The below article has been reproduced from a BMJ series to help medical students make the leap to budding doctors. In this article, Richard Beasley and colleagues give an overview of less mainstream specialties available to medical graduates.
Please note: this article has been adapted to be more relevant to the New Zealand context.
While some people are lucky enough to realise when they are five years old that they want to be a paediatric surgeon, most graduates are still wondering what they want to do with the rest of their lives. One common misconception is that the choice is between clinical medicine in a hospital and general practice. Numerous other opportunities for anyone with a medical degree exists, and it is important to know what the options are, what training is required, and what the careers entail. More information on choosing a medical career can be found here: www.careermed.co.nz
Academic medicine
While most consultants teach at both undergraduate and postgraduate level and do some clinical research as part of their routine practice, it is possible to have primary employment in this field. Usually within a university or research unit, these jobs entail varying amounts of research, teaching, administration, and clinical work. This is a rewarding specialty for those wishing to make an important contribution to medical education and knowledge. It is a highly competitive field and it can be demanding balancing the different parts of the job. Completion of a higher research degree such as a Masters or PhD is usually required.
Aviation medicine
A subspecialty of occupational medicine, aviation medicine is developing rapidly as more and more people take to the skies. The main role of the aviation medic is to assess the fitness to fly of pilots and cabin crew and to advise infirm passengers on their eligibility to fly. They also have a role in the management of natural disasters—for example, aviation medics were concerned with the management of the severe acute respiratory syndrome (SARS) epidemic because of its swift transmission by air travel. The lack of a formal career structure is a disadvantage, but for those interested, job opportunities exist with the Civil Aviation Authority and the airlines as well as in academic research.
For more information:
The University of Otago offers postgraduate qualifications in aviation medicine, for more information visit: http://www.otago.ac.nz/wellington/departments/medicine/postgraduate/occupationalaviationmedicine/study/otago019260.html
Aviation Medical Society of New Zealand: http://www.amsnz.org.nz/
Management
Frustration with existing systems and lack of resources motivates some doctors to work in medical management. Medical managers have to tolerate a general lack of respect from clinicians and often bear the brunt of their frustration. However, this may be outweighed by the satisfaction of being in a position to change things that are not working. Most medically trained managers spend several years in a clinical specialty before going into management. A management post will test skills such as communicating, prioritising, delegating, and coordinating. It can be a challenging role owing to the crisis driven nature of the current health system, which can result in unpredictably long hours. However, being able to change failing systems is probably less stressful than working within them.
For more information:
Royal Australasian College of Medical Administrators (RACMA): http://www.racma.edu.au/
Medical law
This is an emerging specialty owing to the increasingly litigious nature of medicine. If the idea of completing both a medical degree and a law degree does not put you off, people with the dual qualifications are in demand. Job opportunities exist within medical defence organisations, as a risk manager for health trusts, as a coroner, or in forensic medicine. Law firms also look out for people specialising in medical law.
Medical writing and journalism
A surprising number of people have trouble deciding between arts and sciences at school and are equally skilled in both. Medical school entrance requirements force you to choose the sciences, but it is possible to combine your artistic or language skills through medical writing. This is an undervalued skill which many people find difficult and normally entails communicating clinical information and data to a wide range of audiences. You will need good writing skills and an eye for detail. Opportunities include preparing manuscripts for publication, assembling items for conferences, and writing documents for drug companies. Medical writers can work freelance, allowing them to pursue non-medical interests or continue with clinical practice at the same time. Opportunities also arise in radio and television, although these are few and far between.
Occupational medicine
Occupational medicine deals with the relation between work and health: preventing injuries and illness that can occur as a result of work and rehabilitating people back into the work force if they have had an injury or illness. Jobs are varied and require a broad knowledge base spanning clinical medicine, behavioural sciences, industrial processes, toxicology, and medical and employment law. A relatively flexible specialty with few on-call commitments, occupational medicine is one of the easier specialties to combine with family life. Awareness of the importance of occupational health is growing, making this an exciting career option.
For more information:
The Royal Australasian College of Physicians (RACP) offers advanced training in occupational and environmental medicine: www.racp.org.nz/trainees/advanced-training/advanced-training-programs/occupational-and-environmental-medicine
The University of Otago offers postgraduate qualifications in occupational medicine: www.otago.ac.nz/wellington/departments/medicine/postgraduate/occupationalaviationmedicine/study/otago019260.html
Australian and New Zealand Society of Occupational Medicine: http://anzsom.org.nz/
Pharmaceutical medicine
The drug industry offers considerable opportunities for medical graduates, and these are usually well remunerated. Possibilities include medical advisory positions, clinical research, and becoming medical director of a company. Clinical experience is an advantage, but the job also calls for good skills in communication, management, problem solving, and generating ideas. The working environment tends to be positive and focused. Patient contact is limited but still possible in the clinical trials area.1
Public health medicine
Public health medicine deals with health at a population level rather than an individual level. It can vary from responding to outbreaks of disease that need a rapid response, such as food poisoning, to the long-term planning of health care. Spending some time in clinical medicine is recommended before training in public health, which usually requires a diploma or fellowship in the first instance. Salaries are lower than for most clinical specialties, but little or no on-call work is entailed and usually a substantial amount of study leave is available. Public Health medicine specialists are employed by a wide range of organisations, including the Ministry of Health, Universities and PHARMAC.
For more information:
New Zealand College of Public Health Medicine (NZCPHM): www.nzcphm.org.nz/
Sports medicine
This is an exciting specialty that applies medical knowledge to all areas of physical activity. It has the advantage of dealing primarily with motivated and healthy individuals, although it may also deal with special needs groups. It combines work in the gym or playing field with consulting, management roles, and teaching. The impact on family life varies depending on the nature of the job: physicians attached to sports teams may find themselves away from home on tour for extended periods, and most competitive matches are played at the weekends. However, this may suit sports fans who enjoy travelling.
For more information:
The University of Otago offers postgraduate qualifications in sports medicine: http://dnmeds.otago.ac.nz/departments/medicine/sports/index.html
Sports Medicine New Zealand: www.sportsmedicine.co.nz
Travel medicine
With the increasing ease of international travel, people are travelling to more remote places and therefore exposing themselves to a variety of infectious diseases. Many popular destinations have substandard or no health care systems, and seeking the advice of a travel doctor before embarking on these trips is essential. Travellers may need advice on immunisations, malaria prophylaxis, and what to pack in their first aid kit. Travellers with established medical problems seek advice on how to manage their conditions while overseas. Advice on air travel may also be required. Travel medicine does not have its own training programme, and people enter through different routes: for example, general practice, infectious diseases, and public health medicine. However, specialised certificates, diplomas, and degrees are available, such as the International Certificate of Knowledge in Travel Medicine.
For more information:
The University of Otago offers postgraduate qualifications in travel medicine: www.otago.ac.nz/wellington/departments/primaryhealthcaregeneralpractice/postgraduate/otago021119.html
Voluntary work overseas
The Asian tsunami in 2004 and the earthquake in Pakistan in 2005 highlighted the difference doctors can make in disadvantaged countries and the valuable work relief organisations do in these circumstances. However, the reality is that opportunities to make a difference in developing countries arise every day, not just when a natural disaster strikes. The tsunami killed over 250 000 people, but the same number of people die worldwide each week from preventable diseases. Various organisations offer placements for doctors who wish to contribute to relief work overseas.
For more information:
Projects Abroad: www.projects-abroad.co.nz/projects/medicine-and-healthcare/
Médicines Sans Frontiéres: www.msf.org.au/
Conclusion
Although some graduates feel restricted by their medical degree, a wonderful diversity of careers is available. We have touched on only a few. Opportunities also exist in diving medicine, the civil service, the prison system, politics and the armed forces, to name a few more. Continuous trimming of the medical school curriculum means that undergraduates are not exposed to many careers. Most of the careers discussed above require some initial general medical training, so do not feel in a rush to make a decision. But knowing what possible careers are available can prevent that feeling of panic if you realise after a couple of years that mainstream hospital medicine is not for you.
The best sources of career advice are your senior colleagues or someone in the field you are considering. Keep an open mind and be flexible enough to take opportunities when they present themselves. A medical degree can lead to a huge variety of both clinical and alternative careers.
Original authors:
Sarah Aldington, senior research fellow
Richard Beasley, general physician, Medical Research Institute of New Zealand, Wellington, New Zealand
Geoffrey Robinson, general physician, Wellington and Kenepuru Hospitals, Wellington.
We gratefully acknowledge the BMJ for permission to reproduce this article.
References
- Smethurst D. Pharmeceutical medicine: making the leap. studentBMJ 2004; 12:66-7
