Careers A In this section C1 Careers DELIVERING A MJ GREAT CAREER What does it take Career overview to make it as an obstetrician? C2 REGISTRAR Q+A Dr William Milford, obstetrics and Delivering a gynaecology registrar C5 MEDICAL MENTOR great career Associate Professor John Svigos on delivering babies C6 MONEY AND PRACTICE How to choose a practice manager C8 ROAD LESS TRAVELLED Arab Spring medicine For many obstetricians, it is the excitement of gynaecologists. “Unlike some bringing new life into the world that fi rst attracts other fi elds where the degree of subspecialisation is quite high, we them to the specialty. still have a fairly large generalist workforce and we aim to keep it that r Rupert Sherwood, president hands-on involvement, especially way, particularly in rural and regional of the Royal Australian and in complicated labour or caesarean Australia”, he says. D New Zealand College of deliveries. Dr Sherwood, who practises in Obstetricians and Gynaecologists Hobart, says that obstetrics allows (RANZCOG), says one of his favourite doctors to use an appealing mix of Dr Rupert Sherwood parts of his job is seeing the fi rst medical and surgical skills. ‘‘There are still many ultrasound images of a growing embryo. “I describe myself as an operating “After 25–26 years [as an situations where nature physician. [The specialty suits] people obstetrician–gynaecologist], I still get who don’t want to do the technical ‘‘I still get a buzz a buzz when I see that fi rst ultrasound is not a good midwife thing all day, but enjoy consulting and image of an embryo at 8–9 weeks, medicine as well.” when I see that with a heartbeat … it’s a story that you Junior doctors who are considering fi rst ultrasound can watch together with the parents”, ”Before the pregnancy, obstetricians a career in obstetrics need to be he says. are also involved in pre-pregnancy empathetic, with good communication image of an The excitement of delivering a baby medical care, and after the birth skills. “Because you are dealing with embryo at 8–9 is also something many obstetricians they provide postnatal care, which people at a diffi cult emotional time in continue to fi nd stimulating after is defi ned as care up to around their lives, you need to be supportive weeks many years of practice (eg, see Medical 6 weeks after the birth. and have good interpersonal skills Mentor, page C5). Intrapartum care Dr Sherwood says most specialist … you can’t survive on technical can range from a supervisory role to obstetricians also practise as excellence only”, says Dr Sherwood. ”continued on page C2 Editor: Sophie McNamara • [email protected] • (02) 9562 6666 MJA 195 (10) · 21 November 2011 C1 Careers Career overview continued from page C1 Professor Ian Fraser, professor of Registrar Q+A reproductive medicine at the University of Sydney, says would-be obstetricians Dr William Milford is a 4th-year obstetrics also need to have a real enthusiasm for and gynaecology (O&G) trainee currently the fi eld so they can handle the often based at Bundaberg Hospital, Queensland antisocial working hours. Why did you decide to do O&G training? “They need to fi nd the wonder Factors which drew me to the specialty included of reproduction and pregnancy and its generality, with medicine, surgery, emergency birth and new life something that medicine and imaging all part of the work. Every excites them, because it’s a demanding day is diff erent. Along with this was the potential specialty in terms of time and in the private sector, often have to pursue subspecialty areas as diverse as cancer commitment.” long-term relationships with their surgery, minimally invasive surgery and maternal–fetal Obstetricians also need to be able to patients over many years, or even over medicine. I also wished to care for mainly young, project an air of confi dence, which will generations. As well as the close care healthy patients and families during what were inspire confi dence in other staff, such provided during a pregnancy, many hopefully normal life events, rather than just caring for as nurses and midwives, as well as their obstetrician–gynaecologists will also the sick. patients — particularly when things go provide gynaecological care between What do you like most about your training so far? wrong. pregnancies. I enjoy most of my training but the intellectual “There are still many situations “Getting to know your patients and challenge of managing high-risk pregnancies, where nature is not a good midwife”, their children and their families over particularly in women with medical comorbidities, says Professor Fraser. “You need a the years, and seeing the children of the is something I enjoy greatly. I also get great pleasure personality which doesn’t freak out women you delivered, or, when you get from performing surgical procedures. The three main when something unexpected happens. to my stage, the grandchildren — that modalities of surgery — vaginal, abdominal and You have to have confi dence in yourself, aspect can be particularly satisfying. We laparoscopic — require diff erent techniques, which makes operating diverse and interesting. It sounds a bit and a calmness in your personality that fi nd that in few other specialties”, says nerdy, but I particularly enjoy the academic stimulation will extend to the people around you.” Professor Fraser. brought by research and teaching. Obstetricians, particularly those Sophie McNamara What do you dislike or fi nd challenging? There is no aspect that I truly dislike but challenges Training as an obstetrician are aplenty. Managing patients who have poor outcomes, from miscarriage through to intrapartum complications, is always challenging and stressful, but Training as a specialist obstetrician– Dr Sherwood says the training can be satisfying when done well. Similarly, dealing gynaecologist involves a 6-year program is competitive, and the with chronic conditions such as incontinence or course, run by RANZCOG, after standard of applicants high. pelvic pain brings its own challenges and frustrations, completion of a medical degree and More than 70% of trainees are particularly once the limits of therapy are reached. registration as a medical practitioner. women. Dr Sherwood says the The fi rst 4 years provide an overview College has worked hard to make What’s next? of obstetrics and gynaecology, with the training program fl exible, I would ideally like to remain a generalist, practising trainees rotating through at least with the possibility of part-time both obstetrics and gynaecology with public, private three hospitals including a rural training and training breaks. and academic aspects to my practice. I would like to hospital and a tertiary hospital. RANZCOG also off ers several continue to participate in research and teaching and Membership of RANZCOG is courses for general practitioners, am currently studying for a masters in public health, awarded after successful completion including the Diploma of RANZCOG. which ties into this. In the short term, I’m hoping to fi nd of 4 years of training, plus a This course aims to provide GPs a job in Europe towards the end of next year, preferably written and oral examination. with skills to safely undertake in a specialised unit with a research role. During the next 2 years, trainees non-complex deliveries and basic complete the elective program, which gynaecological procedures. It is a Do you have any mentors or role models? allows doctors to focus on their self-paced course, but all training Probably the biggest infl uence has been working with own educational interests, such as and assessment must be completed and for other trainees early in my career. These trainees operative obstetrics. Following this, within 4 years. provided valuable role models and created inspiration, trainees are awarded the Fellowship while setting the standards by which I judge my own of RANZCOG and can begin formal More information about all the practice. Probably my fi rst role model was my father, subspecialty training in areas such as courses is available at www. a practising GP, who used to do obstetrics as well. I maternal–fetal medicine or obstetric ranzcog.edu.au, under the remember as a child being taken up to the maternity and gynaecological oncology. “Education & Training” tab. ward or waiting in the car while he did his ward rounds on the weekend. C2 MJA 195 (10) · 21 November 2011 Careers Anyone for tenens? (locum that is) Are you a well rounded health professional? Being a locum is a lifestyle choice and Health 24-7 can help you find the right balance between work and play. 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See our Job Board at: www.skilledmedical.com/jobboard Contact us on 1300 900 100 or [email protected] C4 MJA 195 (10) · 21 November 2011 Careers Medical mentor Associate Professor John Svigos refl ects on his career as an obstetrician-gynaecologist Associate Professor John Svigos is an obstetrician-gynaecologist at Women’s Health to be non-judgemental — just because they do something that you don’t Specialists in Adelaide and an associate professor in obstetrics and gynaecology at philosophically agree with doesn’t mean the University of Adelaide.