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Time to end lucky-dip approach to career choices

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For many junior doctors, the choice of vocational training and subsequent medical career is a complex and poorly-understood process.

In fact, it’s fair to say that no two junior doctors’ career pathways are quite the same, a unique mix of perspective, desires and interests, heavily shaped by mentors and early career experiences.

As described by Anthony Scott and Catherine Joyce in the 21 July edition of the Medical Journal of Australia, the medical workforce is undergoing substantial change, and career choices may not be the same for tomorrow’s doctors as they are today — or perhaps even yesterday, so to speak, given current training bottlenecks.

A medical training system that demonstrates social accountability should be responsive to community needs, both in terms of location and specialty of training.

The challenge for policy makers and the profession is to sustainably achieve these aims while maintaining an employed and engaged generation of doctors with the high-quality training required to meet Australia’s future health needs.

Various policies have been implemented to influence the location of future practice, including bonding schemes. But there is little guiding input into pathways of specialty choice.

With the exception of posts funded by the Specialist Training Program, trainee numbers in each vocational pathway are relatively loosely coordinated and, depending on pathway, remain determined by complex negotiations between health services and accrediting Colleges, service needs and trainee progression.

Given the numbers of prevocational trainees moving through the medical training system, there is a clear need for expansion in vocational training programs.

Ideally, the first targets for expansion should be those specialties and locations with the greatest current and projected workforce needs. The work of the National Medical Training Advisory Network in the coming months will be important to help better define data on the size of the prevocational workforce that will require vocational training in the coming years.

However, medical career pathways will not evolve through the addition of capacity alone, without risking cohorts of junior doctors embarking upon career paths in which they have little interest or engagement. Such an outcome would produce a system that does not meet the standards of excellence expected by the Australian community.

The factors that make fields of practice more or less appealing to trainees are incredibly diverse, but the cross-cutting issue is often a lack of accurate understanding about what really goes on in a particular field.

It’s often said that medical students see all of the glamour (and go home on time or early) and residents see all of the paperwork. Is it enough to see the full picture only after beginning vocational training, or worse, only when fully qualified?

There is a critical need for relevant, profession-led and up-to-date resources for junior doctors to assist their effective decision-making. Information on career pathways, application requirements, projected workforce need and future career opportunities must be produced in formats accessible to junior doctors — there are few junior doctors who read lengthy workforce reports in their spare time.

Tools that assist junior doctors analyse their aptitudes, characteristics and preferences are used in the UK and New Zealand as part of resources provided to assist career choices. Professional ‘portraits’ and formalised, supported career plans developed in the early prevocational years have useful roles.

With the number of junior doctors coming through prevocational training, now is the time to invest in better career planning resources for trainees.

Coupled with sufficient vocational training capacity, there is no better opportunity to produce an engaged generation of doctors with the high-quality training required to meet Australia’s future health needs.