People change. It seems a stupid thing to articulate, but conventional career paths are built as though people are static - no affordance for growth, or for wanting something different at thirty than you wanted at twenty-four.
Medicine is the most rigid of them, and specialising is the most rigid part of medicine. It’s a narrow, sharply defined path - not only in structure, but in the shared culture of each specialist cohort. I’ve seldom found a group as intolerant to differently shaped personalities as a group of registrars and consultants in a given field.
And maybe that’s the cost of learning to do something high stakes, where human life is on the line and the protocols are well defined. Maybe the way you produce good specialists is to put them through a cookie-cutter that doesn’t permit much deviation or independent thought. It seems to work.
But the stakes cut both ways. You’re a newly qualified doctor deciding whether to commit to four plus years of a track that will affect your life in irreversible ways. Surely there should be a mechanism to let you sample whether it’s for you?
Because specialising is about more than the subject matter. You could absolutely savour the content of a field and have a marked aversion to its culture.
There’s a reason orthopaedic surgeons come up so often in this kind of discussion. The collective values that ortho training circuits embody are polarising, and not something just any person can stomach. So you should be able to spend one, two, even six months working day-to-day in that space to understand what your next four years is going to look like.
In South Africa we have medical officer posts. These exist in specific departments to allow for non-specialist resourcing to drive provision of care - and then - to allow someone interested in specialising to accumulate experience in the given field.
Gross under-resourcing and I guess increased demand to some extent mean this is no longer possible. There is no ‘I want to try this out’ option available to doctors anymore. You need 100% commitment to a given field or nothing - despite not having any reasonable sense of the work and culture that field entails.
MO posts are fiercely contested and rationed out by consultants to those who have already achieved qualifications previously reserved for specialists more than halfway into their journey. And the registrar post above it wants the same thing in writing - Wits paediatrics asks for FCPaed Part 1 before you even apply. That’s R12,200 a sitting at last year’s rates.
The amount that a doctor has to commit to specialising - without any guarantee of a post, prior to obtaining a post - is obscene. Exams. The cost of the exams. The time spent studying. The hours spent working in non-accruing roles waiting for an MO to open up. Often the time spent working for free as a supernumerary in the hope of having a favourable decision made by the department lead.
It’s all very hunger games flavoured.
And this is where it gets demoralising, because inevitably many are going to succumb to the sunk cost fallacy. If you’ve spent thousands of rands on exams and thousands of hours building goodwill, even if you hate your chosen field, you’re going to stick out any hardship because ‘I’ve put too much into this to quit’.
Don’t get me wrong: grit and persistence are hallmarks of our South African doctors and we are better for it. But there’s a point at which this keeping-on-for-the-sake-of-keeping-on costs you your family. It costs you your happiness. It robs you of your you-ness.
So if you’re bright eyed about specialising, by all means do that. But be candid with yourself that the system is broken, and it demands a huge entrance fee before it gives you anything back.