The path to consultancy in the early 1930s was a steep and hard one. Most students, after qualifying, became general practitioners, many joining family practices established by their fathers. A few went into the armed services and even fewer into academic medicine. The remainder (about one-fifth) took the steep and stony road towards becoming a specialist working in a hospital. The forward way for these students involved postgraduate examinations at the universities and Royal Colleges while gaining experience by taking expanding responsibility for patient care in posts of increasing seniority in specialist hospitals. The bastions of these were the teaching hospitals of London and some of the provincial universities. William Nixon had taken all the right steps: he had been a house surgeon to powerful men, he had worked in paediatric surgery, then in increasingly senior posts in obstetrics to the satisfaction of people like Alec Bourne at St. Mary's and at Queen Charlotte's Hospital. He worked in gynaecology at the Samaritan and Soho hospitals, coming back as a registrar for some years at his own teaching hospital.

In consequence, in 1934, when he was thirty-one, he applied for and was appointed as the second surgeon to the outpatients in obstetrics and gynaecology at St. Mary's Hospital. In those days, surgeons were divided into those who had inpatient facilities with the right to admit patients to beds and those who did not.