What to consider when switching specialisations

With so much time and energy involved in pursuing a medical speciality, it may feel like switching specialisations is a bad idea. But as Dr Alyssa Ormond discovered when she was four years into intensive care training, switching could be the decision that reinvigorates your love of medicine.

Originally from Cairns, Dr Ormond completed her undergraduate and postgraduate studies in Brisbane and Adelaide. Following internship and a year as a Resident Medical Officer (RMO) at Flinders Medical Centre, she decided to commence a Fellowship with the College of Intensive Care Medicine. While she loved it initially, four years as an ICU registrar had her questioning whether she was on the right path.

“With time, intensive care lost its shine for me, and multiple factors contributed to my first dance with burn-out. I just felt worn out from something I was meant to enjoy doing,” Dr Ormond says.

In search of a change of scenery, Dr Ormond moved to Darwin and dipped her toe into emergency medicine. It was there that her love of medicine was reinvigorated. She thrived on the fast-paced environment, the doctor-patient interaction and being part of an enthusiastic team of consultants.

“It reminded me of what I am here for as a doctor and lured me to the ‘dark side’, which is what many in ICU call Emergency. 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,” Dr Alyssa says.

As well as thoroughly enjoying her new specialisation, Dr Ormond is glad to have made the switch from a city hospital to the regional setting of the Cairns and Hinterland Hospital and Health Service.

“To be honest, I would hate to go back to working in a metropolitan area. From my experience, there’s more of a medicine hierarchy in the capital cities. Up here, everyone cares about each other a little bit more. I also think you get a wider breadth of medicine here. The diversity of cases and the supportive environment have made for a very positive training experience. I look forward to coming to work now!”

If you’re unsure about what specialisation to choose or are thinking of switching, Dr Ormond has some tips for you based on her experience…

• Figure out what you love
  Some people have a very clear vision from early on, but many 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!