Changing lanes

Jenny Simper says her change of medical career ‘may seem like a classic mid-life crisis’ but it’s the best decision she has ever made.

Changing specialty is not easy. Some feel security, some a certain tribalism, as they gain experience, knowledge, pay and status in one field, passing the necessary exams along the way. It takes years, and it is hard work, and the thought of beginning again, in a different place and at a more junior level can be extremely off-putting.

Dr Simper (pictured top, left), an ex-GP, and her two colleagues switched to become specialty trainees in histopathology in London. They have a story to tell about their sense of wonder and delight in their new – and often overlooked – specialty, but theirs is also a tale of what happens when you change direction.  

Inevitably, there are pushes and pulls. Susie Bradwell (pictured top, centre) had planned to become a haematologist but the accumulation of harrowing experiences made her question whether she could do the job long-term.

Having completed IMT (internal medical training) and successfully passing MRCP, she had been offered a registrar job working in haemato-oncology, managing patients having bone marrow transplants and with acute leukaemia. 

‘Over the previous months my enthusiasm had begun to wane, my emotional resilience had floundered, and I had once found myself crying in the toilet after seeing a 27-year-old dying of acute leukaemia.

‘The faces of patients who had passed away were haunting my thoughts and this number was only increasing. Did I really want to make this my career? Could I actually do this forever?’

Dr Bradwell says this was a ‘huge blow to my confidence and identity’ because it meant she questioned not just her role at the time but everything she had worked towards.

In addition to the emotional burden, the sheer unsustainable intensity of many specialties is a major reason for switching.

Victoria Barker (pictured top, right), a former speciality trainee 6 in obstetrics and gynaecology, reflects on the ‘sensation of impending doom that I used to experience driving in to start a run of night shifts’. 

She recalls ‘the backlog of patients waiting in obstetric triage and A&E, the levels of activity and risk on the labour ward, antenatal, postnatal and the gynaecology wards, midwife shortages, rota gaps, juggling multiple emergencies at once, the exhaustion, the long drive home hoping to stay awake’.

She adds: ‘Despite having only 24 months of O&G training left, I felt the risks within the specialty had increased exponentially due to chronic staffing shortages in an unforgiving “old-school” hierarchical culture. The challenges within maternity are well known and documented but the impact on the doctors in training is often forgotten especially those training in the COVID pandemic.

‘On starting histopathology the shift was recognisable immediately, there was great support, engagement and encouragement from our consultant body.’

For Dr Simper, it was more that she wanted ‘something deeper – a little extra oomph to my day’. They had different reasons but what they all found was fulfilment in a different specialty. 

Dr Simper describes histopathology as like ‘cracking a code’.

‘The precision and detail-oriented nature of this work has rekindled my intellectual curiosity in a way that I hadn’t experienced in years. Every day feels like I’m unlocking the secrets of the universe, one biopsy at a time. It’s oddly thrilling. Plus, there’s something deeply satisfying about making a concrete diagnosis. It’s like cracking a code, and feels like solving a small mystery, offering the fulfilment I craved.’ 

This idea of solving mysteries underlines the doctors’ enthusiasm for it.

Dr Simper says: ‘As a GP, I was the frontline detective, trying to figure out what was wrong with my patients while they presented with vague symptoms and threw me curveballs. The same intellectual curiosity is necessary in histopathology, where one must recognise and interpret a wide range of diseases, only now at the cellular level with a microscope instead of a stethoscope.’

Dr Barker speaks of a much better work-life balance: ‘My physical and mental well-being is at an all-time high and I have a renewed enthusiasm for life and the opportunities that lie ahead,’ and Dr Bradwell concurs, saying simply that she ‘chose life’.

There are certainly challenges, apart from those which come with any new job. New exams, a new and perhaps reduced status. Pay protection usually only applies if you move to a hard-to-recruit specialty, have caring responsibilities or a disability. The BMA has some useful advice. Dr Simper sums up her move as ‘incredibly impractical, nonsensical, and financially annihilating’ – although still utterly worthwhile.

Another obstacle is that of a doctor’s own preconceptions. Every specialty has its own reputation, in-jokes and stereotypes.  

Colleagues told Dr Bradwell that ‘histopathology isn’t a sociable specialty, it’s a waste for someone who can interact with people, such as you’ – but it only took a few days for her to realise this was not the case.

Dr Barker says the experience has in fact been very sociable. ‘I feel extremely privileged to be in such a training job that feels so happy, kind and safe. I started with a group of mature, like-minded people, who like me had their own unique journey and experience to bring to their new careers.

‘We have managed to learn, socialise, enjoy the delights of the hospital canteen and form friendships which I have come to realise is something that was absent in my life since being a foundation year 1 in 2015.’

It’s a ringing endorsement for a specialty. It’s fair to say it may not be shared by all those who work in it, and that other specialties have their advocates, too. But what is undeniable is that their courage paid off.

A report last year found workplace burnout was forcing doctors to ‘take matters into their own hands’ to protect themselves and patients. Almost a quarter of doctors had taken time off owing to stress the previous year, 16 per cent had taken hard steps to leave medical practice in the UK and a fifth had reduced their hours.

Moving to a more suitable specialty is only part of the solution. But in this case, it shows very clearly that a change can be as good as a rest.

With thanks to Jenny Simper MRCS MRCGP, Susie Bradwell MRCP and Victoria Barker MRCOG