Dr Ahmed Rashid speaks of his personal experience in general practice, an important area of medicine that has recently been thrust into the spotlight.
Foundation year one (FY1) is an odd time. After endless years of jumping through academic hoops and revising for increasingly difficult assessments, you finally get to make that satisfying phone call to your bank asking them to change your debit card to include those two magic letters – “Dr”!
That’s not the only change you’ll experience during this year. You have a full-time job and a commute to work. People treat you like a grown up and expect things from you. At the end of the month, you even get paid – not loads but enough to go out on weekends and give yourself a well-deserved break. The other FY1 doctors are all in the same boat and you get to share the journey together. You find even more friends among the nurses on your ward; friendships which often continue for the rest of your career.
It all sounds like rather good fun, doesn’t it? Well, it really is. It is easy to focus on the scary bits and the steep learning curve, but in reality, the FY1 year is the most enjoyable year in most doctors’ careers. It is also a time when they are often deeply influenced by the characters they meet as they fully immerse themselves in the medical world of work. I met a number of truly inspiring healthcare professionals and was frequently in awe of their brilliant diagnostic and procedural skills. There was, however, one particular academic physician whom I remember with great fondness to this day.
Despite the high pressure environment of a busy teaching hospital, she always found the time to talk to people. She regularly punctuated her long ward rounds with conversations with patients and their relatives, displaying an interest in social and psychological nuances that I would never have thought to explore. Her kindness and warmth wasn’t just directed toward patients; she also took a genuine interest in her junior colleagues, using her coffee breaks to listen to their concerns and share advice. One thing she said to me in particular has stayed with me ever since, and I think all medical students and junior doctors could stand to benefit from hearing it.
Reflecting on the fact that she had ended up training in a specialty different to the one she had in mind initially, she felt that doctors dwell far too much on early career choices. No matter which specialty you train in, she said, you’ll find your own niche within it. Back then, choosing the right specialty seemed like the most momentous decision in the world and I could not, for the life of me, understand what she meant. Fast-forward a few years and having come to the end of my own training journey, I realise that she had been absolutely right.
When I was working for her, I was certain that cardiology was the specialty for me. I simply couldn’t picture myself doing anything else. I enrolled on an MSc in Cardiology and, to my surprise, discovered that I was far more interested in other aspects of the course such as epidemiology, risk, and patient experiences of heart disease. I was on a foundation year two rotation in general practice at the same time and often found myself being steered towards holistic preventive medicine, among various other things. Fortunately, I saw the light just in time and got accepted into a National Institute for Health Research (NIHR) funded academic clinical fellowship in general practice, allowing me to combine clinical training in primary care with research training in the public health department at the University of Cambridge.
Having taken up this academic training fellowship, I further extended my training by spending a year on the National Medical Director’s clinical fellow scheme, which involved a 12-month placement at the National Institute for Health and Care Excellence (NICE). As a trainee, I had the chance to work with distinguished cardiovascular researchers, deliver seminars and lectures about cardiovascular risk to medical students, junior doctors and GP colleagues, and develop guidelines and implementation products for cardiovascular diseases at a national level.
More importantly, I have met countless doctors who have managed to defy the stereotypes of their specialty. From orthopaedic surgeons with a special interest in health economics to oncologists doubling as hospital chief executives, the medical world is full of individuals who use their skills to traverse career boundaries and buck trends.
So I urge medical students to avoid obsessing over career choices. Until you are exposed to working in the various specialties as a junior doctor, it is hard to see what each one truly entails. As a medical student, I would never have believed anyone who told me that I would become a GP but as it turns out, I cannot think of any specialty that better suits me. Sure, everyone’s journey in medical training is unique, but no matter which path you take, there will undoubtedly be opportunities to develop new skills that lead to a varied and rewarding career. Work hard, play hard, but also be sure to seize any of these opportunities that come your way. Last but not least, do not forget to choose a foundation year job that includes at least one block in general practice. Like me, you may never look back.
By Dr Ahmed Rashid