Doug Pearman: February 2016

Medical speciality decision: amusement

For the first time in the medical course we're being asked to prioritise from our areas of speciality interest (choosing 4 from 100 or so) to direct 20 days we'll spend during Year 3 of our 4-year graduate medical course. Eeek!

Overeager? Well, by most measures it's pretty minor this early on - what's 20 days in a 1500 day course, after all. But there's something in it. It's a guarantee that one day some Morpheus-like character will present the proverbial blue pill and a red pill for the speciality choice, and it'll be well to know which one to take. Else it'll be a rerun of schooldays' UCAS with a zillion courses and little to pick between them, or the extraordinary array of projects to pick from on consulting jobsites...

So - last summer I was gathering tips from my cardiology mentor (Diane) on where next to network and get experience in medicine, and she rightly tasked me to draw out a picture of how the future might look (and where I might be for it). Undoubtedly, one of the benefits of the medical career is the predictability of career pathways, still a tough task.

View pinged to Diane @ close of 2015

Specialities under consideration
So there are lots of options & here are three which have some appeal...

Orthopaedics (e.g. broken bones, joints, muscles, tendons): a long but practical route, takes about 15 years from med school start till consultant, which is when you're fully trained. This 15 years would be varied - working on all different parts of the body; then the second half of the career would be potentially 15 years as a specialist hand surgeon (finer detail, get to sit down, better hours!). It has interesting patients of all ages, you see rapid and dramatic change in the patients, hand patients are awake during the procedures, there's the important psychological angle around pain & physio adherence, and it's internationally relevant - the development agencies seek orthopaedics and there's a big demand for surgical training in the developing world. Plus I had a great time observing this in Nairobi. What's not to like? LINK

Infectious disease (e.g. hepatitis / meningitis / HIV / MRSA / TB): there's all the fascination of problem-solving which the medical dramas make a play on, as well as the integration of animal and human disease vectors. And the great thing is - most diseases are controllable, so the patients tend to get better. Naturally lots of docs deal with infections, but specialists have extra interest in hepatitis / meningitis / HIV / MRSA / unexplained fever / TB / malaria as well as the less common neglected tropical diseases. The contagious nature also gives a significant public health component which appeals. However, bit of a less clear career structure. Haven't shadowed here yet. LINK LINK

Cardiology (e.g. heart murmurs, heart attacks, blocked arteries): combines some of the interesting breadth of medicine with surgery (e.g. pacemaker fitting, stenting, angiography); and I've met a couple of lovely people that work in it, my bro included. Only trouble is, it's pretty western-world bound: it's relatively expensive to deliver and patients in poorer parts of the world tend to die before they get old enough for the complex coronary interventions. Plenty of money available for research tho. Plus I had a great time observing at Arrowe Park.

Of course, medicine's not all about the theatre or time with the patients. You have to take on extra responsibility to boost your department, and I think a bit of teaching (I've always enjoyed training/lecturing) and/or management (FMLM is one related organisation) may suit - whether research is interesting in the domain is probably a bit speciality-dependent. Time's likely to be pressed, but I also like the idea of engaging with a more broad-reaching institution too. That could be an international organisation with a speciality focus (e.g. an NGO like WOCUK, GNNTD or WHF), or something more cross-speciality (e.g. the APPG, King's Centre for Global Health: Surgery). Let's not think too far ahead...

Stereotypes of the specialities (haven't held true yet in my experience)
Aside from the minutiae of which body parts you'll be working on, some say the most important consideration is whether you like the people and the team cultures in the departments you work in, as these specialities can have prevailing cultures. I'll have to see about that as I start rotating through the departments.

Orthopaedic surgeon (general stereotype: of a meaty thuggish sportsnut, well that's certainly not me)
Hand surgeon - a subspeciality of orthopaedics once you're trained (stereotype: a little softer hands, a little calmer)
Infectious disease physician (stereotype: intellectual traveller types - includes lab work tho)
Cardiology (stereotype: smartest of the lot.)

Competition in the specialities (applicants per place) after FY1 and FY2, i.e. 4 years from now for me:
Orthopaedics: 2.5:1 for core surgical training Y1-2; then 5:1 for orthopaedic specialist training Y3-7. LINK Alternatively 10:1 for run-through training from ST1-7
Infectious disease: 2:1 for core medical training Y1-2; then 2:1 specialist training Y3-6 + PhD LINK
Cardiology: 2:1 for core medical training Y1-2; then 6.5:1 for specialist cardiology training Y3-7 + PhD LINK

Quotes
> "Every surgeon must have a little internist in them and vice versa if they are going to be master in their field"
> "A wrong decision is generally less disastrous than indecision"
> "Half of graduate medical students become GPs"

Upshot
I've gone for orthopaedics for this specialist placement (I'll give it a go with the meatheads and hopefully practice some of the suturing we've been learning), with a backup choice in hand surgery (which is a part of orthopaedics anyway) as a close second. With luck it'll be good exposure for ruling in / ruling out.

I'll have to book in those days in infectious disease when I have a gap. And try for now to ignore the stats which suggest I'll eventually end up as a GP anyway...