One of the hardest decisions in your career begins at foundation level, when you have to start thinking about which specialty to pursue. With over 60 specialties and more than 30 subspecialties to consider after foundation training, it can be a tough choice.
If you know which specialties you prefer, you may be able to opt for particular foundation or core programmes that assist your career decision. Other trainees are more influenced by factors such as geography – they want to stay in a particular region, and will consider a range of specialties in order to fulfil that aim.
If you have decided on a career as a physician, the first step is relatively simple, because there are only two main training routes. You should apply for either core medical training (CMT) or acute care common stem (acute medicine; ACCS) training. Entry is at core training level 1 (CT1), and training lasts for 2–3 years. Both routes open up access to over 30 medical specialties, which commence specialty training at level 3 (ST3). This ST3 training lasts 4–5 years, and can sometimes lead to subspecialty training (eg as a gastroenterologist, you could specialise further in hepatology).
Factors to consider
When choosing a specialty, it’s important to take into consideration who you are: your personality, likes and dislikes, abilities, interests, ambitions, aptitudes, limitations and task-management skills.
Are you a hands-on practical person, or do you like to think about detail and solve complex problems? Can you deal with uncertainty and complex/busy situations, or do you prefer a more ordered approach with time to think?
Many of the medical specialties require a mixture of attributes because of the varied and variable nature of work as a physician. Many deaneries / local education and training boards (LETBs) and foundation schools provide personality and learning style testing through their careers department, as well as detailed specialty descriptions.
Key preferences to consider while choosing a specialty include:
- Patient contact levels – will you have time to develop patient relationships, or would you prefer to see many patients in a day? What kind of patients do you want to treat?
- Training schedule and time taken to reach consultant level – how long do you need to train for, how many hours are required and, once you are a consultant, what hours are you required to work?
- How competitive is the specialty selection process – do you have the knowledge and skills base to get selected?
- Career progression – how far can you go in each specialty, and how far do you want to climb in your career?
- Stress management – how do you cope with stress? Could you work in the high-pressure environment of acute medicine?
- Do you like research? Data and analysis?
- Do you like problem-solving, or straightforward care practices – structured work?
You need to consider the specialty’s requirements, conditions of success, advantages and disadvantages, financial and personal compensations, prospects, and opportunities for further career and educational development. You should be realistic about the relative strength of your application; some specialties are very oversubscribed. You should investigate competition ratios, but bear in mind that these data are historical, and do not necessarily reflect future competition – indeed, the mere act of making this information available can change applicant behaviour.
All specialties require completion of an application form. The application process is now completed through an online system called Oriel, which allows you to view vacancies, apply for posts, book interviews and manage offers, all in one place. You need to register with Oriel before you create an application for the first time. You can do this on the Oriel website, where you will also find a comprehensive applicant user guide.
Your application will be marked at the shortlisting stage according to a number of specified achievement categories. These include:
- undergraduate degrees and qualifications
- postgraduate degrees and qualifications
- additional achievements
- clinical audit and quality improvement.
Full details of the number of points available for each category are given in the Joint Royal Colleges of Physicians Training Board’s (JRCPTB’s) ST3 Applicant Guide, available to download on the ST3 recruitment homepage.
Opportunity for change
If you find yourself in the position where you doubt that you are in the right specialty, there are still opportunities for change. Quite a few specialties recognise that trainees who move from one training path to another, bringing with them useful skills – for example, undertaking CMT before moving into radiology or general practice, or undertaking general practice before entering physician training. However, the more changes you make, the longer your overall training pathway becomes, and your decision-making capabilities may be questioned by selectors.
You could consider a fixed-term post, either in the UK or abroad, to gain experience in particular specialties; this will help you validate your decision about the specialty that you want to pursue next. This is also relevant if you are having trouble choosing your first specialty.
Quite a few foundation doctors step off the career ladder before entering specialty training, in order to experience different specialties and different healthcare systems, and the experience gained is usually very useful.
Liz Berkin, clinical lead for specialty recruitment, RCP London