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18 Feb 2019


In medicine a ‘typical’ career path is neatly defined. A smooth arc from student to intern to undertaking specialty training to becoming a consultant, whereupon you find your ‘forever job’ and settle in. Done. Right?

Tell that to every trainee working in an unaccredited registrar job. To every trainee who has changed or is considering changing specialty training. To every new consultant who finds themselves scraping around for fractional appointments on opposite ends of a major city.

It’s easy to get stressed out by a winding road when the expectation is constant progress towards a specific destination, and to be afraid of a protracted training time when its demands on you are unsustainable.

When I graduated medical school it was just ahead of the ‘intern tsunami’. A surge of graduates thundering towards vocational training, the only certainty being that gaining entry to your chosen program would become less certain. So many of us with a goal in mind put our heads down and sprinted, did a Masters, a Diploma, and got ‘on the escalator’ of specialty training, buckled down, held our breath and tried to sprint to the finish.

We were so afraid of being left behind, of training taking longer than the minimum expected, of doing anything that can’t be ‘accredited’ – but what about not being the best doctors we can be? Relative lack of job security aside, it’s not all bad.

Some of the most interesting and inspiring careers start can without clear direction or veer dramatically off course, often take unexpected direction at uneven pace, meandering then leaping forward, gathering skills either deliberately or by chance. My partner studied ecology and biodiversity at university, before working in finance, intelligence, corporate affairs and now public policy and government relations. He has no streamlined career path ahead of him, but a unique skillset that creates diverse possibility.

A good friend of mine spent a number of years in unaccredited jobs chasing a dream of plastic surgery, and ultimately found his place in dermatology – on first application – where his procedural skills separated him from the rest. Many post graduate students bring with them a wealth of experience from other fields, in law, visual arts, computer science and more. I know others who have taken a year out to repeat an exam, travel, go on electives, volunteer, climb Everest or start a family. How can any of these things be a waste of time?

All these scenarios result in a longer absolute period between graduation from medical school and specialty fellowship, but I suspect this only increases the likelihood of distilling job satisfaction, gradually carving out a niche for yourself that resonates most clearly with your values. It may also mean that you have more of an opportunity to enjoy the view along the way.

A better work life balance is not a millennial luxury but a necessity to rediscover equilibrium in an altered social context to that of the generations of doctors who came before us. With many more dual professional couples, a distinct wife drought – especially for female professionals – and no sign of the hours in the day expanding beyond 24, there needs to be space and time for family, for life outside the hospital and rooms.

I try to live by the principle that there is no wasted experience. To believe that every job, every failure, every misdirection can provide some kind of learning, some new skills, even if they mightn’t seem that relevant or useful at the time.

There is probably an exception that proves the rule – such as trainees who commit significant time and expense on a training program before exhausting attempts to pass fellowship exams and being removed from training. Or more commonly, trainees caught by the ubiquitous tension between service and training, performing secretarial and other tasks that are predominantly a function of system inefficiency.

Medical training is too often accepted as something life will be put on hold for, something to ‘get through’. No wonder we are all so keen not to extend it. We can’t hold our breath indefinitely. But rather than trying to race through, I think we’re better off making the process more sustainable.

We shouldn’t have to be afraid of taking a circuitous route to a final specialist qualification, but rather celebrate the diversity it brings.

This will require not only change in mindset, but change in structure of vocational training pathways. We need to redefine specialty training across Colleges in a more interchangeable, modular fashion, accrediting an individual’s skills and competencies rather than just time spent in a certain kind of job. We should expand global health training opportunities, and perhaps follow New Zealand, where taking parental leave can actually count towards several months of general practice training, a fantastic approach to recognising the skills it will develop.

These moves would discourage trainees to remain on a certain ‘escalator’ despite changing ambitions due to the sunk costs fallacy and allow greater lateral movement, encourage diversity of skillmix among similar professionals, and perhaps help break down barriers between specialty silos.

There is no wasted time – there is only unrecognised experience.


Published: 18 Feb 2019