Why choose Respiratory Medicine?
Because the specialty is so interesting, wide and diverse, and provides excellent opportunities for individualised career development! We deal with over 30 different conditions, some very common and some rare, so there is ample opportunity to sub-specialise as well. Being part of the multi-disciplinary respiratory team involves working with specialist respiratory nurses, community respiratory teams, respiratory physiotherapists and specialist respiratory technicians as well as other medical staff. This provides great opportunities for developing local services and encourages lifelong learning.
Some respiratory units are highly specialised and provide regional services, for example lung transplant, sleep related medical problems and adult Cystic Fibrosis units, while in the majority of units a large proportion of the workload is acute respiratory and general medicine. Lung conditions account for about a third of emergency admissions. All respiratory trainees have to undergo intensive care training and many individuals now look for jobs that involve both critical care and respiratory work. Being able to perform 'procedures' is another interesting and varied aspect and brings a practical edge to the job. Bronchoscopy involves inspecting the inside of the lung using fibreoptic scopes and techniques for inspecting, biopsying and draining the pleura are also commonly learnt. There are close links between the specialty and both radiology and thoracic surgery. Opportunities exist for education and training work both locally and regionally while the national specialty body, the British Thoracic Society (BTS), is probably the most active in the country. We have a reputation for being a friendly and progressive specialty with strong emphasis on involving doctors at all stages of their career.
Overall there are ample opportunities to work as a consultant or specialist, on a full-time or part-time basis, both in hospital and in the community and to organise a job to focus on an individual's own specific interests.
What are the current job prospects?
They are excellent. Lung disease is very common and unlikely to decrease in the future. Lung cancer services have expanded to meet the two-week waiting time while the number of patients with mesothelioma who will need care will continue to rise. There is expansion in sleep services and more respiratory high dependency units are being opened to manage cases of acute respiratory failure and provide non invasive ventilation. The number of adult CF patients requiring specialist care increases year on year and there is growing acceptance that respiratory specialists best manage asthma. There are better treatments for COPD and pulmonary rehabilitation services continue to expand. This all demonstrates a need for continued expansion of the specialty both now and in the future.
The consultant expansion rate has averaged 6 - 7% over the last 8 years. There are currently over 430 respiratory trainees - the largest number in any of the acute medical specialties. There are established models of working part-time as a consultant physician in respiratory medicine, and the British Thoracic Society is committed to developing models of good practice for part-time consultant posts. There are also increasing opportunities for staff grade and associate specialist posts. Overall the prospects look bright.
How do I become a Respiratory Physician?
Initially a broad general medicine training at ST1/2 level is essential and it is advisable to have one period on a unit with a specialist respiratory interest. Ward based practical skills can be developed during this time and there is sometimes an opportunity to begin to learn bronchoscopy. This may help crystallise your decision to pursue a career in the specialty. For anyone wishing to obtain a training place at ST3 level, the MRCP qualification should be regarded as essential, career progression to CCT will not be possible without it.
In recent years out of programme research experience has been difficult to achieve under ‘MMC’ regulations. Since the Tooke report however it is now encouraged. A period of research with the aim of obtaining an MD or PhD is likely to be most commonly pursued after entering specialist training. It could also be undertaken prior to ST3 appointment. Some would see this as a means of demonstrating commitment to the specialty and a way of enhancing prospects of appointment in what is a competitive specialty. It is certainly not the only way to enhance a CV however, and of itself does not guarantee appointment to specialty training in respiratory medicine.
If you are considering a career in respiratory medicine it is always wise to get advice, as early as possible. Speak to the local training director and other consultants. We’re a friendly bunch of people and always happy to speak to young, enthusiastic new recruits.
Most specialist registrar training positions last for five years and give training in general and respiratory medicine. It is also possible to train in respiratory medicine part-time as a flexible trainee. BTS is supportive both of core medical trainees wanting to enter the specialty as flexible training Specialist Registrars and of individuals who want to switch to flexible training during their SpR programme. There will be regular regional teaching in both disciplines and attendance at national meetings will be expected. There may be opportunities for anaesthetics and ITU secondments. Specialist skills, including bronchoscopy, will be developed. The end of specialist training is perhaps where real choice and career development begin.
More details about the training curriculum can be found here: www.pmetb.org.uk/index.php
What do Respiratory Physicians do?
The work is very varied. Respiratory physicians spend a lot of their time in outpatient clinics. Clinics are either general or more specialist. The general clinics deal with conditions such as asthma, chronic obstructive pulmonary disease (COPD), or bronchiectasis, and with patients referred from primary care with haemoptysis, unexplained breathlessness, and chest X ray abnormalities. The more specialist clinics deal with lung cancer, tuberculosis, cystic fibrosis, parenchymal lung disorders, chronic cough, sleep medicine, pulmonary vascular disorders, and so on. Most respiratory physicians also look after inpatients and have ward rounds with ward nursing staff, junior medical staff and respiratory physiotherapists several times a week. Procedures such as bronchoscopy lists take up other sessions.
Many choose to have a general medical commitment and participate in "medical takes," which often entails looking after patients with general medical conditions who are not subsequently referred to any specialty. Respiratory Physicians, whether in district general or teaching hospitals, tend to have a subspecialty interest. They often develop a special interest during their training period as a specialist registrar or once they have become a consultant.
Desirable qualities for a Respiratory Physician
Several personal qualities are desirable for a career in respiratory medicine:
- Good general medical knowledge
- Good communication skills
- Ability to work with other multidisciplinary team members
- A cool head and an ability to troubleshoot in an emergency situation
- Aptitude for practical procedures
- Ability to recognise multisystem diseases
- An empathetic approach towards patients with chronic disorders, especially when therapeutic intervention is limited
- A willingness to accept new ideas and changes to established management regimes
It is also fundamental to the specialty to have a thorough understanding of the basic pulmonary physiological and anatomical principles, along with how different disease processes affect lung function.