Vocational training has a nomenclature problem

Physician trainees having just completed their viva examinations are anxiously awaiting results and are deciding they want to do for the rest of their lives: they are about to embark on what is called vocational training. This is supposedly training for which these individuals have a special calling – like the priesthood.

In reality many of my peers and my juniors seemed/seem to have no idea what they have a vocation for and in fact base their sub-specialty on a variety of factors including exposure (it was the best of a bad bunch), lifestyle choices (financial , overtime/shift-work), brains/brawn (physicians vs. surgeons), and even parental expectation. As a consequence I often see fully qualified professionals who are not suited for their ‘chosen vocation’ for a whole variety of reasons ranging from technical incompetence, through to boredom and burnout.

I ultimately went down two vocational training pathways: medical oncology and clinical pharmacology. Notably I had always thought my vocation was psychiatry. I did a consultation-liaison psychiatry term for my option term in a New York cancer hospital and loved it but when I returned to do a general psychiatry term it really didn’t gel – I didn’t hate it but at the time I thought it was (and perhaps remains) flawed both in philosophy and science.

As it happened I did 2 terms each in medical oncology, haematology and gastroenterology and a term in palliative care and thoroughly enjoyed them: so what to I do now? – gastrointestinal oncology. Oncology lead me to drug development and an interest in quality care and this in turn lead to clinical pharmacology as a second specialty.

I could tell you why I like these specialties but I can’t actually tell you why I ended up here rather than performing cardio thoracic surgery (although I do often tell patients I could take them apart I just couldn’t put them back together again).

Unfortunately many trainees don’t get broad enough exposure to different disciplines in order to find their calling. In addition their modes of practice often don’t reflect what it is like as an actual consultant. For example many doctors get put off oncology because of the death and dying aspects as they only do inpatient work and no outpatient work – this is not a unique problem.

What I can tell you is this: get exposed to as much as possible and then do what you really enjoy and have found satisfaction doing. The success, career-wise, will follow-on and hopefully you’ll never get bored. In medicine never view the practice of medicine as a view to making money: if you take this pathway you need to remember the only way to make money is volume (i.e. lots of work). You’ll make more than enough doing what you really like and perhaps more than you expect. But if you really view financial gain as the reason for your ‘vocation’ then you chose wrong.

Finally don’t view a ‘vocation’ as being a singularity. First and foremost physician sub-specialty trainees need to remember that being a physician brings skills and opportunities to do things in the same way that law or commerce does.

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