This discussion is closed.
madmedman
Badges: 5
Rep:
?
#1
Report Thread starter 1 year ago
#1
Hi all.
For the past year or so, I have been seriously considering switching specialties. I always liked working in medicine but somehow ended up in psychiatry and for the past decade I have been a staff grade. I am 42 years or age and seriously considering applying for the next IMT training. However, I am perfectly aware of the difficulties I will face regarding getting into training. The competition ratios are such that it might keep someone like me out.

Is there anyone who has done it and would they have an advice for me?
I would also welcome advice from medical trainees about getting into training.

Just to mention, apart from audits and CPD activities, I have no other accomplishments. I have been predominantly doing clinical work and never had any interest in research. You could imagine how low I would score at the first stage so I am aware that getting an interview would be a long shot. But then I am sure I will do well in the interview. I worked in A&E many years ago and some of the interview stations are a bit familiar.

I would really appreciate any input really at the stage.
0
ecolier
Badges: 22
Rep:
?
#2
Report 1 year ago
#2
Ideally you should have posted in the "Current Medical Students and Doctors" forum.

(Original post by madmedman)
...However, I am perfectly aware of the difficulties I will face regarding getting into training. The competition ratios are such that it might keep someone like me out
:confused: What?! IMT is one of the least competitive core specialties.

The problem isn't getting into IMT, it's getting through IMT (it's not that bad but it can be quite bad).


Is there anyone who has done it and would they have an advice for me?
There are a few of us here who have gone through Core Medical Training (the predecessor of Internal Medicine Training), and who are currently in CMT.

Remember that IMT is new, only having started in the 2019/20 year.

I would also welcome advice from medical trainees about getting into training
It honestly isn't that hard getting into IMT. It's the ST3 (or ST4 depending on your specialty) applications. What medical specialties do you want to do?


Just to mention, apart from audits and CPD activities, I have no other accomplishments. I have been predominantly doing clinical work and never had any interest in research. You could imagine how low I would score at the first stage so I am aware that getting an interview would be a long shot. But then I am sure I will do well in the interview. I worked in A&E many years ago and some of the interview stations are a bit familiar.

I would really appreciate any input really at the stage.
As I have said several times already, you'll get an interview. Just make sure you don't fail (i.e. deemed non-appointable) and you should have an IMT job somewhere. If you wanted London then you'd have to make yourself competitive.

Why do you want to change specialties? Remember IMT can be tough (especially for the registrar year) - if you wanted to do a specialty with acute medicine even as a registrar you'd be working nights and long days.
0
madmedman
Badges: 5
Rep:
?
#3
Report Thread starter 1 year ago
#3
Hi. Thank you very much for the detailed and informative reply.

It is reassuring to know I do have a chance. I know London has always been competitive. I don't think I have the luxury to chose where I want to train. I would be delighted to train anywhere. You're right that the first task, after being shortlisted of course, should be to not be unappointable. I think I would need to find out if there are courses being run to prepare for the interview. As a first step, I have enrolled for the ALS course.

Regarding the actual field work, I have a bit of an idea how the rota would be like. I have worked long shifts in A&E and can appreciate how stressful the medical reg job can be. Its a lot of responsibility and basically you're covering the whole hospital without direct supervision. So I am (hopefully) ready to face the consequences of my decision. What I sometimes dread is not able to access help or advice from seniors which I believe is not unheard of. I remember having an awful reg in A&E who never gave me anything beyond a "yes" or a "No". And he was always clear that I had to formulate a question in a way that he could either say aye or nay. But these people are very few and far between. Most of the senior staff I have encountered are indeed very helpful and patient.

I hope to do cardiology but I know it would be an uphill task to get into it as the specialty has always been one of the most competitive. At this stage I am happy to consider my second or third preference. I have given GP training a thought as well but I don't think its for me.

The only thing I am going to struggle with is the pay cut. It will drop from 70k to 37k which won't be pleasant, especially for the better half. But I guess I can live with that as well. If not, I might get a loan or do some locuming, section 12 work a few times a month, if I could get the time.

There are many reasons I have been thinking of changing my specialty. I really don't want to discourage any prospective Psychiatry trainees. I am in Psychiatry since 2006. It is a great specialty with excellent work and social life balance. But I just feel I am not making much of a difference. Unfortunately, its all about risk assessment now. Studying or eliciting psychopathology in your patients and making decisions based on that is a thing of the past.

Oh and sorry I didn't realise there was a dedicated forum for his post.I will appreciate it if a mod can move this thread.
1
ecolier
Badges: 22
Rep:
?
#4
Report 1 year ago
#4
(Original post by madmedman)
...I don't think I have the luxury to chose where I want to train. I would be delighted to train anywhere.
Don't talk yourself down, you may be better than you think you are! Remember that for many regions, CMT (IMT's predecessor) was non-competitive (< 1 applicant to 1 post). The reason why CMT was slightly above 1 to 1 (around 1.5 to 1) was probably because of the competitive regions.

You're right that the first task, after being shortlisted of course, should be to not be unappointable. I think I would need to find out if there are courses being run to prepare for the interview. As a first step, I have enrolled for the ALS course
You don't really need to go to any courses (in my opinion). Just read through what is to be expected (https://www.imtrecruitment.org.uk/re...re-and-content) and in my opinion that should be enough.

Regarding the actual field work, I have a bit of an idea how the rota would be like. I have worked long shifts in A&E and can appreciate how stressful the medical reg job can be. Its a lot of responsibility and basically you're covering the whole hospital without direct supervision. So I am (hopefully) ready to face the consequences of my decision.
Sure, but (having not worked in A&E so this is from friends / as a colleague) I personally think that A&E doctors have a better working life than medical registrars. At least they can leave on time, and sort of control when they see the last patient. A med reg could be bleeped 15 mins before handover about a sick patient and they would have to see because it is "right" that we don't leave sick patients. In A&E they is (virtually) always someone to hand over to, in medicine many feel it is not appropriate to do so.

What I sometimes dread is not able to access help or advice from seniors which I believe is not unheard of. I remember having an awful reg in A&E who never gave me anything beyond a "yes" or a "No". And he was always clear that I had to formulate a question in a way that he could either say aye or nay. But these people are very few and far between. Most of the senior staff I have encountered are indeed very helpful and patient.
For medicine, you should be able to access the consultant even out of hours. The chances are in the middle of the night they'd be at home sleeping, but at least they're contactable. Surely you've experienced that as a psychiatry registrar when you were one?

I hope to do cardiology but I know it would be an uphill task to get into it as the specialty has always been one of the most competitive. At this stage I am happy to consider my second or third preference. I have given GP training a thought as well but I don't think its for me.
Again, you'll need to do more research into this. Cardiology is most definitely not the most competitive. Its' competition ratio hovers around 2 - 2.5 to 1 on average like most mainstream specialties. Dermatology on the other hand, holds that honour (on average 5 to 1).

e.g. in 2018, the competition ratio for Cardiology ST3 was 2.56 to 1; in 2017 it was 2.65 to 1; in 2016 it was 2.33 to 1.

Some other specialties for comparison:
The competition ratio for Gastroenterology ST3 was 2.51 (2018), 2.77 (2017) and 2.71 (2016).
The competition ratio for Neurology ST3 was 2.63 (2018), 3.44 (2017) and 4.00 (2016).
The competition ratio for Rheumatology ST3 was 2.40 (2018), 3.43 (2017) and 3.34 (2016).
The competition ratio for Dermatology ST3 was 3.13 (2018), 5.58 (2017), and 4.56 (2016).

The only thing I am going to struggle with is the pay cut. It will drop from 70k to 37k which won't be pleasant, especially for the better half. But I guess I can live with that as well. If not, I might get a loan or do some locuming, section 12 work a few times a month, if I could get the time
You can locum?

There are many reasons I have been thinking of changing my specialty. I really don't want to discourage any prospective Psychiatry trainees. I am in Psychiatry since 2006. It is a great specialty with excellent work and social life balance. But I just feel I am not making much of a difference. Unfortunately, its all about risk assessment now. Studying or eliciting psychopathology in your patients and making decisions based on that is a thing of the past.
It's not just you (on this forum!!). Just ask GANFYD who was a psych consultant for 12 years then left for GP-land!


Oh and sorry I didn't realise there was a dedicated forum for his post.I will appreciate it if a mod can move this thread.
Moved :yy:
Last edited by ecolier; 1 year ago
1
fishfacesimpson
Badges: 9
Rep:
?
#5
Report 1 year ago
#5
You'll have to seriously consider how the pay drop will affect your life. You won't want to do locums on top of your normal job.

I don't know how possible it would be whilst in a job but my advice would be to do some shadowing or something similar. Maybe even a short term locum job if possible. General medicine is probably quite different to what it was like when you last did it. This isn't about whether you could handle it or not but just to make sure you know what you're committing to and are aware of how things have changed in hospital medicine over the last 10-15 years. It's not just about workload or supervision but also about the bureaucracy and challenges faced in a daily basis.

There are sometimes other ways of spicing up your job as well without training in a whole new specialty. Things like teaching or management roles etc. Expanding a job by doing some sessions in hospital/gp etc. You may have already explored these though
2
nexttime
Badges: 22
Rep:
?
#6
Report 1 year ago
#6
(Original post by madmedman)
Hi all.
For the past year or so, I have been seriously considering switching specialties. I always liked working in medicine but somehow ended up in psychiatry and for the past decade I have been a staff grade.
As above - by all accounts medicine has changed a vast amount - such as cardiologists now being dual-certified in acute med now, for instance, and I'm concerned you're making an uninformed decision. Do you think you can approach a medical consultant and ask for some shadowing (of consultants and juniors)?
1
notespad
Badges: 14
Rep:
?
#7
Report 1 year ago
#7
Yes, definitely shadow and speak with consultants about this! It's not a decision to take lightly. But if you're truly unhappy with psych, then why spend the next 30 years of your life doing it?

To the person above, A&E isn't much better than medicine as an SpR lol I've done 10 months as an A&E SHO and the SpR rotas are brutal (although i love the work!)

IMT CT1 salary will be at least £45k.
1
madmedman
Badges: 5
Rep:
?
#8
Report Thread starter 1 year ago
#8
Thank you very much for the detailed insight. I can Locum but if I move to medicine, I think I would rather recuperate at home than work another shift. The competition ratios you posted are extremely helpful. I do Locum a few times a month and may be able to continue if I switch specialties. But I am also prepared to sacrifice finances and social life for job satisfaction. I really enjoyed working in A&E and am kicking myself for making a bad decision to get out of it. I have zero interest in completing rcpsych exams or become a consultant. I don't feel any sense of accomplishment which is what made me go to medical school in the first place. I have my fingers crossed for the next round of recruitment that starts in November. So there is more time to reflect on my decision and its consequences.
0
madmedman
Badges: 5
Rep:
?
#9
Report Thread starter 1 year ago
#9
(Original post by notespad)
Yes, definitely shadow and speak with consultants about this! It's not a decision to take lightly. But if you're truly unhappy with psych, then why spend the next 30 years of your life doing it?

To the person above, A&E isn't much better than medicine as an SpR lol I've done 10 months as an A&E SHO and the SpR rotas are brutal (although i love the work!)

IMT CT1 salary will be at least £45k.
Thats great advice. I already have contact details of a tutor and have emailed him. Just waiting for him to get back to me.
I agree, A&E reg/SpR aren't better off than their medical counterparts. They are basically supervising the whole floor. Its good to know the consultants here are physically present until 10pm. They used to be a rare commodity after 5pm.
I imagine the 45k is after the banding is applied?
0
madmedman
Badges: 5
Rep:
?
#10
Report Thread starter 1 year ago
#10
(Original post by nexttime)
As above - by all accounts medicine has changed a vast amount - such as cardiologists now being dual-certified in acute med now, for instance, and I'm concerned you're making an uninformed decision. Do you think you can approach a medical consultant and ask for some shadowing (of consultants and juniors)?
Hi. Unfortunately, I believe that I am at a point that I need to change careers. But I completely agree and have been thinking of shadowing a medical reg a few hours every weekend and on annual leave. Apart from that, do you have any other advice for me at this stage?
0
Etomidate
Badges: 15
Rep:
?
#11
Report 1 year ago
#11
You can string some sentences together in English. You're already overqualified for IMT.
2
Democracy
Badges: 20
Rep:
?
#12
Report 1 year ago
#12
(Original post by madmedman)
Hi. Unfortunately, I believe that I am at a point that I need to change careers. But I completely agree and have been thinking of shadowing a medical reg a few hours every weekend and on annual leave. Apart from that, do you have any other advice for me at this stage?

Out of interest, what makes you say GP training isn't for you? It's quick, the training programme is better supported than medicine and you could always do clinical assistant or special interest work in a medical specialty or A&E. Were GP SHO jobs available when you were a junior and do you think you saw enough GP to definitively rule it out as an option? Just something to think about perhaps (if you haven't already).

The state of acute medicine is pretty dire atm - I'm sure it's always been tough but as others have said the level of demand and bureaucracy have both skyrocketed which makes the clinical work all the more difficult. A period of shadowing is certainly a good idea.
1
nexttime
Badges: 22
Rep:
?
#13
Report 1 year ago
#13
(Original post by madmedman)
Hi. Unfortunately, I believe that I am at a point that I need to change careers.
That doesn't mean IMT is suddenly your only option though. Despite the degree of dissatisfaction (on here and in real life), its a nice option in terms of variety of potential consultant jobs (derm vs cardio vs onc vs gerries etc etc), but its far far from the only one. GP, as mentioned, is good because you will get back up to your prior earnings in just 3 years - you'll only just be becoming an SpR down the IMT route!

Just saying you need to do some groundwork before jumping the lucrative ship you currently sail.
0
Elles
Badges: 17
Rep:
?
#14
Report 1 year ago
#14
(Original post by Democracy)
Out of interest, what makes you say GP training isn't for you? It's quick, the training programme is better supported than medicine and you could always do clinical assistant or special interest work in a medical specialty or A&E. Were GP SHO jobs available when you were a junior and do you think you saw enough GP to definitively rule it out as an option? Just something to think about perhaps (if you haven't already).

The state of acute medicine is pretty dire atm - I'm sure it's always been tough but as others have said the level of demand and bureaucracy have both skyrocketed which makes the clinical work all the more difficult. A period of shadowing is certainly a good idea.
I agree - if you're going to do some shadowing then it might be worth considering shadowing a GP or GPwSI mental health too?
There is plenty of actual mental health diagnosis and management if that is what you enjoy - rather than just risk assessment as the CMHTs/Crisis Teams/CAMHS seem to reject so many referrals these days and even if patients are seen it's by a wider member of the team who seems to just risk assess them and then discuss in MDTs without reaching a diagnosis unless they're ever risky enough to make it to seeing a Psychiatrist - so seem to be doing more and more mental illness diagnosis and management in primary care these days compared to when I did psychiatry jobs as an F1 and GP SHO.
& plenty of autonomy!

Quite a few GPs do Section 12 work and can be available for that out of hours as no mandatory on call commitments post CCT. Or there is scope for fairly lucrative OOH GP work (~£80-90/hr) in my area too.

You might be able to get GP training shortened by 6 months to be 2.5 years too due to your experience already in Psychiatry - quite a few people switching from Reg level positions in relevant specialties can count that towards training. & the other year of hospital SHO jobs are fairly likely to include something acute medical/surgical/A&E - so if you loved that so much you could always transfer out again at that stage...
0
notespad
Badges: 14
Rep:
?
#15
Report 1 year ago
#15
(Original post by madmedman)
Thats great advice. I already have contact details of a tutor and have emailed him. Just waiting for him to get back to me.
I agree, A&E reg/SpR aren't better off than their medical counterparts. They are basically supervising the whole floor. Its good to know the consultants here are physically present until 10pm. They used to be a rare commodity after 5pm.
I imagine the 45k is after the banding is applied?
Yes, after banding etc. Good luck! By the way, in terms of "not making a difference," do you think this is applied to all subspecialities in psych [from your own experiences purely]?
0
madmedman
Badges: 5
Rep:
?
#16
Report Thread starter 1 year ago
#16
(Original post by nexttime)
That doesn't mean IMT is suddenly your only option though. Despite the degree of dissatisfaction (on here and in real life), its a nice option in terms of variety of potential consultant jobs (derm vs cardio vs onc vs gerries etc etc), but its far far from the only one. GP, as mentioned, is good because you will get back up to your prior earnings in just 3 years - you'll only just be becoming an SpR down the IMT route!

Just saying you need to do some groundwork before jumping the lucrative ship you currently sail.
I absolutely agree with you. I am very cautious about any impulsive decisions that I may regret further down the line. Otherwise I would have jumped ships a long time ago. The reason I am not considering GP route, despite this being the most suited to my circumstances, is because I want to specialise. And there is something about working in a hospital that I can't explain and live without. Im not sure why, but I feel like I have dedicated my life to hospital work and I cant imagine living without it. Thats part of the reason why I am so unhappy with community psychiatry. I don't mind being an ST3/4 in three years time while I am 44. But then I don't want to be an SpR when I am 50. Looking back I now realise that I always wanted to train in medicine. But I am not going to pull the trigger until I am sure what I am getting myself (and my family) into.
0
madmedman
Badges: 5
Rep:
?
#17
Report Thread starter 1 year ago
#17
(Original post by Elles)
I agree - if you're going to do some shadowing then it might be worth considering shadowing a GP or GPwSI mental health too?
There is plenty of actual mental health diagnosis and management if that is what you enjoy - rather than just risk assessment as the CMHTs/Crisis Teams/CAMHS seem to reject so many referrals these days and even if patients are seen it's by a wider member of the team who seems to just risk assess them and then discuss in MDTs without reaching a diagnosis unless they're ever risky enough to make it to seeing a Psychiatrist - so seem to be doing more and more mental illness diagnosis and management in primary care these days compared to when I did psychiatry jobs as an F1 and GP SHO.
& plenty of autonomy!

Quite a few GPs do Section 12 work and can be available for that out of hours as no mandatory on call commitments post CCT. Or there is scope for fairly lucrative OOH GP work (~£80-90/hr) in my area too.

You might be able to get GP training shortened by 6 months to be 2.5 years too due to your experience already in Psychiatry - quite a few people switching from Reg level positions in relevant specialties can count that towards training. & the other year of hospital SHO jobs are fairly likely to include something acute medical/surgical/A&E - so if you loved that so much you could always transfer out again at that stage...
Hi. Thank you. I work in a CMHT and can totally relate to what you're saying about the referral process. imo risk assessment has completely taken over the field to such an extent that the actual mental state exam to elicit psychopathology and then treat the illness is completely in the background now. But this might just be my biased view. I imagine it would be very frustrating for the GP to manage out patient when the referrals are rejected, which is the most of the time, unless the risk is "high".

Would it be difficult to change specialties during training. I don't know why I always assumed that it would be a nightmare and you would need approval from the postgraduate dean?
0
madmedman
Badges: 5
Rep:
?
#18
Report Thread starter 1 year ago
#18
(Original post by Democracy)
Out of interest, what makes you say GP training isn't for you? It's quick, the training programme is better supported than medicine and you could always do clinical assistant or special interest work in a medical specialty or A&E. Were GP SHO jobs available when you were a junior and do you think you saw enough GP to definitively rule it out as an option? Just something to think about perhaps (if you haven't already).

The state of acute medicine is pretty dire atm - I'm sure it's always been tough but as others have said the level of demand and bureaucracy have both skyrocketed which makes the clinical work all the more difficult. A period of shadowing is certainly a good idea.
Hi. As I mentioned in my response to nexttime, the main reason I haven't given a thought to GP training is because I want to specialise and there is something about working in a hospital that I cant let go of.
Can I ask about the bureaucracy of working in medicine, how has it changed the practise? I am not jumping ship straightaway and applications are a few months away and next rotation starts in August, so I believe I have sometime to give thought to all the ideas.
0
madmedman
Badges: 5
Rep:
?
#19
Report Thread starter 1 year ago
#19
(Original post by notespad)
Yes, after banding etc. Good luck! By the way, in terms of "not making a difference," do you think this is applied to all subspecialities in psych [from your own experiences purely]?
Thank you very much.
I think that's how I feel about general adult. I liked liaison better but I guess the reason is that its closely linked with medicine, A&E and its hospital based. Old age is great for the same reasons. I guess that's because I am more of an "organic" kind of person. Never had a thing for psychology and I always felt that supportive counselling was as good as any kind of specialised therapy. Don't quote me on this though. Its just my opinion.

But in terms of making a difference or a sense of reward/achievement, you could always do worse and join CAMHS.

On a totally different subject, the most helpless person I have ever seen is a consultant psychiatrist. You are the one holding responsibility for so much but there is so little you can do. Just never wanted to be that person.
0
Democracy
Badges: 20
Rep:
?
#20
Report 1 year ago
#20
(Original post by madmedman)
Hi. As I mentioned in my response to nexttime, the main reason I haven't given a thought to GP training is because I want to specialise and there is something about working in a hospital that I cant let go of.
Can I ask about the bureaucracy of working in medicine, how has it changed the practise? I am not jumping ship straightaway and applications are a few months away and next rotation starts in August, so I believe I have sometime to give thought to all the ideas.

I've recently finished a year of A&E. I can't compare to what it was like 20 years ago but currently it feels like everything has to be documented and re-documented obsessively. Electronic records are becoming more ubiquitous which has helped in some respects but also seriously slows things down. There seem to be so many different risk assessment scores which then influence the management (and inevitably produce further paperwork).

The process of arranging referrals, admission to CDU, 2WW oncology, liaison psych referral, ambulatory care appointments, major trauma CT, etc is all based on completing forms/risk assessments and seriously eats into your time when it's happening so many times a day. You spend 15 minutes doing all the clinical stuff and 45 minutes grappling with the system. It's not enough to just do the job well, you have to show your working every step of the way on electronic systems that have clearly not been designed with busy doctors in mind.

Another problem is that there is no downtime whatsoever. If it were just the case that there was annoying paperwork with frequent gaps to catch up then that would be a bit more workable. That's not what it's like though - the admissions just keep coming and coming. Ambulance queues and the hospital being at full capacity can occur at any time now, not just the worst weeks of winter.

This obviously impacts all staff btw, not just doctors. Nurses, HCAs etc are also overburdened and understaffed which means that they are less available to do what you ask them, so once again, you are slowed down.

Was it like this when you were an SHO?
0
X
new posts
Back
to top
Latest
My Feed

See more of what you like on
The Student Room

You can personalise what you see on TSR. Tell us a little about yourself to get started.

Personalise

Feeling behind at school/college? What is the best thing your teachers could to help you catch up?

Extra compulsory independent learning activities (eg, homework tasks) (1)
4.55%
Run extra compulsory lessons or workshops (4)
18.18%
Focus on making the normal lesson time with them as high quality as possible (3)
13.64%
Focus on making the normal learning resources as high quality/accessible as possible (2)
9.09%
Provide extra optional activities, lessons and/or workshops (9)
40.91%
Assess students, decide who needs extra support and focus on these students (3)
13.64%

Watched Threads

View All