TMC Podcast: Interviews with Medical Specialists

Prof Michelle Leech is a rheumatology consultant and deputy dean at Monash University's Faculty of Medicine. It is hard to believe that she was once a self-described "shy" medical student that dreaded answering questions given her success as a doctor! Today, we walk to Prof Leech about how she evolved from timid medical student to academic pioneer and respected clinician.

Michelle thoroughly enjoys the clinical side of her specialty. For her, it comes down to taing a "good history" in order to tackle the "diagnostic dilemmas" she faces on a daily basis. Her description of a typical day is truly reflective of her university's motto, "ancora imparo" (I am always learning). We learn lots about the perks of rheumatology, including the teams they interact with, and the cases encountered on the wards, which sound fascinating. Moreover, Michelle is able to delve into each in great detail with both the patient and their families. The constant opportunity to teach students and delve into research limits Prof Leech from getting "stuck in a rut". Yet as with any specialty, dealing with patients can bring an emotional toll, especially in rheumatology where it can seem a "world of pain".

We talk at length about the "training bottleneck" troubling many specialties, its impact on rheumatology, and where the future of specialty training may lie (literally - and it's not in hospitals!). Other ideas, such as dual training and flexible working hours, are explained to us by our wonderful mentor. Michelle also gives us fantastic insight into her pathway to being an academic professor and researcher, and how this has helped her clinical work.

Michelle's advice to use students is to simply "have a rest!". We debate the origin and future of the hypercompetitive state of medical school which she believes is up to us as a group to "dial up and down". Her opinion is that work and life exist on a "continuum", not as separate entities, and that we should pursue that which keeps us "energises, and causes [us] to energise others" rather than to fill out our CVs. Wise words! Work and life is a "continuum". She also implored young doctors to admit their vulnerability and ignorance, to lean on those around them for support, and share our stories with colleagues, to foster a supportive community that will stay with us through our junior years (and beyond).

Lots of interaction with ortho, ID, haem, resp.

If you have any other questions you'd like us to ask Dr Michelle Leech, fill out the form below or shoot us a message!

Pathways into Rheumatology

Medical School → Internship → Basic Physician’s Training (3 years full time equivalent) → Advanced Training in Rheumatology (3 years) → Consultant

Source: Royal Australian College of Physicians

Salary

According to the Australian Government Taxation Data, in the 2013-14 income year we had:

50 female general medicine specialists earning an average of $169,409

85 male general medicine specialists earning an average of $256,933

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Dr Alan Briedahl is a plastic surgery consultant working at the Royal Melbourne Hospital. Today, we chat to him about his journey from GP-loving medical student to his lofty positions today! As an intern, Alan decided to specialise due to the vast breadth of knowledge required to stay up-to-date as a GP. He found his way into plastics, which suited his self-described "obsessiveness" and desire to use his hands. Listen in to find out why plastic surgeons are the only ones not "pressed for time" and the "creative" ways solutions they find to complex problems.

Dr Briedahl splits his time between public and private work in his theatres and clinic. Both of these involve waking up fairly early and working long hours, with additional on-call work in the public system. This aspect grants him access to some of the more exciting presentations - involving hand, craniofacial and skin trauma - albeit in the middle of the night. For the most part, plastic surgeons deal with skin lesion excisions and cosmetic surgery, and we were surprised to learn which of the two are more grateful for the work done on them!

His work has taken him overseas, where he has honed his skills with basic equipment and helped improve the lives of countless patients. This involves his work as a missionary and board member of Operation Smile. Alan is excited about the future of plastics, especially with the prospect of facial transplants on the horizon. He sees the workload increasing, due to the increase in trauma and skin cancer. Most surgeons tend to subspecialise, but Alan enjoys the variety that general plastics offers. He mixes things up by teaching and making time for his hobbies of sailing and golf - we were amazed how he does it!

 

As always, we finish with some insider tips as to how to make your resume glean and how to make the most of our intern year. Alan's key message to everyone, regardless of their predisposition, is to "enjoy the journey".

We hope you guys enjoy this podcast! Feel free to send through any questions you may have for Dr Alan Briedahl, and give us feedback on this week's episode by filling out the survey.

Pathway into Plastic sugery

Medical School →  Internship → Surgical Education and Training program (3 years) → Advanced Surgical Training in Plastic surgery (4 years) → Consultant

Source: FRACS

Salary

According to the Australian Government Taxation Data, in the 2013-14 income year we had approximately:

56 female plastic surgeons earning an average of $281,608

237 male plastic surgeons earning an average of $448,530

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Dr Heidi McAlpine is a neurosurgery registrar at the Alfred Hospital in Melbourne. Today, she gives us fantastic insight into what it's like being the only female registrar currently on the program! While occasionally being mistaken for another, more junior member of the team on ward rounds, Heidi thoroughly enjoys her work. She initially wanted to be a neurologist but loved surgery, eventually finding a field that combined her two passions.

Nowadays, her typical day lasts from 7-5 (eek), and involves a mix between clinic and theatre. Listen in to hear some of the awe-inspiring cases she has led or been part of. This high-risk, high-reward specialty lends itself to immense reward from managing the "unexpected" and the adrenaline rush it provides. It provides fantastic vaiety. Nevertheles, she has had to address many uncomfortable and heartbreaking situations, such as breaking the news to family that the team cann't resuscitate their loved one. It is also difficult "when things don't go to plan", as the slightest deviation can have devestating consequences,  making it a "considered" decision to undergo surgery.

From Dr McAlpine's perspective, neurosurgery constitutes a significant time commitment, but not one that should get in the way of pursuing one's own life outside of medicine, including starting a family. She encourages all female medical students (including you guys!) to enter the program to show that it's doable, as doctors will change the system by "pushing those boundaries" and "highlighting and addressing" issues within the program. To everyone else, she urges us to "experience everything that we can", especially "hands on" activities, "look after each other", and do what we enjoy.

We hope you guys enjoy this podcast! Feel free to send through any questions you may have for Dr Heidi McAlpine, and give us feedback on this week's episode by filling out the survey.

Pathway into Neurosurgery

Medical School →  Internship → Surgical Education and Training program (3 years) → Advanced Surgical Training in Neurosurgery (4 years) → Consultant

Source: FRACS

Salary

According to the Australian Government Taxation Data, in the 2013-14 income year we had approximately:

26 female neurosurgeons earning an average of $323,682

142 male neurosurgeons earning an average of $577,674

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Dr Ranjana Srivastava is a well-decorated oncologist that also holds numerous accolades, including the Westpac Women of Influence Award, recipient of the Medal of the Order of Australia for her service to medicine in the field of doctor-patient communication, and award-winning author for The Guardian. As a medical student, she enjoyed most fields, but ruled out obstetrics when she "almost dropped a baby", and surgery when she fainted in theatre! It was a rural rotation in oncology where she saw the calming influence her consultants had on patients that she decided to pursue this field.

She has also kept up her writing and journaling which she began at age 5, which has led to her writing for the Lancet (as a medical student no less!), Penguin, The Age and now The Guardian. Her focuses include society and ethics, especially on issues she thinks it is "important for the public to know" about. Dr Srivastava encourages students and doctors alike to read medical journalism exposes. These include JAMA's "A Piece of my mind", NEJM's "Perspective", and the Annals of Internal Medicine's "On Being A Doctor", writing to inform patients and/or doctors.

Her typical week involves a mixture between clinical work and authoring. Listen in to discover how she deals with the emotional burden of discussing prognoses, terminal illnesses and chemotherapy on a daily basis to patients and families. While she finds it incredibly rewarding to help patients, managing their expectations and breaking harsh truths to them can be tough. Moreover, the specialty is "bounding along at an unprecendented pace". This makes keeping up to date inrcredibly difficult, especially with patients consulting the internet for novel regiment. In future, she sees treatments being targeted to patients.

There is no "magic solution" to maintaining a work-life balance, but Ranjana gives us some aspects we should prioritise. Increasingly, clinicians can choose their own hours and draw boundaries from an early age. She encourages students to spend extended periods of time following consultants to learn what each specialty is like. The initial "glitter and glamour" can fade away unless one truly enjoys what they are doing. At the end of the day, Ranjana stresses the importance of being "present" in each consultation, since we "may never see that patient again".

If you have any other questions you'd like us to ask Dr Ranjana Srivastava, fill out the form below or shoot us a message!

Pathways into Oncology

Medical School → Internship → HMO → Basic Physicians Training (3 years full-time equivalent) → Advance Physicians Training in Oncology (3 years full-time equivalent)

Source: Royal Australian College of Physicians

Salary

According to the Australian Government Taxation Data, in the 2013-14 income year we had approximately:

145 female oncologists earning an average of $208,612

200 male oncologists earning an average of $322,178

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Dr Belinda Hibble is an emergency medicine physician currently working in Geelong. Her self-admitted short attention span and desire to experience a variety of encounters in a single day makes her perfectly suitable for her position. Based in a rural setting, one simply "makes it work" in an emergency department. We debate the advantages and disadvantages of not having subspecialties at hand to "siphon off" broad or complex patients, and how this has helped her learn to manage patients in a more pragmatic manner.

Dr Hibble describes high burnout rates amongst ED physicians. To combat this, she suggests doctors involve themselves in other aspects of medicine, including administration, research and teaching, while working in multiple public and private hospitals and considering subspecialising. Work-life balance seems to be an aspect ED physicians struggle with. We discuss the importance of "learning how to say no", and the seemingly impossible task of truly "switching off" with smartphones at hand 24/7.

Belinda emphasises the need to remain "well-rounded", no matter how far along our training we find ourselves. She explains why the Colleges hold extra-curricular activities in "good stead", even for things as seemingly unrelated as sports coaching. She has been able to do this through remaining involved with her Geelong-based Deakin University and spearheading critical care projects. We learn how we can become involved in effecting change from any (sub)committee and any position we hold within one.

Belinda's time with MUMUS has served her well not only in her career but in other aspects of her life. She has used her experience with policy to work with the ED college in changing their curriculum. This leadership has also translated over into her clinical work, as well as looking impressive on her CV. At the end of the day, Belinda encourages us to get out there, experience as much as we can and make an educated decision about a path we want to pursue.

We hope you guys enjoy this podcast! Feel free to send through any questions you may have for Dr Belinda Hibble, and give us feedback on this week's episode by filling out the survey.

Pathways into Emergency Medicine:

Medical School → Internship → Provisional ED Training (1yr) → Advanced ED Training (4yrs) → Consultant

Source: Australian College of Emergency Medicine

Salary

According to the Australian Government Taxation Data, in the 2013-14 income year we had:

474 female emergency medicine specialists earning an average of $165,786

829 male emergency medicine specialists earning an average of $232,595

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Dr Shavi Fernando is an obstetrics and gynaecology consultant working in metropolitan Melbourne. As a medical student, he gravitated towards O&G and paediatrics, deciding on the former after a BMedSci, an initiative he encourages us all to take. He is currently completing his PhD, moreso out of interest than requirement, although we do discuss the growing competition within the field.

Dr Fernando was drawn to O&G because of the "high acuity" of problems facing young, mostly healthy patients. In this way, he sees his work as adding great benefit, and always appreciates the thanks he receives from patients. While he found some barriers as a male medical student, his success demonstrates the (mostly) level playing field O&G offers to both genders, aside from a few hiccups.

Shavi's current practice involves a mix between obstetrics and gynaecology, in both public and private settings. He offers insight into why some doctors choose one over the other, as well as why O&Gs get sued so much and what prospective ones can do to protect themselves (hint: honesty is key)!. In future, he sees a further split between the field's two branches, as well as a greater focus on the growing obesity rate and its complications on pregnancy and delivery. We also discuss the training program's requirements, including the emphasis on research, rural work and clinical time.

One of the main drawbacks of O&G seems to be the "unpredictable" working hours (even more so than Dr Fernando had expected!). Shavi described a typical week and how he functions being on call practically 24/7 at each of the 3 hospitals he works at! He also walks us through the minefield that is taking time off, and tells all our interns to "buy a house early" and follow their passion, both of which seem to be a major focus in the 21st century.

If you have any other questions you'd like us to ask Dr Shavi Fernando, fill out the form below or shoot us a message!

Pathways into Obstetrics and Gynaecology:

Medical School → Internship → HMO (1 year minimum) → Core Training Program (4 years) → Advanced Training Program (2 years)→ Consultant

Source: RANZCOG

Salary

According to the Australian Government Taxation Data, in the 2013-14 income year we had:

570 female obstetricians and gynaecologists earning an average of $264,628

641 male obstetricians and gynaecologists earning an average of $446,507

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Dr Alessandro Demaio is a doctor in the field of public health that works for the World Health Organisation. He has pioneered several global public health movements, including NCD free, the UN decade of action on nutrition, and Festival 21. Alessandro's work has taken him all around the world, from assisting aid workers in Sri Lanka after the tsunami, Copenhagen - where he completed his PhD in public health - Harvard University, where he pursued a post doctorate fellowship, Geneva, for his work with the WHO, and even Mongolia!

Listen in to hear what it was exactly that swayed Alessandro from aiming towards life as a rural GP to applying for and being accepted as an intern at the WHO. It was in this role that he realised that preventable diseases were found "everywhere", not just in developed nations. Controlling preventable diseases has become the force that drives him to achieve his lofty goals.

The biggest struggles Alessandro faces are the requirement to be "cautious" with what he says when representing the WHO, and the slow pace at which it effects change. He sometimes missed the "immediacy" of the impact one can make as a clinician. Nevertheless, he humbly counts himself "lucky" to work on projects that can effect change globally. His particular interests involve nutrition, food waste and obesity.

A typical day lasts 11 hours and involves practically nothing of what we expect of your average doctor! Alessandro spends his time liaising with experts from around the world and working on large-scale projects. For those of us wanting to do our part, Alessandro encourages us to become involved in the WHO, medical school organisations, or other non-medical organisations. Indeed, he sees his best investment as the "time and risk" he put in to leaving the "safe" path of medicine, with a clear goal and the comfort of equifinality in mind (yep, we had to google that one too). He believes life "comes in stages", and he is happy to sacrifice his work-life balance for the moment to make an impact on the world.

We hope you guys enjoy this podcast! Feel free to send through any questions you may have for Dr Alessandro Demaio, and give us feedback on this week's episode by filling out the survey.

Also, Happy Fathers' Day to all the dads out there!

http://ncdfree.org

http://www.who.int/nutrition/decade-of-action/en/

Pathways into Public Health:

Medical School → Internship → Masters of Public Health (recommended; 1-2 years)

Source: Monash University (degree available at other universities around Australia as well)

Salary

According to the Australian Government Taxation Data, in the 2013-14 income year we had approximately:

3,252 female public health specialists earning an average of $118,310

3,551 male public health specialists earning an average of $187,468

Let us know how this has impacted you

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Mr Philip Jumeau is an ENT surgeon working in Melbourne. Philip takes enormous pride in his calling, most of which involves nasal reconstructive work, which he finds challenging but rewarding. The "growth and change" he sees in his patients after operations makes it feel like he's contributing to their lives. Such satisfaction more than makes up for the competitive nature of the field's training and practice. While ENT is growing in popularity, there is little overlap with other fields, resulting in fantastic "diversity" with regards to cases. He deals with people from all walks of life with myriad medical ailments, as well we being able to work with implantable technology.

Philip also spends 1 in every 8 weeks in Cairns, where he has established his own business. This aspect of his work involves a higher case load and can be difficult due to the lack of support and tropical climate. However, he sees many weird and wonderful ENT conditions and emergencies (no spoilers here!). At the same time, dealing with hospital administration and budgets can make one "disillusioned" with the healthcare system.

ENT surgeons are beginning to pursue fellowships overseas, taking longer to establish themselves due to the growing subspecialisation of the field. Philip gives us his take on what this means for future applicants. Outside of his field, Philip enjoys mountain bike riding and racing, a passion he has gladly protected by sacrificing some of his work hours. We end with some advice to consider the patients, lifestyle and outcomes we are hoping to deal with instead of the type of work we do when considering a career.

If you have any other questions you'd like us to ask Mr Philip Jumeau, fill out the form below or shoot us a message!

Pathways into ENT

Medical School → Internship → HMO → Surgical Education and Training (SET) Program (3 years) → Advanced Training in Otolaryngology Head and Neck surgery (3 years) → Consultant

Source: Australian Society of Otolaryngology Head and Neck Surgery

Salary

According to the Australian Government Taxation Data, in the 2013-14 income year we had:

17 female ENT surgeons earning an average of $200,136

85 male ENT surgeons earning an average of $445,939

Let us know how this has impacted you

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Dr. Daniel Golshevsky is a paediatrics consultant working in metropolitan Melbourne. As a student and junior doctor, Daniel had the "pleasure and displeasure" of enjoying every rotation, a dilemma to which many of us can relate. But before he committed to a training program, Daniel took extensive time off (2 years!) to travel during his medical studies, and worked part-time for a while during his training. Listen in to hear about what he did and why he thinks this helped him to become a "better person and better doctor".

The 'mantra' he wishes to impart onto listeners is "don't be in a hurry". In particular, he urges us to consider and seek out the different perspectives of specialties from that of a student, junior doctor and consultant, all of whom see the profession differently. This could help us to not make a "premature" decision. When push came to shove, he was faced with the dilemma of choosing between paediatrics and geriatics, between which he saw many similarities (which we thought was counter-intuitive but which he explains perfectly). Yet it only took one day as a paediatrics JMO to cement his decision.

With increasingly fewer full time public metropolitan consultant jobs available, Daniel originally dabbled in private practice and locum work. This helped to grow his patient base and fill the (surely very few) gaps in his knowledge. Currently, he operates on a 50/50 split between private and public work. He has also noticed that fewer people are using a regular GP, instead turning to public EDs and private paediatricians.

Additionally, Daniel stresses the importance of having a life outside of medicine. For him, his passions are keeping fit and pursuing a field he refers to as "infotainment". He loves "demistifying" the concerns of patients that have been consulting Dr Google or present to him with common misconceptions about their childrens' health or illness. Regardless of the patient's outcome, he feels like he has made a difference. Yet paediatrics isn't all fun and games. In particular, caring for the very sick patients, especially when they are separated from their parents, is tough work. However, seeing his own kids grow up has made it "easier to relate" to his patients on a day-to-day basis.

We finish our interview, as usual, with a couple of pearls for students and interns.

We hope you guys like today's show! As usual, we appreciate any feedback you may have for us.

If you have any other questions you'd like us to ask Dr Daniel Golshevsky, fill out the form below or shoot us a message!

Pathways into Paediatrics

Medical School → Internship → Basic Paediatric Training (3 years) → Advanced Training in General Paediatrics (3 years)

Source: Royal Australian Fellowship of Physicians

Salary

According to the Australian Government Taxation Data, in the 2013-14 income year we had:

654 female paediatricians earning an average of $147,347

683 male paediatricians earning an average of $239,405

Let us know how this has impacted you

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Dr Michael Gingold is a rheumatology consultant working in Melbourne. Today, we unpack this oft forgotten specialty, in which Michael has an abundance of experience. His training has taken him all over the world, and he is yet to meet a rheumatology consultant that isn't "happy". He personally puts this down to the enduring relationships he forms with his long-term patients.

The work Michael performs on a daily basis seems intriguing. As with most doctors, he splits his time between public and private practice, with most of this comprising outpatient work, as well as teaching and supervising the trainee program. However, a good chunk of his day is also dedicated towards answering questions from GPs, specialists and patients. Rheumatologists seem to be an accessible, easy-going bunch! He also gives his two cents on why the current "workforce review" might result in a large changeover of staff in the near future, and encourages all of us that are clinically inclined to be a part of this. Many novel and newly-generic medications will continue to change the pharmacological landscape in this time as well.

Michael's advice for students - aside from taking up rheumatology - involves how and when to take time off, as well as finding and prioritising our interests, both within and external to medicine. "Jobs will be waiting" for us when we return, he assures us! Michael creates envy in listeners they listen to the fantastic places his training and work have taken him. Tune in to this one!

If you have any other questions you'd like us to ask Dr Michael Gringold, fill out the form below or shoot us a message!

Pathways into Rheumatology

Medical School → Internship → Basic Physician’s Training (3 years full time equivalent) → Advanced Training in Rheumatology (3 years) → Consultant

Source: Royal Australian College of Physicians

Salary

According to the Australian Government Taxation Data, in the 2013-14 income year we had:

50 female rheumatologists earning an average of $169,409

85 male rheumatologists earning an average of $256,933

Let us know how this has impacted you

Fill out the Google form below to let us know how useful this episode was for you. We really appreciate your feedback, it's very important to us!

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