Training program dilemmas

It’s becoming extremely difficult and highly competitive for DiTs to get into a formal training program to pursue the specialty of their choice. As it is, very few spots are made available in training programs every year – and it doesn’t help the situation with the number of medical graduates on the rise. As a result, many DiTs spend years as a resident or as an unaccredited ‘service’ registrar in the hope of eventually getting into a training program.

Unaccredited registrars are doctors who don’t have a formal training position, but still perform all the expected duties of a registrar. We see them predominantly in those specialties where the entry processes are highly competitive. For DiTs, this is a way to gain experience in a specialty while waiting to join a training program.

The number of applicants accepted for various specialty training programs can vary from year to year. For example, 36 candidates were shortlisted for the orthopaedics training program in Victoria alone this year, but they were planning to take only five candidates. This is an extremely low percentage, considering there were probably more than 100 applicants. An added complexity is that if you apply unsuccessfully three times, you’re no longer eligible – which means there could be many ‘failed’ orthopaedic applicants around in the next few years.

Likewise, the paediatric surgery training program appointed only one trainee in 2018, and no positions were offered in 2019. Despite this, there are many unaccredited positions for doctors working as paediatric surgery registrars, which means the number of unaccredited positions far outweighs the potential training positions. When there clearly is a clinical need for unaccredited registrars at a hospital, it would be great to have adequate training positions created to fill that need.

Currently, there’s no cap to the number of years you can work as an unaccredited registrar, which means there’s no guarantee of career progression after all those years of work. It would certainly be great if the time and experience gained during unaccredited work could be recognised when applying for training positions, or even considered so as to reduce the length of the accredited training. However, the current training system doesn’t seem to value the extra experience gained from unaccredited work.

So the main goal is to just get into the training program, as this is where the more structured teaching occurs. Being in a training program also provides secure employment for the duration of the training program, whereas those not in the training program are on yearly contracts and need to reapply every year. 

With training program spots being extremely competitive, many junior doctors are doing more research and higher degrees to get CV points to be selected for specialty training – which not only eats into their already limited spare time, but also costs a lot of money. For instance, there are doctors aspiring to do surgical training who have spent over $30,000 doing a ‘Master of Traumatology’ for the sake of CV points. Some also undertake intensive interview coaching to be prepared.

Working as a locum is great money. But unless you can use spare time to improve CV applications by publishing research or completing further degrees, then the time as a locum means less time working with the supervisors who will be your referees – and this is crucial in getting into the program. Another downside is that time spent as a locum doesn't count towards experience in the training program application process for any of the specialties. It's also hard to take time off and work as a locum, and then return to work and try to compete for a position in a training program.

Other options to specialisation would be an alternative medical or surgical specialty, e.g. emergency physician, radiology, pathology, general practice, sports medicine. Often, however, you would have to re-train to some extent to be eligible for these options. You can also consider pathways such as medical administration, health economics, medical consultancy or medico legal.

There is a Facebook page, Creative Careers in Medicine, where health professionals have discussed a few options, but they seem few and far between. It leaves many junior doctors wondering where to go to next when they’re unsuccessful in getting into their chosen training program. It also creates a lot of anxiety for them – given there’s so much uncertainty, competition, and a further erosion of a healthy work-life balance to complete the additional degrees and research.

At the other end of the spectrum, by the time you’ve completed a training program (if or when you’ve managed to get in), there aren't necessarily enough consultant jobs available.

There’s a lot of pressure for DiTs to join a training program, and to do so early to enable career progression. The earlier doctors can complete their training program and become fully independent practitioners, the sooner they’ll be available to work in the areas where they’re most needed.

• It’s apparent that the training program dilemma is an important issue prompting junior doctors to have to start thinking about future training pathways at an early stage, possibly straight out of medical school or internship.

   

• Useful sources of support and guidance through your journey to specialisation include your professional associations and the Australian Medical Association (AMA) in your state.

   

• Dr Caroline Elton (a psychologist who specialises in helping doctors) and Dr Benjamin Veness (a Psychiatry registrar) share advice for coping with medical training and career delays, disruptions and unknowns in this 20-minute MDA National podcast: Career complications and contending with uncertainty.