Domhnall MacAuley: Matching doctors’ roles to skills and personality

Domhnall Macauley“The thing that makes someone get up at 5am and run—we want it.” Besides the text was a picture of a running shoe. It was a recruitment advertisement for managers of Aldi, the low price supermarket store. The message was clear—they knew the type of person they wanted, and the reader knew immediately if it was for them. What type of advertisement would they create if recruiting a doctor?

There is no identikit doctor. If I have a surgical emergency, I want a no nonsense technical expert who is precise, accurate, unemotional, and decisive. My histologist should be academic, thoughtful, and thorough—and I don’t really mind if they are slow to make up their mind. My interventional radiologist should have exceptional manual dexterity, spatial awareness, and be skilled in very fine movements. My physician should be well read, thorough, and with the questioning enquiring mind of a detective. My GP should be wise, empathetic, considerate, and a advocate on my behalf. I don’t really mind if my surgeon says little, and my histologist says nothing, but I want my GP to communicate and my palliative specialist to care.

No job description could cover everything; no personality profile, psychological testing, interview, or personal statement could select the ideal doctor. The skill set and person types needed in different roles are as variable as our diseases and our patients. And yet we try to select people for medical school at a very early stage in their personal development choosing future doctors as undifferentiated, but academically gifted schoolchildren. We look for certain generic attributes using aptitude tests and interviews, but the real problem comes later. How can we match the right person to the right skillset in postgraduate specialisation. In fact, we don’t really try. We trust it to some self selection process hoping that junior doctors choose a role that fits their abilities based on their exposure to various specialities during medical training. There must be a better way.

Domhnall MacAuley is primary care editor, BMJ