Consultant gastroenterologist Dr Richard Shenderay shares his advice on choosing the right specialty and why he settled on gastroenterology.
I’m often asked by foundation doctors and final year medical students about career choice. Usually they know what they don’t want to do, but struggle in choosing exactly what they do want.
Remember, you don’t have to decide on an exact choice very early in your career so don’t worry, and once you have made a decision you can always change your mind if it turns out not to be what you expected.
Sources of help
I would certainly recommend making use of “Taster days” available to foundation doctors and these are usually easy to set up. I’ve helped arrange days in ICU, Genitourinary medicine and GP in the last two years, which have helped foundation doctors find out what they do – and don’t – want to do.
Registrars, consultants and other senior doctors in the areas you’re interested in can be a tremendous source of information. They can tell you about the job, their day-to-day life and why they chose that area to work in.
Most people could end up spending more than 30 years in their career, so make sure it’s something you enjoy, that stimulates your mind and enables you to get your desired work/life balance.
Making the right choice
An important issue to consider is how competitive a career is and how hard you will have to work to get into that field. But, if it’s what you really want to do, you should go for it no matter the competition. If you end up in the wrong career because it was the “easy” option you may well regret it. I have friends who chose the “easy” road only to find either they haven’t enjoyed it, or it wasn’t as easy as they thought it was going to be.
As to my own career choice - why gastroenterology? I knew I wanted to work in a hospital from an early stage and not general practice. I knew it was medicine, as I didn’t enjoy surgery, wasn’t tolerant or patient enough for paediatrics or psychiatry, struggled too much with headaches in dark rooms for radiology, never understood the pink blobs of pathology and really wanted to work in an acute field with direct patient contact.
I spent time in lots of medical specialties as a junior, but then went into emergency medicine thinking that’s what I wanted. However, after just a couple of months as an emergency junior I knew it wasn’t for me and an acute medical specialty would be better. I liked the mix of acute and chronic patient management too much.
Work in emergency medicine
Still, I tell everyone that no matter what area you end up in, that you simply must spend time working in emergency medicine. For one, you will learn a huge amount in a short time. More importantly you will realise exactly what the emergency departments does, how hard they work and be far more forgiving when a patient who really shouldn’t have been admitted slips through the net!
After passing my exams I decided I wanted to work in gastroenterology or cardiology, and in my case a gastroenterology job came up which included basic endoscopy training and I jumped at it. However, with more structured training now, if you want to know if you like endoscopy, go and watch some.
Gastroenterology gives me the best bits of different worlds. I love the acute side of things – managing GI bleeds and acute liver failure can be incredibly rewarding. It also allows me to work within medicine seeing a huge variety of medical presentations and patients. However the medium to long-term management of so many different diseases is also fascinating.
In the six years since I got my consultant post, the world of Hepatitis C looks curable, new drugs have been launched in inflammatory bowel disease and so many new ways to manage things have been invented. Seeing a frail, severely malnourished Crohns patient have his or her world turned around is really satisfying.
Gastroenterology is also incredibly hands on with all gastroenterologists trained in endoscopy allowing diagnostics and therapeutic management of multiple conditions traditionally in the reserve of surgeons. The opportunity to sub-specialise in liver, nutrition, luminal disease, advanced endoscopy, EUS, ERCP is also there at any level, allowing further training and skills to be developed.
We work with patients from teenagers to those over one hundred years old, deal with so many different parts of the body, use hands on skills as well as work through diagnostic conundrums, and get to work closely with dietetics, surgery, radiology, endoscopy and pathology. There are downsides and frustrations but there is in any choice.
Looking back, if I could start over, I’d do the same again. I’d recommend my job to anyone. I hope the steps I described earlier help you do the same.
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