This is a summary of a panel discussion on career paths held at the 2019 onthewards conference, with panel members, Dr Belinda Gray (Cardiologist), Dr Bridget Johnson (Palliative Care Consultant), Dr Rhea Liang (General and Breast Surgeon), Dr Ken Liu (Transplant Hepatologist), Dr Clare Richmond (Emergency Physician and Pre-Hospital & Retrieval Medicine Specialist).
Some paths in medicine traverse a well-trodden path, for example, a specialty eyed off during medical school, then internship/residency/registrar followed by advanced training, fellowship and/or PhD in a speciality. Take Dr Ken Liu, a young budding gastroenterologist who decided on a career in gastroenterology in medical school. He subsequently actively pursued this from early on with rotations and research projects in gastroenterology which got him onto the training program. After an overseas fellowship and a PhD, Dr Liu is now back as a staff specialist transplant hepatologist at Royal Prince Alfred Hospital, Sydney, Australia.
Dr Clare Richmond initially wanted to do “a million things” during medical school including neonatology, geriatrics, intensive care and anaesthetics. She still does a million things but found a way to package them all-up. Dr Richmond is now an Emergency Physician working in pre-hospital and retrieval medicine with NSW Ambulance.
On the other hand, some paths in medicine may take unexpected turns. Take Dr. Belinda Gray, who always saw herself as a rural GP with a focus on women’s health working in country NSW after her internship and residency. Her career took an unexpected turn after an inspiring cardiology term. During an ED term, she found herself drawn towards seeing all the chest pain patients. She eventually went on to complete cardiology training, a PhD and an overseas fellowship in the UK. Now she returns as a cardiologist, NHMRC early career fellow with a subspecialty focus on sudden cardiac death in the young.
Dr Bridget Johnson initially wanted to become a paediatrician but fell in love with the complete opposite in adult palliative care medicine after an inspirational palliative care rotation which she describes as someone “switching the colour on”. Dr Johnson is now a staff specialist in palliative care and the Director of Physician Education at Greenwich Hospital in Sydney, Australia.
Dr Rhea Liang always imagined herself as a GP, even through her junior years. However, she kept getting a pull towards surgery year after year. After a consultant surgeon saw potential in her and ‘coerced her’ (“you will not pass this rotation unless you sign up to surgical training!”), she gave in. Dr Liang is now a consultant breast and general surgeon on the Gold Coast, Queensland, as well as the Chair of the Operating with Respect committee for the Royal Australasian College of Surgeons (RACS).
Everyone seems to tell junior doctors to ‘be strategic’. Whether it be preferences, rotations, interviews or life. What does that actually mean?
Dr Richmond knew she wanted to become an ED physician by the end of residency. That didn’t mean she spent her life as a junior in the ED. She opted to do a plastic surgery term to gain unique skills. Not the highfalutin microsurgeries but the skills in tendon repair and facial fractures that would be invaluable to her role as an ED registrar. She also opted to take consults in ED during her surgical terms. Dr Richmond also sought out terms in ICU and anaesthetics specifically for a skillset that would prepare her well as a retrievalist. She was strategic about gaining the skills required in the long-term by planning ahead.
“Get the skills you need for the job you want”
There is always a reason not to go overseas, whether it be family, a job opportunity locally, a partner with an established non-medical career or the timing just doesn’t seem right. But there is never a perfect time to go overseas.
Dr Johnson took the plunge with an SRMO year to travel to rural North-Eastern Thailand to conduct cryptococcal research on HIV populations. It was a ‘mind-blowing’ year that opened up opportunities that she never could have imagined prior to going. She was told that it would ruin her chances of getting a job as medical registrar: that everyone would ‘forget her’ and she’d be a year behind her colleagues. However, it was a detour that massively paid off. Not only did she gain invaluable skills, but it dominated all her job interviews when she came back and in fact it was nearly the only thing that was talked about! Perhaps the hardest part of the medical train is not getting back on it but leaving it. If you’ve got an inkling for it, be brave and take the dive. You will be rewarded. No career experiences are wasted.
During her UK fellowship, Dr Gray worked at a London hospital that had 40 cardiologists on staff. The volume of patients simply can’t be matched due to our population size. You subsequently widen your skillset, especially for procedure-based specialties, which become important in consultant interviews (procedural logbooks). Additionally, Australia is restricted in many research field contacts purely due to its isolation from Europe and North America. Dr Gray now has extensive research and personal contacts in the UK and all across Europe and North America as a result of her fellowship.
Good mentors will come in many shapes and forms, depending on your relationship and stage of career. A good mentor is someone that will be interested in your progress and willing to invest in you. It will be someone who will enjoy watching your progression through your career. Someone whose personality will gel with yours and know your strengths and weaknesses.
Dr Richmond discusses that a good mentor is not someone who tells her what she needs to do but will suggest ideas and bring up questions so that she can come to the decision herself. Dr Liu emphasises the importance of mentors outside of your own specialty. Have a mentor for academia, have a mentor for work-life balance, have a mentor for clinical work. Dr Gray says that, ultimately, a good mentor is someone who you can call up, have coffee with or a glass wine with, even after a prolonged period of minimal contact.
Predatory menteeship – what is it? Predatory menteeship is the idea of a mentee seeking out mentors only for what they can get from the relationship, not for what they can contribute.
“Can I write a paper with you? Can I clip myself on to one of your research projects?”
Senior staff all get approached by a lot of people, but the trainees seniors really want to mentor often feel like no effort at all, says Dr Liang. “You delight so much from what each brings to every meeting”. Be respectful and find a way that you can contribute. If you can’t contribute early on, stick around till you can!
Keep mentors updated! A good mentor will gain satisfaction from your progress and milestones. When you achieve a goal, share it with them – thank them for the contribution they made to your progress.
Overall, a good mentee will be reliable, punctual, enthusiastic and respectful. Little things do not go unnoticed and the more you put in the more you will get out of it!
Rural and peripheral terms can be mistaken for a necessary labour, being involuntarily sent out to the middle of nowhere for a lonely three-month existence. However, Dr Liang had a wonderful experience in Rotorua Hospital, New Zealand during her training years, as one of just eight junior doctors that coordinated the wards at the time, meaning frequent close contact with consultants and exposure to the operating theatre. She was frequently seeing consults and assisting in operations “getting my hands dirty”. There is a smaller consultant to junior ratio and if you are keen and enthusiastic, it will most likely be reciprocated.
There is also a misconception about referees and their titles and roles. Many junior doctors are of the belief that the most distinguished professor at the biggest hospital is the golden ticket to a coveted registrar job at a metropolitan hospital. Take it from senior staff who sit on interview panels who read hundreds of CVs, this is categorically not true. Find someone who knows you well, who will go out to bat for you.
Whatever path you take, there is no right or wrong way. Take advice from those you respect. Seek out a mentor. Be a good mentee. Take opportunities that come up. Plan ahead and make opportunities for yourself. Sometimes you won’t realise what or who redirects your path. Be open and you might end up somewhere you could never have imagined!
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