How to pick your dream specialty

Choosing a medical specialty can seem daunting for doctors who haven’t settled on their path before or during medical school, or wish to make a career pathway transition.

When weighing up clinical interests, preferences, experience on rotations, training time and financial demands, as well as lifestyle considerations, it’s a complex and life-altering decision.

Medical career planning expert Dr Ashe Coxon recommends starting with the basics, first considering: “Am I aware of all of my options?”

“Many people jump into a career without having a complete understanding of the other pathways available to them,” Dr Coxon says. “This is fine if you are certain it’s what you wish to do, but if you are uncertain, then I would recommend doing some research around all of the options you can pursue to help make your decision.”

Dr Coxon, a Townsville-based general practitioner, became fascinated by career counselling during her postgraduate years and branched out not long after completing her RACGP Fellowship.

After qualifying as a certified career development practitioner, she started a business helping doctors figure out their careers. She now works with medical students and doctors-in-training to assist them in their career goals, career uncertainty and career transitioning.

With a Master’s in Clinical Education and a Graduate Certificate of Career Development, Dr Coxon runs Medical Career Planning as well as working as a clinical GP. 

Dr Coxon’s top 3 tips for a student or junior doctor deciding on a specialty pathway are:

1. Instead of saying, 'I want to be an XYZ', spend some time reflecting on how you want your career to be. For example, ‘I want to work in a hospital, surrounded by team members, in an acute, fast-paced environment.’ By doing this you leave your options open to many careers and not just focus on the one specific career.
2. Be aware of your interests: Know what you like within medicine and know what you don't like! Know what you like outside of medicine and ask yourself if you are still pursuing this interest and whether you can somehow make it work within medicine?
3. Be aware of your core values: What is really important to do? What do you value most? And which career will move you towards this?

Switching specialties down the track

It’s a big move to shift course after investing years in a vocational training pathway that doesn’t feel like the right fit. But all experience sets the foundation for a new challenge, and changing specialties doesn’t mean time in a previous discipline was wasted. Dr Alyssa Ormond has no regrets about her decision to switch specialisations four years into intensive care training. A move from Adelaide to Darwin to dip her toe in emergency medicine reinvigorated both her career interest and her outlook.

“It reminded me of what I am here for as a doctor,” Dr Ormond says. “So I joined the Australasian College for Emergency Medicine (ACEM) and continued dual training when I moved back to Cairns in 2018. I’m now pursuing emergency and have my ICU training on deferment.”

The supportive training environment of a regional hospital and the diversity of cases in comparison to metropolitan areas are part of why she now looks forward to coming to work each day.

Dr Ormond’s advice to doctors who are considering a switch or unsure about what specialisation to choose:

Figure out what you love

Some people have a very clear vision from early on, but others just don’t know what they want to do. I speak to junior doctors all the time who say they’re still unsure, and that’s OK! I would advocate for everyone to use their rotations as proactive opportunities to determine their interests. Medicine takes up so much of your life, you want to be happy with what you’re doing.

Prepare your letter of recommendation

If you’re switching specialisations, you’ll need to consider which supervisors or colleagues you could approach for a letter of recommendation. I had a letter from three of the emergency physicians from my time in Darwin who endorsed my entry to ACEM. The letters basically stated that I was reliable and that they enjoyed working with me!

Make a submission for recognition of prior learning

I was four out of five years into intensive care before I switched, but I don’t view those years as wasted time! There’s a lot of crossover between the colleges so you can apply for recognition of prior learning. It’s judged case by case and they’ll credit your previous experience to the new fellowship where it’s deemed relevant. Everything you’ve done adds to your experience as a doctor.

Tailor your RMO years

Since some colleges won’t accept you until you’re at least PGY3 or PGY4, use your time as a Resident Medical Officer (RMO) to prepare for the future. Investigate the requirements and recommendations of the college you’re interested in and tailor your rotations to reflect the trajectory you would like to take.

Ask yourself, ‘What have I got to lose?’

From my experience, I would say if you’re thinking about switching, just do it! If you’re in one college, you don’t have to leave it to apply for another. If you’re successful, you can take a deferment to try the new specialisation. I'm lucky that my specialisations have similarities and crossover of rotations so if I do an anaesthetic rotation that counts in both specialisations, so that can fast-track the training. But you don’t have to give up one completely to try another.

Find out what’s available and where

With 54 medical specialisation training pathways available in northern Queensland, you can explore options and map your journey. If location is important, look at these NQRTH resources to see the available clinical pathways in your desired region: 

• Specialties available in Cairns and Hinterland HHS
• Specialties available in Townsville HHS
• Specialties available in Mackay HHS
• Specialties available in North West HHS
• Specialties available in Central West HHS
• Specialties available in Torres and Cape HHS

Explore where the need is. There are many stories of specialists who have developed services in regions and communities that previously lacked those services. There’s an opportunity here to meet the needs of regional and rural communities by training in specialties that are not oversupplied, and in fact are in demand in the regions. Each regional hospital has a dedicated workforce and education unit that can assist you in identifying gaps in specialist services in their communities and support you transitioning into specialty training.

Ask senior colleagues and your regional hospital’s Medical Education Unit (MEU) about pathways and how to pursue them. MEUs can help you understand the accredited speciality training available at each site in North Queensland, connect you with local college-active consultants or local trainees, explain equipment and services available in local HHS service groups, as well as provide college support contacts, local wellbeing services and information on educational opportunities. All MEUs in North Queensland are involved in facilitating career events annually, for example, Townsville Careers Fair, Mackay Open Day and Careers Sessions and Cairns Career Focus sessions.

Consider extensions like General Practice with a special interest in Sexual Health, or Psychiatry with special interest in Addiction Medicine.

Think outside the box – consider non-clinical or non-traditional options, for example, Global Health, or Public Health Medicine, which is considered a ‘future-proof’ specialty.