Switching specialty

Leanne Darwin thought she wanted to work in general medicine. But shortly after starting her rotation as a senior house officer in 2005, she discovered another specialty held more appeal.

“I found I enjoyed the more acute aspects of dealing with patients. After speaking to colleagues it became clear that anaesthesia, a specialty I’d not really experienced as a medical student, might allow me to develop skills more suited to my interests. I realised it was time to change specialty.”

Although there are no statistics to show how many doctors switch disciplines, anecdotally it is clear that, like Dr Darwin, many find themselves in the wrong specialty and want to change the course of their career.

Those who work in a specialty they feel unsuited to can end up feeling stressed and dissatisfied. Occasionally such feelings might force them to leave the profession altogether. David Farren moved from a senior house officer post in general medicine to microbiology, where he is about to complete his specialty training year 2 in Belfast. Dr Farren recalls how working in the wrong area made him feel he “wasn’t achieving anything.” He believes doctors who “settle for a specialty” can become unhappy with their work and life in general.

Caroline Elton, psychologist and head of careers advice and planning at the London Deanery, suggests clinicians can end up in the wrong specialty because trainees are “under pressure to choose a discipline” before they have the chance to experience what it is really like.

Sometimes trainees and qualified doctors find there is a “fundamental mismatch” between their core skills and the specialty they have chosen, Dr Elton explains. Aspects of a discipline can jar with a doctor’s personal preferences—for instance, they might prefer to work alone rather than as part of a team as their specialty demands. Specialties can also develop in ways that no one can predict but that diminish the consultant’s personal job satisfaction, such as becoming more technology driven.

So how do doctors know when it’s time to switch specialties? Dr Elton stresses that clinicians should give “considerable thought” to changing their discipline, as often they might think they are unhappy in their specialty when actually “the reasons are more complicated.”

The consultant who is fed up with his or her discipline might actually have had enough of full time work or would prefer to work in a country hospital rather than for an inner city trust. A personality clash between a trainee and a mentor in a placement might have coloured the trainee’s perception of his or her chosen specialty. Poor health, family troubles, or a long commute could be the real reason for a doctor’s unhappiness—not their discipline.

Before making a decision about your career, Dr Elton advises: “You need to look at what’s really going on in your life to see if there are ways to resolve your problems other than retraining.”

For those who are not enjoying the core aspects of a specialty “it might be time to change,” Dr Elton says. Specific requirements to switch specialties will depend on the discipline; however, there are some general steps all clinicians can take when looking to move posts.

Joan Reid, head of careers at Kent, Surrey, and Sussex Deanery, says those wanting to switch specialties should go through a “career planning process.” This entails trainees and consultants doing a “self assessment” where they consider their interests, skills, and abilities and decide on what is important to them. They should then find out which specialties best match their abilities and personal priorities, learn more about them, and plan what they must do to work in them.

Trainees who are unhappy in their specialty and wanting to change should be proactive, Ms Reid says. They should seek advice from as many people as possible, including their educational supervisor, training programme director, consultant mentor, and, if necessary, deanery. They should also talk to other trainees, clinicians, or a careers adviser.

Ms Reid emphasises that doctors shouldn’t be afraid that asking for support to leave a specialty will be counted as a “black mark” against them. Dr Darwin recalls that while she was “a little apprehensive” about talking to her educational supervisor about her doubts about her choice of discipline, he was “extremely supportive.”

Other sources of support include the BMA Careers Service and professional careers advisers. The UK Foundation Programme Office is in the process of assembling a list of careers support provision for doctors.

Johann Malawana, deputy chair of the BMA’s Junior Doctors Committee, advises trainees to “get as much general advice as possible from informed, reliable sources.”

“Individuals should also find out as much detail [as] possible about their preferred specialty, especially what the eventual job that they will be trained for involves, rather than basing [it] purely on what happens during the training years,” he says.

For consultants, changing specialty is harder—and, therefore, rarer. Mark Porter, deputy chairman of the BMA’s Central Consultants and Specialists Committee, says that while years ago it was fairly easy to move between specialties, medicine has become more specialised. Changing disciplines for a consultant is also a “major upheaval”—for example, a surgeon, after years of medical training and practising medicine, must go through the training grades again to become a psychiatrist.

Senior clinicians who switch specialties and find themselves back on the training ladder lose the protection of their consultant contract, Dr Porter says. Although their previous consultant salary is “broadly preserved” during retraining, senior clinicians do not have access to those opportunities offered to consultants to improve their earnings.

Consultants wanting to change specialty should ask for advice from their postgraduate dean and those working in the specialty they aspire to, and invest in some careers counselling.

For those who make the switch, the difficulties resulting from these changes can be cancelled out by the benefits, as Dr Darwin, who has nearly completed her specialty training year 2 in anaesthesia in Wigan, has found.

“Starting a new specialty was daunting and involved a steep learning curve. Now I’m really enjoying what I do and looking forward to a career in anaesthesia,” she says.

Even though doctors may change specialty, that doesn’t mean their previous experience is wasted. Dr Farren says his time in general medicine gave him “valuable experience of working with patients.”

Being unhappy in one specialty doesn’t have to spell the end of a medical career, but being unhappy with your second specialty choice could have an impact on your employability, Dr Elton warns, so it’s crucial clinicians “look before they leap” into a new discipline. “Take the time to be as sure as you can that the alternate pathway you are considering is the right one,” she advises.

And why rush? After all, this is a decision that is likely to affect you for the rest of your working life.