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Career Opportunities in the Smaller Medical Specialties

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Career Opportunities in the Smaller Medical Specialties I EDITORIALS Career opportunities in the smaller medical specialties Alistair McIntyre Alistair McIntyre Choosing a specialty in which to build a career has required to offer emergency support. Consultant BSc MD FRCP, always been difficult. In the past the ability to rotate appointments occur relatively rarely in these special- Director of the through a variety of senior house officer posts per- ties and this appears off-putting, but numbers are Medical Workforce mitted variable delay until an appropriate specialty appropriate for the number of trainees so prospects Unit (August was identified and successful application made. In are usually excellent. Career advisers, consultant 2004–August medicine the achievement of MRCP(UK) and the mentors and junior doctors should be aware of these 2008), Royal first, usually general, medical registrar job led to a fur- specialties when considering a career choice. College of Physicians; ther decision on which of the specialties should be Allergists deal with the very broad spectrum of Consultant chosen. The increasing number of medical graduates allergic disease from drug, food and venom allergy Gastroenterologist, coming through for a limited number of training and idiopathic anaphylaxis to the many organ-based Wycombe Hospital posts, some of the constraints in the initial introduc- allergic diseases such as eczema, rhinitis and asthma. tion of Modernising Medical Careers (MMC), and the Audiovestibular physicians diagnose and manage Clin Med Medical Training Application Service debacle in 2007 hearing and balance disorders arising not only from 2009;9:10–11 brought the choosing of a specialty into much more ear pathology but also presenting as a symptom of a focus. The constraint of a limited number of applica- diverse range of conditions including vascular, renal, tions, by design to encourage people into less popular endocrine, autoimmune and mitochondrial disease, specialties, made the choice even more daunting. In neurological disorders and chromosomal abnormal- addition, the choice had to be made substantially ear- ities. Clinical genetics is concerned with the diag- lier than in the past. Despite these changes, however, nosis of inherited disorders and birth defects, the the amount of competition for medical specialties has estimation of genetic risks and organisation of remained relatively unchanged. Some of the larger appropriate genetic testing, and the provision of acute medical specialties have been fiercely competi- genetic advice to individuals and family members tive (eg cardiology, gastroenterology, respiratory med- who may have, or be at risk of, a genetic or inherited icine) and applications for these and similar ones disorder. Clinical immunology encompasses clinical remain in excess of 10 per appointment since early and laboratory activity dealing with the study, diag- data collection in the mid-1990s until MMC applica- nosis and management of patients with diseases tions in 2007. The Department of Health predicts that resulting from disordered immunological mecha- competition in 2008 will be more severe than in 2007. nisms, and conditions in which immunological In contrast there was substantially less competition manipulations form an important part of therapy. for many of the small medical specialties in 2007. Clinical pharmacologists in the UK are physicians These included allergy, audiovestibular medicine, whose patterns of work and specialist interests vary clinical genetics, immunology, clinical pharmacology enormously and are often based in teaching hospi- and therapeutics, neurophysiology, medical ophthal- tals. They have expertise in the development, evalua- mology, metabolic medicine and paediatric cardi- tion and use of drugs applicable in many different ology. Candidates have little experience of these spe- sectors including in academia, the NHS, pharmaceu- cialties often with only brief introductions in medical tical companies, and drug regulatory authorities. school. Some have application rates of one candidate Clinical neurophysiologists evaluate patients referred for two posts. Many are not listed separately on the with neurological symptoms for diagnosis or quanti- MMC website. Smaller specialties potentially have tative assessment of severity. The core work is in elec- advantages for some. Specialist departments are often tromyography and electroencephalography but there based in larger cities or university hospitals with excel- are numerous other investigative techniques and the lent support and research facilities. The opportunities list is expanding. Medical ophthalmologists treat for teaching and training at all levels still exist. conditions affecting the eyes, orbits and visual path- Management of the service is still required. The work ways. Training in internal medicine and ophthal- is diverse, interesting and predominantly outpatient mology enables them to offer a comprehensive based. For some applicants the lack of uncertainty, assessment of a patient with visual symptoms or excitement and chaos of the acute medical take as well ocular signs and to monitor systemic effects of ther- as freedom from the potentially disruptive hours is a apies. Metabolic medicine for physicians offers a way bonus although some smaller specialties are also of pursuing a focused interest in one or more of the 10 Clinical Medicine Vol 9 No 1 February 2009 © Royal College of Physicians, 2009. All rights reserved. Career opportunities in the smaller medical specialties five areas of the curriculum (diabetes, lipids, nutrition and obe- Dr Sue Holder, Consultant Clinical Geneticist, Imperial College sity, metabolic bone disease and osteoporosis, and inborn errors London. Email: [email protected] of metabolism). It is potentially a very attractive route for those Dr DJ Unsworth, Consultant Immunologist, North Bristol NHS Trust. interested in these specific areas who may wish to work in acad- Email: [email protected] emic units. Paediatric cardiologists deal with a diverse group of Dr Jeffrey Aronson, President of the British Pharmacological Society; Reader in Clinical Pharmacology and Honorary Consultant conditions that can result in significant morbidity and mortality Physician, University of Oxford. but for most there are treatments available. It is a high-risk but Email: [email protected] high-gain specialty that gives excellent job satisfaction and it Dr Albert Ferro, Reader in Cardiovascular Clinical Pharmacology and remains a field where clinical skills, practical procedures and Honorary Consultant Physician, King’s College London. technical expertise are important. There will be a need for con- Email: [email protected] sultants specialising in looking after adults with congenital heart Dr R Kennett, Consultant in Clinical Neurophysiology, Oxford disease with the improved survival for infants and children with Radcliffe Hospitals NHS Trust. Email: [email protected] these conditions. Dr Catherine M Guly, Specialty Registrar in Medical Ophthalmology, The Eye Clinic, Aberdeen Royal Infirmary. To enter most of these specialties at specialty training year Email: [email protected] three a trainee needs to have completed two years of core med- Dr John Olson, Consultant Ophthalmic Physician and Lead Clinician, ical training or acute care common stem (though other path- Scotland’s National Managed Clinical Network for Uveitis, ways are possible or extra experience is required) and to have Aberdeen Royal Infirmary. Email: [email protected] passed or imminently likely to pass MRCP(UK). For those who Dr Jennifer Logue, Specialist Registrar in Chemical Pathology and think they might be interested in some of these smaller special- Metabolic Medicine, Glasgow Royal Infirmary. ties they should seek information from the Royal College of Email: [email protected] Physicians’s website (workforce section), consider contacting Professor Mike Lean, Professor of Human Nutrition, University of Glasgow, Glasgow Royal Infirmary. local specialists whom they know or the specialty representa- Email: [email protected] tives. Ideally they should arrange to spend a few sessions within Dr Robin Lachmann, Consultant in Metabolic Medicine, National the field to see if this helps their career choice. For those who do Hospital for Neurology and Neurosurgery, Queen Square, decide on applying for one of these smaller specialties the career London. Email: [email protected] opportunities look good. Dr Robin Martin, Paediatric Cardiology SAC Chair, Consultant in Paediatric Cardiology and Adult Congenital Heart Disease, Bristol Royal Hospital for Children and Bristol Royal Infirmary. Contributors Email: [email protected] Dr Pamela Ewan, Allergy Department, Addenbrooke’s Hospital. Email: [email protected] Dr Ewa Raglan, Consultant Audiovestibular Physician/Honorary Senior Lecturer, St George’s NHS Trust. Email: [email protected] Clinical Medicine Vol 9 No 1 February 2009 11 © Royal College of Physicians, 2009. All rights reserved..
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