SA MET Newsletter - Spotlight on Career Pathways

1. What made you choose your career pathway? Is there anything that influenced you? For more than 10 years I worked as a Family Physician medical officer (GP in the state health sector) in South Africa, gaining a vast amount of experience in many different fields including years of emergency medicine, surgery, obstetrics, paediatrics, anaesthetics, rural and remote medicine, and forensic medicine – even doing my own autopsies! In the latter years of my work (as a Family Physician) I gravitated towards the GP sub-speciality of HIV medicine in South Africa – and found it was a field of medicine I loved.

HIV medicine proved not only to be a rigorous scientific field – involving complex medicine – but also a field that addressed the patient in a holistic multi-disciplinary way. My husband, two boys and I immigrated to Australia almost 8 years ago. I had to undertake vocational training in Australia – and due to my love of HIV medicine decided to embark on Physicians Training with the RACP. After successfully completing my basic physicians training, I longed for the holistic approach that my previous years of HIV medicine had offered. I had also realised by this stage that the patient population groups that I loved the most were those that were often marginalised, misunderstood and on the fringes of main stream society – hence I decided to pursue advanced physicians training in Addiction Medicine – the best career decision I have ever made!

2. We’ve noticed there aren’t many consultants in Addiction Medicine. Can you tell us a little bit about your training? That’s true – there aren’t many consultants in the field of Addiction Medicine – yet! A relatively newly established and recognised speciality field – is growing and gaining momentum across the country as more and more doctors are exposed to exactly what we do. Traditionally many in the medical field assume that Addiction Medicine is a subspecialty of psychiatry only. Indeed there are Addiction Medicine Psychiatrists – however Addiction Medicine is a speciality in its own right.

Training is undertaken through the Chapter of Addiction Medicine, Royal Australasian College of Physicians (RACP). To enter the training pathway you have to have EITHER completed basic physicians training (with success at both the written and the clinical) – e.g. Addiction Medicine is your advanced training pathway in Physicians training OR you can enter as post fellowship training after completing a fellowship in another speciality – most commonly psychiatry, general practice or emergency medicine. It’s a 3 year FTE training program.

Information about the training requirements is available on the RACP website, this includes exposure to all of the fields in Addiction Medicine. Theoretically you are required to complete a research project, a detailed case history write up, a public health assignment, directly observed patient interviews, case based discussions – a very busy and well managed training program. The advantage of being a registrar in a small speciality is that you really do receive intensive one-on-one training throughout the training period.

Although I have a physician’s background – and am very interested in issues such as alcoholic liver disease, treatment of hepatitis C in a substance using population, liver transplant assessments from an Addiction Medicine point of view, acute care of the unwell dependent patient – my colleagues have a wealth of experience in a variety of fields due to their background prior to Addiction Medicine specialisation – including psychiatry, adolescent health, obstetric medicine, custodial medicine, indigenous health issues. As you can imagine – this provides complete holistic care for our patients – and is a very satisfying way to approach any disease management.

3. How different are the medical career pathways in South Africa compared to Australia? As one would imagine – some things are similar, some are vastly different. The overarching pathways are somewhat similar (undertake a 6 year pre-graduate degree and become a doctor).Then, you undertake a yearlong internship – like Australia. In South Africa, all doctors then have to undertake what is called a Community Service (rural and remote) year before the Health Professions Council of South Africa will register you.I did this year many years ago and had a fabulous year! I worked about 500 km from the closest hospital with a registrar. I was supervised by the town’s local GP. I learnt more in that year than I ever have anywhere else.

I took my own X-ray’s, gave anaesthetics for the GP, performed autopsies and all forensic reports, I attended to many multi-trauma victims prior to the 500 km transfer to the bigger hospitals, I delivered twins, managedbreach births, vantouse and forceps deliveries on my own – and then resuscitated the neonates ! It was a very busy year and a huge challenge for a junior doctor – both physically and emotionally – but it was the year that truly transitioned me from a student to a real doctor.

Once you are registered as a doctor with the South African Medical Board, you can either work as GP in private practice, continue as a medical officer in the state health system or you could undertake specialist training.

Specialist training is quite similar – South Africa has Colleges of Medicine, Surgery, General Practice, Psychiatry, Paediatrics etc.General specialist training takes 5 years of full time training. Once you complete training you are considered ageneral specialist in your chosen field of speciality. You can either continue work as a specialist or specialise further in sub-speciality fields such as endocrine, geriatrics, haematology, neurology, gastroenterology, endocrine or if a surgeon: endocrine, transplant, hepato-biliary as examples. This subspecialising takes a further 3 years. This training model is similar in all fields of speciality. The advantage of this model is that the general specialists (such as the general physicians) - get to do a vast amount of work and procedures such as gastroscopies, angiographies, external pacing, renal biopsies etc. The patients are only referred to the doctors in the sub speciality areas when the general specialist is satisfied they have exhausted all options and as such the sub speciality doctors are not over whelmed by patients that could be managed by general specialist.

In South Africa, doctors such as me - who chose to remain medical officers and not specialise – played a vital role in the smooth running of the state health system. We ran what were called primary care clinics and hospitals. Our work included inpatient and outpatient work, surgery, obstetrics, anaesthetics, paediatrics, general medicine and emergency department medicine. We were the initial contact for all patients and referred the patients who needed to see the general specialists on to the relevant department. The general specialists then decided who was referred to the sub specialities. It is a system that created ongoing patients flow, as well as multiple career pathways for those that doctors that wanted to specialise and those that did not.

4. What is the one piece of advice you would give to an intern? ENJOY your year – grab every opportunity you can in that year to do everything you can. Accept that as a doctor you have chosen a career with high demands – emotionally and physically. You are going to be exhausted at times – embrace it – that’s part of being a doctor.

AND

Don’t rush career choices. Give yourself time to decide what you like and don’t like. It’s awful to be stuck in a 6 year training program when you’re not sure of what you want to do. Work as a general trainee for a year or two, before making a commitment to a training pathway. When you decide to enter a training pathway, make sure you have a definite end goal in site – it’s that dream that keeps you going through many long sleepless nights.