Career focus - Combining medicine and law

Doctors and lawyers come from two very different traditions. Wai-Ching Leung considers the possibilities for crossover between the two career paths

The need for knowledge of both medicine and the law features prominently in many jobs, and it is not surprising that many doctors find law interesting and have seriously considered a career relating to it. Medicine and the law remain distinct professions: on one hand, there are various medical careers for which knowledge and experience of the law are valuable or even essential (see box). On the other hand, there are legal careers for which knowledge of aspects of medicine may be desirable. These careers are exclusively for lawyers, and a medical qualification, though valuable, is not essential. Training is provided by lawyers and follows a similar course to that of other legal careers - academic and vocational stage of legal training, barrister pupillage or solicitor articleship, and specialisation in medical law.

Very few careers are truly open to both lawyers and doctors. Before you decide to get qualified in law, it is essential for you to clarify at the outset which of these groups of careers you are interested in.

Medical careers in law training

Careers in this category consist of subspecialties in different specialties with different qualifications and training. In general, after completing your house officer posts and your general professional training as a senior house officer, you need to apply for a specialist registrar (or general practitioner registrar) post in the relevant specialty and pass the relevant postgraduate medical examinations. After at least two years as a specialist registrar, you can usually start to concentrate on your chosen medicolegal subspecialty.

Qualifications

Many doctors pursuing medicolegal careers sit the examinations for the diploma in forensic medicine (DipFMSA) and the diploma in medical jurisprudence (DMJ), although these are not compulsory. Both examinations are held by the Society of Apothecaries of London. The DipFMSA demonstrates basic competence in forensic medicine, and the examination can be taken by a qualified doctor, dentist, or lawyer who has attended a nine month, part time course of lectures in forensic medicine offered by the Department of Forensic Medicine and Science of the University of Glasgow. The course is held in Glasgow, London, and Sheffield and covers basic medical, legal, scientific, and toxicological aspects of forensic medicine and may be a good taster for those who wish to test their interest in forensic medicine. The DipFMSA gives exemption from taking part 1 of the DMJ examination.

The DMJ is intended to identify those who are specialists in clinical forensic medicine. Entry to part 2 of the DMJ examination requires a minimum of three years of relevant experience. A holder of the DMJ can give an independent expert opinion to the police, crown prosecution service, and the defence in clinical forensic medicine.

High flyers might also wish to obtain a legal qualification such as a diploma or degree in law or a professional qualification as a solicitor or barrister. Some doctors derive great intellectual satisfaction from such studies, and a legal qualification may enhance career advancement at a senior level. However, such additional qualifications cannot compensate for deficiencies in the core competencies required for subspecialties. Also, doctors are unlikely to obtain financial support to study for a legal qualification. Hence, it is important to weigh up the time and financial costs before committing to a course leading to a formal legal qualification.

Essential qualities

What are the essential qualities for doctors entering these careers? First and foremost are the qualities demanded by the relevant specialty (such as aptitude for histopathology for forensic pathologists and for psychiatry for forensic psychiatrists). Secondly, you must have a logical mind and strong analytical skills. Thirdly, you must be able to explain complex technical matters to a lay person in a simple and concise manner. The table gives details of the individual medicolegal careers.

Attractions and drawbacks

Again, the most important attractions and drawbacks are those inherent to the relevant specialty. Further attractions are that you will find the work intellectually stimulating and your analytic skills will be used to the full. You can develop and demonstrate your skills in handling widely publicised cases under rigorous cross examination in open court. Of course, this would represent a drawback if you dislike such public and open challenge.

Legal careers in medicine

Although quite a few doctors have later also become qualified as lawyers, it is much rarer for lawyers to become medically qualified as well.

In England and Wales, the legal profession is represented by solicitors and barristers. Generally speaking, solicitors can be considered as general practitioners, providing legal advice and representation in the lower courts directly to members of the public, businesses, or voluntary bodies, whereas barristers provide solicitors with specialist advice on the law and advocacy in the higher courts. There are currently about 9000 practising barristers and over 60 000 practising solicitors. Most solicitors and barristers work in partnerships, although a few are employed by central or local government and commercial or industrial organisations. Some solicitors and barristers specialise in cases involving medical negligence, medical law, and mental health law. Doctors who wish to pursue these careers must first qualify as lawyers.

 

Training and qualifications

In order to qualify as a lawyer, it is neces- sary to complete three stages - academic, vocational, and practising. Although it takes three years for school leavers to complete a basic law degree in order to fulfil the academic stage of the training, it is possible for doctors (in common with all other non-law graduates with class 2:2 degrees or better) to complete the academic stage in one year by taking the common professional examination or postgraduate diploma in law. However, there are seven foundation subjects (contract, tort, criminal law, equity and trusts, property law, public law, and law of the European Union), and the academic load is much more onerous than that of first or second year medical students.

Vocational courses focus mainly on the practical skills required as a solicitor or a barrister. The legal practice course for solicitors is mainly run by the College of Law, and the bar vocational course is mainly run by the Inns of Court Law School in London. However, other institutions also run these courses. Both courses are highly intensive, and it would be extremely difficult to engage in part time medical work while studying full time for these courses.

The practising stage of training lasts for two years for solicitors and one year for barristers and usually take place in a solicitors' firm or barristers' chamber. The income for trainee solicitors is likely to be considerably higher than that for trainee barristers.

Essential qualities

You are unlikely to succeed unless you have analytical ability and logical reasoning, reasonable academic ability, good time management, good written and verbal communication skills, perseverance, and unless you are hard working.

Attractions and drawbacks

The main attraction is the intellectual stimulation from the wide variations of people, cases, and issues you will encounter in your new career. There is opportunity to become an expert in medical law and potential for great financial reward provided you are capable, hard working, and lucky. A legal qualification is still highly marketable in careers outside law in industry and civil service.

However, there are substantial drawbacks. Competition is extremely fierce at all stages of a legal career, and a medical qualification does not confer any advantages. According to figures from the Bar Council, there are about 16 500 places on degree courses in law and 3500 places for the common professional examination. There were over 2500 applications for the 1500 places on the bar vocational course, and in 1996, 840 of the 1032 students on the bar vocational course were successful. In 1999 there were over 2000 applicants for pupillage, but there were only 671 advertised pupillages, of which only 226 were funded. The number of barristers who entered active practice was 527 in 1997-8.

The financial commitment is also formidable when you consider the fees (about £10 000 for both academic and vocational stages) and the income forgone during the training period. It would be difficult to keep up with medical advances for returning to a medical career later on, and you might have to spend the first one or two years in general aspects of law before you could move to medically related areas.

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