Medicine career path

virtus

Hi there,

I have posted a few times before about going to medical school and it's possible that I could be starting this October.

What is the actual career path when becoming a Doctor? I understand that you have standard periods of training when you graduate and become a registrar. Is there a website which clarifies the actual training periods and durations in a concrete manner?

It seems rather late in the day to be asking questions like these, but better late than never. Here goes:

What exactly happens after intern year?
What exactly is an SHO and how does that differ from a registrar/consultant?
Does a registrar train under a consultant and if so how long does this take?
Is there a list anywhere of the specialities which are offered in Ireland?
Is a specialist the same as a consultant?

Hopefully someone will be able to help with the above questions. I may be jumping the gun a little, but I'd prefer to get the whole picture before I commit. I'm feeling rather nervous about the whole thing.

Thanks for reading!

Chunky Monkey

http://www.rcsi.ie/index.jsp?1nID=93&2nID=95&3nID=122&pID=300&nID=362

http://www.pgmdb.ie/index2.tmpl

^interesting stuff in the speciality database tab there though it says feb 06

Sitric

There is a lot of info on the medical councils website

http://www.medicalcouncil.ie/education/postgrad.asp?NCID=18

Pete4779

virtus wrote: »

Hi there,

I have posted a few times before about going to medical school and it's possible that I could be starting this October.

What is the actual career path when becoming a Doctor? I understand that you have standard periods of training when you graduate and become a registrar. Is there a website which clarifies the actual training periods and durations in a concrete manner?

It seems rather late in the day to be asking questions like these, but better late than never. Here goes:

What exactly happens after intern year?
What exactly is an SHO and how does that differ from a registrar/consultant?
Does a registrar train under a consultant and if so how long does this take?
Is there a list anywhere of the specialities which are offered in Ireland?
Is a specialist the same as a consultant?

Hopefully someone will be able to help with the above questions. I may be jumping the gun a little, but I'd prefer to get the whole picture before I commit. I'm feeling rather nervous about the whole thing.

Thanks for reading!

This is the sequence after graduation from medical school:

1. After (or in reality, during) Internship: you have already applied for a BST (Basic Specialist Training) post in a speciality of your choice. E.g., Surgery, Psychiatry, Medicine. From completion of internship you now have Full Registration as a doctor; however, you cannot practice as a specialist/consultant until you have completed training in a specialised area. BST is the beginning of that period.
- the length of time varies according to speciality. In surgery, BST is 2 years. In psychiatry, it is 3 years. The "name" you are given is arbitrary: Psyciatry BSTs are called Registrars and Surgical BSTs are called SHOs. It makes no difference what the name is.

2. SHO = Senior House Officer. These names are a hang over from the original apprenticeship model of medical training. Interns in the UK used to be called House Officers. Once you finished internship, and had a job, yu were now an SHO. Registrars are those who generally have completed BST and achieved the basic memberships of the various royal colleges (MRCS, MRCP, MRCPsych).

3. Higher Specialist Training: after completing BST (usually 2-3 years, you have done your royal college memberships and so on) you need to focus on one specialist area of your choice. E.g., the General Surgical BST might decide to do Orthopaedic Surgery. In Psychiatry, it may be Forensic Psychiatry. They will for this purpose then compete for a HST (Higher Specialist Training) post in that area. Those on this will be referred to as a variety of names (generally SpR - Specialist Registrar) but it changes according to the speciality and length of training. Some fields require further ongoing speicalist training after SpR. This used to be term Senior Registrar. As each field has different duration of training, it becomes confusing: BST in Psychiatry is longer than medicine or surgery, but HST is shorter.

In reality, you are either a BST or HST, and the SHO/Registrar/SpR/Senior Registrar is irrelvant and simply a monicker from a long time ago.

The goal of HST to achieve a CCST (CCT in UK). This is the Certificate of Completion of Specialist Training. This allows you to refer to yourself as a specialist consultant and practice independently without supervision.

The length of time to achieve CCST varies according to speciality and country. CCSTs are recognisable across europe, but obviously some countries award it in as little as 4 or 5 years in some specialities. In UK and Ireland it takes a minimum of 7 years. Due to the limited number of HST places, many people leave after BST to achieve what would be HST equivalent in Fellowships abroad (e.g., US) and so on. HST numbers are very small, and in some specialities there may be 1 or 2 places per year, even with 40-50 eligible applicants.

Your career path is as such: on graduation, you must complete internship to become fully registered. Until you complete specialist training, you will always need to practice under someone else. due to lack of regulation and other gaping holes, some people can start private plastic surgery clinics or primary care clinics with no training in those areas once you have completed internship.

sam34

Pete4779;59824951]The "name" you are given is arbitrary: Psyciatry BSTs are called Registrars and Surgical BSTs are called SHOs. It makes no difference what the name is.


In reality, you are either a BST or HST, and the SHO/Registrar/SpR/Senior Registrar is irrelvant and simply a monicker from a long time ago.

excellent, informative post pete.

just want to be pedantic and pick up on the first point above - AFAIK it is only in teh private psychiatric hospitals that basic specialist trainees are automatically called registrars, generally in the public hospitals they are SHO's until they have passed the first part of the membership and can then apply for a reg job. i dont know what the logic is - maybe it sounds better to the fee-paying private patient that the registrar is admitting them rather than the SHO :rolleyes:

and wrt the second point, the pay scales differ depending on whether youare an SHO/reg etc

Vorsprung

Just to make a small addition to what Pete said - to get into the Higher Surgical Training programme, you need to have some research under your belt, and for all intents and purposes this means a Masters/PhD, which you'd do after your SHO years.

So what people doing surgery commonly do is this:

Intern
SHO1
SHO2
Research 1
Research 2
Junior Registrar (clinical year, often as part of teaching hospital tutor job) and then keep trying to get on the HST scheme.

Pete4779

Yeah actually! Quite a gaping hole there!

The gap in time from BST to starting HST can be many years, and for some, they never get on it. After BST in surgery, you can do several yers of research, lecturing, clinical posts to gain experience, publications and so on to compete for a HST place.

7 years is minimum; for many it would take 10-12 years from graduation to achieve CCST, which is why a US residency (3-5 years depending on field) + fellowship (1-2 years, again depending on field) is more attractive.

Anthony16

Medicine

How is that a specialty?Isnt that the course?lol.Forgive me im badly informed:pac:

AmcD

Anthony16 wrote: »

Medicine

How is that a specialty?Isnt that the course?:pac:

"Medicine" is an umbrella term which covers all the adult hospital-based, non-surgical specialities e.g. cardiology, respiratory, gastroenterology, dermatology etc.
Generally after intern year people usually decide between "medicine", surgery, paediatrics, psychiatry, obs+gynae and general practice. These specialities are pretty distinct and there isn't that much cross-over once that choice is made. e.g. it would be quite unusual for a surgeon to apply for a cardiology job. As a medical SHO you would rotate through a number of specialities while doing basic specialist training. I started as a general medical SHO in a peripheral hospital, then changed to endocrinology, before ending up as a rheumatology SHO.
Surgeons also go through a broadly similar set of choices e.g. general surgery, vascular, orthopaedics, urology etc.