Why do doctors tend to choose one career over another and how should you approach the subject? In 2017, the BMA conducted some qualitative research into the drivers of career choices and here are the top 5 factors driving specialty selection.

1. Enjoyment and excitement of the work

Enjoyment and excitement of the work was the top factor cited for choosing a specialty in the BMA 2017 focus groups, by 40% of those surveyed. Look back at what you enjoyed at medical school and during foundation programme and understand why. Take time to understand yourself and what motivates you. Beware of making assumptions based on the fun you had due to the team rather than the specialty itself. You’re not always guaranteed a fun team or department. Also protect yourself against innate bias – be honest with yourself; if you’ve always hated working on your own, don’t ignore that because it’s been your childhood dream to become a general practitioner.

2. Variety of the specialty

Variety is the second highest factor, cited by 30%. This recognises that as we specialise the range of work becomes much narrower, therefore variety becomes a much more critical factor.

Variety will mean different things to different doctors – it could be variety from a clinical perspective or variety through the interests you can pursue in a specialty.

For example, Andrea Collins, Specialty Trainee Year 7 in Respiratory Medicine loves the variety in subspecialism within respiratory medicine:

“Many people seem to believe that respiratory medicine is all sputum, but I’d argue that gastroenterologists in particular have to deal with a lot more bodily fluids than we do… In fact there’s a lot of variety in respiratory medicine: from acute medical conditions, such as acute pulmonary emboli, to managing chronic conditions such as bronchiectasis and chronic obstructive pulmonary disease, to involvement in palliative care.”

Yet Steve Mowle, Vice Chair of the Royal College of General Practitioners Council and General Practice Trainer in the London Deanery comparably cited the variety of General Practice:

“In my experience, a career in general practice offers variety and flexibility. I can choose to work out of hours shifts; I have been able to develop my interest in treating mental health and addiction; and it’s been possible to achieve the right work-life balance for me, enabling me to fit medical education and politics around my practice.”

You have to think long-term and about what type of variety you’re looking for.

3. Amount of patient contact

How important is patient contact in your clinical work? Previous BMA survey data highlights the importance of this for medical students, so it’s not surprising it’s a driver for later career decisions. The level of patient contact you want is a key determining factor for which specialty would suit you.

As Hywel-Jones, sub-dean of medicine at Gwent Clinical School, a practicing anaesthetist and president-elect of the Royal College of Anaesthetists council says:

“Some friends joked that I chose anaesthetics because I didn’t want to speak to my patients, but anaesthetists have to be excellent communicators to reassure patients when they are at their most vulnerable. Our role is to humanise what is inevitably a frightening experience, especially for young children, and do our best to ensure it is as stress free and pain free as possible. The responsibility can be stressful, but experience helps, and you are never isolated because you are always working in a team.”

4. Matching your skillset & personality

Every specialty has a stereotype; whilst they’re certainly not always true they can be surprisingly accurate. Aim to do a thorough evaluation of your likes and dislikes, strengths and weaknesses to ensure your specialty choice is right for you. We tend to like what we’re good at and comfortable with, but bear in mind that being challenged and growing in your job will make your career more fulfilling and rewarding.

Take a look back at your placements and time at medical school and be honest about your skills. Are you the practical type who enjoys? Sounds like surgery is for you. Do you enjoy attention to detail and being meticulous? Radiology is one to look at. Draw up a list of achievements and compare them to the person specifications on the specialty training website.

5. Intellectual challenge of the specialty

The final reason was intellectual challenge. Think about your ambitions and what motivates you. Where do you see yourself in 15 or even 40 years? Will this choice of specialty still stimulate you at consultant level? Choosing a specialty requires taking a step back and assessing long-term about what you want.

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