How Hard Is It to Specialise in Medicine?

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      Save Medicare on 26/08/2019 - 07:40

      • masters, research, volunteering every year overseas multiple times, committees

      Sounds exactly like the girl I know. i guess there's a formula. You just have to tick ALL the boxse

      Then I have another mate who wants to do opthalmology…. but also radiology… but maybe anaesthetists. Good luck to him, if he hasn't even committed, he's way too far behind.

      Hasn't thought about derm yet? The ROAD (rad, ophthal, anaes, derm) to success

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  [Deactivated] on 25/08/2019 - 21:17

  refer to username

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  Coatesy on 25/08/2019 - 21:34

  +3

  3rd year (out of 4) medical student here. As the many doctors have already pointed out, getting into a training program is very challenging and is a common concern among medical students and junior doctors alike. To make matters worse, there's also a shortage of consultant jobs at the moment. So even if you do specialise and complete a training program there's no gaurantee you'll be able to find a consulting you.

  Fortunately, junior doctors in Australia are quite well paid. So it's not like you're starving until you make it to being fully trained. Your nephew will definitely be comfortable. Although, not quite as comfortable as the 7 figures many of the consultants are making haha.

  In terms of getting in to opthalmology. I was recently on an opthalmology rotation and asked one of the unaccredited trainees what he was doing to get in. He lectures at one of the universities, volunteers in a rural outreach program and actually took 6 months unpaid leave so he could work for free in the opthalmology clinic. He's pretty optimistic about getting in next year but it sure sounded like a slog.

  Although, it may be a little taboo to say. Just because you have a medical degree does not mean you have to then go work as a doctor in a hospital. There's many companies that value people with medical degrees and will compensate them well for their training. So there's lots of options if your nephew ever decided to leave medicine.

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  Tech5 on 26/08/2019 - 08:45

  I'm curious what doctors think about Maxillofacial surgeons?

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    solidweiner on 26/08/2019 - 09:15

    +2

    Generally speaking, they are excellent at what they do.

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    [Deactivated] on 26/08/2019 - 09:45

    +2

    Have to do both dentistry and medical. Then all the way to surgery subspecialty in maxi.

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  rezok on 26/08/2019 - 12:42

  "He says he is interested in Ophthalmology if that makes a difference but from how things look"

  I see what you did there ;)

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    Mikey88 on 27/08/2019 - 16:12

    Haha

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  Bid Sniper on 26/08/2019 - 15:31

  I completed a Science PhD, I would not recommend it to anyone. UNLESS they really want to do it and love the discipline they are/want to be in.

  The job market in my field dried up here is Australia, fortunately I found a related field that is better suited for me. If your nephew is good he always find some job in the Health industry. Every job market has oversupply, an oversupply of clowns but not competent people. You dont know what the job market will be in a decade but competent skill is transferable.

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  jonnochen on 26/08/2019 - 19:16

  +1

  Don't do ophthalmology if you don't want a 15 year post grad career including a phd, if you are lucky.
  I've dual trained in intensive care and general and acute care medicine. Will be 13 years out of uni when I start my consultant job.

  In general, GP and psych, lots of need, lots of job, much less competition.

  Surgical subspecialties (i.e ENT/maxfax/cardiothoracics/ophthalm) particularly taxing and difficult to get into. Long haul for most.

  General surgery and ortho, also difficult, most don't succeed.

  Which state you train/apply in will affect how hard or easy it is. Once you're onto a program, if you don't mind where you work, there will be LOTS of jobs. If you want to be in central Sydney, tell him to start his masters now. And start sucking arse.

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    [Deactivated] on 26/08/2019 - 21:33

    So theres a big demand for doctors that actually do work

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  Livert on 26/08/2019 - 20:19

  Got into O&G training in PGY4 (2nd attempt). Wasn't too hard back in 2009 but a lot more competitive these days due to the sheer numbers of doctors coming out of med school. My advice is always have a plan B in case you can't get into the specialty of your choice. I was accepted into GP training a week before I got my O&G training position. Was determined not to waste anymore of my life trying to get into O&G beyond that point.

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    cuteduck on 27/08/2019 - 00:15

    +1

    plan B = Gladstone :P
    plan A = Redland :)

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      Livert on 27/08/2019 - 10:51

      Plan B will never be Gladstone lol.

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      Livert on 27/08/2019 - 11:35

      DA?

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  nikey2k27 on 26/08/2019 - 21:47

  if happy to move around he get a job i had lots of Townsville move to other regional city and get jobs. Bush is cry out fo GP

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  frankste on 26/08/2019 - 22:40

  I can echo the concerns here. Speciality training is very difficult to get into these days due to the massive increase in medical graduates. Over the past ten years the number of medical graduates has doubled. There is a growing imbalance between speciality place demand and supply. As a result many junior doctors end up spending significant amounts of time in unaccredited positions (2-8 years) to build up skills and experience. Shockingly, none of this workplace experience is recognised by the colleges even though the work and experience may be the exact same as the 'formal' training.

  At the end of the day most graduates end up in GP or a 'generalist' practice (e.g. rural generalist). This is where most of the available jobs are, particularly in regional and rural areas. The specialities that have less competition are psychiatry and emergency medicine. There is also a growing pool of hospital non-specialists (CMO's) who do a lot of ED work and after hours ward cover.

  Any experience is good experience but my advice to your nephew would be think about what you want to do early on and work towards it. And be realistic about your skills, drive and competitiveness.

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  drrrr on 26/08/2019 - 23:27

  I wanted to become an opthal in my first year of med school as well. By the time I finished, I was a lot more realistic. For certain specialities only trainees with the most drive would get in, unless they have the 'connections'.
  Perceptions change when you actually work in the job. Some already knew what they want, and worked towards their aim. Others are like me, fell into the specialty through luck (or thanks to career advice from mentors)
  For a nice life and minimal stress, gp is fine. I did physician training, which I can also recommend. It's pretty easy getting into basic physician training. The exams are stressful. Getting advanced training position can be tough depending on the specialty. And finally, getting the actual consultant position at a public hospital… That final hurdle! Private work always an option for some specialties of course.

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    Mikey88 on 27/08/2019 - 16:11

    Thanks for the input drrrr, what made you change your mind about ophthalmology? Was it the competitiveness or something else about the job?

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      drrrr on 31/08/2019 - 11:12

      It's too competitive, most naive med students (ie old me) have no idea how much committment is required. I knew some who already did phd and they still struggled getting onto the program. Unless you're truly passionate about the specialty and don't mind spending many years trying to get on the training program (with potential of never getting on..) or an outstanding doctor with fantastic CV (lots of prizes, committees, publications, basically a lot of extra work to differentiate you from the rest), better be realistic and look at all options. Remember most med graduates become GPs. Backup plans are essential in medical careers lol

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  Mparadox on 27/08/2019 - 09:50

  +1

  There's a lot of misinformation on this thread. So I think i'll chip in my two cents.

  Most medical specialties unfortunately are getting harder to get into. This is mostly a function of deregulated university places which has increased the supply of doctors and therefore increased the demand for training spots. The rise of SRMO positions and Unaccredited positions means it is hard for people to get in PGY2—> PGY3.

  Some specialties you will never get into PGY2 —> PGY3. In fact, you could be the greatest candidate ever and still not get in straight away because of hurdles they've put up.

  Plastic's is probably the hardest specialty to get onto. I've not heard of someone get into the program before PGY5 even with the best possible connections. Most surgery you are looking at getting on PGY3 —> PGY4 earliest.

  Opthalmology is not the hardest specialty to get into. Not by a long way. Off the top of my head I would say Plastics, Neurosurgery, Ortho and ENT are harder. I know of at least 3 people in the last 2 years who got on PGY3 —> PGY4 into ophthalmology WITHOUT having a PhD in ophthalmology. I cannot say the same for any of the other specialties. For opthal - you need to be excellent clinically, work on your CV and have the right references who will bat for you. You do NOT need family connections to get into Opthal. I cannot state this enough. Whilst it might help to get you on, it is not the factor that will get you on. I can say this pretty assuredly.

  Whilst we are at it. Anaesthetics is also not as competitive as people say it is. I can say I know plenty of people even now who are getting in PGY3 —> PGY4. I would say 75% of my colleagues and friends who've wanted anaesthetics have gotten it. The hard part is not so much getting in as (1) getting the SRMO position before it and (2) staying in and passing the exams.

  Medicine pays well. ATO understates how much doctors make significantly - because it's reporting taxable income. If you have good business acumen, almost any specialty can make 7 figures. In fact undersubscribed specialties like psychiatry can make $1mil if you know what you're doing in private practice.

  Ultimately just do what you're passionate about. Don't pick a specialty because it pays better. If you really care about money, I would argue that GP has the opportunities to make more money than anyone (I believe the Ramsay Health founder was a GP).

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    Mikey88 on 27/08/2019 - 16:10

    Thanks for the input Mparadox, what are these SRMO positions you're talking about?

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    bidam1 on 27/08/2019 - 22:48

    I feel like this is very dangerous advice.. While I agree with most of the things you're saying, you fail to mention there are pgy8 applicants that still can't get onto ophthal (and may never ever get in).

    Yes there are people that get in pgy3 for pgy4 start but they are usually absolutely stacked and incredible applicants within the top 5%ile of medical students…

    It's dangerous giving people hope that they can get in, without mentioning what type of people usually get in.

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  [Deactivated] on 27/08/2019 - 12:34

  +1

  PhD's etc to enter some training programs

  Our medical specialists having more qualifications and being the best of the best (through competitiveness) is a very good thing .
  I understand it must seem tough to him, but then don't they get a ridiculously high wage as a specialist… For all the work you put in, there is a 'pay off' at the end of it (if you're successful). I am glad to hear that those at top of medical profession are working so hard to get there. Once you are there (among the top of your field as a specialist) there still should be some ongoing training and education, but certainly pulling in a ridiculously high wage, after putting in all that work invested earlier on to get where they are.

  Too many people these days seem to have this common misconception that people who are wealthy and/or highly successful, just got there . realistically this practically never happens.
  Best advice for him, is to understand that perseverance through adversaries (including failures, where you move forward and just keep trying), ~This is the key point of difference to many of the most successful people and/or organisation.
  Also, if he is worries that he feels other people are a bit smarter and he won't be able to compete against them for that top spot as a specialist in training etc…. Well you could explain to him, that the key determinate for success when comparing students who have all gotten accepted into the same degree, the key thing which shows up and correlates with highest GPA etc, is conscientious-ness, actual highest IQ is not what gets good grades .
  The student who is more conscientious will do better than the student with highest IQ.
  The examples we were given when we learnt this in psych, was the type of student that preps every week what they learnt that week, in study groups, and has their assignments ready 3 days before due date (so they have time to go over it, before submitting) , being similarly prepared for exams .
  What I haven't tried, but was suggested by one of my tutors I think it was, he said he got through, by each week they would have a study group, and different people would in a sense conduct a lecture on a certain section/topic they had learnt that week in class. Now the idea behind this is, that teaching someone forces you to learn it very well. It also puts things in a more relatable manner . ie. It is quite a mixed bag with lecturers, some a outstanding teachers, others, although clearly very good at their fails they're lecturing on, but some are not the best at imparting that knowledge to an average person.
  I think the uni seems to give alot of teaching jobs to someone who knows someone or someone who is studying PHD at the campus. It seems at my uni, as long you as you are studying a PHD there, you get a job as a "tutor" . Like an automatic thing, they don't choose the best teacher, the uni just gives you position because you're studying PHD there, and some extremelt intelligent scientists make awful teachers . In the weekly study group, they can teach at their level. So maybe 2 of them get it, and the other 3 don't, it should be fairly easy for them to explain/teach each other.
  If he is super keen, and willing to put in the effort, get him to work on his conscientious. Something which he can change, and will give him much more chance at greater success.
  One of my friends actually was doing lectures with only a masters degree, something I was told is impossible at my uni, as you must have a PHD or doctorate .
  Upon speaking with him further, I found out him and his girlfriend both out in about 60-70 hours every week. He was getting paid to do lectures before even completing his PHD or doctorate etc, and he had practically all HD (high distinction) on his grades. Which he explained will help him succeed after graduating.
  He had a partner who understood, because she was also studying and putting in crazy amount of hard work into study.

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    Save Medicare on 27/08/2019 - 17:55

    Respectfully I disagree. The guy with the PhD or the head of department or the guy with the clinical Professorial title isn't necessarily going to be the best clinician.

    You only have so many hours in a week. If you're doing 1/3 research 2/3 clinical you're probably seeing fewer patients or doing fewer procedures.

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      [Deactivated] on 27/08/2019 - 19:31

      +1

      The guy with the PhD or the head of department or the guy with the clinical Professorial title isn't necessarily going to be the best clinician.

      I agree with you there. I'm pretty sure I didn't mention anything to indicate otherwise. Someone with very high marks and higher qualification is not "necessarily going to be the better clinician and/or surgeon.

      However,

      Respectfully, in my opinion it cannot reasonably argued, that the person who passed the medicine specialty course with a pass grade of 51, would be just as likely to be a better clinician than their counterpart who got all HD's and a GPA of 98, and went on to complete his PHD with 1st class honors. Sure, there is a chance that the one with much less qualification and lesser marks and barely passed the course, they could, turn out to be a the better of the 2 as a clinician. That is entirely possible… However, Respectfully… I think most would agree that someone with really high grades and higher qualifications is 'more than likely' , going to make a better clinician.

      So, for them to let people through with poor grades (and remember someone with better marks missed out here, and possibly changes feilds) I believe you would need something else to go by ie. Some sort of measure besides grades, which they can fit into the mix of things that influence their decision of which students to allow progression, and which to reject.
      In the world of highly competitive specialist medicine, I don't see how we could possibly let people through based on much besides grades.
      Generally speakin of course….One of the greatest predictors of future performance, is past performance. Before they graduate, their grades are their past performance ..
      Surely rejecting the ones with highest grades, and letting through the ones that don't appear to be as good, although this would be nice , I cannot conceivably think how it could be practical and put into practice.
      I hope they put a list out of the specialists who were passed through and graduated with PHD, when they didn't really make the cut. To me it would be a bit like student doctors etc operating on me. If I have the choice, I would certainly want the best and most qualified when it comes to my health treatment.
      Interesting topic though. And I am genuinely interested to hear what you have to say, given your screen name, you must be up with much of this debate.

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  aliam on 27/08/2019 - 14:57

  The hours, length of training, study etc didn't really concern me during my training. Sure it was demanding, but I accepted it.

  What was the hardest was not being in control of things like where I was going to be sent by my training college for the next 12 months. It's hard having kids and a wife, and finding out in October where I was going to be posted for the following year. I had to go to 3 states, countless rural rotations over my training.

  You need to have a supportive family to survive it - and planning things like when to have kids (harder for women of course), putting your life on hold for exams etc is hard. Some of my current trainees have their spouse living interstate, which is hard when kids are involved.

  It is much harder to enter my speciality than it was when I applied 13 years ago… and it is an arms race of publications, courses, presentations etc. I am involved in the selection of trainees to enter my speciality, so if the OP wants to PM me, I'm happy to answer questions.

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  majuks on 27/08/2019 - 16:57

  +6

  GP Here.

  My career progression IIRC (taxable income pre ANY deductions and solely income from working purely clinically , not interest or investmentor practice ownership ,rough estimates)

  Intern 68k
  RMO 87k
  1st year GP reg 112k
  2nd year GP reg 188k
  3rd year GP reg (final)/1st few months of full time GP 220k
  2nd year of full time GP: 284k, exclude super
  3rd year of full time GP: 303K, exclude super
  4th year of full time GP: 370K, exclude super

  5th year - hopefully break 400k with passive income

  granted, I take 3-4 weeks of holiday per year and work approximately 5.25 days per week to reach where I am now.

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    Mikey88 on 27/08/2019 - 17:56

    Thanks for the input majuks, is that at a bulk-billing/mixed/private? Urban/rural? How many hours/week?

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      majuks on 27/08/2019 - 18:27

      +1

      95% bulk billing, urban, approximately 50-52h/week. normalish hours, no sundays/overnights.

      Had I saved all the after tax money I had and put it into ASX: WAM, I could have a grossed up 50k p.a. income via dividends @ age of 32..
      Lifestyle creep really takes its toil.

      Best part of GP is:

      1) You are your own boss, as in, you no longer need to take it up in the arse and still say to your bosses you have a great day. You can piss off anytime you want as a contractor.

      2) You are no longer bound to 1 year contract and constant move to different cities to complete your training post

      3) You no longer need to lick other bosses's arse and be the good little choir boy that takes everything in both ends.

      4) You don't need to tolerate crap anymore.

      5) You can choose your own hours, holidays and be a human and have family time.

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    kiitos on 30/08/2019 - 08:30

    Wow that's insightful. What level of deductions do you incur? Is that things like insurance etc? How does contacting to a practice work, do you pay the practice/give then a percentage of billing?

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      majuks on 31/08/2019 - 14:45

      Minimally

      RACGP fee: $1445
      Medical Indemnity (no discount) ~ $5500 to $7500
      AHPRA: $787
      Super: You take out your income and pay it into your super $25,000, but you may be hit with Division 293 tax, so rather than paying the usual 15% tax on your super, you get 30% of what you put in taxed instead.

      Extras

      Income Protection: 250-400/month
      Any Interest paid for investment (renting out investment properties, borrowed money to buy shares, etc)
      Phone + Internet - 15-20/month or so
      Car usage ( travelling between clinics, not home to clinic) - ? $0.66/km ( max claim 5000km p.a.)

      Most bulk billing places offers 70%, in reality, its means the management fee is 30% + GST, so technically the total pretax lump sum is 100% -30% -3%(GST component of the management fee = 67% of what you bill

      Then there's stuff you can depreciate like laptops, medical equipment unless cost total <20k

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        kiitos on 01/09/2019 - 08:57

        Thanks for that, that level of income is much more than I was led to believe for a GP. Good one!

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    barozgain on 31/08/2019 - 17:26

    Amazing!! this just shows how the ATO numbers are no where near the actual numbers

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