The depth and breadth of medicine are staggering. Even after graduating from medical school, there’s still a lot of unknown.
This post summarises and highlights some key information about a career in medicine. We’ll be covering:
- Different medical and surgical specialties
- The different roles in the hospital
- Doctor salary and hours
Medical and surgical specialties
When we think of possible careers as a child, we imagine this huge range of options: plumbers, fire-fighters, lawyers, doctors, electricians, teachers,… Well, within medicine, you have this entire range recreated.
Specialties are distinct and very separate from each other. The work of one specialty can be similar to another, but more often it is very different, with very different personality types finding value in different areas of medicine and surgery.
Most people only know of a few popular specialties, but we’ve got a comprehensive list below. Technically, some of the specialties listed below are actually sub-specialties of others, belonging as a branch under a wider college. For example, haematology is a sub-specialty branch under the college of pathology, however, the work they do is very different which is why they have been separated completely in this list, despite the heavy overlap in training and work at the early stages of the career.
If one of them catches your attention, read into it a bit more!
Note that most specialties have the opportunity for private and public practice, though surgical and interventional specialties are more common, popular and therefore better paying, financially.
|Anaesthesia and Pain medicine||Other||Puts patients to sleep and keeps them asleep during operations. Manages the patient immediately before and after operations. Manages difficult pain conditions across the hospital and in palliative care.|
|Intensive Care||Other||Manages critically unwell patients in intensive monitoring wards. Intensive care is the net at the very bottom of the cliff.|
|Emergency Medicine||Other||Doctors who work in the emergency department. They manage a wide range of patients and conditions who are at the beginning of their diagnosis. Lots of uncertainty and the objective is to broadly classify urgency and diseases. Emergency doctors are also called the “wall” into the hospital because they refer to specialty services further in the hospital. Also useful for Doctors Without Borders and disaster relief work|
|Radiation oncology||Other||Cancer doctors who use ionising radiation therapy to treat cancers.|
|Pathology||Other||Looking at diseases under the microscope. Low level of patient interaction and heavy science and lab focus. They work with doctors from all different specialties, especially surgeons.|
|Radiology and interventional radiology||Other||Specialists of medical imaging, such as X-ray, CT scans and MRI scans. A core component of all modern medical practice to facilitate diagnosis and treatment. Interventional radiology involves doing procedures with medical imaging guidance, often inside blood vessels that normally are not easily accessible or visible. Lower level of patient interaction. Good lifestyle/pay ratio.|
|Medical Admin||Other||Changing healthcare systems and processes (new and growing field) to bridge the problematic disparity in modern healthcare of hospital management being very detached from actual clinical practice.|
|General Practice||Medical, Other||Primary care doctors who work in the community. Lots of patient interaction but can be high stress due to workload, especially in rural areas where there is only one GP. Despite common misconception that GP’s are not specialists, they are specialists at primary care, requiring a high level of knowledge about a wide range of conditions and referring to hospital care when appropriate and urgent. Where hospitalists have depth of knowledge, GP’s specialise in breadth. GP’s also have much higher capability for lifestyle interventions for patients due to continual care. GP’s overall contribute more to the health of the population than any other specialty (other than, arguably, public health doctors). High flexibility and control. Wide range of options. Good lifestyle/pay ratio.|
|Psychiatry||Medical, Other||Mental health specialists. They are different from psychologists in that they can prescribe medications. Can work in the community or in mental health units at hospitals or urgent response community teams. High demand and future-proof from an artificial intelligence perspective. Easy to enter the training program as there is an enormous demand for psychiatrists.|
|Cardiology and interventional cardiology||Medical, Procedural||Heart specialists who use medications to solve heart problems. This is different from cardiothoracic surgeons who use surgery to solve heart problems. Interventional cardiology is a mix of both where procedures are performed such as inserting stents in blood vessels under medical imaging/radiological guidance.|
|Gastroenterology||Medical, Procedural||Digestive tract medical specialists. They also do camera scope examinations such as colonoscopies and gastroscopies.|
|Rheumatology||Medical||Joint specialists that deal with diseases primarily affecting joints. These diseases tend to be relatively complex, though not as well known to the public.|
|Dermatology||Medical||Skin specialists. Good lifestyle/pay ratio.|
|Renal||Medical||Kidney specialists. Kidney diseases tend to be complex and can often deal with patients with near terminal stage diseases with very poor long-term prognosis.|
|Oncology||Medical||Cancer specialists, mainly dealing with non-blood cancers. Each type of cancer is quite unique and so there are comparatively more sub-specialties in oncology compared to some other specialties.|
|Infectious Diseases||Medical||Specialists at managing infections. Mostly consult and manage patients from other specialties who have multiple or difficult types of infections that are too complicated for non-specialists to optimally manage. They also manage tropical travel diseases and HIV/AIDS.|
|Microbiology||Medical||Specialists at microbial organisms and clinical management. Microbiologists are infectious diseases specialists also, or work closely with them. Unlike pure science microbiologists, clinical microbiologists view the organisms with respective to how they cause disease and the implications on management for patients.|
|Neurology||Medical||Brain and nervous system doctors who use medication. Neurologists manage diseases like strokes, congenital brain abnormalities, medical spinal cord issues and diseases affecting the nerves elsewhere in the body.|
|Endocrinology||Medical||Hormone doctors who specialise in managing conditions like hypo or hyperthyroidism, diseases of the adrenal glands, and tumours of the brain causing changes to hormone production.|
|Rehab||Medical||Sub-specialists who manage the rehabilitation of patients who suffer from a range of diseases (e.g. degenerative neurological, spinal cord, post-traumatic, sports-related etc.) that reduce their abilities to mobilise and independently manage the mechanical aspects of daily living. They work mostly in clinics or centers in the community.|
|Haematology||Medical||Specialists of the blood and the many diseases involving the blood, including blood cancers like leukemia.|
|Nuclear medicine||Medical||Sub-specialists of delivering medicine for diagnostic or treatment purposes that involve radioactive substances and special types of medical imaging.|
|Urgent care||Medical||Doctors in the community who manage patients halfway between emergency doctors and GP’s. Often more in demand in rural areas.|
|Maternal||Medical||Pregnancy sub-specialists who help manage the medical conditions that affect pregnancy.|
|Paediatrics||Medical||Doctors of children. Paediatrics has its own range of subspecialties (e.g. paediatric orthopedic surgery, cardiology, etc.)|
|Palliative care||Medical||End of life and quality of life care specialists. They are involved in any case where the quality of life is the primary focus, rather than quantity of life. This is not always in imminently terminal patients. Pallitative care doctors work both in hospitals, consulting patients in other specialties, as well as out in the community, especially in hospices.|
|Rural health||Medical, Surgical||Specialists that manage an enormous range of conditions in challenging rural environments. Potentially good lifestyle/pay ratio. Potentially very busy because of low staffing in the area.|
|Obstetrics||Medical, Surgical||Specialists at the pregnancy and birth process. This is slightly different (though overlapping) with maternal medicine in that maternal medicine is more deeply specialised in the medical conditions that are generally more complicated in pregnancy. Obstetricians are also the doctors who deliver the babies and perform C-sections. Maternal medicine does not do this. The two specialties are under the same Royal College and are considered sub-specialties.|
|Gynaecology||Medical, Surgical||Specialists of female reproductive organs. They are different to obstetrics and maternal medicine in that gynaecologists are not primarily involved with pregnancy.|
|Ophthalmology||Medical, Surgical||Eye specialists. These are different to optometrists in that ophthalmologists prescribe medications, perform complicated and fine surgeries, and manage medical conditions as a doctor, while optometrists primarily deal with vision correction with glasses, basic management of common eye conditions, and screening for more complicated cases to refer to ophthalmologists. Good lifestyle/pay ratio.|
|Ear-nose-throat (Otorhynolaryngology)||Surgical||Doesn’t take a genius to figure out what they specialise in.|
|General surgery and trauma||Surgical||Surgeons who operate mostly in the abdomen. Trauma is a sub-specialty of general surgery in NZ, Australia and the UK as most major traumatic injuries tend to involve a serious or life threatening complication to the abdominal organs. General surgeons also manage skin infections and skin conditions that require surgery or minor procedures to manage. However, depending on the situation, these skin conditions may go to dermatology, infectious diseases, or even orthopedics if it affects the joint under it.|
|Cardiothoracics||Surgical||Surgeons who operate on the heart and other organs in the chest (primarily the heart and lungs, or the major vessels and airways going to and from them). Cardiothoracic surgery is often thought to be reducing in demand as medical interventions become better, which prevents diseases from becoming bad enough that it requires surgery.|
|Paediatric surgery||Surgical||Surgeons for children.|
|Vascular||Surgical||Surgeons that operate on blood vessels. A famously high-stress and high-intensity specialty as a number of vascular conditions can be life or limb-threatening, some even imminently life-threatening.|
|Orthopedic||Surgical||Surgeons of bones, joints and muscles. A very mechanical surgical specialty that commonly fixes broken bones with metal plates, rods and screws. The line between orthopedic care and trauma team care is often hospital dependent, with many hospitals having no trauma team at all.|
|Neurosurgery||Surgical||Surgeons of the brain. Another famously high-stress and high-intensity specialty due to the complex, detailed and sometimes urgent nature of the conditions to be managed.|
|Urology||Surgical||Specialists of the organs, vessels and tubes relating to the bladder and urinary system, as well as the male reproductive system.|
|Plastics||Surgical||Specialists that deal with reconstructive or cosmetic plastic surgery. Commonly, plastic surgeons work with burns and other conditions where the skin is badly damaged. In many countries, cosmetic-only plastic surgery is a lucrative private practice, which has made it so most members of the public are not aware that plastic surgeons in hospital settings are critical for skin reconstructive surgery.|
Different roles in a hospital team
There are many different occupations within a hospital team. Ward clerks, nurses, pharmacists, orderlies, healthcare assistants, students, doctors, occupational therapists, physiotherapists, nutritionists, pastoral support, social workers,…
This focuses on the different types of doctors on the team. Remember, doctors only make up a small percentage of the health workforce!
Hierarchy of doctors
“PGY” stands for post-graduate year. So PGY1 means you are a first-year doctor who has just graduated from medical school. House officers often distinguish themselves from each other with their PGY level because the amount of experience between even a PGY1 and a PGY2 can be considerable. Registrars onwards tend not to track or use PGY to differentiate themselves.
Doctor salary/pay vs. hours of work
A topic of taboo for some reason.
Here’s news for anyone in the mainstream public. Doctors are not saints. It isn’t fair to think that doctors should work endlessly, sacrificing their entire lives for their work.
Let’s take a real, unfiltered look at how much doctors really get paid and how that balances with the real hours worked.
The hours are calculated as a weekly average across the entire quarter’s roster.
📆 For example, a typical roster might look like this:
— 0730 to 1630 hrs every weekday
— 0730 to 2230 hrs once per week
— 0730 to 2230 hrs on Saturday and Sunday, once per month for 3 months, a.k.a. 1 quarter
This calculates to 58.5 hours per week, on average.
However, the actual hours worked is almost always greater than this, partly due to high workload, but sometimes due to inaccurate rostering hours.
📆 For example, if your roster is formally 0730 to 1630 hrs:
The department may start their morning staff/patients handover at 0700 hrs. Including preparation time, this may require you to be at work at 0640 hrs. Similarly, the end of shift handover may begin at 1630 hrs, meaning you are regularly unable to leave work for a further 30 minutes or more.
In this way, you would be getting paid for 58.5 hours (formally rostered), despite realistically and consistently doing closer to 65 hours. This over-time is never paid.
The question may be then 🗨 “If the system clearly requires different work hours, why not have the rostered adjusted so that the hours reflect the real work done?”
We’ll get to that soon.
Payscales and salary
Doctors are paid according to their run category. For example, if a General surgical attachment is category B, a first-year house officer would make $102,900 before tax, while they are working in that department.
House officers are on 3-month rotations, so the combination of runs throughout the year may be something like B, B, C, D. Therefore the yearly salary on average for a first-year house officer is approximately $88,000 before tax.
💡 The following payscale is accurate within the 2018 to 2020 period. If you want to check up-to-date information, you can find this information on the Auckland Doctors website.
A few quick notes:
- A and B tend to be surgical runs
- C and D tend to be medical runs
- E tends to be community runs
- F tends to be rehab and part-time
As mentioned earlier, the total hours for each category are split as an average per week.
So back to our question:
🗨 “If the system clearly requires different work hours, why not have the rostered adjusted so that the hours reflect the real work done?”
Correspondence with the management team around this issue reveals that if the hours of work were rostered accurately, the pay category would increase, therefore the hours are kept below the next category’s average weekly hour limit.
Now hang on… doesn’t it make sense to get paid for the hours worked, if they are consistently the hours being worked on a daily basis, rather than creating a false roster to avoid paying the actual hours worked?
Yes, it does make sense.
End of conversation.
What is the MECA?
Upon graduation from medical school, you will be working for a public hospital under a particular region, governed by one of NZ’s 20 district health boards (DHB) that receives funding from the ministry of health.
DHBs have a collective agreement held with a union that forms the basis of how they employ various health professionals (Doctors, Nurses, etc).
This agreement is called the MECA (Multi-Employer Collective Agreement) and it outlines the various important aspects of working conditions such as hours worked, leave and compensation.
How do unions fit in?
Unions negotiate the MECA for us to ensure fair working conditions. The work of unions is indispensable and though not everyone is always satisfied, unions are as important to doctors as the contracts themselves.
There are currently two unions for junior doctors in New Zealand:
- New Zealand Resident Doctor’s Association (NZRDA)
- Specialty Trainees of New Zealand (SToNZ)
These may change by the time you are working.
This article has been checked for quality and reliability by…
Dr Jin XuMBChB
Jin is a University of Auckland Graduate and NZ registered practising doctor. He has an interest in clinical radiology, starting on the radiology training program in 2020.