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The Complete Guide To Becoming A Stroke Medicine Doctor

Published on: 5 Oct 2021

Stroke Medicine Doctor

 

A stroke is a clinical syndrome with developing signs of cerebral dysfunction, lasting more than 24 hours or leading to death. With pathology of vascular origin, strokes can be divided into ‘ischaemic’ or ‘haemorrhagic’ with both causing blood supply to the brain tissue to be interrupted. Ischaemic stroke accounts for 87% of all stroke cases, often caused by blood clots in the arteries that supply blood to the brain1. 

In the UK, strokes are responsible for 38,000 deaths each year making it one of the leading causes of death and disability, and thus a top priority for the NHS(2).

 

The Role Of A Stroke Medicine Consultant:

Stroke as a clinical syndrome encompasses many different aspects of medicine. When approaching a patient acutely suffering a stroke, the clinician must consider underlying causes, investigations, treatment and long-term management.

At this point, a picture builds that includes cardiovascular disease, geriatric medicine, neurology, interventional therapeutics and rehabilitation - the disciplines involved in patient care are numerous. 

The primary purpose of a stroke physician’s job is to contribute to the provision of skilled acute and rehabilitation care to patients. Consultants are required to lead and contribute to providing specialist stroke services throughout the UK. 

A stroke specialist will be responsible for very medically unwell patients and must be competent in emergency situations. Time is of the essence in stroke management, with door-to-needle time being 4.5 hours when it comes to life saving thrombolysis(3). 

With the increasing age of population and the subsequent incidence of stroke predicted to follow, there is lots more research and growth to be had for the specialty. There are many innovations and improvements already in the pipeline with programmes aimed to enhance patient care by increasing access to life saving thrombolysis and thrombectomy and well as improving rehabilitation services.

Following these changes, the British Association of Stroke Physicians (BASP) foresee the number of full-time stroke consultants in the NHS needing to increase by a third to meet UK patients’ current needs(4). In short, a good time to enter a career in stroke medicine.

 

A Typical Week:

Stroke medicine is itself a subspecialty that can be accessed via training in the different medical specialties listed below: 

  • Geriatric medicine

  • Neurology

  • Rehabilitation medicine

  • Clinical pharmacology and therapeutics

  • Cardiology

  • General internal medicine

  • Acute internal medicine

The detailed role of a stroke physician will vary depending on the type of service within which they are practising. It is therefore understandable that stroke consultants have input at different points over the course of disease depending on their underlying knowledge base.

The neurologist with interest in stroke may focus on the acute stroke service and outpatient clinics, whereas a geriatrician’s role in stroke medicine may have more emphasis on rehabilitation, although involvement with different aspects of care is flexible.

These are examples of doctors working in stroke medicine alongside their parent specialty. However, some consultants choose to work in stroke medicine full-time.

Stroke physicians are subject to varied work, though with a large proportion of it taking place in an acute setting. Doctors can be called to emergency departments, based in hyperacute stroke units, and emergency TIA clinics; each with the underlying goal to determine the most appropriate pathway of patient care.

 

The Route To Becoming A Stroke Medicine Consultant:

5 steps towards becoming a stroke medicine consultant 

  1. If interested in pursuing stroke medicine as a career path, try to obtain one of the listed specialties in your foundation rotations to further develop experience in the field and increase opportunities to get involved with relevant audits or research. 

  2. After completion of foundation years, there are two possible pathways to complete core training - Internal Medical Training (IMT) or Acute Care Common Stem- Acute Medicine (ACCS-AM), both of which are 3 years in duration. (In 2019 IMT replaced core medical training (CMT)). Competition to enter core training remains reasonable with the ACCS places tougher to obtain. In 2019, there were 2,229 applications for 1,563 places across the UK5. The completion of either pathway, as well as passing the MRCP (UK) along the way, renders you eligible for further specialty training.

IMT Vs ACCS

IMT: The newly revised IMT curriculum aims to produce doctors with the generic professional and specialty specific capabilities needed to manage patients presenting with a wide range of general medical symptoms and conditions. It will include mandatory training in geriatric medicine, critical care and outpatients.

ACCS in acute medicine:  If you have a strong interest in the ‘acute’ end of the general medicine spectrum and management of the sick patient then this option might be for you, especially if considering a career in acute internal medicine.

The first two years of ACCS are spent rotating through Emergency Medicine (EM), Acute Internal Medicine, Anaesthetics and Intensive Care Medicine (ICM), followed by a third year spent in general medical specialities6.

The next step is to apply for specialty training. Though the stroke medicine subspecialty curriculum is aimed at those in geriatric and neurology specialty training, it is accessible via any of the following specialties(7):

  • Geriatric medicine

  • Neurology

  • Rehabilitation medicine

  • Clinical pharmacology and therapeutics

  • Cardiology

  • General internal medicine

  • Acute internal medicine

It is important to consider in what respect you want to be a stroke specialist as the specialty training programme chosen will mould the angle from which you approach a stroke.

Having said this, the stroke medicine training programme strives to produce stroke specialists with core knowledge and skills in all areas of diagnosis, investigation and treatment relevant to the care of stroke patients. 

Specialty Training Programmes

Competition Ratios 2019

 

Geriatric medicine

1.18

Neurology

2.65

Rehabilitation medicine 

0.88

Clinical pharmacology and therapeutics 

1.17

Cardiology

3.35

Acute internal medicine 

2.93

Competition ratios for Specialty Training (ST3) 20195. Number of applicants per post.

The programme for stroke medicine subspecialty training itself is 2 years long. If already in a specialty training programme with a substantial component relevant to stroke medicine already, such as neurology and geriatric medicine, the first year of stroke medicine training can be integrated into your specialty training. The second year however focuses on advanced stroke training and is best done in the penultimate year of specialty training and adds an additional year to the length of the specialty programme of choice. The training will include an attachment to a comprehensive stroke service that includes:

  • A hyper-acute stroke unit

  • Acute and longer-term rehabilitation units

  • TIA and outpatient clinics

Specifically, for the stroke medicine training there are no written assessments, rather competencies are assessed through workplace-based assessments (WPBA).

Once sub-specialty training in stroke medicine has been completed, trainees will have the sub-specialty of stroke medicine included in their entry in the GMC’s specialist register alongside their certificate of completion of training (CCT) in their main specialty(8).

 

Earnings:

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.  Salaries can be further enhanced with NHS excellence awards. Private practice opportunities are limited as a stroke specialist.

For more information on salaries within the NHS, please feel free to review The Complete Guide to NHS Pay.

 

Further Information:

 

Related Job Sources With BMJ Careers

 

Other Complete Guides By BMJ Careers

 

References:

  1. Overview of stroke - Summary of relevant conditions | BMJ Best Practice [Internet]. Bestpractice.bmj.com. 2018 [cited 19 October 2020]. Available from: https://bestpractice.bmj.com/topics/en-gb/1080?q=Stroke%20(overview)&c=suggested

  2. NICE: impact stroke [Internet]. London: NICE; 2019 [cited 19 October 2020]. Available from: https://www.nice.org.uk/Media/Default/About/what-we-do/Into-practice/measuring-uptake/NICE-Impact-stroke.pdf

  3. Bell S, Cooper J, Doubal F, Hart S, Harkness K. A career in stroke medicine. BMJ. 2017;:i6372.

  4. Iacobucci G. NHS is urged to increase number of stroke specialists by a third to tackle “serious shortfall”. BMJ. 2019;:l4740.

  5. Specialty training competition ratios 2019 - https://specialtytraining.hee.nhs.uk/Competition-Ratios

  6. About ACCS [Internet]. Imtrecruitment.org.uk. 2020 [cited 19 October 2020]. Available from: https://www.imtrecruitment.org.uk/about-imt/about-accs

  7. Stroke medicine [Internet]. Health Careers. 2020 [cited 19 October 2020]. Available from: https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/medicine/stroke-medicine

  8. Stroke Medicine (sub-specialty) [Internet]. JRCPTB. 2020 [cited 19 October 2020]. Available from: https://www.jrcptb.org.uk/specialties/stroke-medicine-sub-specialty