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Respiratory Career

Respiratory Medicine

Why choose Respiratory Medicine

Respiratory medicine is a hospital-based specialty and together with general internal medicine and cardiology, this is one of the three major medical specialties. The specialty is wide and diverse, and provides excellent opportunities for individualised career development! It entails dealing with over 30 different conditions, some very common and some rare, providing ample opportunity to sub-specialise as well:

  • inherited (eg cystic fibrosis)
  • congenital
  • infective (eg pneumonia, empyema, opportunist infection including transplant and HIV-related disorders, bronchiectasis, TB)
  • inflammatory (eg eosinophilic lung disease, vasculitis, diffuse parenchymal (interstitial) lung disease)
  • vascular (eg pulmonary embolism, primary pulmonary hypertension)
  • malignant (eg lung cancer, mesothelioma, mediastinal tumours)
  • allergic, sleep-related, neuromuscular, and
  • airway (asthma, COPD, obliterative bronchiolitis) Being part of the multi-disciplinary respiratory team involves working with specialist respiratory nurses, community respiratory teams, respiratory physiotherapists and specialist respiratory technicians as well as other medical staff. This provides great opportunities for developing local services and encourages lifelong learning.

Some respiratory units are highly specialised and provide regional services, for example lung transplant, sleep related medical problems and adult Cystic Fibrosis units. In the majority of units, a large proportion of the workload is acute respiratory and general medicine. Lung conditions account for about a third of emergency admissions. All respiratory trainees have to undergo intensive care training and many individuals now look for jobs that involve both critical care and respiratory work. They also run early discharge, hospital at home and pulmonary rehabilitation services for chronic obstructive pulmonary disease (COPD) and have considerable skill in the management of terminally ill patients. There are close links between the specialty and both radiology and thoracic surgery. Opportunities exist for education and training work both locally and regionally while the national specialty body, the British Thoracic Society (BTS), is probably the most active in the country.

Common procedures/interventions

Respiratory medicine produces doctors with a wide range of interests and many different abilities, including research skills, clinical skills and considerable technical skills. They undertake bronchoscopy (both diagnostic and, increasingly, interventional), pleural procedures including pleural biopsy and chest drain insertion, medical thoracoscopy for the more invasive investigation of pleural effusion and non-invasive ventilation. They are also responsible for providing the non-invasive ventilation services as well as the sleep services in most hospitals.

Respiratory specialists have considerable expertise in cardiopulmonary physiology and run lung function laboratories in most hospitals for the interpretation of complex lung function testing, a cornerstone of respiratory diagnosis. In the outpatient setting, respiratory physicians run the services for lung cancer and tuberculosis (TB) in most trusts.  

Associated sub specialties

There are no formally recognised sub specialties, but there are a number of important “special interest” areas: adult cystic fibrosis, pulmonary hypertension, lung transplantation, domiciliary non-invasive ventilation, lung cancer, sleep breathing disorders and TB.  

Future vision

Approximately 30 per cent of all acute admissions are for a primary respiratory problem and respiratory physicians are major contributors to the acute medical take in all acute hospital trusts.  The speciality is growing and expanding.  It is certain that there will be a significant demand for respiratory specialists for the foreseeable future. Technical skills are increasing. Interventional bronchoscopy is expanding and it is likely that medical thoracoscopy will become more widespread.   

Improvements in the management of asthma and COPD are around the corner, and progress is finally being made in the field of lung cancer. Research is also increasing. In the future, it is also possible that some respiratory physicians may become more community based.   

What are the current job prospects?
They are excellent. Lung disease is very common and unlikely to decrease in the future. Lung cancer services have expanded to meet the two-week waiting time while the number of patients with mesothelioma who will need care will continue to rise. There is expansion in sleep services and more respiratory high dependency units are being opened to manage cases of acute respiratory failure and provide non invasive ventilation. The number of adult CF patients requiring specialist care increases year on year and there is growing acceptance that respiratory specialists best manage asthma. There are better treatments for COPD and pulmonary rehabilitation services continue to expand. This all demonstrates a need for continued expansion of the specialty both now and in the future.

The consultant expansion rate has averaged 6 - 7% over the last 8 years. There are currently over 430 respiratory trainees - the largest number in any of the acute medical specialties. There are established models of working part-time as a consultant physician in respiratory medicine, and the British Thoracic Society is committed to developing models of good practice for part-time consultant posts. There are also increasing opportunities for staff grade and associate specialist posts. Overall the prospects look bright.

How do I become a Respiratory Physician?
Initially a broad general medicine training at ST1/2 level is essential and it is advisable to have one period on a unit with a specialist respiratory interest. Ward based practical skills can be developed during this time and there is sometimes an opportunity to begin to learn bronchoscopy. This may help crystallise your decision to pursue a career in the specialty. For anyone wishing to obtain a training place at ST3 level, the MRCP qualification should be regarded as essential, career progression to CCT will not be possible without it.

In recent years out of programme research experience has been difficult to achieve under ‘MMC’ regulations. Since the Tooke report however it is now encouraged. A period of research with the aim of obtaining an MD or PhD is likely to be most commonly pursued after entering specialist training. It could also be undertaken prior to ST3 appointment. Some would see this as a means of demonstrating commitment to the specialty and a way of enhancing prospects of appointment in what is a competitive specialty. It is certainly not the only way to enhance a CV however, and of itself does not guarantee appointment to specialty training in respiratory medicine.

If you are considering a career in respiratory medicine it is always wise to get advice, as early as possible. Speak to the local training director and other consultants. We’re a friendly bunch of people and always happy to speak to young, enthusiastic new recruits.

Most specialist registrar training positions last for five years and give training in general and respiratory medicine. It is also possible to train in respiratory medicine part-time as a flexible trainee. BTS is supportive both of core medical trainees wanting to enter the specialty as flexible training Specialist Registrars and of individuals who want to switch to flexible training during their SpR programme. There will be regular regional teaching in both disciplines and attendance at national meetings will be expected. There may be opportunities for anaesthetics and ITU secondments. Specialist skills, including bronchoscopy, will be developed. The end of specialist training is perhaps where real choice and career development begin.

Desirable qualities for a Respiratory Physician
Several personal qualities are desirable for a career in respiratory medicine:

  • Good general medical knowledge
  • Good communication skills
  • Ability to work with other multidisciplinary team members
  • A cool head and an ability to troubleshoot in an emergency situation
  • Aptitude for practical procedures
  • Ability to recognise multisystem diseases
  • An empathetic approach towards patients with chronic disorders, especially when therapeutic intervention is limited
  • A willingness to accept new ideas and changes to established management regimes

It is also fundamental to the specialty to have a thorough understanding of the basic pulmonary physiological and anatomical principles, along with how different disease processes affect lung function.

Useful Links & Resources
 
 
Training Curriculum:
 
 
Workforce Statistics:
 
 
Medical Careers:
 
 
British Thoracic Society:
 
 
European Respiratory Society:
 
 
American Thoracic Society:
 
 
Ameircan College of Chest Physicians (ACCP):
 
 
British Lung Foundation: