make the decision right away (e.g. taking a year out before pursuing further training like having an F3 year) and even if you do and decide a specialty is not for you, you CAN put a halt on your training and shift gears to another field. Do not feel like you're stuck! I have signposted the Healthcare careers webpage on switching specialties and a real life story of a doctor who changed from Psychiatry to General Practice.
It is important to make sure you’ve considered the practical and financial aspects of your career as well as how it is subject to change in a rapidly changing health care landscape. It may also be worth keeping in the back of your mind where you hope to practice as a doctor - if you are hoping to leave the UK, it is good to consider how over or under-subscribed that specialty is abroad and whether it may be worth training there.
What specialties do you want to go into?
I currently have an interest in surgery. I am very pragmatic/practical which I think will come in handy when planning surgeries. I think I will really enjoy drawing and visualising what the surgery is going to turn out like and I am extremely organised (so I like that surgery has a list of patients who you will be doing throughout the day). I also love to be hands-on and see immediate results which is why I think a surgical career will give me those short bursts of satisfaction that tend to keep me hooked.
I have 4 surgical specialty interests at the moment:
Obstetrics & Gynaecology
What attracts me: I have thoroughly enjoyed working with women and my placements in labour ward and acute medical admissions have been amazing. I have learnt so much and the OBGYN doctors have always been so kind and welcoming which has definitely encouraged me to pursue the field.
Drawbacks: Very anti-social hours and you are likely to be 'on-call' often (first point of contact if there is an emergency)
Plastic & Reconstructive Surgery
What attracts me: I love the idea of real-life editing. I think this particular specialty is often really misunderstood! I attended a conference in 2018 and have been a fan ever since. It showed me that plastic surgeons are actually the 'cleaner uppers' who make highly invasive surgeries (e.g. open heart surgeries) more aesthetically pleasing for the patient. Horrible scars, puckered skin and deep wounds can be crippling to someone's self esteem. You can also sub-specialise and one of the subspecialties that has piqued my interest is in 'Onco-plastics' (I have a mentor who is a breast onco-plastic surgeon and I think what she does is SO COOL). I think being able to make someone feel more confident in the skin they are in after going through quite a traumatic surgery and the experience attached to that is something that will fulfil me long-term! It is also a well-paid specialty due to the amount of private work you can do.
Drawbacks: Highly competitive.
What attracts me: Although I have never witnessed neurosurgery in real-life, neuroanatomy is my favourite anatomy topic and therefore, I have made extra effort to learn it. I would like to be able to apply that knowledge to real patients one day.
Drawbacks: Neurosurgeons are often working against the clock in most surgeries they do. Every second counts for serious emergencies like strokes, haemorrhages and other traumatic brain injuries. This means it is a very pressurised surgical specialty to work within and it also takes a VERY steady hand. Patient outcomes can also vary between extremes - patients may recover miraculously as if nothing ever happened or could be left in a vegetative state. These aspects frighten me a little bit.
What attracts me: I like the 'Bob the Builder' ideation that Orthopaedics gives me haha! I love AI, med tech and using new, fancy instruments and Orthopaedics is one of the up and coming specialties that is really taking advantage of these methods (e.g. 3D printing bones/limbs). I like that patients often have an immediate outcome (and it is usually successful) and I can treat patients of all ages, from young sports stars to frail old ladies, meaning there is a wide range of weird and wonderful fractures, breaks, dislocations and sprains (I like a bit of gore too). Again, it also gives me the chance to apply anatomical knowledge to real life patients.
Drawbacks: This is a very male-dominated specialty and can be off-putting when considering how successful I will be in progressing in the specialty as a female. It is also highly competitive.
I am also open to General Practice and Emergency Medicine. I feel like I definitely need more exposure through my clinical placements and future Foundation Doctor posts in order to be sure though.
What specialties are you interested in? Comment below!
GMC page on all of the different specialties and sub-specialties + training routes