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How I managed my late-career switch from general practice to obstetrics

 

Was it the thought of slippery little beings being delivered into my welcoming hands? Was it a feeling of bored complacency? Or – perish the thought – a midlife crisis?  The prospect of change enticed me when I applied for entry into the Advanced Diploma of Obstetrics traineeship. Naysayers and sceptics abounded, with sagas of sleep deprivation, eight-litre postpartum haemorrhages and lightning ambulance trips with arms, elbows and shoulders up vaginas supporting uterine inversions. “You’ll come crawling back to general practice begging for your job back” they sniggered.

My initial few weeks were a terrifying blur of inexplicable acronyms, abbreviations and staccato instructions yelled in rapid transit. “CTG” no longer meant “close the gap”, “stretch and sweep” didn’t connote house work, and third stage had little to do with opera. I learnt to wear only meconium coloured clothes, to roll up my sleeves before rupturing membranes, and that amniotic fluid rots the Velcro on shoes.

The seriousness and difficulty of my new challenge was quickly apparent. Simple procedures like cannulation, long forgotten, had to be perfected. My first few vaginal examinations during labour left me perplexed. Didn’t these women have cervixes?  I wish someone had taken the trouble to describe them as a stretched balloon with a hole, instead of the nose like structure to which I was accustomed in general practice. I now use this handy analogy as a teaching tool.

Twelve hour days, plus nights on call, with missed meals were followed by intense studying for the written and clinical exams. Challenging for the young, but nearly impossible in one’s sixties. My energetic, obsessive personality prevented me from leaving until every “i” was dotted and ”t” crossed, so my hours escalated in a malignant fashion, inversely proportional to my sleep time.  I hated living away from home and my long-suffering husband. My first rental accommodation was cockroach ridden, dark and depressing – a far cry from the beautiful rural farm that is my home. I missed my children and grandchildren, my friends, my life. Family events came and went in my absence. I suffered severe insomnia as well as horrific nocturnal leg cramps. I’d awake up to six times a night, screaming in agony, with my gastrocnemius muscles caved in. Initially I blamed my marathon walking on hard surfaces, until the correlation with the most stressful days became evident. How my neighbours must have loved me!

Learning skills from people the age of my children was humbling, and often humiliating. Negotiating different, and often aberrant, personalities amongst consultants was challenging. It was evident that one particular “boss” thought I should be at home knitting, while others patiently tolerated my slow but steady acquisition of skills. Another was openly disdainful. Initially, I simply tried too hard. To my horror, a patient complained that I hadn’t finished an examination when she’d asked me to do so. My boss had told me it was IMPERATIVE to complete this examination to avoid a dire clinical outcome and I’d gone at it like a bull at a gate. Naturally, I apologised, but my first ever patient complaint distressed me and crushed my already waning confidence.

The competitive atmosphere of the hospital took me by surprise. Gone was the collegiate atmosphere of General Practice. It was dog eat dog now! Fights for the caesarean lists, scrambling for labour ward shifts, crafty manipulation to avoid certain consultants. And I was as guilty as anyone! Those – like me- who were less aggressively competitive, missed out.

Surgery almost proved my nemesis. It had been nearly forty years since I’d graced an operating theatre or studied anatomy. Scrubbing, gloving and turning to tie up sterile gowns were nearly my undoing. Gnarled theatre sisters rubbed their withered hands with glee when I contaminated myself yet again, or forgot the name of some ubiquitous, obscure instrument! I mean, why the eponymous title for forceps? (Greene Armytage? Moynihans? Wrigleys?). Pointing or referring to them as “that one” didn’t really inspire confidence!

Surgical knot tying practice left my home resembling a sadomasochism den. Although I can certainly tie a hook on my fishing line better now! Other trainees learnt surgery so much more easily than I did! Yet, learn I painstakingly did. It seemed to take forever, but I can now perform straightforward caesareans, challenged occasionally by the odd impacted or high floating head. Instrumental births were difficult, but I am gaining my confidence. I passed my theoretical and clinical examinations with flying colours, and my “case syntheses” were marked as “excellent”.

After 18 interminable months, my traineeship is effectively over. Other trainees are progressing well but I still have a couple of skills to sign off. This, of course, presents a new challenge! I have begun ad hoc locums as an obstetrics registrar, but I am now the bottom of the pecking order as far as skills acquisition goes. Where to from here?

I look back at these 18 months with a mixture of horror and deep satisfaction. The knowledge that I was accumulating was massive and interesting, the studying strangely enjoyable, the care of mothers in labour and birth exhilarating. I’m often asked: ”Why? What are you planning to do with these skills?” My original plan was GP Obstetrics in remote and third world regions. Now I am assailed with self-doubt. Am I capable? Do I have the stamina? Can I cope with the stress and the inevitable occasional adverse outcome?

At this stage I can’t answer these questions. But the other day, as I delivered a beautiful baby boy with forceps, following a long and exhausting labour, I felt that slippery little bundle in my welcoming hands and witnessed the joy and relief on his parents’ faces, and all those negative memories flew out the window as I immersed myself in the miracle of new life, and felt so grateful to be a small part of this exquisite epiphany.

 

Switching medical specialties: is it feasible?

 

Of all the professions, medicine has one of the most rigid career pathways; it can feel like a conveyor belt that you can’t get off. But what if, during or after your training, you decide you’ve chosen the wrong specialty? Are you stuck with what you started, or is it feasible to switch horses midstream?

Around 10% of residents in the Australian system do choose to switch their specialty each year, so the answer is that it’s certainly possible. But it’s not a decision to be taken lightly, as it could involve up to three years of supplementary training.

It’s not uncommon for those in training to feel unsuited to their specialty, leaving them stressed and sometimes like they may want to leave medicine altogether. A discipline might end up being a poor match for the person’s core skills or might jar with his or her personal preferences. Registrars embarking on a career in pathology might find that they miss the patient contact and pine for the hospital wards; or alternatively a registrar in general practice might find the constant personal contact too emotionally draining.

But no decision should be made about switching specialties without considerable reflection and consultation with colleagues. Often, doctors might think they’re unhappy with a specialty when in fact other issues are at play: difficulties with a particular colleague, a desire to work part-time instead of full-time, an overly long commute or even problems at home.

“You need to look at what’s really going on in your life to see if there are ways of resolving your problems without retraining.” says Dr Caroline Elton, a UK-based psychologist and medical careers advisor.

Dr Elton says doctors finding themselves at a career crossroads should go through a “career planning process”, whereby they carry out a self-assessment to identify their interests, skills and abilities and to decide what is really important to them.

They should then look at what specialties best match their skills and priorities, learn more about them and plan what to do to be able to work in them.

Here are a few tips for doctors who find themselves wondering whether they’re in the right specialty:

  • Be aware that taking a step sideways will inevitably also mean taking a small step backwards:
  • Be proactive and seek advice from as many people as possible, both within the specialty in which you are already training, and in the one to which you’re think of switching. Don’t feel that it will be considered a black mark against you if you ask for support in leaving a specialty. Such support is crucial;
  • Find out as much as possible about the preferred specialty, particularly what the eventual job entails rather than just what you go through in training;
  • If you are still unclear about the way ahead, consider a dual training pathway;
  • For consultants, switching specialties is likely to be considerably harder and involve a major upheaval; be prepared to lose the protection of your consultant contract;

Source: BMJ Careers

Visit the AMA Career Advice Hub for useful information across the whole medical-life journey as well as Career Counselling Service resources. For one-on-one assistance, contact Christine Brill at careers@ama.com.au .

Click here to sign up to the doctorportal jobs board.

Five keys to taking charge of your medical career

 

You’ve done your internship, you’re nearing the end of your PGY2 year, and you’re thinking seriously about where you want to go next. It can be a daunting stage of your medical career, particularly as competition for training positions can be ferocious. What can you do to take charge and give yourself an edge when applying for positions?

Christine Brill, Career Adviser at the Australian Medical Association, says this stage of a doctor’s career is a complex crossroads but the key to navigating it is to know yourself first.

“You have to know what intrinsically motivates you,” she says.  “You’ll know what you like and dislike about medicine to this point, so it is more likely than not that you’ll have a number of specialty options in consideration. Our Career Service website’s Specialty Training Pathway Guide will help you narrow down your choices by allowing you to view up to five specialties on your screen.  This is one of our most popular web resources.”

Another critical factor, Christine says, is what kind of lifestyle you want as you move further into your medical career. Orthopaedic surgeons, for example, work very long hours and are often on call with a high level of unpredictability, so if this doesn’t sound like your preferred lifestyle, it may not be the right career path for you.

Location is also key aspect: in choosing a medical specialty, you should think about whether you’re ready to move to pursue your career, and whether your chosen specialty can be done in one location.

Other issues to think about are whether you want to work in the public or private sector, or a blend of both; how much it’s going to cost you to achieve your objectives; how long the training will take you; and how competitive you’ll need to be with your peers to get a place in your chosen program.

“You’re going to be competing, so what you’ll need above all else is a really good CV,” says Christine.

“Every CV that crosses my desk needs to be tweaked. People don’t always understand what needs highlighting. You need to present information so that it excites interest and offers a solid snapshot of the candidate in the shortest possible time. Because your CV will not be the only one looked at on any given day.”

Christine adds that the cover letter and any statement addressing selection criteria are equally important.

“These documents will determine whether you get an interview – or not.  So it’s worth investing time in them.”

Another question that junior doctors ask themselves is what other things they should be doing in their early years to help them achieve their objectives. Should they be going off to do a PhD, a Masters, or getting into research?

“Generally, good advice is just to get lots of experience,” Christine says. “Narrowing your focus may not serve you as well as getting lots of experience.  Look at what the Colleges are looking for in their candidates, and focus on those as your prerequisites.”

Here are some keys to making the right decisions as you move forward in your medical career:

  • Know yourself and understand what motivates you;
  • Make sure you get as much experience as possible. Find out what your preferred training College is looking for and focus on that. Time off for a PhD or Masters at this stage may not be the best idea;
  • Think about where you want work, how hard you want to work and how much you’re prepared to sacrifice;
  • If you’re leaning towards one specialty, talk to a senior colleague and ask if you can tag along to get a feel for the discipline;
  • Your CV and cover letter are critically important: get professional advice to make sure they’re as sharp as they can be.

Visit the AMA Career Advice Hub for useful information across the whole medical-life journey as well as Career Counselling Service resources. For one-on-one assistance, contact Christine at careers@ama.com.au .

Click here to sign up to the doctorportal jobs board.