The Role Of A Respiratory Medicine Doctor:
A respiratory medicine doctors job is to diagnose and treat respiratory conditions. Examples of pathologies managed by respiratory medicine doctors comprise chronic obstructive pulmonary disease, cystic fibrosis, pneumonia, pulmonary embolism and lung cancer.
Circa 30% of the acute medical caseload present with primary respiratory disorder and, accordingly, many doctors of this specialty contribute to the acute medical take.
Respiratory medicine doctors guide the management of acute respiratory failure and acute respiratory distress syndrome in intensive care and high dependency settings. They also work in outpatient clinics.
General respiratory clinics are attended by patients with diseases such as asthma and COPD and those that have been referred for further investigation of cardiopulmonary symptoms of unknown aetiologies, for example, haemoptysis, breathlessness and abnormal chest x-rays. These patients can have pulmonary or non-pulmonary conditions, as effects of systemic illnesses often manifest in the lungs.
Consequently, respiratory medicine doctors are adept at diagnosing a range of conditions and are often consulted by doctors of other specialties for challenging diagnoses.(1) Specialist clinics run by respiratory medicine doctors include cancer, cystic fibrosis and sleep-related breathing disorders. Respiratory medicine doctors also have expertise in early discharge, hospital at home and pulmonary rehabilitation services for COPD patients, palliative care and lung transplantation.
Respiratory medicine doctors utilise an array of diagnostic modalities, for example, bronchoscopy, thoracoscopy, ultrasound and lung function testing.1 They perform interventional procedures, for example, bronchial thermoplasty and insertion of stents and chest drains.
In 2017, 44% of respiratory medicine doctors were female.2 A strong medical knowledge base, skills such as dexterity and multidisciplinary teamwork – alongside, for example, histopathologists, physiotherapists and radiologists – are key for doctors of this specialty.
A Typical Week:
For respiratory medicine doctors, a standard week features two ward rounds in which between 20 and 25 patients are reviewed.3 Ward rounds are conducted by foundation and core trainees, nurses and physiotherapists and are led by consultants.
When contributing to the acute medical take, frequency of ward rounds may be increased to two per day. There may also be two or three outpatient clinics – each attended by between 15 and 20 patients – and one practical procedure session, for example, bronchoscopy per week.2
Additionally, there are regular multidisciplinary meetings with, for example, radiologists and pathologists. Other activities in a week may include special interest clinics, administration, teaching or research. Most respiratory medicine doctors work routine daytime shifts, for example, 0830 to 1700.
The frequency of on-call work is variable. 70% consultants report routine on-call work at weekends.2 There may be between 0.5 and 1 nights on-call. On average, respiratory medicine doctors work no more than 48 hours per week, according to ‘Working Time Regulations 1998’.
The Route To Respiratory Medicine:
The route to respiratory medicine commences with successful completion of a medical degree and two years of foundation training. The subsequent three years comprise core medical training.
This can be Internal Medicine Training (IMT) stage 1 or Acute Care Common Stem (ACCS) Acute Medicine. IMT features rotations across a selection of medical specialties and is concluded by the Membership of the Royal College of Physicians of the United Kingdom (MRCP (UK)) examination.
ACCS is a similar programme but, in the initial two years, there is greater emphasis on acute medicine, emergency medicine, anaesthetics and critical care medicine.
ACCS trainees must also pass the MRCP (UK) examination. In 2019, the competition ratio for IMT/ACCS Acute Medicine was 1.43.4 Higher specialty training in respiratory medicine has a minimum duration of four years.1 In 2019, the competition ratio for Respiratory Medicine ST3 was 2.64.4 The programme comprises a minimum of twelve months each in a district general hospital and tertiary centre and a minimum of sixty days in an intensive care unit.1
Trainees acquire competencies in respiratory anatomy, physiology, pathology, microbiology and pharmacology and experience of working in multidisciplinary teams in inpatient and outpatient settings.
Additionally, there is dedicated time for training in lung function testing and radiological and imaging techniques. Trainees also acquire experience in palliative care medicine and pulmonary rehabilitation. Most trainees take some time Out of Programme (OOP) for research, teaching qualifications and leadership fellowships. It is advised that trainees attempt the Specialty Certificate Examination (SCE) in Respiratory Medicine in the penultimate year of higher specialty training.1
Finally, trainees are awarded a Certificate of Completion of Training (CCT) by the General Medical Council. Consultant posts can be applied for six months prior to attainment of a CCT.
Most trainees complete dual training in respiratory medicine and general internal medicine (GIM). This extends the minimum duration of higher specialty training by a year.1 Some trainees choose to specialise in respiratory medicine and intensive care medicine, for which the higher specialty training is 5.5 years. Additionally, some trainees attain a dual CCT in respiratory medicine and allergy.
Medical students interested to pursue a career in respiratory medicine should attend conferences, join the university student society and choose relevant topics for student selected components. It is possible to join the British Thoracic Society as a student.
An early specialty decision may be of use and can be aided by careful observations on clinical placements. Foundation trainees should aim to complete a rotation in respiratory medicine or, if unfeasible, in a related specialty. Management, teaching and research experiences, including publications and poster presentations at conferences, are beneficial for foundation and core trainees.
No subspecialties of respiratory medicine are recognised. However, the Respiratory Medicine Special Advisory Committee lists areas of special interest: pulmonary hypertension, adult cystic fibrosis, domiciliary non-invasive ventilation services, occupational and environmental lung disease and lung transplantation.1
All trainees should have knowledge of these disciplines, but some may undertake additional training in one area to acquire a level of competency suitable to organise, regionally, care for patients requiring these services. Training in an area of special interest can be attained via OOP experience, research or post-CCT training.
Most respiratory medicine doctors have an interest in research. Research is a core component of training in respiratory medicine and all trainees must acquire research competencies by completing a higher research degree, presenting nationally or internationally and completing an assessed research course, applying for appropriate ethical research approval and writing a scientific paper, or completing a research degree in medical education.1
NHS consultant salaries are the same for all specialties but vary between Scotland (highest), England, Northern Ireland, and Wales (lowest) and increase with service (up to 19 years). In 2020, the salary bands range from £77,779 to £109,849.5 Salaries can be further enhanced with NHS excellence awards.
There is some private practice earnings potential in respiratory medicine, but this equates to a small fraction of the NHS salary and is significantly less than in some other medical specialties.6
The recommended starting salary of accredited consultants in the British Army is similar to that in the NHS. In 2017, this was £80,527.5
For more information on salaries within the NHS, please feel free to review The Complete Guide to NHS Pay.
The primary society for respiratory medicine professionals in the UK is the British Thoracic Society, which hosts biannual meetings and publishes the journal Thorax and its open access companion BMJ Open Respiratory Research.
Additionally, there are the Primary Care Respiratory Society and the British Association for Lung Research. Internationally, the European Respiratory Society hosts an annual congress and multiple conferences, for example, the lung science conference and sleep and breathing conference. It also publishes the European Respiratory Journal and European Respiratory Review. Other key journals in the field are Lancet Respiratory Medicine, American Journal of Respiratory and Critical Care Medicine and Journal of Thoracic Oncology.
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Other Complete Guides By BMJ Careers
Specialty Training Curriculum for Respiratory Medicine [Internet]. Joint Royal Colleges of Physicians Training Board; 2015 [cited 16 September 2020]. Available from: https://www.jrcptb.org.uk/sites/default/files/2010%20Respiratory%20%28amendments%202014%29.pdf
NHS Digital. Analysis of the representation of women across the hospital and community health services workforce [Internet]. NHS Digital; 2018 [cited 16 September 2020]. Available from: https://digital.nhs.uk/data-and-information/find-dataand-publications/supplementary-information/2018-supplementaryinformation-files/analysis-of-the-representation-of-women-across-the-hospitaland-community-health-services-workforce
Working life (respiratory medicine) [Internet]. Health Careers. [cited 16 September 2020]. Available from: https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/medicine/respiratory-medicine/working-life
Specialty Recruitment Competition Ratios 2019 [Internet]. Health Education England; 2020 [cited 16 September 2020]. Available from: https://specialtytraining.hee.nhs.uk/Portals/1/Competition%20Ratios%202019_1.pdf
Pay [Internet]. British Medical Association. [cited 16 September 2020]. Available from: https://www.bma.org.uk/advice/employment/pay
Morris S, Elliott B, Ma A, McConnachie A, Rice N, Skåtun D et al. Analysis of consultants' NHS and private incomes in England in 2003/4. Journal of the Royal Society of Medicine. 2008;101(7):372-380