The The Other Other Side Side
Contents 6
Aboriginal Health
7
Academia
9
Dermatology
O
Dr Peter Fitzpatrick
Perspectives on Careers in Medicine
Dr Grace Higgins
Dr Tony White
edited by Greg FOX Amy HAYDEN Archana RAO
10 Emergency Medicine Dr Simon Brown
12 Forensic Pathology Professor Stephen Cordner
13 General Practice (Rural)
30 Police Medicine
14 General Practice (Urban)
31 Politics (Government)
16 Information Technology
32 Politics (Medical)
17 Management Consultancy
34 Psychiatry
19 Medical Journalism
36 Public Health
20 Medical Research
37 Royal Flying Doctor Service
21 Medicolegal
38 Sexual Health
23 Obstetrics & Gynaecology
40 Sports Medicine
24 Occupational Medicine
42 Surgery (Plastic & Reconstructive)
26 Paediatrics
44 For Further Information
Dr Chris Homan
Dr Bernd Lorenzen
Dr Matthew Cullen
Dr Reg Seeto
Dr Mark Ragg
Dr Andrew Elefanty
Dr Elaine Fabris
Dr Khai Mohamed Noor
Dr Robert Scott
Dr Rima Staugas
27 Palliative Care Dr Amanda Walker
28 Physician (Endocrinology) Dr Bronwyn Crawford
Dr Edward Ogden
Dr Brendan Nelson
Dr Rosanna Capolingua-Host
Professor Ian Hickie
Dr Gary Dowse
Dr Rosalind Reid
Dr Wendell J Rosevear
Professor Peter Fricker
Dr Mark Gianoutsos
The Other Side - Perspectives on Careers in Medicine was edited and published by Archana Rao, Amy Hayden and Greg Fox, for The Australian Medical StudentsÂ’ Association Limited. ACN 079 544 513. Copyright 2000. The full text of this publication can be found on the AMSA Website, www.amsa.org.au.
TheOther Other Side The Side
Page 1
TheOther Other Side The Side
Page 2
Preface Preface
O
The Other Side
So, what do you want to do when you graduate?
It s probably the first
question most med students are asked by well-meaning friends and relatives, after divulging that they re studying medicine. By now you ve probably worked out your own standard response to the question, such as I m really interested in paediatrics , I d like to go into research or I can see myself being a GP. These answers are often based upon positive experiences we ve had during our course, doctors who have had a particular influence on us, or suggestions that we ve picked up from other role models or the media. Whatever your answer is, chances are that there is a vast array of other options out there that you haven t even considered. That is where The Other Side comes in. We hope to stimulate you to explore a wide range of ideas about your future career - both within and outside of traditional areas of medical practice. As you will see, medical graduates can follow a myriad of career pathways. Within the more traditional areas of medicine, doctors are able to pursue interests ranging from clinical practice to research and public health. Outside of the specialties , the options for medical graduates are broader still. In many ways, medicine is the ultimate generalist degree. Employers often view the degree as a considerable asset, both within and outside of jobs in health care. If you are one of the significant proportion of medical graduates that will eventually follow a non-medical career path, we encourage
you to consider your options early on in your career. As the profiles demonstrate, there are as many different career paths available as there are doctors who will follow them. But having a satisfying professional life is about much more than finding an enjoyable job. It is also important to consider the how one s career fits into the broader context of one s lifestyle. The profiles in The Other Side illustrate how some doctors have balanced their work with a family travel and other personal interests. We hope that you enjoy discovering more about the wide range of careers profiled in The Other Side. While a large number of career paths are described herein, we have not attempted to be comprehensive in our coverage. Rather, we hope to provide a wide range of ideas that may stimulate further thought and investigation. Finally, many thanks must go to each of the contributors to this publication, who kindly agreed to write the articles found herein. We hope that their contributions will be valuable as you embark upon your career as a doctor. We wish you all the best as you complete your medical studies, and find out what lies ahead for you on the other side Greg Fox Amy Hayden
O
Archana Rao
this publication can also be found on the web at www.amsa.org.au TheOther Other Side The Side
Page 3
Clinical Paths ClinicalCareer Career Paths
TheOther Other Side The Side
Page 4
Pathways Pathways toto Practicing Medicine racticing medicine
O
The Other Side
Clinical Career Paths
While medicine is a profession that provides a very structured career pathway, there are a lot of variations across specialties, and many opportunities to diverge from the set pathways that are presented in the adjacent diagram.
training lasts a number of years. At the end of Advanced Training, some specialties automatically admit trainees as Fellows of their College (for example, Physician Training, Paediatrics). However, most require candidates to sit exit examinations.
All Australian medical graduates must satisfactorily complete one year as an intern in order to be registered as a medical practitioner. Following this, graduates must complete a period of postgraduate training before they can enter private practice. The majority of graduates undertake general practice, surgery, or physician training, with smaller numbers moving into the other specialties. Postgraduate training is undertaken through the various specialist Colleges, and results in trainees being awarded the Fellowship of that particular College.
Having gained postgraduate qualifications, doctors then have a number of options in terms of practice. These vary according to the specialty, but include entering private practice, practising as a Visiting Medical Officer or Staff Specialist, or undertaking further training and specialisation.
In general terms, most training programs require a certain period of general hospital training (Basic Training) following the intern year. For some, this may involve posts specific to the specialty (for example, basic surgical training predominantly requires trainees to undertake general surgical posts). Others accept broader hospital experience, however all training programs generally have specific requirements for this period of training (particular terms, accredited hospitals etc.).
Consult the Astra-United Handbook Careers in
At the end of this period, trainees generally sit an exam (written and/or clinical) which they must pass before they can enter Advanced Training. This next period of
The actual details of the training programs, such as duration of training, entry requirements, type of training, and assessment, vary greatly from specialty to specialty. To obtain more details: Medicine this book details training requirements for each of the specialties, and is published each year by The Hunter Postgraduate Medical Institute, University of Newcastle. For more information, contact the Institute by email (jwalsh@mail.newcastle.edu.au) or phone (02 4923 6173). Contact the Colleges directly contact details for all of the Colleges are included on page 44. Speak to trainees/qualified doctors who work within the specialty you are interested in.
Where can I go to do my internship? How much will I be paid? What rotations do hospitals offer interns? We have the answers. AMSA Intern Survey Book is coming in mid 2000. TheOther Other Side The Side
Page 5
Aboriginal Aboriginal Health Health Dr Peter Fitzpatrick
Remote General Practitioner Borroloola, Northern Territory When I approached my final year in secondary school I did not have any firm ideas as to what to do next. It seemed to me at the time that the best option for somebody who did not know what to do was to do medicine, so I did.
to find out more
?
national aboriginal and torres strait islander health clearing house www web site www.ecu.edu.au/chs/nh/ clearinghouse/ This site is a comprehensive site, providing links to a range of relevant resources.
racp - indigenous health education and resources guide www web site www.racp.edu.au/indig/ index.htm office for aboriginal and torres strait islander health www web site www.health.gov.au/ pubhlth/indig/index.htm
Toward the end of medical school the same dilemma loomed, what next? I spent my final year electives with aboriginal medical services in Central Australia and the Kimberley region of Western Australia. The environment and the work suited me, and I found some direction. In the middle eighties the career path for a prospective rural or remote doctor was less didactic than today. The Family Medicine Program of the RACGP existed but did not really meet my needs. Instead I spent several years at the Alice Springs Hospital and subsequently, several more in Tennant Creek Hospital. After about seven years between these two towns I moved north and spent a year on Groote Eylandt as the District Medical Officer. In 1991 our growing family moved to Borroloola, a remote town in the gulf country of the Northern Territory, and I became a GP. Prior to Borroloola I had been working for the Northern Territory Health Department and I was not a GP. When I left NT Health to work in Borroloola I though of myself as doctor who happened to work in a remote area, not a GP. I had not had any formal GP training, nor had I needed to. Then vocational registration was created and it became advantageous to become a GP, so I became a GP.
TheOther Other Side The Side
Age: 43 years Qualifications: MBBS, Flinders University, 1982 FACRRM I get the impression now that doctors lives are more regulated. To become a GP you have to undergo formal training. This is in itself a good thing, but the training path is limited to that provided soley by the RACCGP and no longer recognises prior learning and experience adequately. This has proved detrimental in maintaining an adequate rural workforce. The establishment of the Australian College of Rural and Remote Medicine has addressed these inadequacies, but alas goes largely unsupported by the Commonwealth. My current situation is unusual in that I am a self-employed solo GP in a remote community 700km from the next town. Most other GP s in similar situations are salaried by a community organisation. I work with a team of community health nurses and aboriginal health workers. About 80% of our patients are of aboriginal descent and the practice reflects this in the high incidence of infectious disease and an alarming growth in cardiovascular, renal and metabolic disease, principally diabetes. I bulk bill Medicare, I am supported financially by the Commonwealth by a yearly grant and my rooms, and pharmaceuticals, medical sundries and receptionist/aboriginal health worker are supplied by the Northern Territory Health Services. • Aboriginal Health continued on page 11 •
Page 6
Academia Academia Dr Grace Higgins
Senior Lecturer in Pathology, University of NSW and Visiting Academic at the NSW Institute of Forensic Medicine Some careers are the consequence of a chosen pathway, but mine, like many others, evolved as a melange of choice and chance, with two main streams.
to find out more
?
royal college of pathologists of australia
)
post 207 Albion Street Surry Hills NSW 2010
&
phone 02 9332 4266
Ê
fax
02 9331 1431
@
email secretariat@rcpa.edu.au to find out more about careers in academia, contact your medical faculty
I am a Senior Lecturer in Pathology at the University of New South Wales and a Visiting Academic at the New South Wales Institute of Forensic Medicine. At UNSW I teach medical students in third and fourth years of a six-year undergraduate course, and Science and Chiropractic students in the Mechanisms of Human Disease course. I was born in 1935, the second child and only girl of four children. My father had an engineering background and my mother was a politically incorrect housewife . I attended Domremy College, where the curriculum was strongly arts focussed at that time. I thought of becoming a school teacher, but was coerced into studying medicine by my older brother. We both graduated with an MBBS in 1960. Only 20 of some 200 graduates that year were females. How this ratio has changed over the years! Of these, about a third became pathologists, some did not practise, and most of the remainder became general practitioners. At that time, prejudice within the teaching hospitals imposed a quota for the number of females appointed as residents and registrars. During my term as a senior resident at the Royal Alexandra Hospital for Children, I
TheOther Other Side The Side
Age: 65 years Qualifications: MBBS, University of Sydney, 1960 MD, Universiy of New South Wales, 1978 became interested in Pathology. As a registrar position was not presently available, I spent a year as a Teaching Fellow in Pathology at the University of Sydney, where my interest in teaching was rekindled. When I became a Pathology registrar, I continued my association with Sydney University, teaching part-time. My next registrar appointment was at Royal North Shore Hospital. Whilst there, I married. My husband is not a doctor. He understood my career aspirations, but could not accept the hours involved, often alternate nights and weekends, with no extra pay for overtime. On medical advice, I quit my registrar job, but continued part-time teaching. In 1969, I was invited by Professor Wilhelm to join the School of Pathology at the University of New South Wales. The appointment involved some teaching, but there were only about 70 students in each year, and my main function was to help establish the Museum of Human Disease. As this appointment was academic rather than clinical, my career goals shifted from becoming a fellow of the Royal College of Pathologists of Australasia, to obtaining a higher degree. I proceeded to study the role
ò
Page 7
• Academia •
of exudation in chronic inflammation, and was awarded the degree of Doctor of Medicine (UNSW) in 1978. As student numbers increased over the years, so did the need for teaching materials, and I became a visiting academic at the New South Wales Institute of Forensic Medicine in 1977. I soon appreciated the variety and complexity of material there, and recognised an opportunity to show medical students aspects of disease they were not likely to see elsewhere. I have now been taking fourth year students on their morgue visits for several years. My working lifetime has seen many exciting changes in Medicine. There have been more major developments in the last fifty years than in any
similar period, not only in research and clinical areas, but in education at both undergraduate and postgraduate levels. The didactic talk and chalk instruction of my student days has given way to problem-based and computerassisted learning. While welcoming these advances, I still see a place for face-to-face teaching. Two major career determinants are the role models and opportunities available at a particular time. Had I been able to secure a registrar s position initially, I would likely have followed the FRACP pathway, probably in a hospital Anatomical Pathology Department, with minimal student contact. Juggling a career and family life is always difficult. I think that graduates, particularly females,
TheOther Other Side The Side
will in future find it more difficult to enter specialist-training programmes. In my field, the emphasis has shifted from General Pathology, which included Anatomical Pathology, Microbiology, Clinical Chemistry and Haematology, to a specialisation in one of these areas. This is a consequence of centralising pathology facilities, so eliminating the need for a laboratory in every hospital. As far as job satisfaction is concerned, I have been teaching long enough to see former students have highly successful careers, and their children now undergraduates. The Museum of Human Disease, of which I am Curator, is recognised as one of the best museums of its type in Australia, and is now open to the public as well as to medical students.
O
Page 8
Dermatology Dermatology Dr Tony White Dermatologist
A good exercise for AMSA to consider would be a survey of job satisfaction among practitioners of the various branches of medicine. Dermatologists would surely come out close to the top. There is a huge gap between what outsiders think of the specialty (not much!) and the feelings of dermatologists themselves about their work (very positive).
to find out more
?
australasian college of dermatologists
)
post PO Box B65 Boronia Park NSW 2111
&
Ê
phone 02 9879 6177 fax
02 9816 1174
Let me try to illustrate the appeal of dermatology. Because skin is the interface between the individual and the world, dermatology embraces the whole person, their character, self image, occupation, hobbies, hygiene, how and where they live, their beliefs and so on. We are not restricted to any age group one s patients are to be found anywhere from neonatal intensive care to the nursing home. Skin disease can greatly affect a person s quality of life. For example, cystic acne, quite apart from its effect on self-esteem at a vulnerable age, has been shown to reduce young people s employment prospects. Psoriasis kills few people but can ruin lives. Spotting that early melanoma can save a life. Every day one has the opportunity to provide real help to many whose gratitude is rewarding. There is a niche for all within dermatology. Those liking procedures can develop their surgical skills in the management of skin cancer or by using an array of laser devices. There is a great deal of psychiatry in any day s practice. Some dermatologists specialise in occupational medicine,
Age: 59 years Qualifications: MBBS, University of Sydney, 1965 Diploma of Dermatological Medicine (USyd) FACD (Fellow of the Australasian College of Dermatologists) visiting work places, and delving into the detail of industrial processes. Many systemic diseases have dermatological manifestations -indeed their initial presentation may be on the skin. Cosmetic dermatology is a new field that appeals to some. How did I get into dermatology? A bit of a roundabout route! I was a broke fourth year medical student in 1961. Those were the days of serious university fees. I therefore sold my soul to the army, which paid my way. After my intern year (1965) I repaid my bond by serving five years as an army doctor. This included one year in Vietnam and two in Singapore. Skin disease is a big part of tropical medicine and this experience planted the seed. After leaving the army, I did my internal medicine training and had then to decide on either general practice or becoming some sort of ologist. As happens more often than not, it was pure chance that led on to training as a dermatologist. Dr Adrian Johnson, head of the department at the Royal Prince Alfred Hospital, suggested that I should think about dermatology. I applied and was accepted. To be fair to 2000 graduates, the competition then was nowhere near as bloodthirsty as it now • Dermatology continued on page 11 •
TheOther Other Side The Side
Page 9
Emergency Emergency Medicine Medicine Dr Simon Brown
Director of Emergency Medicine, Royal Hobart Hospital
to find out more
?
australasian college for emergency medicine
)
post 17 Grattan Street Carlton VIC 3053
&
Ê
phone 03 9663 3800 fax
03 9663 8013
During Residency I discovered the immense satisfaction derived from being able to respond appropriately to emergency situations. Initially I decided to pursue a career in Intensive Care but after just a few shifts in the Emergency Department realised that it offered more variety, the greatest challenges, and the most social interaction. Critically ill patients arrived with little or no warning and required immediate responses. In between, there was a constant flow of less serious, but always interesting and challenging cases. The tension, the challenge and the satisfaction were palpable. In a short career I have seen an obsession with invasive resuscitation give way to an attitude that quality of life is more important than survival. Emergency Departments are seeing steadily increasing numbers of psychiatric patients, and older people with complex medical and social problems. In the past we have concentrated on saving lives in a relatively young population suffering from trauma and serious (but usually single system) illness. Increasingly, we find ourselves sorting out more complex problems, with a pressure to get people home, saving hospital beds for only the most serious cases. In the past, such complex assessment was handed to inpatient teams, but now efficiency demands that such a process begins as soon as the patient arrives. The major down-side of Emergency Medicine is the attitude of others. Some General Practitioners cannot grasp why we are a specialty, and some specialists (and
Age: 34 years Qualifications: MBBS, University of Tasmania, 1988 FACEM (Fellow of the Australian College for Emergency Medicine) their trainees) cannot grasp why they are not the most appropriate people to make the decisions we undertake. Such ignorance can only be dealt with by a concerted and carefully considered approach. Thankfully, I have found that we have more allies than enemies, and the key is to learn good negotiating skills, rather than the age-old intellectual intimidation that many doctors habitually use. Only some of my time is now spent doing the heroics that attracted me, and many things that were challenging initially now seem fairly dull. Such skills are important, regularly used and life-saving, but many lives and much morbidity are saved by concentrating on the less glamorous aspects of the job. Also, I have found the research opportunities in Emergency Medicine to be enormous, leading me to undertake further studies and get involved in several complex projects. A unique feature of our specialty is that we spend considerable time on system development, training junior staff who later enter a broad range of specialties, and maintaining quality control mechanisms that detect and correct errors. This is a huge burden for the Director, and as a specialist trainee I could never understand why the Boss spent so much time in his office (we assumed
ò TheOther Other Side The Side
Page 10
• Emergency Medicine •
it was because he was lazy). During my training, I said to one of my colleagues If ever I become a Director, just shoot me . He is working as a specialist in my department now, so I am watching my back! Now I understand the importance of the job, and the satisfaction of winning just a small battle that results in a palpable improvement in patient care. Unfortunately it can
be a thankless task, so if you are planning to take on a Director s job, make sure that you have enough self-confidence to see it through. Family life and maintenance of outside interests are not easy for any specialist, but Emergency Medicine does offer advantages. Shift work and episodic patient care (without a responsibility to regular patients) means that time off is time off. Although the work is hard, hours
can be set and shifts can be arranged to suit your lifestyle. Best of all, Emergency Medicine is probably the most general of specialties. If you want to maintain a broad exposure to all aspects of acute medicine and maintain your adaptability with the opportunity to head down a number of different career paths after graduation, Emergency Medicine is for you!
O
• Aboriginal Health continued from page 6 •
My base is in Borroloola, population around 900, but my patch cover an area of about 600km east to west and 300km north-south. We abut the Queensland border in the gulf of Carpentaria region of the Northern Territory, and the total population is around 2,000. My base is in Borroloola but I have a regular series of visits to smaller communities, mine sites and stations, usually by light aircraft. Overall, the region is grossly under resourced and I am becoming increasingly frustrated at the lack of social and infrastructural
development that has taken place in my time here. The good side? Freedom - being self employed I have a minimum of bureaucracy to deal with in day-today operation. The patients being predominantly aboriginal are an interesting and challenging mob. The country is riverine and savannah with significant rocky ranges largely unexplored, beautiful and fascinating. The fishing is sometimes good too. What do you need? A social conscience, a driving desire to break
new ground, to go where no GP has gone before, to seek out new positions .. Seriously, there are a significant number of opportunities in the NT for GP s to become the first resident medical practitioner s to work in remote aboriginal communities. These positions are challenging (read difficult) but offer a chance to make significant inroads into the health problems of some of the most disadvantaged Australians. I look forward to meeting you all as you line up for jobs in the remote Northern Territory.
O
• Dermatology continued from page 9 •
is. Also helpful in those days was the fact that both physicians and dermatologists training each lasted only two years. After qualifying in dermatology, I did two years as a clinical and research fellow at Massachusetts General Hospital and returned to Sydney where I entered private practice. I am a visiting medical officer at Royal Prince Alfred Hospital and clinical lecturer at Sydney University. I have a
particular interest in medicine in underdeveloped countries, a healthy antidote to practicing in Sydney s eastern suburbs. I have worked in Laos and, under the auspices of AusAID s Pacific Islands Project, in Vanuatu and Samoa. On the personal/family side, I have been blessed with a very supportive wife and we have two children. They were arriving and toddlers when I was in the midst of my postgraduate studies. This was tough all round,
TheOther Other Side The Side
but in those days accepted as the way things went. Dermatology is probably more friendly to family life than most specialities. I get a night or weekend call about half a dozen times a year. It is also possible to fine-tune one s workload more readily than other fields (e.g. general surgery) where one is either flat out or not working. This is an obvious advantage to those keen to enjoy both a career and a family.
O
Page 11
Forensic Forensic Pathology Pathology
Professor Stephen Cordner
Professor of Forensic Medicine, Monash University Director, Victorian Institute of Forensic Medicine In 1987 I was appointed to the Foundation Chair of Forensic Medicine at Monash University. By virtue of that appointment, I became the Director of the Victorian Institute of Forensic Medicine. The Institute is created by the Coroners Act 1985 and has a number of functions:
to find out more
?
royal college of pathologists of australia
)
post 207 Albion Street Surry Hills NSW 2010
&
phone 02 9332 4266
Ê
fax
@
02 9331 1431
email secretariat@rcpa.edu.au
• the medical investigation, including autopsies of deaths reported to the Coroner (approx. 2,500 a year) • associated investigations such as toxicology, molecular biology and histology • running the Donor Tissue Bank of Victoria which is the means by which cadaveric tissues such as aortic valves, bone and skin are made available for transplantation • providing clinical forensic medicine services (e.g. examination of adult and paediatric victims of physical and sexual assault) • teaching and research I regard myself as about 25% a forensic pathologist, 50% an administrator and 25% a teacher and researcher. I was one of those medical students who, for good or bad, always knew what he wanted to do: forensic medicine. I did a BMedSc in forensic after my fourth year (investigating tattoos!) and a Diploma in Criminology during 5th year. I was also a beneficiary of the care the Professor of Medicine, Professor Lovell took of his students. While I was still a student, he wrote on my behalf to Guys Hospital in
Age: 47 years Qualifications: MBBS, University of Melbourne, 1978 FRCPA FRCPath MA (London) Diploma of Medical Jurisprudence Diploma of Criminology London to find out what someone with my interests should be doing. In a feat of administration that still makes me gasp, a letter I wrote on my own behalf some years later was united with Professor Lovell s letter indicating to Guys an interest in forensic spanning some years. That, I believe, was a critical factor in being given a lectureship, sight unseen, in the Department of Forensic Medicine at Guys in 1981, which I took up after two years as a registrar in Pathology at the Geelong Hospital. While at Guys I was able to get my Fellowships from the Australasian and British Colleges of Pathologists. There are many positive aspects to my work. Being a relatively new organisation we were not constrained by historical practice, but could start afresh. This means, of course, that when things go wrong there is no one else to blame! The organisation is a happy one, notwithstanding the work it has to do because the staff appreciate the value of their work: contribution to justice, contribution to death and injury prevention, tangible contribution (tissue) to life and well-being, • Forensic Pathology continued on page 15 •
TheOther Other Side The Side
Page 12
General Practice General Practice (Rural) (Rural) Dr Chris Homan
General Practitioner Moura, Central Queensland
to find out more
?
australian college of rural and remote medicine
)
post Level 1 467 Enoggera Road Alderley QLD 4051
&
Ê @
phone 07 3352 8600 fax
07 3356 2167
email acrrm@accrm.org.au www web site www.medeserv.com.au/ acrrm for further details, contact the rural health society at your university
I am a rural doctor in Moura, Central Queensland. Moura is a town of 2000 people about 200km inland from Rockhampton. Local industries include coal mining, beef cattle and wheat production. Being a rural doctor means much more than being a general practitioner, rather the role is of the extended generalist. It is arguably the most professionally rewarding of all medical craft groups, with little chance for boredom to settle in! In one day, it is not unusual to oscillate between general practitioner, plastic surgeon, psychologist, obstetrician, ultrasonographer, emergency physician and hospital administrator. My clinical role involves lots of high level general practice, including plenty of paediatrics / psychology / orthopaedics / women s health. The general practice is very interesting when combined with my knowledge of the local community and its residents. There is certainly no need to follow a soap opera after you ve been a rural doctor after a while nothing suprises you; In the month prior to writing, highlights of my medical ministerings have included:
Medical consulting (acute myocardial
infarct, new diabetics, hyponatraemic coma, encephalitis); Toxicology (Brown Snake envenomation successful outcome after seven ampoules of anti-venom and two VF arrests);
TheOther Other Side The Side
Age: 33 years Qualifications: MBBS, University of Queensland FACRRM FRACGP DipRACOG Obstetrics (LSCS for obstructed labour,
evacuation of premature labour at 25 weeks gestation); Allergy (severe allergic reaction to wasp bite required adrenalin infusion for 24 hours); Psychiatric emergency (regulation of a homicidal/suicidal patient); Administration (balancing budget integrity with community needs). The discipline of rural medicine has received a boost in recent years through the formation of the Australian College of Rural and Remote Medicine. ACRRM has nearly 2000 members and has provided a sharper focus on the training pathway into rural practice. At present, the Royal Australian College of General Practitioners still has a legislated monopoly on generalist training and prospective rural doctors must undertake their training program. However, ACRRM now has equal input into this training and awards its own Fellowship. The life of a rural doctor is a busy yet rewarding one. On the up side is the professional satisfaction, the status in the community, a good income, and the country lifestyle(especially good for young families). • Rural General Practice continued on page 15 •
Page 13
General Practice General Practice (Urban) (Urban) Dr Bernd Lorenzen
General Practitioner, Adelaide Chairman, SA & NT Faculty RACGP I am the Practice Principal at Whites Road Medical Centre in Adelaide. I am also the Chairman of the South Australian & Northern Territory Faculty, RACGP. My other responsibilites include: • Vice Chairman, Council RACGP
to find out more
?
royal australian college of general practitioners
)
post RACGP National Office 52 Parramatta Road Forest Lodge NSW 2037
&
phone 02 9577 6655
Ê
fax
02 9577 6666
for further information, contact the college, faculty, or the training programme officers in your state or territory
• Board Member, Adelaide Northern Division of General Practice • Branch Councillor, AMA South Australian Branch • Immunisation Project Coordinator Central Clinical Privileges • Committee Member SA Department of Human Services My practice is in the northern suburbs of Adelaide. We have a modern, wellequipped surgery where we provide a broad range of medical services, and also have nursing and allied health providers. We have seven general practitioners, including Registrars. Over the last nine years, my career has encompassed the development of a high quality general practice service. My commitment to this also involves the development of the profession of which I am a part. The choice in where I am is in part opportunistic and in part, a recognition in 1990 that I did have to choose what I was going to be. It was clear that general practitioners had mandated that it was no longer the default occupation and so I decided that general practice would be my career path. Prior to that, I had been more inclined to make decisions on the basis of
TheOther Other Side The Side
Age: 41 years Qualifications: MBBS, Flinders University, 1982 DipRACOG my immediate interest, not only in medicine but also in the countryside, leading me to rural areas. I have fond memories of my rural adventures and to not do rural medicine is a tragedy for any aspiring general practitioner. The experience in medicine and personal development cannot be under-estimated. General practice can be professionally isolating and it can be hard to look at the same four walls day in and day out. I am fortunate to have good partners and staff as well as gregarious colleagues in my area. General practice can have some headaches in the area of risk management. As the income base remains static, but cost creep up, the reward in relation to risk inexorably decreases, leading to phenomena such as less holidays, avoidance of sick leave or rest leave, long hours and so on. However, we are not beholden to anyone in terms of the operation of the practice. Furthermore, as general practice develops it will take greater notice of how risk management and financial health are inextricably linked to best practice. This area of incorporating sound business practice with the end result being improving the quality of service and robustness of the enterprise is a positive step for our practice. In order to try and improve the status of
ò
Page 14
• Urban General Practice •
general practice I have been given an opportunity to contribute at the state and national level through the RACGP. I joined the RACGP with some ambivalence but I see that there is an increasing role for general practitioners to improve their self worth through motivated vehicles such the RACGP. The involvement of general practitioners outside of their pastoral areas is critical to the development of the craft. Although
this is not always popular, the development of general practice depends heavily on its motivation to be part of a team. I am fortunate to work in a practice that has a considerable motivation to be involved in outward looking activities. Life is filled with choices. Currently, I have devoted considerable personal effort and time into contributing to the advancement of general practice at the expense of
my social calendar - which was thrown out when I became Faculty Chairman. Minorities, not majorities have changed history, and to that end the work of a few is pushing general practice forward into a viable professional entity, not a gaggle of failed specialists . To this end, I am proud to be a part of a decades long push to value general practice, through my work and through the advocacy I share with my tireless peers.
O
• Forensic Pathology continued from page 12 •
and making a contribution to medical and legal education. Personally, I still very much enjoy the hands on forensic pathology, especially the court end of the experience. More recently, being part of the extension of my discipline into the international arena with the investigation of gross abuses of human rights has been fascinating. The downsides of my work relate to the daily grind of repetitive administration. We are not such a big organisation that I can pass all of this on to someone less fortunate
than me! On the other hand, most people do not appreciate how hard good administration is, and that in itself it is a constant challenge. Forensic Medicine crosses most barriers in medicine. Because of what we do I get involved in a number of related areas. • Committees investigating deaths in anaesthesia and surgery and evaluating medical management in road traffic fatalities. • Committees relating to national activities in forensic pathology, tissue banking.
• Medical law and ethics. My family are critical of the amount of time I give to my work. The sort of job I have simply cannot be done in a 38-hour week. I admit to finding enormous satisfaction in my work, but I manage to drop my daughter at school three mornings a week, and three nights a week I am home by 6.15 pm. One week in five I am on call which has about a 75% chance of interrupting the weekend by having to attend the scene of a homicide or suspicious death and then do the autopsy.
O
• Rural General Practice continued from page 13 •
One of the unique benefits of rural practice is the camaraderie of your rural colleagues (medical and other). The only significant downsides pertain to lack of anonymity in the community and the demands on your time. The first requires a big fence and attitude, and the second, good time management skills. Certainly, the lack of commuting time each day (a one minute walk for me) helps compensate for any
longer hours in the consulting rooms. The family is critical to a doctor s success in rural practice and it is important to maintain the correct balance between family and professional responsibilities. This said, it is possible to have the best of both worlds. My observation of my senior colleagues is that successful rural doctors tend to have
TheOther Other Side The Side
extremely happy, healthy family lives. The unique challenges tend to pull everyone together as a team. If you enjoy challenges, and don t see yourself being boxed into a narrow professional field doing the same things repetitively, then rural practice is a great career option.
O Page 15
nformation Technology Information Technology Medicine && Medicine Dr Matthew Cullen
Joint Managing Director, High Performance Healthcare Presently I am Joint Managing Director of High Performance Healthcare, a high technology healthcare company specialising in the delivery of telephone and internet based healthcare services for health insurance and public sector health organisations, and pharmaceutical companies. Initially, after completing my intern and residency at Royal Prince Alfred Hospital in Sydney, I was very attracted to a career in psychiatry. I subsequently completed my fellowship in 1992 with a period of 18 months working in the United Kingdom in the National Health Service. Psychiatry appealed largely because of the time it allowed to spend with patients. Secondly, it seemed to me that it was more of an art than a science. Nonetheless, shortly after completing my psychiatry training, I became aware that there was a substantial move afoot in terms of alternate health care service delivery models. I came to the view that one of the best ways to capitalise on it was develop a business that utilises my knowledge of service developments, technology etc.
The business has been modestly successful, now employing approximately 150 people, and it has certainly been highly stimulating. In terms of what fundamentally motivated me to go down this path as opposed to maintaining my psychiatry was a concern that psychiatry, over time, would become limiting, and I felt that there was an opportunity to remodel healthcare delivery. The choice in terms of remodelling healthcare delivery eventually fell down to either doing it within the system, or developing an external agent, in this case High Performance Healthcare, to drive change. The pros of my work include autonomy, excitement, a sense of being on the cutting edge, and learning how to run a business. The cons include a back seat in terms of my clinical role (I am now largely a manager), and long hours. I have maintained some clinical work, doing half a day, one day a week, as a consultant psychiatrist in private practice. Until a year ago, I also continued to work as a Visiting Medical Officer at the South Eastern Sydney Area
TheOther Other Side The Side
Age: 39 years Qualifications: MBBS, University of Sydney, 1985 FRANZCP
Health Service. A sense of strong commitment to give back is within my make-up, and for many years I served with the Schizophrenia Fellowship, a nongovernment organisation. Finally, I have a number of directorships, the most prominent being of a peak mining company. How one manages to integrate one s career and personal and family life is a highly difficult question to answer, and it would depend on one s perspective. Balancing all of these competing objectives has tended to be a struggle. The main way I have been able to do this, given the extent of travel that I do currently, is to package together time in my different roles and try to be fairly strict about when is family time, when is career time and when is my time. Keeping fit is highly important and I find that this contributes substantially to my state of well being and my stamina.
O
Page 16
Management Management Consultancy Consultancy Dr Reg Seeto
Management Consultant, McKinsey and Company Medical Registrar, Sydney To change or not to change ..just give it a go or you will never know.
to find out more
?
for more information contact the following consulting firms in your capital city or on the web Boston Consulting Group www.bcg.com
McKinsey Consulting www.mckinsey.com
Andersen Consulting www.andersenconsulting.com
I am working for an international consulting firm. I left the physicians program eight months ago but I am still unable to say whether I made the right choice to leave full-time medicine, or if my new job was the right alternative. However, I do know it was the right time to leave and begin an 18-24 month journey that would help decide my career. I still find it hard to believe I have given away more than a decade of my life that was dedicated to the medical profession. This may partly explain why I still work as a doctor on weekends. Well, why did I bother to leave if I am still interested and enjoying medicine?
Bain Consulting www.bainconsulting.com.au
Booz Allen & Hamilton www.bah.com
LEK www.lek.com
I have always had a burning interest in business and this passion was evident when I started share trading at high school. My interest in investing expanded once the penniless days of medical school finished. After reviving the financial position of the RMO Association of a large teaching hospital, I knew I had to find out if business was a passing interest or a potential career. Is change possible? Any business contemporary would have more than a decade head start in education and experience. However, I have always had the firm belief that medical graduates from the undergraduate medical system who could have done anything as 17-18 year olds could still do so later down the track.
TheOther Other Side The Side
Age: 28 years Qualifications: MBBS (Hons), University of Sydney, 1995 BSc Med (Hons), University of Sydney, 1992 Making our final career choice at seventeen years of age seems a bit ambitious in retrospect. However, it would have been safer and easier not to switch than to change after all the years of study, financial struggles and personal sacrifices. Unfortunately (or fortunately) I have never believed in taking the easy option. I needed to find out whether business was my forte. The need for ongoing stimulation, timing, financial status and personal situation were my major considerations before switching careers. The challenge of medicine began to diminish more and more as my career became more predetermined. I had completed several research stints with publications at the Liver Units at the University of California, San Francisco (UCSF) and at Duke University, North Carolina and I had planned to do a PhD overseas. I had anticipated an academic career in Gastroenterology. In the last year I saw too many disgruntled VMOs in different specialties to realise something was wrong with the system and career tree. The mid-life crisis of many specialists had been delayed by those twenty years of study. We had been driven since 1718 years of age to reach this final level and now it was over. Where was the next challenge?
ò
Page 17
• Management Consultancy •
Terrible as this may sound, I found money had become the focus of some specialists and that scared me. I would never practice medicine if that would be my driving motivation. I needed to find out where my greatest passion lay. In considering doing both medicine and business one would have to take priority. If it was business then I needed to exit fulltime medicine. This was my main reason for leaving. I needed to know.
Leaving the most financially stable profession in the world, where rewards increase with experience, was a risk. Finding my true passion was more important. After all, two years is a small time frame to decide the next thirty-plus years of my working life. I had the full support of my parents, which was important because of my Chinese origins. If I had a family and/or dependents then they would have come first and outweighed any of my above decisions.
I see the opportunities of working with the largest companies in Australia and with some of brightest people in the industry. My current team consists of two Rhodes Scholars, two with overseas MBAs and the Young Australian Businessman of the Year. There was also the opportunity to work with some charity organisations which fitted my extracurricular interests (I am currently State Coordinator of Weekend Outings for the Young Variety Club of Australia)
If I had completed my physicianÂ’s training then I it would be unlikely I would have pursued another career. I would not recommend leaving without reaching a registrar level first. This provided a comfort zone so I could re-enter at this level if I did realise medicine was meant to be my primary career. A two-year plan was sensible, as I felt a longer period would be too great a deficit in knowledge and skills.
I chose management consulting as my avenue to learn about business. We are like doctors of the corporate world, solving the problems of companies. I had been tempted to do an MBA but the lure of working with one of the most respected international consulting firms proved too great an opportunity to bypass. Unlike other consulting firms we work with top management and in a non-hierarchial team structure.
Notably, there have been four other doctors that have all joined in the last eighteen months (two with MBAs, an ophthalmology registrar, and an RMO with University Medal). I know of several doctors who have recently joined our largest competitor, including a qualified cardiologist. The traditional recruitment ground for consulting firms has been the MBA schools, but more and more recruits are coming from non-traditional backgrounds. Exciting as this may sound, it is still hard work, less secure as a long term future than medicine and we are behind the eight-ball to start with. Hopefully, at the end of 24 months I will acquire all the structure and framework an MBA would have given me, combined with the practical experience I would have acquired along the way. I will have worked and met some of the current and future business leaders in the country, and have acquired a whole new set of skills that will provide opportunities that I would have never imagined. I see this as my greatest investment to date and by then I will know where I will focus all my energy and time. My takeaway message is never be afraid to try something else, as we have what it takes to succeed elsewhere, but medicine could potentially be the most rewarding career one could hope for.
O
TheOther Other Side The Side
Page 18
Medical Medical Journalism Journalism Dr Mark Ragg
Senior Writer, The Sydney Morning Herald I m a journalist, and very very glad of it. In what other career could you wilfully and publicly prick the egos of the elite? Where else could you indulge your twin passions for writing and scepticism? Who else has a job that has so much time for thinking and talking?
to find out more
?
Australasian Medical Writers Association www web site www.midcoast.com.au/ ~amwa/amwa.html National Press Club, Canberra www web site www.npc.org.au student membership is available Media: Radio and Print Journalism a three year media and film course can be completed at universities in most capital cities for more information, contact a local university, for journalism, media & communications and arts courses
I got into journalism after a bit of drifting. I had decided medicine didn t look good so I worked part-time, started an arts degree to have a look around, enjoyed the writing, enjoyed the humanities side of life and, after a few months, decided to try journalism. I entered through the old way of writing articles and applying for jobs until I got one. I got very lucky - a job at The Australian with no experience and no apparent ability, but a willingness to have a go. But there are courses and degrees and all sorts of things which might help, although, considering the regard they command within the industry, they might not. The Australian lasted two years, followed by eight busy months editing a magazine for the Australian Medical Association and getting up the nose of Bruce Shepherd, among others. Then back to The Australian for another couple of years, followed by eight years or so freelance where I wrote articles and books, did consultancies for health groups, edited magazines and worked in emergency once a week. I started at The [Sydney Morning] Herald last year. The medical degree has been both a help and a huge nuisance. I m sure I got my first job because I d been a doctor, and it s helped me understand some of what is left unsaid in interviews. But has also meant that there is always pressure to write
TheOther Other Side The Side
Age: 38 years Qualifications: MBBS, University of New South Wales, 1984 BA, University of Sydney, 1993 about health, when there are many other interesting things to write about. It s restricted opportunities, as well as offered them. Things are pretty good at The Herald. I write news and features on a range of subjects, some health-related, some not. There s a bit of travel, the odd lunch and plenty of good people to talk to. It s a job demanding individual thought and drive, which suits. And you don t have to wear a suit, which suits. As a way of life, journalism is just wonderful. We re constantly pushed to think about the world around us, about the way we do business, about the way we live, about the variety of ways people can live, about the variety of meanings any event has for different people, about how fortunate a group of people with money and education can be, and about how rarely they realise it. We get to indulge our passions, be that for hosiery or human rights, politics or poetry. We get to keep an eye on the people with power, and point out what they do with their power. We get to talk to people who have done something good, or bad, or very, very ugly. It s rarely someone indifferent, or who s done nothing. We get to write and express ourselves, which is a damn fine thing to do. And unless you re editing something, or on a big project, or a nutter, you can usually keep the working week down pretty close to 40 hours. You can have a life, which is, also, a damn fine thing to do.
O
Page 19
Medical Medical Research Research Dr Andrew Elefanty
Senior Research Fellow, The Walter and Eliza Hall Institute of Medical Research
to find out more
?
australian society for medical research
)
post 145 Macquarie Street Sydney NSW 2000
&
phone 02 9256 5450
Ê
fax
02 9252 0294
@ email asmr@world.net www web site
www.asmr.org.au national health and medical research council
)
post Executive Secretary Office of NHMRC (MDP100) GPO Box 9848 Canberra ACT 2601
&
phone 02 6289 9184
Ê
fax
02 6289 9197
@ email exec.sec@health.gov.au www web site www.health.gov.au/nhmrc
I am writing this piece from the perspective of a recently appointed laboratory head in an NH&MRC funded research institute. To set the scene, I work alongside several other senior scientists, under the greater umbrella of the Division of Cancer and Haematology at the Hall Institute. Two technicians and a variable number of students and post-doctoral fellows are directly responsible to me. My research interests include the genetic regulation of blood cell formation during embryonic development. The control of these processes is both intrinsically interesting to me and practically relevant, since the genetic elements needed for normal development are frequently the same ones that go awry in diseases such as cancer. Furthermore, the ability to understand and manipulate these processes may open the door to the generation of autologous blood cells in vitro in the future, perhaps eventually replacing the need for blood transfusions. I completed my basic training in internal medicine and then did two further clinical years one in general medicine and a second in medical oncology. My hospital training was completed at Prince Henry s Hospital in Melbourne now a hole in the ground whose contents were translocated to the Monash Medical Centre in Clayton. I took a year off after my basic training and travelled around Europe. This was an invaluable experience and a great time to have a break, since having passed my FRACP Part I examinations meant that I could relatively easily get a job upon my return to Australia.
TheOther Other Side The Side
Age: 42 years Qualifications: MBBS (Hons) Monash University,
1980 PhD Melbourne, 1992 FRACP, 1992 After my year of oncology training, I was strongly advised to do a bit of research , since I was interested in pursuing a career as a full-time hospital specialist at that time. Whilst this seemed a good idea at the time, I would now advise that any prospective physician/researchers clarify with their specialist advisory committee whether their research years would be accredited as part of their specialist training. In my case, I had to wait until my PhD was passed before the Oncology SAC approved my training. This meant that I could not do any physician locums during my PhD candidature.
I embarked upon my research career in 1988 at the Walter and Eliza Hall institute of Medical Research under the supervision of the now-Director, Professor Suzanne Cory. Choosing a prestigious research institute rather than a hospital or university department had some advantages and some disadvantages. On the positive side, the quality of the science, the calibre of the scientists I interacted with and the available resources were first class. However, I was required to work very long hours, in an environment which was not particularly forgiving and one in which medical graduates were generally not held in high regard. After completion of my PhD, I stayed as a post-doctoral fellow at the Hall Institute for 18 months before journeying to London, • Medical Research continued on page 29 •
Page 20
Medicolegal Medicolegal Practice Practice Dr Elaine Fabris
Lawyer, Health Industry Team, Phillips Fox, Melbourne
to find out more
?
graduate law degrees contact the faculty of law at your university for more information about graduate law courses solicitors admission board (SAB) many aspiring lawyers choose to complete a 3 year course with the SAB enquire at the SAB in your capital city
It wasn t until I was in my first year of an Arts/Law course at the University of Melbourne that I contemplated becoming a doctor. While I was pouring over dusty books in the Law Library, my medical student friends were doing exciting things like dissecting frogs and tracing the development of human embryos! I decided to take a year off to think about what I wanted to do with my life, and during that year I worked as a pink lady (volunteer) at the Royal Melbourne Hospital, and completed HSC Biology and Chemistry so that I would have the pre-requisite subjects needed for entry into medical school. Six years later, I was an intern - an incredible learning experience although horrendous at times! After my intern year, I joined the Royal Australian College of General Practitioners Family Medicine Program. As a medical student, I had enjoyed several different aspects of medical practice, particularly paediatrics, obstetrics and psychiatry. I decided that general practice would allow me to practice in all those fields as well as in general medicine and surgery, and other areas. I obtained experience in those fields by working as a resident/registrar in various hospitals, including stints in New Zealand hospitals. I then spent a few years working in various GP clinics as well as in a community health centre. I obtained the DipRACOG in 1988 and became a Fellow of the Royal Australian College of General Practitioners after sitting the examination in 1993.
Age: 41 years Qualifications: MBBS, University of Melbourne, 1983 LLB (Hons), University of Melbourne, 1995 DipRACOG, 1988 FRACGP, 1993 Overall, I enjoyed general practice and really loved some aspects of it, in particular, being able to care for patients on an ongoing basis. During my time in general practice I developed a keen interest in medico-legal issues - perhaps not surprising, as I had studied Law for a year at university. I eventually decided that my ideal career would be to work part-time as a GP, and parttime in the medico-legal field, perhaps with a medical defence organisation or law firm, or even a government (health) department. So I applied for admission to the University of Melbourne law school and completed my degree over five years, while I worked parttime as a GP. During my law course, I chose subjects and assignment topics, wherever possible, that allowed me to explore medicolegal issues. I studied Health & Medical Law and wrote essays addressing questions such as whether or not the doctor-patient relationship is a fiduciary one and whether or not the human body and body parts should be considered property in a legal sense. While it was great working part-time and studying the rest of the time, it was hard work! Although it seems relatively easy to obtain a
ò TheOther Other Side The Side
Page 21
• Medicolegal Practice •
law degree, these days the competition for articles (especially with a big firm) is so intense that a high honours degree is almost essential if one wants to have a choice of firms. I therefore worked quite hard and I don t recall too many weekends during my five year course that were entirely free of study! Also, some firms (but luckily not all) do not like taking on matureage students as articled clerks and a few firms (which I will not name!) seem to view a medical degree in itself as a reason to reject an application for articles. Who knows why? I was lucky enough to be offered articles by Phillips Fox, Melbourne, my firm of first choice. Phillips Fox is recognised as Australia s leading health industry law firm and the Melbourne team was ranked as the best health industry legal team in Victoria in the 1998/99 edition of Legal Profiles. I joined the team in 1997, at the end of my articles year. During my first 18 months at Phillips Fox, I continued to work as a GP, but at my position as Phillips Fox was full-time, my GP work was limited to Saturday morning sessions on a weekly or fortnightly basis. I eventually realised that it is not really possible to be a competent GP while working such limited hours, and made the extremely difficult decision to give up my GP sessions. Even now, thinking back to that decision makes me feel a little sad! Overall, however, I consider myself very lucky to be one of the fortunate (seemingly) few people who really enjoys their work, so the decision was the right one for me. My work mainly involves the conduct of medical negligence litigation on behalf of public hospitals in Victoria. I also provide advice to hospitals on a variety of issues including, consent to treatment,
medical records, legal aspects of infection control practices and privacy/freedom of information issues. I also provide risk management advice, for example, to blood banks regarding the legal risks associated with blood-borne communicable diseases. The team often undertakes project work for Government departments, in particular, the Victorian Department of Human Services. Last year I prepared a report for that Department which addressed ways in which the provision of genetic services might be regulated in order to minimise the risks associated with the increasing knowledge of genetics and new genetic technologies. That project focused on such issues as privacy and confidentiality, medical records, consent and discrimination. As a result of undertaking that project, the legal and ethical aspects of developments in genetics has become a particular interest of mine. What don t I like about my work? Time sheets and billable hours ! Most lawyers in medium and large firms have to complete daily time sheets which are usually divided into 6-minutely units. In addition, they usually have to record a certain number of billable hours per day, and are expected to bill a particular amount each month. Although one does get used to timesheets and billable hours , I envy people who don t have to worry about such things in their daily working life! The other major thing I don t like about working as a lawyer is dealing with some other lawyers! Although most lawyers are (believe it or not) reasonably nice, decent human beings, there are a few that certainly do fit the nasty, sleazy stereotype! What about life outside work? Again, I consider myself quite lucky to be working at Phillips Fox because unlike many other big firms, employee solicitors are not
TheOther Other Side The Side
expected to put in sixteen hour plus days. My working day starts at around 8.15 to 8.30am and usually finishes sometime between 6.30pm and 7.00pm, I occasionally work on weekends, although that is quite infrequent. However, I know that some firms expect their employee solicitors to work much longer hours. It is also fantastic not to be on-call overnight or on weekends! I certainly don t miss the sound of the telephone ringing in the middle of the night! I am very lucky and relieved to be working in an incredibly interesting area, and in an area that allows (and requires) me to pursue and develop my interests in both law and medicine. In my working life, I have regular contact with both lawyers and doctors. Two of the things I enjoy most are going out to hospitals to talk to medical and nursing staff, and keeping up to date (or at least attempting to) with new medicolegal cases and the medico-legal academic literature, which is usually extremely interesting and often fascinating. I should sound a note of caution, however. It has not been easy getting to where I am now, and jobs in law firms in the medico-legal area are quite limited. There are, however, other opportunities for medical graduates in the medicolegal field and in associated fields apart from positions in law firms. Those opportunities might include, working for a government health department, for disciplinary bodies (such as Medical Boards), for tribunals (such as the Victorian Civil & Administrative Tribunal), for medical defence organisations, in medical administration, in risk management and in academia. It may well be a matter of doing some exploring and finding one s own niche!
O
Page 22
Obstetrics Obstetrics & & Gynaecology Gynaecology Dr Khai Mohamed Noor Obstetrician & Gynaecologist
I am a thirty-seven year-old Obstetrician and Gynaecologist working in Melbourne. I am of Malay extraction, and was born and completed primary and secondary schooling in Kuala Lumpur. I obtained a scholarship to further my studies overseas, and arrived in Australia in 1980 at the age of 17. I attended MacRobertson Girls High School in my HSC year, and despite initial difficulties with Australian English, matriculated and went on to do Medicine at Monash University. I graduated in 1987 and started Obstetrics and Gynaecology training at the Royal Women s Hospital (RWH) after completing my first two postgraduate years at the Alfred Hospital. After an unsuccessful attempt at the RACOG first part exam, I took time
to find out more
?
royal australian and new zealand college of obstetricians and gynaecologists
)
post College House 245 Albert Street East Melbourne VIC 3002
&
Ê @
phone 03 9417 1699 fax
03 9419 0672
email racog@racog.edu.au
off from O&G and spent three years as a registrar in the Neonatal Intensive Care at RWH. After passing the first part exam in 1992, I resumed O&G training and obtained the FRACOG in 1998, winning the FJ Browne medal for the highest mark in the oral examination. When I obtained my Fellowship, I was appointed as Gynaecologist to RWH and my public work includes general gynaecology outpatients, Dysplasia Clinic, operating, teaching and being on the on-call roster for my unit. During the last year of training, two colleagues and I discussed the idea of working together, and we set up the Women s Obstetrics and Gynaecology Specialist group practice two years ago. Obstetrics and Gynaecology is a very attractive specialty as it has a little of everything. It combines general medicine, endocrinology, surgery, oncology, neonatal paediatrics and preventative medicine. And, of course, it is very rewarding to be involved in the birth of a child. The training takes six years to complete and is by no means easy. One year of training has to be spent in rural practice, and overseas experience in the last one or two years is still very much encouraged.
TheOther Other Side The Side
Age: 37 years Qualifications: MBBS, University of Melbourne, 1983 FRACOG, 1998 There is no longer a first-part examination, but there is continuing assessment by structured modules. The second-part exams are usually undertaken in the fourth year of training and consist of two multiple choice papers and an oral clinical examination. The main downside of O&G as a specialty is the irregularity of the hours, and I am very fortunate to be sharing my obstetric practice with two other colleagues. We share on-call nights and weekends, and patients are informed of the group s arrangements when they book in for their pregnancy. Although this arrangement does not suit every patient, the majority are very supportive of the way the practice is run. I may get very little sleep sometimes but at least I do have nights that I know are completely free, and on which I can catch up with sleep and social and family activities. I think that it is important to be passionate about one s career, but also to have a balance between work and leisure. The day I stop feeling the exhilaration of being a part of a birth is the day I retire from obstetrics.
O
Page 23
Occupational Occupational Medicine Medicine Dr Robert J Scott
Private Consultant in Occupational Medicine
to find out more
?
australasian faculty of occupational medicine
)
post c/o RACP 145 Macquarie Street Sydney NSW 2000
&
phone 02 9256 5400
Ê
fax
02 9252 3526
What is your Occupation? In 1700, Bernadino Ramazzini, the father of Occupational Medicine, urged his colleagues to ask this question of their patients. We still should, but so often doctors do not, and as a result, they often miss out on vital information to help in their diagnosis and treatment. Occupational Medicine basically deals with the effect of work on health and health on work. It deals with all aspects of all work environments, including noise, dusts, asbestos, chemicals, office problems and so on, and their effects on our bodies, including every system from the central nervous system (e.g. mercury and solvents) to the urogenital system (e.g. chemicals toxic to the foetus, and bladder cancer agents). More and more musculoskeletal problems arise from work (e.g. back injuries due to occupational overuse syndromes). I was in General Practice and started parttime work with General Motors Holden Pty Ltd with an emphasis on prevention. The then Professor of Social and Preventative Medicine at the University of Queensland commenced the first ever lectures and site visits in Australia on Occupational Medicine, to medical undergraduates. I was invited to help. This encouraged me to study the field, and in 1975 I gained postgraduate qualifications from Sydney University. By this time I had left General Practice and was consulting to a variety of companies in Australia and New Zealand. In 1978, I was awarded a Churchill Memorial Fellowship in Occupational
TheOther Other Side The Side
Qualifications: MBBS, University of Queensland FFOM (RACP) Fellow of Faculty of Occupational Medicine FFPHM (RACP) Fellow of Faculty of Public Health Medicine FFOM (RCP London) Fellow of Faculty of Occupational Medicine FFOM (RCP Ireland) Fellow of Faculty of Occupational Medicine FISA Fellow of Safety Institute of Australia DOH Diploma in Occupational Health, University of Sydney
Health and traveled the world to learn the latest developments. In 1983, I was invited to become the Senior Advisor in Occupational medicine to the Commonwealth Government, and later to the National Occupation Health and Safety Commission. There was seen a need for doctors in this area to have a common society which was formed, and is now known as the Australian and New Zealand Society of Occupational Medicine (ANZSOM). This society is open to any medical practitioner interested in this field general practitioner or specialist. A need was seen for specialists in the area to have their own College, and the Australian College of Occupational Medicine (ACOM) was formed, granting Fellowships after examination. This eventually merged into the Royal Australasian College of Physicians as
ò
Page 24
• Occupational Medicine •
the Faculty of Occupational Medicine, with specialist recognition given to its Fellows. As the years passed I became more and more busy with special interests in zoonotic diseases (such as Q fever, leptospirosis and hydatid disease); noise and noise induced hearing loss, dust diseases including silicolsis and asbestosis related diseases; and musculo-skeletal problems such as back injuries. Occupational Medicine is so often a subset of Public Health Medicine, and I gained a Fellowship is Public Health Medicine within the Royal Australasian College of Physicians, as well as a Specialist Fellowship in Occupational Medicine from the Royal College of Physicians in London. My career pathway has thus seen me pass from General Practice (including Obstetrics and Surgery) where I practiced Occupational Medicine (often without realising it), to gaining specialist qualifications and consultancies to private companies, to government, and in private consultancy generally. Currently I have resumed private consultancy and am heavily involved in Medicolegal work. My career path has been influenced by many factors. • my interest in all the aspects of
General Practice, but then realising how little I know of the work my patients did, what effects this may have on their health, and how ill health could often be prevented. • my realisation of how little importance was placed by some other specialties on these work effects, and their emphasis on treatment. • the need for interaction between general practitioners and specialists, and between specialists themselves. For example, the relationship between a thoracic surgeon or physician and an occupational physician when dust diseases, including asbestos related diseases, are being discussed. Another example is the nature of carcinogenic agents in the work place, their effects and the methods of controlling and monitoring these agents. I have always believed that a good grounding in General Practice helps to develop a good specialist, and have been lucky to have been both, while realising the difficulty now as knowledge in all areas expands. For this reason I believe all doctors should try and mix with colleagues from other disciplines, to attend as many and as varied meetings and conferences as possible, and when asked, jump at the invitation to give lectures and talks.
As safety is an important aspect of health, I gained a Fellowship from the Safety Institute of Australia. The Australian Medical Association (AMA) is, in my opinion, the body representing our profession and I have enjoyed the privilege of being on the Council of the ACT Branch for the last four years. I see many pros in my work and few, if any, cons. I miss the hands on work of Obstetrics and Surgery, but I still maintain patient (or client) contact in a personal way in my current work. As well I have to deal on level ground with those from different disciplines such as lawyers, engineers and production managers. While General Practice may have interfered with my personal/family life and I leave that to my family to decide my work in Occupational Medicine does not. I now have no emergency work and at times miss that (strange to say), in the same way that I miss the joy of delivering a baby. Equally, I gain great satisfaction by trying to make the workplace healthier and safer. It is difficult to know of any doctor who does not certify fitness or unfitness for work, but I know of many who do not know the work for whom they are certifying their patient to be fit or unfit.
O
• Palliative Medicine continued from page 27 •
contrary, the predominant theme is more often that a preoccupation with work clouded out family life. No one has ever said, gee, I wish I spent more time at the office. This has also been a reassuring factor when uni friends and colleagues imply that Palliative Care is a soft option that just involves hand-
holding and winding up the morphine. My husband is a Medical Oncologist, and therefore we both have a fair idea of what the other one can be going through, which makes things easier. One of the best
TheOther Other Side The Side
things about a professional respect for Quality of Life, is that it extends to the personal - Palliative Care has a female predominance, and is much more accepting of those who wish to work part time, which I hope to in the in the not too distant future.
O
Page 25
Paediatric Paediatric Medicine Medicine Dr Rima Staugas
Chief of Paediatric Medicine & Paediatric Thoracic Physician, Women s & Children s Hospital, Adelaide At the risk of sounding falsely sincere, I would have to say that I have not regretted a day of my career in medicine. There is no doubt that when you take on a profession which is, by its nature, one that serves, there can be significant challenge, and none more so than staying positive in the currently rapidly changing health system. I believe my choice of paediatrics was a sound one. My hand was forced after my intern year in a large teaching hospital, which did anything but reinforce the view that we were there to provide for our patients. Unfortunately what I saw were people who were - although working hard - also extremely territorial, quick to discipline in a harsh way, and certainly wedded to power. My paediatric teaching experience at medical school had been very
?
to find out more
royal australasian college of physicians division of paediatrics
)
post 145 Macquarie Street Sydney NSW 2000
&
Ê @
phone 02 9256 5408 fax
02 9256 5465
email paed@racp.edu.au
positive, with role models who showed great empathy towards the children and families in their care. I therefore followed this course. On experiencing good role models in the respiratory area, and enjoying the positivity and organisation of the respiratory physicians in Australia, my choice was easy. The options were also broad, with the ability to work part-time when family issues demanded it, and also to participate in interesting research, both of a clinical and basic nature. As the years progressed I was exposed much more to the issues that the consumers of our services faced, and was called on to sort out many of their issues. I became more interested in the potential doctors may have to change the face of the services within which they worked. Many people have heard of the dire straits of the health system, but I believe part of this is due to our abrogation of our administrative responsibilities within the system. In the last few years there has been an increased participation of medical people in administrative areas, and I believe there will be improvements over the next few years, both in general practice and within hospitals, with doctors taking the lead. There is still a long way to go, and when I had the opportunity four years ago to apply for a position with a significant administrative role, I grabbed it. This has led to a
TheOther Other Side The Side
Age: 46 years Qualifications: MBBS FRACP plethora of new opportunities, not least of which are those that have been added by doing business studies and applying this to how we access and deal with our patients, and also how we look at our clinical outcomes. I would never put anyone off a career in medicine, and certainly not if they wanted to do administration as well. The motivator must be to serve people. This can have a significant impact on the way you enjoy and participate in your own family and personal life, but I believe remains a basic requirement of this profession. You have to cultivate a sense of humour, and be able to laugh at the things that try you. I believe we take ourselves far too seriously at times, and it is often a little bit of levity which softens some of the difficult situations which we deal with on a constant basis. I still continue as a thoracic physician and gain great enjoyment from the work that I do with my patients. I could highly recommend it as a career for any woman as it offers unlimited opportunities for part and full-time work and research.
O
Page 26
Palliative Palliative Medicine Medicine Dr Amanda Walker
Clinical Fellow in Palliative Medicine, Braeside Hospital, Sydney Currently I am in a position involving half-time clinical work in a Palliative Care Unit, consulting in a general hospital, and doing domiciliary visits, as well as halftime clinical research and education. I am currently undertaking a masters of Masters in Palliative Medicine by correspondance with the University of Melbourne My internship was in a large teaching hospital in Western Sydney, doing two terms in Emergency, a term in ICU, then a crazily hectic surgical term, during the NSW government s waiting list reduction scheme . None of these were particularly satisfying, and I was left with a gnawing sense of what did I do this for? My last rotation was in Medical Oncology & Palliative Care, and it was the first time that it just clicked - I felt like I could make a difference to my patients, and there was an emphasis on psycho-social issues which appealed to me. My consultant was really thorough, but more
to find out more
?
royal australasian college of physicians
)
post 145 Macquarie Street Sydney NSW 2000
&
Ê
phone 02 9256 5444 fax
02 9252 3310
importantly, he was human. He was interested not just in the information that he needed to make decisions, but also in what was important to the patients. I finished two more years as a resident, doing general medical terms including Haematology, Anaesthetics, High Dependency Surgery and even more Emergency. I then joined the Registrar Training Programme with the Sydney Institute of Palliative Medicine, which involves three years of supervised training in hospitalbased consultancy services, community services and inpatient/ hospice units through Central, South-Eastern and South-Western Sydney. Some terms are particularly trying, just due to the distance to be traveled from home. With the formation this year of the Chapter of Palliative Medicine under the umbrella of the College of Physicians, future entry will be into a three year advanced training program via either the College of Physicians or of General Practitioners, following Basic Training. I have found Palliative Care much more satisfying than any other area of medicine - you have the opportunity to make an impact at a really difficult time in a patient s life, and therefore affect their whole family. Some days it is a bit wearing, especially when you re looking after
TheOther Other Side The Side
Age: 30 years Qualifications: MBBS, University of Sydney, 1995 Clinical Certificate, Sydney Institute of Palliative Medicine
a person either younger than you, or for some reason their situation particularly relates to you. For example, when I was engaged, the distress of a 29-year-old patient s fiancée really touched me.
People think it must be depressing, but actually it tends to be uplifting and life affirming. I think that it is much easier when you come to see that death is not a medical failure. Rather, it is the inevitable conclusion of life - and your goal is for it to be a dignified and fitting conclusion, like the fourth movement of a symphony. In terms of professional interests, apart from the symptom-related research I am involved in at the moment, my main interests at the moment relate to cultural diversity, and the exposure of the junior doctor to death and dying Watching other normal people weigh up their lives has definitely had an impact on my career decisions. Although I would have been involved with more than a thousand people who were dying, not one of them has expressed regrets relating to work. On the • Palliative Care continued on page 25 •
Page 27
Physician Physician (Endocrinology) (Endocrinology) Dr Bronwyn Crawford
Staff Specialist, Department of Endocrinology, Royal Prince Alfred Hospital Sunday afternoon, 3 pm. Finally, time to myself. My husband has again removed two children and taken them visiting family. This arrangement has been used repeatedly over the years to enable me to study for my FRACP exams, write my PhD, and now catch up with some of the teaching, research and administrative commitments that I have acquired as a staff specialist.
to find out more
?
royal australasian college of physicians
)
post 145 Macquarie Street Sydney NSW 2000
&
Ê
phone 02 9256 5444 fax
02 9252 3310
Today is a little different in that the time available is limited - my four year-old is asleep in bed, sick with a severe gastroenteritis that has kept us up for the past three nights. My thoughts hang on my youngest - surely her recovery must be soon doesn t she know it s Monday tomorrow, the babysitter has gone to Japan, the grandparents have better things to do and I have the usual day consisting of research and clinical meetings, ward round, afternoon clinic plus, as an additional bonus, a lecture to pharmacy students in the evening? Through a haze of tiredness I can t recollect any clinics on a Monday for my husband perhaps .. What has led to this chaotic existence? I graduated from UNSW in 1981 and was an intern/RMO at St George Hospital. Here I discovered the pleasures of working with children they smelt better and felt better than adults, and sometimes gave you cuddles on ward rounds! I transferred to Prince of Wales Children s Hospital as a paediatric registrar, and was seconded to Liverpool Hospital where I
TheOther Other Side The Side
Age: 41 years Qualifications: MBBS, University of New South Wales, 1981 FRACP PhD, University of Sydney, 1995
met my future husband, a staff specialist in paediatrics. We married, and I sat the FRACP exams shortly after. Through a lack of forethought, I was 36 weeks pregnant when sitting my viva in Melbourne. The combination didn t lead to success that time but was followed by the birth of a healthy, beautiful girl with the loudest lungs and the worst sleep disorder, sent especially to test the non-existent mothercraft skills of one paediatrician and one paediatrician-to-be. Somehow we managed to survive two and a half years without a single solid night s sleep just in time for the birth of a sister. Having deferred the FRACP viva for 12 months, during which time I was unemployed in the financial sense but studied clinically at my own pace, I was successful on the second attempt. Advanced training consisted of a variety of part-time and job-sharing work which resulted in far too much developmental paediatrics and child psychiatry for my liking - but my priority then was to have some time with the children. Unfortunately, I believe that women in this situation are frequently railroaded into the unpopular terms due to limited bargaining power. The clinical highlight during advanced training was a six-month period of full-time
ò
Page 28
• Endocrinology •
work in Endocrinology at the Children s Hospital, Camperdown. This had always been an area of interest and I worked with a wonderful group of enthusiastic, generous physicians. I was also introduced to clinical research at this time, and obtained my first publication. Following the birth of Number Two, I did twelve months job sharing at The Children s Hospital, and I believe that my colleague, Sally Poulton, and I were the first trainees to negotiate such an arrangement. By this time, however, I was tired of overtime shifts as well as evenings and weekends away from the family. A PhD seemed like a good idea at the time as a means of having flexible working hours and completing my advanced training. Oh yes, and to pursue the academic thrills of endocrinology research! My PhD was conducted at Sydney University under the rule of Professor David Handelsman, a wonderful supervisor, brillant researcher and a warm-hearted person. Our families each added two
children during my four years there. Our relationship has been maintained through collaborations on clinical research projects that I am involved in as a staff specialist at Royal Prince Alfred Hospital (RPAH). People often ask how I managed a PhD with family commitments. Life was and still is very hectic. I spent little time contemplating things that did not relate directly to my work or my family. My spare moments were spent like an army general masterminding a military exercise mentally reworking various combinations of childcare, school commitments and domestic chores with my research commitments. My research was on male puberty and it involved animal as well as laboratory work. I had monthly trips out west to a baboon colony I was studying, and I also organised a collaboration with a group in New Zealand which had a particular mutant variety of rat, and a group in Oxford, UK which had a hypogonadal mouse. This latter collaboration resulted in a 9-week trip to the UK, accompanied by the family providing, again, an
unexpected experience.
but
remarkable
After my PhD (and the birth of my fourth and final child!) I returned to the New Children s Hospital for some part-time work in diabetes and also a period at the Andrology Unit, RPAH. It was such a shock returning to the hospital after a long absence whole generations of antibiotics had come and gone in that time, and investigations were being used that I had never heard of! Subsequently I have been appointed as a staff specialist in Endocrinology at RPAH. The first twelve months in this position was like rolling the learning of a registrar, fellow and consultant all into one rather daunting! Particularly as this position represented a medical backflip going from paediatrics to full-time adult medicine. It would take another chapter to discuss the pros and cons of full-time versus part-time work, but at this stage of my working life, the opportunity finally to earn a respectable living was worth the challenges in domestic organisation!
O
• Medical Research continued from page 20 •
where I spent the next two years in the laboratory of Professor Frank Grosveld at the National Institute for Medical Research in Mill Hill. This was a great opportunity to live and work in another country. It was not all beer and skittles however, as living in London was very expensive and the climate left a lot to be desired! Nevertheless, an overseas post-doc is still an excellent life experience and is also still considered rather necessary for the advancement of a scientific career. For family reasons, I could only stay in London for 2 years. In retrospect, it would be preferable to allow at least 3 to 4 years for an overseas post-doc to obtain the
maximum benefit, both scientifically and socially, from the experience. I returned to the Hall Institute in 1995. I was fortunate that I had been awarded a Neil Hamilton Fairley travelling fellowship which paid me a salary both overseas and for two years after I returned to Australia. Finding a job back home is one of the great difficulties faced by all those embarking on a career in medical research. I have certainly been one of the lucky few. Over the past five years I have continued to work very hard and for very long hours. I was appointed as a Senior Research Fellow in January 2000.
TheOther Other Side The Side
Compared to clinical medicine, scientific research offers job insecurity and poor remuneration for the hours worked. So why do it? At least at the moment, the thirst for knowledge and the excitement that accompanies those occasions when our experiments work is enough to tilt the balance. Research is certainly not for everyone, and may not even be right for a whole working lifetime for many. Nevertheless, I would urge any graduates who have the opportunity to sample its delights as well as its disappointments to have a taste for themselves.
O Page 29
Police Police Medicine Medicine Dr Edward Ogden
Senior Medical Officer, Victoria Police Associate Director, Private Hospital Emergency Department Prisoners in police custody are among the most vulnerable, deprived people in our community. They are not in gaol. They have nothing to do except contemplate the futility of their predicament. Many of them are mentally ill. Seventy percent have a life-time diagnosis of substance abuse, and many actively seek medication. Twothirds are positive for one of the major viruses. As a group they are difficult, manipulative and ungrateful, yet there is immense satisfaction in keeping them safe and meeting genuine medical need when it is identified. I graduated in 1976 and by 1980 was the junior partner in a busy, sixpartner, outer-urban practice. I wanted to go bush, but I married a city girl. My internship included a rotation to a little hospital on the fringes of the city were I found many of the advantages of country-style practice without being too far from the city.
to find out more
?
for further information, about work in the police force, contact your state police department also see profile forensic pathology on page 12 for an additional insight into work in the police force
It was a good practice, we delivered several hundred babies each year. I did two elective anaesthetic lists each week and was on-call one day each fortnight. Not long after I joined the practice, a family friend, the late Peter Bush, was appointed Police Surgeon of Victoria. At his suggestion I became a part-time police surgeon ministering to sick prisoners, examining victims of crime, assessing the mentally ill and becoming part of the local police district. I attended murders and fatal collisions, I went with police on a raid to rescue allegedly abused children away from an eccentric religious cult. Many police offices and their families became my patients. I became immersed in a side of our community that many people never see. Life in general practice was busy and exciting. Some aspects were very satisfying, but I never quite adapted to the tyranny of the waiting room. The feeling that each day was spent on a treadmill and no matter how hard one worked, one would never quite catch up. The waiting room was like a modified magicpudding, the more patients you took out, the more there were to see. So, in 1988 when Peter Bush retired, I left general practice to work full-
TheOther Other Side The Side
Age: 49 years Qualifications: MBBS, University of Melbourne, 1976 BMedSc FRACGP MA (Criminology) time in forensic medicine. The work was endlessly fascinating. Many people watch cop shows and medical dramas to get a taste of what we did every day. The lure of forensic medicine is a heady combination of intellectual and clinical challenge mixed with the insatiable human appetite for mystery; not to mention the wonderful people. Unlike medical and surgical specialties were seniority is sometimes accompanied by arrogance - forensic medicine is practiced in a strangely public arena where your work is scrutinised by police, lawyers and courts. Seniority implies experience and lots of humbling experiences. Visiting academics and practitioners from overseas, the ones who wrote the textbooks, made me so welcome. The police needed help supporting prosecutions against drivers affected by alcohol and other drugs. I mastered the literature on alcohol, drugs and driving and learned to withstand the cross-examination of the best lawyers. I was soon • Police Medicine continued on page 35 •
Page 30
Politics Politics (Government) (Government) Dr Brendan Nelson
Federal Member of Parliament, Liberal Party of Australia As an economics dropout, I chose a career in medicine based on my observation that those who end their working lives with the greatest sense of satisfaction are people who commit themselves to the service of other human beings.
to find out more
?
the australian democrats @ email www.democrats.org.au the australian labor party @ email www.alp.org.au the liberal party of australia @ email www.liberal.org.au the national party of australia @ email www.ozemail.com.au/ ~ npafed/ for more information about involvement in government organisations, contact your local member of parliament
Age: 41 years Qualifications: MBBS, Flinders University, 1983 Fellowship, Australian Medical Association. Honorary Fellow, RACP
My career choices and day to day decisions are deeply rooted in values acquired firstly from parents, who considered education the foundation of a life fulfilled improving the world in which you live and, secondly the Jesuits, to whom I owe a debt that cannot ever be repayed.
To my surprise, I finished my degree and intern year in pretty good shape. In fact, the further I got into the clinical end of the course, the easier it seemed to become so much so that by the end of my intern year I had a choice of virtually any training program.
These remarkable men taught me four values that remain the touchstone of decisions I have made to this very day:
But I left Adelaide for Hobart, having spent my early life in Tasmania and knowing I could get much better clinical exposure at the Royal Hobart Hospital in a general year whilst considering my career options.
• Commitment to achieve your goals you need to consistently apply yourself, whatever the obstacles. • Compassion constantly ask yourself how your actions and words impact upon the feelings of others, striving to share another persons pain . • Conscience all successful lives are built upon an eternal question, what is the right thing to do? . • Courage nothing in life of value is achieved without having what might be described as a brave heart . I didn t ever consider myself likely to do well in my undergraduate years at Flinders. My ambition was simply to get through what I still consider to be six years of hell alleviated by the resource of personal friendships.
I returned to Adelaide, joining the paediatric training program at Flinders. It was during the grueling term in neonates that the niggling doubt about specialising grew into a torrent of deep seated unhappiness, unleashed by a chance meeting with one of those people who I most admire. The late Deane Southgate was a GP in the primary care department. With his trademark pipe, and looking over the rim of his glasses, he d caught me finishing a thirty-six hour shift. I hear you re going pretty well with the baby doctors Brendan. But all this high tech stuff isn t you. You ll make you mark more in the world of general practice. You re a people person. • Politics (Government) continued on page 33 •
TheOther Other Side The Side
Page 31
Politics Politics (Medical) (Medical)
Dr Rosanna Capolingua-Host
President, WA Branch of Australian Medical Association, General Practitioner I am a General Practitioner in a northern coastal suburb of Perth. It is a career that delights me and taxes me, and provides me with great reward and satisfaction. It also constantly reminds me to be humble about life.
to find out more
?
australian medical association
)
post PO Box E115 Kingston ACT 2604
&
Ê @
phone 02 6270 5400 fax
02 6270 5499
email ama@ama.com.au www web site www.ama.com.au
doctors reform society
)
post PO Box 14 4 Goulburn Street Sydney NSW 2000
&
Ê @
phone 02 9264 9804 fax
02 9267 4393
email drs@nlc.net.au www web site www.drs.org.au
A GP is the front line in the delivery of health care, and general practice is unique in its variety, integration and its ability to be all encompassing - not just of the physical being and its health, but in preventative issues, and the mental, social, family, occupational and psychological health of the individual. The GP can get to know all these aspects of the patient s life, and total care is a real possibility. I graduated in Medicine from the University of Western Australia in 1983. My first child was born on July 24 of the preceding year, so that you can imagine that in the short weeks leading up to my finals I was preoccupied with a new born child as well as a final surgical term and preparation for exams. When you are young and flexible, you don t spend much time thinking about it, you just do it. I learnt many lessons in life along the way. As a female undergraduate and graduate I never felt that my choices were limited or restricted. It was a matter of choosing what you wanted, and making it happen, and putting in your utmost no matter where you were or what you were doing. Things are a little different now with
Age: 41 years Qualifications: MBBS, University of Western Australia, 1983 restriction of training positions, provider number restrictions, and a stressed system. There are perhaps more external forces that make it more difficult. The profile of internship and residency, with a babe and a student husband, made life a very intense but excellent experience. I was fortunate to have great family support with me. The idea of General Practice led me into the very early Family Medicine Programme which I commenced as a resident, and continued when I went into practice. Again quite different from today with the structured training, and its link to government funding. I will never forget the look on my training supervisor s face when he came in to the surgery to assess me in General Practice and I hadn t told him that I was seven months pregnant with my second child. By the way, this was three and a half years after the first. I m not quite sure that variable had been factored into the equation. And that of course is the challenge to all female medical practitioners who want to be mothers as well. It can be done, it can be done well, the balance is possible, but you have to make it happen. No one can do it for you.
ò TheOther Other Side The Side
Page 32
• Politics (Medical) •
I did not complete the FMP training because it became increasingly bureaucratic. Can you see the political seed beginning to germinate? Vocational registration appeared not too long after, and I refused to become VR d because I saw it as the government gaining increasing control over General Practice (I wasn t the only one), and splintering and dividing GPs. One morning I became aware that the practice receptionist was informing patients that they would get a bigger rebate if they saw the other GP, and I succumbed to vocational registration, but took up the battle on a bigger front than only my little surgery consulting room.
General Practice has been the biggest football of government. We have been kicked around, and they keep making new rules to control the game. What happens to GPs always has repercussions on the rest of the profession. The big picture of course is health funding overall, and the balance between public and private, government, doctor and patient responsibilities. As a result of all of this, over the last five years I have served on the AMA Western Australian Branch Council, first as Assistant Honorary Secretary, Honorary Secretary, Vice President, and am now in my second year as President. Concurrently, and as a consequence of this I have also been on the AMA Council of GPs and AMA Federal Council.
It has been an enormous learning curve, a great deal of fun, and a small way of contributing back and defending this profession that I love so much. I have developed a greater understanding of my colleagues. I would recommend it to any one, and encourage you to come on board. My other life is still there. I deliver and collect kids from school and elsewhere. I go to debating, assemblies, mass, softball (team manager), baseball, football, netball, help with assignments, etc - just like any one else does. I shop, I cook, I run a house - and I work part time in General Practice. It is a good and fortunate life.
O
• Politics (Government) continued from page 31 •
And so, a few months later I left, joined the locum circuit and relocated to Hobart where David Crean and I established two medical deputing services. I joined the AMA in 1989 because I was angry. Like the critical events in anyone s life, it was triggered by an incident the significance of which I did not appreciate at the time. George Gear, a then federal Labor MP, had grabbed headlines denigrating my profession and GPs in particular. The AMA s inadequate response was more than I could stand. But having joined for the wrong, selfish motives, I soon saw how the influence of our profession could be adapted and used to challenge and change the attitudes of the society we serve not only to professional and industrial issues, but also a range of social and human injustices.
The following year my life was changed again, by a man I had until then admonished. Bruce Shepherd taught me that one person can make a difference, and that you must always be prepared to fight for that in which you believe. Those possessed of these qualities are people who change a world which yields so painfully to it. Indeed, it is only such individuals who ever have. I didn t ever expect I would become the federal President of the AMA, any more than I planned a career in politics. The former I sought to implement a vision of the kind of health care system most doctors would want, and the latter to ensure that perhaps I might complete the task.
can be used to build a better future for the next generation whilst challenging the mores of those who profess to lead, but who are most often led by public opinion. To succeed, you need to keep your mind open to new ideas, jealously protect the inner integrity of your intellect, and treat others with the humanity you expect for yourself and those whom you love. In medicine and in politics, people are remembered not for what they know, the wealth they accumulate or the status they achieve. A decade from now you will not remember who topped your year, but you will derive strength from the memory of those who by their presence, participation and personality made your experience and life that much better.
But you have only one life in which every position or potential position
O
TheOther Other Side The Side
Page 33
Psychiatry Psychiatry Professor Ian Hickie
Professor of Community Psychiatry University of New South Wales
to find out more
?
royal australasian and new zealand college of psychiatrists
)
post 309 La Trobe Street Melbourne VIC 3000
&
Ê @
phone 03 9640 0646 fax
03 9642 5652
email training@ranzcp.edu.au
As a Professor of Psychiatry my working life is filled with a rich tapestry of clinical, teaching, research and social roles. I got into psychiatry in the hope that I wouldn t get bored professionally. While I had a major interest in internal medicine as an undergraduate and resident, I was afraid that most of the career paths available seemed very technical and highly specialized. I couldn t see myself dealing with only one body system or one set of technical skills. Additionally, I had always had an interest in the broader social, political and philosophical issues that are relevant to people when they are sick. My undergraduate experiences in psychiatry were stimulating. Even though the hospital environments weren t fabulous, the clinicians seemed to be struggling with really difficult situations. These clinicians were clearly people first and doctors second. Increasingly I found their company more interesting than other specialist groups. Throughout my professional life, involvement with psychiatrists has proved to be an ongoing reward. Despite the stereotypes, as a group psychiatrists tend to be interested in a wide range of personal and social issues, rather liberal in their personal philosophies and, generally, more tolerant than other more conservative sectors of the medical profession. Human behaviour is a fascinating thing and while many traditional psychiatric theories (or the little I knew about them) didn t seem to be all that relevant at least the fundamental topic was challenging. During my time in psychiatry I ve been
TheOther Other Side The Side
Qualifications: MBBS FRANZCP fortunate to come to realise that what we recognise as normal behaviour, and what we call mental illness, both represent very complex outputs (phenotypes) from the interplay of key biomedical factors (genesbrain development-brain pathology) and social and developmental influences. It remains, for me, the one area of medicine where my biomedical knowledge can be usefully combined with broader personal and social insights to relieve patient suffering. The suffering encountered by people with mental illness is of a peculiar and devastating type. The social stigma, the lack of understanding within the general community and the marginal influence of psychiatry in general medical practice have all combined to exacerbate the adverse affects of mental illness on a person s life. Fortunately, we are in a period of rapid expansion in basic aetiological and treatment knowledge such that we now provide far greater relief for the patients we treat. It remains one of the most gratifying experiences within my professional life to be able to assist someone who has lost their fundamental human capacities to get back in control of their life. The academic aspects of my career have been particularly rewarding, Its fun to teach, especially when the undergraduate or postgraduate students are interested in your topic. Its also challenging in psychiatry,
ò Page 34
• Psychiatry •
there is a constant need to explain issues that doctors frequently have never really thought about. The research aspect is an integral part. Some clinicians seem happy to believe that they know what they are doing for the researcher, there is always the wish to test new ideas, reject bad practices and be stimulated by the rapidly expanding frontiers of neurosciences and social and personal psychology. As a consequence of my clinical research, I feel that I do a better job for the patients I look after. They get better access to new ideas, new treatments and optimism about advances in our understanding of the causes of their problems. My university position also gives some capacity to act as an advocate on their behalf in the wider community. Additionally, academic medicine has led me to establish professional relationships and friendships around the world. It allows you to become a global citizen in a way that is very difficult for other clinicians. For many psychiatrists, the trip into psychiatry is a difficult one. It often • Police Medicine continued from page 30 •
welcomed into the international road safety community: an eclectic mixture of researchers, policy makers and practitioners who are impassioned by road trauma. When Victoria Police introduced oleoresin capsicum spray (OC Spray) , I studied the literature on capsaicin. I helped the police develop safety and first aid policy for OC Spray and gave evidence in support of its safety before the Civil and Administrative Tribunal. In the early 90s, I thought forensic medicine had become my career. I expected to be there until retirement, but I was wrong. In the flurry of outsourcing that characterised Victoria in the 1990s, the service passed to Monash University without
involves a move away from procedural medicine just after you ve started to feel technically competent. The training process is often personally challenging. When you start to look carefully at other people s behaviour they start to look closely at you! Since the art of psychiatry relies heavily on an understanding of your own capacities some doctors prefer to stick to more technical tasks. The patients who are really sick, particularly those in the public hospitals, are often not grateful and can be very confrontational. This comes as a shock to many young doctors. At times these patients can be very frightening and the settings for their treatment can be very intimidating. Usually as people progress through their training, however, they come to see the bigger picture and to find areas that really capture their imagination. Like other areas of medicine, specialist and academic practice can be very time consuming and place considerable strains on your life me and I remained on as part-time Senior Medical Officer with the Victoria Police. I am responsible for the health care of everyone in the care of police in Victoria. On any given day there are some two hundred or so people in police lockups waiting for court or their turn for a bed in gaol. Forty doctors around the state assist with clinical assessments and treatment. I provide the administrative support, ensure doctors and pharmacists are paid promptly, and establish policy and procedure. In the metropolitan region I supervise a small unit of clinical nurse practitioners who triage medical priorities, perform health assessments and counsel the most desperate prisoners. The other part of my life is split
TheOther Other Side The Side
outside of medicine. From my perspective, this makes it even more important to me to know that what I do during the day is really stimulating, often fun and personally gratifying. Psychiatry does encourage people to keep in touch with the world outside of medicine. It is a specialty where everyday practice requires a knowledge of the broader social issues. This applies also at the personal level. I m sure my personal life has been considerably enriched for having trained in psychiatry, while having close personal and family relationships outside of work is critical to coping with the professional end of psychiatric practice. In terms of the style of practice, which is largely officebased and occurs during day-time hours, it also means that I can get away from work and do things outside of medicine. As a consequence, its much easier to come back to work and not be bored or overwhelmed by the responsibilities.
O
between management and clinical practice in two private hospitals both very enjoyable and rewarding. Even though the police now get their toxicology support from Monash University, I have remained committed to road safety. At the Brain Sciences Institute at Swinburne University, we are currently researching marijuana and driving skills and have more projects under development. I just completed a project for VicRoads on medications and driving, and am currently working with the National Road Transport Commission on medical standards for commercial vehicles. I now have time at home to enjoy a new baby girl, renew my love of the piano and learn the frustrations of golf.
O
Page 35
public Public Health Health Dr Gary Dowse
Medical Epidemiologist, Communicable Disease Control Branch, Health Department of Western Australia Responsibilities of my current position
to find out more
?
australasian faculty of public health medicine
)
post c/o RACP 145 Macquarie Street Sydney NSW 2000
&
Ê @
phone 02 9256 5404 fax
02 9252 3526
email afphm.medeserv.com.au
as the Medical Epidemiologist in the Communicable Disease Control Branch in the Health Department of WA include: • Management of a small group of staff. • Coordinating surveillance of communicable diseases,including the maintenance of databases such as the state-wide notifiable diseases and HIV/ AIDS registers. • Coordination of communicable disease outbreak investigations in the Perth metropolitan area. • Clinical consultancy to general practitioners and other health care workers on infectious disease control matters. • Analysis and reporting of trends in communicable diseases • Occasional teaching in epidemiology and public health to a range of undergraduate and graduate students. I reached this position through a series of decisions at those forks in the road that we all travel. Following graduation I did resident rotations in Perth teaching hospitals for two and a half years. I was not enthused by the prospect of the hard slog of a specialty training program, and in any case, no specialty particularly appealed. In addition, the prospect of settling down to a life of suburban or rural general practice seemed frightful. The one thing which had excited me during my undergraduate training was the field research and scientific inquiry associated with my study of the epidemiology of an epidemic of asthma, in an area of the
TheOther Other Side The Side
Age: 41 years Qualifications: BMedSc (Hons I), University of Western Australia, 1981
MBBS, University of Western Australia, 1983
MSc (Epidemiology), University of London, 1986
FAFPHM (Fellow of the
Australasian Faculty of Public Health Medicine), 1993
Highlands of Papua New Guinea, for a Bachelor of Medical Science degree. I was lucky enough to have stumbled onto an extremely interesting project, in a remarkable place, and to have three inspiring mentors and supervisors. I came to realise that what I wanted to do was epidemiologic research, apply it to public health and to work in developing countries. At that time there was hardly anywhere in Australia to gain formal qualifications in epidemiology and public health, but that gave me the opportunity to obtain a postgraduate scholarship to study for a year at the London School of Hygiene and Tropical Medicine. As I completed the London course serendipity intervened and I heard of a job for an Epidemiologist based in Melbourne, studying the epidemiology of type II diabetes, obesity and cardiovascular disease in a number of Pacific Island countries and Mauritius. I spent • Public Health continued on page 39 •
Page 36
Royal Flying Royal Flying Doctor Service Doctor Service Dr Rosalind Reid
Medical Officer, Royal Flying Doctor Service Yes, there is light at the end of the tunnel! Whilst the medical student years may at times seem long and arduous (no, I was not a great student), the rewards waiting at the end of the road are many and varied, and can take you wherever you choose.
to find out more
?
australian council of royal flying doctors service
)
post Level 5 15-17 Young Street Sydney NSW 2000
&
phone 02 9241 2411
Ê
fax
02 9247 3351
www web site
home.vicnet.net.au/ ~ rfds
Age: 31 years Qualifications: MBBS, University of Melbourne, 1991 DipRANZCOG DA(UK) (Diploma of Anaesthetics) FRACGP
I am currently based in Meekatharra (population 700, central Western Australia), employed by Royal Flying Doctor Service (RFDS) Western Operations (the WA division of RFDS). As there are only 3 doctors here, all employed by RFDS, we work a one-inthree on-call roster. At Meekatharra Hospital, we are responsible for both inpatients and out-patients. We do a small number of uncomplicated deliveries and occasional anaesthetics for visiting surgeons. About 50% of our patients are Aboriginal, some of whom have complex medical problems as well as the frequent problem of non-compliance.
working in the third world for a while, at some stage. As a medical student, I had witnessed too many stressed young doctors in tertiary hospitals, and not wishing to become yet another, I opted to leave Melbourne and go to Geelong for my intern year. What a great decision! Work was comparatively stress free and often fun and after work, life was one big party with no studying! It was during this year that I visited my brother who was working as a jackeroo on a remote station in NT. It was from that visit that I realised the medical needs of our outback communities are just as great as those of the third world, and I set my sights on the RFDS.
The other challenges we face are the difficulty of gaining access to specialists, and delays in obtaining test results due to our remote location. Our RFDS responsibilities include: telephone consultations, providing advice and utilising drugs from RFDS chests for those in remote locations with no other access to a doctor; flying clinics to remote communities; assessing flight requests from peripheral hospitals, mines, stations and other remote communities and evacuation of critically ill patients. Despite having grown up in Melbourne, my initial aim after graduation was rural general practice, with a vague idea of
Still committed to my long term goal of rural General Practice, I joined the RACGP training program, tailoring it to my interests and anticipated future requirements (not without occasional battles with the often obstructive staff of the Victorian training program). During my hospital years, I completed terms in paediatrics, emergency, geriatrics, psychiatry and ICU as well as six months of O&G to obtain my diploma and fourteen months of anaesthetics in the UK to • Royal Flying Doctor Service continued on page 41 •
TheOther Other Side The Side
Page 37
Sexual Health, Sexual Health, Drug & & Alcohol Drug Alcohol Dr Wendell J Rosevear
General Practitioner, Volunteer Doctor at Brisbane Women s and Sir David Longlands Correctional Centres
to find out more
?
national drug and alcohol research centre
@
email ndarc@unsw.edu.au www web site www.med.unsw.edu.au/ ndarc australian drug foundation @ email adf@adf.org.au www web site www.adf.org.au alcohol and other drugs council of australia
@
email adca@adca.org.au www web site www.adca.org.au national drug research institute @ email enquiries@dri.curtin.edu.au www web site www.curtin.edu.au/ curtin/centre/ncrpda
I work in Alcohol and Drug Recovery, HIV/AIDS, Rape and Sexual Abuse Recovery, General Practice, Gay and Lesbian Health, Prison Health, Suicide Intervention and Counselling Since 1975, I have worked in Prisons in the roles of Chaplain, Doctor and Counsellor. This experience has taught me the benefit of acceptance and honesty as trust-building strategies to facilitate healing and relief for marginalised, isolated and stigmatized individuals. I spent the first 10 years of my working life getting as broad an experience as possible. After rotating through every specialty term in my three year hospital residency, I worked for two years in country general and hospital practice. I had done my Obstetrics Diploma, inspired by my student elective in Hong Kong. In the country I bonded with the community and was busy doing obstetrics and anaesthetics as well as traditional general practice. I also helped in drug and alcohol detoxification and preventive medicine in the associated Health Centre. In my sixth year I worked part-time with Aboriginal Health and as a Psychiatric Registrar while I did my FRACGP. It was also a year of self-acceptance and selfhonesty about my needs, limits and sexuality. Working outside my limits and being what I thought others wanted me to be was not sustainable. From 1996 to 1999, I was working in Hong Kong in a hospital, and learned to speak Cantonese. It was busy and
TheOther Other Side The Side
Qualifications: MBBS, University of Queensland DipRACOG FRACGP
exciting. On the way I had caught the riots at the end of the Marcos era. When I had been a student in 1979, I had been hi-jacked on the Thai-Burmese border. In 1989, I was in Tiannamen Square at the peak of the revolution and witnessed the first coming of the army before escaping. Seeing people willing to lay down their lives for their beliefs challenged me. I also worked as a trek doctor in Nepal. Each of these experiences takes you outside yourself. I decided to settle in my interest areas. I ve found I do best the things that fulfill me the most. I love interacting with people and see being a doctor like a tool for facilitating relief as a friend. I co-founded the Gay and Lesbian Health Service which has grown to two clinics, fourteen doctors, four psychologists and two alternative health therapists (massage & acupuncture). We became the major general practice for HIV/AIDS care even before homosexuality was decriminalised. We provide testing, GP, home and terminal care. I also founded MARS (Men Affected by Rape and Sexual Abuse), and this has helped 460 men. I work with male and female victims and perpetrators and have helped place sexual abuse of males on the national agenda.
ò
Page 38
• Sexual Health •
to find out more
?
continued from previous page... australian national council on AIDS and related diseases (ancrd) www web site www.health.gov.au/pubhlth/ancard australasian college of sexual health physicians - sydney sexual health centre
)
post Sydney Hospital GPO Box 1614 Sydney, NSW 2001
&
phone 02 9382 7457
I founded the GLADS (Gay and Lesbian Alcohol and Drug Support), and help many individuals and families in recovery. My exposure to prisons and the national drug problem has encouraged me to speak out publicly to generate understanding and to lobby for change in the way we relate to these people and issues. Each week I have some media involvement on marginal or stigmatized issues. I have received many awards that help give voice to the hidden issues. • AMA National Award for Best Individual Contribution to Health Care in Australia, 1996 • Brisbane Citizen of the Year, 1996
• Anti-Violence Award for Work in Male Rape, 1997 • Order of Australia Medal,1998 To balance the stress of work I live in a rainforest garden on the river next to Queensland University. I love to run, dance and spend time with friends. I am involved in doctor and student education and lots of public speaking. I d love to write, and have done some writing in the area of prisons, drugs, rape and relationships. Life is an exciting challenge and I feel totally fulfilled. I tell people I live a double-life but neither is hidden. I could not have predicted this outcome, but being open means there is more adventure to come.
O
• Public Health continued from page 36 •
the next nine years in this job, during which I coordinated a series of large scale cross-sectional and longitudinal population studies in Nauru, Mauritius, Fiji, Papua New Guinea, Rodrigues and Western Samoa. I also undertook consultancies on the prevention and control of lifestyle diseases for AusAID, WHO or direct for national governments, in these and other countries, including the Marshall Islands, Singapore and China. During this period I published around 120 scientific articles in peer-reviewed journals and books, and had the opportunity to present at many international scientific meetings. I developed lasting friendships with study collaborators and fellow researchers from many countries. I travelled frequently, and spent around 2 to 3 months overseas each year, invariably in exotic
locations. In many respects it was my ideal job . So why did I move on? A mixture of things, including: the desire for more job security, free of the anxiety associated with 3 yearly research grant submissions to ensure a salary; feeling a bit typecast, and wanting to broaden my experience; and the desire to try a job where I could have a direct role in influencing policy and implementation of public health programs, rather than being the researcher and consultant who could only make recommendations. There was also some desire to move back to Western Australia to be closer to family and friends. As a result I took a job as the Public Health Physician in the regional Public Health Unit based in Geraldton. This represented a big change and a few challenges, including learning on the job about the epidemiology and public health
TheOther Other Side The Side
aspects of communicable disease prevention and control. After about two years I moved to my current position, largely influenced by my partner s desire to live in the city, and the opportunity to continue to develop knowledge and skills in the prevention and control of infectious diseases. Coming to terms with bureaucratic structures and processes has been the most frustrating side of working for the Health Department, compared with the relative flexibility and independence enjoyed in a private research institute. I also miss the research environment and the opportunity to travel and work overseas. The benefits of my current position in the public sector include greater job stability and better remuneration as an Epidemiologist/ Public Health Physician than would be possible in a research or academic position.
O
Page 39
Sports Sports Medicine Medicine
Professor Peter Fricker OAM
Medical Director, Australian Institute of Sport, Canberra (Adjunct) Professor and Chair of Sports Medicine, University of Canberra
to find out more
?
australian college of sports physicians
)
post PO Box 644 Crows Nest NSW 1585
&
phone 02 9410 1061
Ê
fax
02 9410 1062
@
email info@acsp.com.au www web site
www.acsp.com.au
I work full time at the Australian Institute of Sport (AIS) in Canberra and my working week revolves around treating athletes in residence or visiting on training camp programs, as well as seeing a few private patients from outside the AIS who have been referred by GPs because of problems associated with sport or exercise. The nature of this practice is comprehensive and ranges from management of illness and injury to providing advice on exercise and conditions such as diabetes or asthma, to aspects of environmental issues such as heat stress, aquatic medicine or mountaineering. I also teach undergraduates and postgraduates at the University of Canberra, Registrars in Sports Medicine (training for Fellowship of the Australian College of Sports Physicians), and others, including visiting Registrars in Rheumatology from Sydney and Canberra, and visitors from overseas. I am active in research, with involvement in a research team from the AIS, the University of Canberra, and the Hunter Immunology Unit and University of Newcastle, which is interested in exercise and immune function. I also research injuries in sport particularly in gymnastics and football and serve on a number of editorial boards of sports medicine journals from North America, Europe and Australia.
Age: 49 years Qualifications: MBBS, University of New South Wales, 1974 FACSP (Fellow of the Australian College of Sports Physicians) I have served the Australian College of Sports Physicians as a Councillor and as President and I am Deputy Medical Director of Australia s Olympic Team for 2000. I also serve on the Medical Commission of the Australian Olympic Committee, and I work with the Australian Commonwealth Games Association. I am a member of the Medical Commission of the International Gymnastics Federation and have recently been appointed to the Australian Sports Drug Medical Advisory Committee. My interest in sports medicine developed as an undergraduate (in the early 1970 s) when I was asked to act as trainer with an Australian Rules team in which my twin brother was playing. I had no experience (or teaching) in any of the problems presented to me and must admit that the players taught me more than they will ever appreciate! In my intern and resident years, I pursued my interest by taking an interest in sport-related injuries presented to Casualty, and by involvement as a voluntary club doctor with local football teams. Perhaps the inspiration for me around this time was a friend of the family a well-known rheumatologist and sports doctor in Sydney who had been travelling with national cricket, rugby and Olympic teams from the 1960 s. He is still
ò
TheOther Other Side The Side
Page 40
• Sports Medicine •
very active in his retirement from I returned to Canberra and hospital service, and remains an commenced practice as a GP with inspiration. an interest in sports medicine. The sports medicine practice flourished I initially pursued training in and I found myself inundated with rheumatology and then in sports patients, plus giving talks to local medicine. In the late 1970 s, the only football clubs, presenting afterway I could do this was to travel dinner talks and handing out awards (with a young family) to England and at presentation nights. The work on an honorary basis with Dr downside to all this was that the John G. P. Williams. He was an athletes were notoriously bad at extraordinary man who had qualified paying their bills and wanted all in rehabilitation medicine and accounts sent to their clubs none orthopaedic surgery, and who had co- of which were financially strong authored the definitive text Sports enough to meet these obligations. Medicine which was published as a All the weekend match coverage second edition in 1976. John taught was honorary, of course, and being me sports medicine as an art, relying free of charge, I was invited to just on history and careful physical about every football match, examination with minimal basketball game and cricket match dependence on X-rays and other going. tests. I became involved with the AIS I learnt to work with when it opened in 1981 and joined physiotherapists, occupational the staff in 1983. It has grown therapists and remedial gymnastics enormously and has been instructors, all of whom worked fundamental to the development of under Dr Williams direction at sport in this country. It has allowed Farnham Park Rehabilitation Centre me to develop in sports medicine in Buckinghamshire, just out of practice, research and teaching. London. He was so successful he attracted patients from across the The toll on family life is significant United Kingdom. However the local and must be taken into account. Health Authority then closed the While the children (I have three) Centre too expensive for the NHS were young, they were quite happy to run! Under his guidance I to attend weekend fixtures with me, published my first refereed paper (on and it gave my wife a break. os trigonum) and was inspired to However, as they became teenagers research and write from then on. and decided being seen with their
dad wasn t cool, time away from home at weekends and particularly on longer trips with teams to international events, became a problem. Some trips last six weeks and the family does suffer. Sports medicine is now a thoroughly professional, structured career. There is an established training program run by the Australian College of Sports Physicians, and specialist recognition is being pursued. More professional teams and clubs are paying sports physicians for their services, and time away from home is being recompensed to some extent. There is still a huge voluntary workload and, as for most doctors, serving humanity seems to be the drive for most of us, rather than the money. You won t get rich as a sports physician. Athletes, by and large, are great patients. They may be demanding but they don t smoke, don t get addicted to drugs and want to get fit as quickly as possible. They are generally disciplined and compliant. You do see the occasional pushy parent and you do have to counsel the obsessive, the anorexic and the worried well. But it is definitely worth it.
O
• Royal Flying Doctor Service continued from page 37 •
obtain my diploma of anaesthetics. I subsequently did my GP terms, half of these being in rural locations. Whilst I disagree with compulsory country rotations, I think rural experience should be strongly encouraged, as it is both challenging and rewarding and patients are generally much more genuine and friendly. Once I had obtained my FRACGP, I applied to RFDS Western
Operations, having wanted to see WA for some time. I have now been in Meekatharra for 12, months and I continue to thoroughly enjoy my work and the new friends I have made here. It is great to be an integral and valued member of this small community and to feel that I am truly doing a worthwhile job where I do make a difference. The downside is the isolation of living far from family, friends, peer support and the amenities of modern
TheOther Other Side The Side
living, but 6 weeks annual leave and 2 weeks study leave help to alleviate these problems. I think that the most important aspects of any job are enjoyment and job satisfaction and I have found both with RFDS. I believe for each and every medical student, there is a job out there that is uniquely suited to you, even if you have to invent it yourself!
O
Page 41
Plastic Plastic Surgery Surgery
Dr Mark Gianoutsos
Consultant Plastic, Reconstructive and Aesthetic Surgeon I am a Consultant Plastic, Reconstructive and Aesthetic Surgeon with my prime surgical rooms in the Prince of Wales Private Hospital Consulting Suites in Randwick. As a Visiting Medical Officer, I combine predominantly private practice but also a service to the Public Hospitals, both Prince of Wales and the Sydney Children s Hospital. In my private practice I am referred patients both by general practitioners and by other specialist surgeons. My practice covers a wide range of plastic, reconstructive and aesthetic surgery. Specifically, in the Sydney Children s Hospital my main clinical interest is in Craniofacial Surgery - that is, the surgical treatment of children with deformities of the head and face, both congenital and acquired. In the Prince of Wales Hospital, I am very much a General Plastic Surgeon, involved with hand surgery, microsurgery, general plastic surgery and the treatment of skin cancers.
to find out more
?
royal australasian college of surgeons
)
post Spring Street Melbourne VIC 3000
&
phone (03) 9249 1200
Ê
fax
(03) 9249 1219
In my private practice I also see a wide range of plastic surgery, including all aspects of aesthetic or cosmetic surgery, breast reconstruction and microsurgery, hand surgery, craniofacial surgery and the treatment of skin cancers. I am also the Director of the Craniofacial Research Program, and as such am affiliated with the University of NSW and the Department of Surgery. I have a number of ongoing laboratory projects within that Department, and have had a number of medical students do Masters projects with me over a year, and currently have a post-graduate PhD student. My week comprises operating between three and three and a half days per week, one and half days of which is in my private hospital appointments, half a day in my surgical rooms doing minor procedures and the remainder of the time in either Prince of Wales or the Sydney Children s Hospitals. I have an on call commitment to the Prince of Wales and Sydney Children s Hospital which is one in five. That is, I am on call every Wednesday from 8:00am until the Thursday 8:00am, and every fifth weekend from Saturday at 8:00am until Monday 8:00am. I started medical school straight from high school, and completed the course at Sydney University. My
Age: 36 years Qualifications: MBBS, University of Sydney, 1987 MD, University of Melbourne, 1994 FRACS (Plastic), 1995 interest in surgery had always been present, but was particularly sparked by my medical student days in third, fourth and fifth years, where I took a very active part in my surgical terms, being involved both in the Clinics and in the Operating Room as much as I was able, both within and out of hours. I guess, like all of us, I was particularly influenced by a number of individuals who took time and interest in me as a medical student during these terms. Particularly, a General Surgeon by the name of David Glenn at Prince Alfred Hospital, now retired, was very much an influence on my decision to become a Surgeon. I chose surgery as a career path because I enjoyed the intellectual process, the manual dexterity and artistry, as well as the ability to act upon a problem. I had the opportunity to pursue physicians training also, and thought carefully about this, but chose not to do so predominantly for the reasons that I chose to do surgical training. Having completed my medical
ò TheOther Other Side The Side
Page 42
• Plastic Surgery •
course, I was an intern at Royal Prince Alfred Hospital and aimed to undertake as many surgical terms as I was able whilst still fulfilling the prerequisites in Accident and Emergency and in medical terms. Through my intern year, I studied hard for my surgical primary, and sat and passed that in the February/March of my first resident year. Again, in my resident year I aimed to undertake as many surgical terms as possible and in as varied fields as possible. I then undertook an unaccredited surgical registrar training job at Prince Alfred Hospital, where again I aimed to undertake a wide selection of surgical jobs, including transplant surgery, orthopaedic surgery, neurosurgery and plastic and reconstructive surgery. The following year I undertook an accredited general surgical registrar position for six months at the Sydney Melanoma Unit, and then for six months in Dubbo. I greatly enjoyed my country term, although it was extremely busy, averaging ninety hours per week.
training, I undertook a fellowship in hand and microsurgery at Royal North Shore Hospital, and then traveled to New York to be the Fellow in Craniofacial Surgery at the Institute for Reconstructive Plastic Surgery in the New York University Medical Centre. This was a wonderful opportunity and has, along with my basic surgical and plastic surgery training, set me in very good stead for my practice. I returned from New York in 1996, when I started up clinical practice as a visiting medical officer as described. This had been a job that I had applied for prior to going to the United States.
In that year, I applied for a Plastic Surgical Advanced Training position and was granted one in Melbourne. I was a little hesitant initially, but in retrospect it was a very positive move indeed. I spent three years in Melbourne, two of which were as a Plastic and Microsurgical Research Fellow in the Department of Surgery in the Royal Melbourne Hospital and the University of Melbourne. I undertook an MD thesis at that time. I also was involved in clinical training for one year full-time, and for two years part-time following that. In 1994, I returned to Sydney and was the Advanced Trainee in Plastic and Reconstructive Surgery at the Prince of Wales Hospital, and sat my final fellowship exam in July of 1994.
We also have great variation in our practices and we operate on every part of the body and every body cavity from the limbs to the cranial cavity, the thoracic and abdominal cavities, the head and neck, and everywhere in between. It is technically very interesting and demanding. The cons, I guess, are the hours spent and the sacrifices that one needs to make due to this.
Plastic surgery training is very demanding, both from a time point of view and from the skills and knowledge needed to be acquired during that time. The year after my
With regard to the pros and cons of my job, I feel the former vastly outweigh the latter. I am in a field of surgery that requires constant thought. It is not in any way a formulaic approach to patients. Every case, every patient, every reconstruction or aesthetic procedure is different.
My other professional interests are essentially in my research and in teaching of students and registrars. I am the Director of the Training Program for the Sixth Year Medical Students, and also run part of the Training Scheme for the New South Wales Plastic Surgery Advanced Trainees. I am also the Plastic Surgical Representative involved in setting up the Skills Laboratory at the Royal Australasian College of Surgeons for Advanced Trainees in Plastic Surgery.
TheOther Other Side The Side
I believe, as in anything in life, there are compromises that need to be made, and one needs to be cognizant of these both from the family and from the work perspective. It is also important that one s family and partner are at least cognizant of the time demands that one places admittedly on one s self in undertaking a career such as mine. It undoubtedly impacts upon these things, and that is a decision that one must make prior to embarking upon this type of career. One s obligation is always to the patient before all else. Having said that, I believe it is very important to provide a relief valve for one s self on a regular basis so that the temptation of engrossing yourself totally in work is not succumbed to. In summary, I have been very fortunate in being able to undertake my chosen specialty within medicine, and to have been able to do it in as efficient a manner, timewise, as is possible. It has also opened up a great number of opportunities for me not only in Australia, that is, in Sydney and in Wagga, but also overseas, through our Interplast program. Run through the College of Surgeons, the Interplast program allows Plastic Surgeons to travel to South East Asia and the Pacific, and undertake a voluntary program for a two-week period, particularly treating children with cleft lips and palates, but also severe burns and hand injuries. I have been involved in this for some years now, and until last year have been travelling to Kalimantan in Indonesia. I would recommend my career to anyone interested in surgery, with the knowledge that there are many compromises to make along the way but that in my judgment, at this stage, they are all well and truly worth it, if not at least partially forgotten.
O
Page 43
For For further further information information
anaesthetics australian and new zealand college of anaesthetists ) post Ulimaroa 630 St Kilda Road Melbourne VIC 3004 & phone (03) 9510 6299 Ê fax (03) 9510 6786 @ email reganzca@anzca.edu.au
dermatology australasian college of dermatologists ) post PO Box B65 Boronia Park NSW 2111 & phone (02) 9879 6177 Ê fax (02) 9816 1174 emergency medicine australian and college for emergency medicine ) post 17 Grattan Street Carlton VIC 3053 & phone (03) 9663 3800 Ê fax (03) 9663 8013 general practice royal australian college of general practitioners ) post National Office 52 Parramatta Road Forest Lodge NSW 2037 & phone (02) 9577 6655 Ê fax (02) 9577 6666 intensive care faculty of intensive care australian and new zealand college of anaesthetists ) post Ulimaroa 630 St Kilda Road Melbourne VIC 3004 & phone (03) 9510 6299 Ê fax (03) 9510 6786 @ email ficanzca@anzca.edu.au medical administration australian and new zealand college of anaesthetists ) post 35 Drummond Street Carlton VIC 3053 & phone (03) 96635347 Ê fax (03) 9663 4117 @ email registrar@racma.org.au www web site www.racma.org.au
physician training (Subspecialties: Cardiology, Clinical Immunology and Allergy, Clinical Pharmacology, Endocrinology, Gastroenterology, Geriatric Medicine, Haematology, Infectious Diseases, Intensive Care Medicine, Medical Oncology, Nephrology, Neurology, Nuclear Medicine, Palliative Medicine, Rehabilitation Medicine, Rheumatology, Thoracic Medicine) ) post Royal Australasian College of Physicians 145 Macquarie Street Sydney NSW 2000 & phone (02) 9256 5444 Ê fax (02) 9252 3310 obstetrics and gynaecology royal australian and new zealand college of obstetricians and gynaecologists ) post College House 254 Albert Street East Melbourne VIC 3002 & phone (03) 9417 1699 Ê fax (03) 9419 0672 @ email racog@racog.edu.au
occupational medicine australasian faculty of occupational medicine ) post c/o- Royal Australasian College of Physicians 145 Macquarie Street Sydney NSW 2000 & phone (02) 9256 5444 Ê fax (02) 9252 3310 ophthalmology royal australian college of ophthalmologists ) post 27 Commonwealth Street Sydney NSW 2000 & phone (02) 9267 7006 Ê fax (02) 9267 6534 paediatrics royal australasian college of physicians division of paediatrics ) post c/o Royal Australasian College of Physicians 145 Macquarie Street Sydney NSW 2000 & phone (02) 9256 5444 Ê fax (02) 9252 3310 pathology royal college of pathologists of australia ) post 207 Albion Street Surry Hills NSW 2010 & phone (02) 9332 4266 Ê fax (02) 9331 1431 @ email secretariat@rcpa.edu.au
O
Perspectives on Careers in Medicine psychiatry royal australian and new zealand college of psychiatrists ) post 309 La Trobe Street Melbourne VIC 3000 & phone (03) 9640 0646 Ê fax (03) 9642 5652 @ email training@ranzcp.edu.au public health australasian faculty of public health medicine ) post c/o Royal Australian College of Physicians 145 Macquarie Street Sydney NSW 2000 & phone (02) 9256 5444 Ê fax (02) 9252 3310 radiology (diagnostic) royal australian and new zealand college of radiologists ) post Level 9, 51 Druitt Street Sydney NSW 2000 & phone (02) 9267 3676 Ê fax (02) 9264 7799 @ email racr@racr.edu.au www web site racr.edu.au sexual health australasian college of sexual health physicians ) post Sydney Sexual Health Centre Sydney Hospital GPO Box 1614 & phone (02) 9382 7457 Ê fax (02) 9382 7475 sports medicine australian college of sports physicians ) post PO Box 644 Crows Nest NSW 1585 & phone (02) 9410 1061 Ê fax (02) 9410 1061 @ email info@acsp.com.au www web site www.acsp.com.au surgery (subspecialties: cardiothoracic surgery, neurosurgery, orthopaedic surgery, otolaryngology/head and neck surgery, paediatric surgery, plastic surgery, urology, vascular surgery) royal australasian college of surgeons ) post Spring Street Melbourne VIC 3000 & phone (03) 9249 1200 Ê fax (02) 9249 1219
for information about other specialist medical areas referred to in this publication, contact the associated college, or enquire at your medical school
TheOther Other Side The Side
Page 44