Medical Pathway
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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
  • Contracts

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. If one of them catches your attention, read into it a bit more!

SpecialtyTypeNotes
Anaesthesia and Pain medicineOtherFull-spectrum of private to public practice.
Intensive Care Other
Emergency Medicine OtherAlso useful for Doctors Without Borders and disaster relief work
Radiation oncology Other
Pathology OtherLow level of patient interaction
Radiology and interventional radiologyOtherLower level of patient interaction. Good lifestyle/pay ratio.
Medical Admin OtherChanging healthcare systems and processes (new and growing field)
General Practice Medical, OtherHigh flexibility and control. Wide range of options. Good lifestyle/pay ratio.
Psychiatry Medical, OtherHigh demand and future-proof. Easy to enter the training program.
Cardiology and interventional cardiology Medical, Procedural
Gastroenterology Medical, Procedural
Rheumatology Medical
Dermatology MedicalGood lifestyle/pay ratio.
Renal Medical
OncologyMedical
Infectious DiseasesMedical
MicrobiologyMedical
NeurologyMedical
EndocrinologyMedical
RehabMedical
HaematologyMedical
Nuclear medicineMedical
Urgent careMedical
MaternalMedical
PaediatricsMedicalPaediatrics has its own range of subspecialties (e.g. paediatric orthopedic surgery, cardiology, etc.)
Palliative careMedical
Rural healthMedical, SurgicalPotentially good lifestyle/pay ratio. Potentially very busy because of low staffing in the area.
ObstetricsMedical, Surgical
GynaecologyMedical, Surgical
OphthalmologyMedical, SurgicalGood lifestyle/pay ratio.
Ear-nose-throat (Otorhynolaryngology)Surgical
General surgery and traumaSurgical
CardiothoracicsSurgical
Paediatric surgerySurgical
VascularSurgical
OrthopedicSurgical
NeurosurgerySurgical
UrologySurgical
PlasticsSurgical

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

The hospital team is composed of the consultant, fellow, senior registrar, junior registrar, house officer, and medical students.

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.

Rosters

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.

Payscales effective 25 November 2019

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.

Hours and Salary for house officer payscales

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:

  1. New Zealand Resident Doctor’s Association (NZRDA)
  2. Specialty Trainees of New Zealand (SToNZ)

These may change by the time you are working.

💡 You can read the MECA from each union here (for interest only – you do not need to know this for medical entry)

NZRDA: Read their MECA here
SToNZ: Read their MECA here

Professional Reviewer

This article has been checked for quality and reliability by…

Dr Jin Xu - Professional Reviewer
Dr Jin Xu
MBChB

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.

About the author
Justin Sung
Justin Sung
Justin is a medical doctor, University of Auckland graduate, published research author, certified teacher, and founder of JTT. He has assisted thousands of students into healthcare careers since 2011, making him New Zealand's individually most experienced medical entry expert. He regularly works with schools and organisations to help students and professionals learn more effectively.

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