To BPT, or not to BPT, that is the junior doctor’s question…

As my graduating peers and I embark on our medical careers, it’s a fitting time to consider which medical careers we actually desire. I’ve always had a strong sense of direction for the specialty path I wish to pursue, but at times, like now, I flirt with the idea of pursuing other avenues. It is an important issue that deserves deliberate consideration as it’s what most of us will dedicate the lion’s share of our lives to.

• Is being a “specialist in life” as a GP the way to go?
• Or to heal with steel in surgical training?
• What about the variety of skills and presentations in ED?
• How about the doors that open via basic physician training (BPT)?

As I wondered how to systematically manage this internal psychological conflict, I did what any task-oriented and mildly-obsessive junior doctor would do and devised a psychiatric management plan for myself..

32yo male doctor presents with indecision concerning medical career path.

Plan:

1. Priorities/ Risks
   • There are already a surplus of junior doctors.
   • Over 200 graduates missed out on internships this year in Australia, yet Perth has a new medical school on it’s doorstep.
   • Competition will only get fiercer, the risk of missing a place on that desired specialty program has never been greater.
2. Status
   • ?inpatient vs ?outpatient.
   • Do you want a hospital or community-based career? Public sector, private sector or both?
3. Location
   • ?local vs ?rural/remote vs ?interstate vs ?international
   • Where do you desire to live, but also where’s the demand for your specialty?
   • It may be be tough working as an intensivist if you want plan to live in the bush.
4. Collateral History
   • Gain as much knowledge as possible from multiple sources. Corroborate that information. Consider
   • Advanced trainees (a little satire from Gomerblog, find the trainees during their 1-hour reflection time)
   • Mentors – if you don’t have a mentor, get one. The best experiences I’ve had thus far in medicine have been directly attributable to mentors.
   • Training colleges – e.g. Australia’s approved medical colleges
5. Investigations
   • Bedside – surf the web, social media groups, research college societies.
   • Bloods – get some skin in the game and attend conferences – e.g. the Australasian conference calendar
   • Imaging – get a first-hand look at the role with placements. Volunteer. Get your face out there. NB: there’s a great volunteering opportunity next year for all manner of Australasian-based doctors at the 2018 Gold Coast Commonwealth Games.
6. Vitals
   • Supply & Demand – Is it feast or famine for your specialty in the next 5-10 years? e.g. I reviewed the latest workforce statistics and projections in Western Australia.
   • Remuneration – the top 12 most well-paid jobs for men in Australia are all medical specialties, and if you’re a woman, 19 of the top 22 most well-paid are accounted for by medicine.
   • Training Pathway/ Requirements – Compare pathways with this nifty career pathway tool from the AMA.
   • Competitiveness – EVERYTHING is competitive now. Gone are the days off falling into a specialty pathway, so how do you separate yourself from the pack?
   • Have a back-up plan! One of the best pieces of advice I took from a series of orientation lectures recently was to have a back-up plan. Life rarely goes exactly the way we want it, so just keep your options open.
7. Consults
   • Philosophically speaking, what it is you want to do with your working life? Consider consulting some of history’s greatest minds. Warning: the rabbit-hole goes deep.
   • Alain de Botton (Swiss/British Writer)
     • “work is meaningful…whenever it allows us to generate delight or reduce suffering in others”.
   • Oliver Sacks (Neurologist/ Author)
     • “I have been given much and I have given something in return; I have read and traveled and thought and written…Above all, I have been a sentient being, a thinking animal, on this beautiful planet, and that in itself has been an enormous privilege and adventure.”
   • Epicurus (Greek Philosopher)
     • “…work is satisfying when it’s meaningful, in very small groups or alone and when we sense we’re helping others. It isn’t through money or prestige”
   • Jean Paul Sartre (French Philosopher)
     • “…don’t live in bad faith” –  don’t believe you have to do a particular job, remember you’re a free human being.
8. Biological
   • How will your specialty affect you physically?
   • Sedentary vs active role? Would you prefer to mostly sit a desk, or run around outside? (NB: yes, you can run around outside as a doctor and get paid for it).
   • Sleeping? Does the routine of a “9-5” or the variability of shift work suit your sleeping patterns?
   • Planning a family? Is that surgical program or part-time GP more likely to be sympathetic to those plans?
9. Psychological
   • What is your passion? What’s your gut feeling?
   • How is it likely to affect your mental health? We need to be aware that as doctors we’re more likely to experience mental health issues than the general public.
10. Social
    • How will your specialty affect you socially?
    • Work-life balance? Will you work weekends? Nights? On-call? Shift-work?
    • Team-based vs individual specialty? Do you like being part of a big team/clinic or being more of a lone operator?
    • Social support networks? Do you, or your specialty, have support structures in place?
    • Litigation risk? Doctors get sued. Some more than others…
    • Culturally congruent? Does your culture frown upon you working purely in the private sector? Or performing abortions? Or conducting stem-cell research?
    • Is it spiritually fulfilling?
11. Begin discharge planning on admission
    • Start planning to discharge yourself from your desired training pathway the second you step foot on the ward! Begin with the end in mind.

…or if you’re too under the pump for all of the above, you’re probably already familiar with this much simpler management plan..

Plan:

1. Continue current management plan…

Best of luck!

References

1. Royal Australian College of General Practitioners. Your Specialist in Life. 2016.
2. Maria Hawthorne. More than 200 medical graduates miss out on jobs. Australian Medical Association,; 2017.
3. Gomerblog. Week to Reflect on Their Poor Career Decision. 2017.
4. AHPRA. Approved Programs of Study. 2017.
5. MJA. Calendar of Conferences in Australia and New Zealand. 2017.
6. Gold Coast 2018 Commonwealth Games Corporation. Help Shape Our Games. 2017.
7. Australia GoW. Specialist Workforce Capacity Program (SWCP) 2015 summary sheets. 2015.
8. Sarah Kimmorley. Australia’s Top 50 highest paying jobs. watoday.com.au; 2016.
9. Australian Medical Association. Career Pathways Guide. 2016.
10. Alain De Botton. Pleasures and Sorrow of Work. Great Britain: Penguin Books; 2009.
11. Oliver Sacks. Gratitude. Pan Macmillan UK; 2015.
12. The School of Life. Great Thinkers. Latvia: Livonia Print; 2016.
13. Tane Eunson. Super Docs 2.0. : 2016.
14. Mukesh Haikerwal. Doctors’ mental health needs our help MJA InSight; 2016.
15. Anupam B. Jena, Seth Seabury, Darius Lakdawalla, Amitabh Chandra. Malpractice Risk According to Physician Specialty. New England Journal of Medicine,. 2011;365(7):629-636.