Why I went for acute internal medicine
I am currently working in acute internal medicine as a specialty registrar and I am thoroughly enjoying my training.
When I came to the UK, I wanted to do gastroenterology. In core medical training (CMT) year 1, I wanted to do respiratory and then in CMT year 2, I wanted to do renal. I changed my mind again as I found the acute elderly unit a joy to work in . I ended up applying for acute internal medicine (AIM) and geriatrics, got selected in both in my deanery of choice and ended up taking acute internal medicine.
Everyone has their reasons of why they choose a particular specialty. Some reasons seem completely stupid and some tend to stick in other peoples' head paving their way to the same specialty.
Before you read this, please remember that every specialty has its own charm. Also read this blog:
https://omarsguidelines.blogspot.com/2018/12/what-is-best-specialty-for-me.html
Here are some of my reasons:
1. THE ACUTE PART OF AIM:
I came to the UK in January, 2016 and was put on the on call rota in June, 2016. Since then, I have always looked forward to my on calls on the acute medical unit. I loved how we could treat unwell patients and discharge them/ transfer them to the respective specialties.
2. ITU SUPPORT:
The critical care outreach nurses, ITU doctors are always available to help on the acute medical unit ( and of course, other wards as well). They take over care where appropriate and transfer the patient to ITU when necessary. A few acute medical registrars also take up intensive care as a specialist interest and as consultants, they can even cover ITU and use this experience on the acute floor.
3. PROCEDURES:
I learnt everything from doing ABGs to ascitic drains and lumbar punctures on AMU. You get plenty of opportunities to do all of these as a SHO and then as a registrar, supervise foundation trainees and SHOs.
4. NO FUSS:
This is the best part of the acute medical unit. You treat them, discharge them or transfer them to appropriate wards. There is a very high turn over in the acute medical unit.
5. AMAZING NURSING TEAM :
I met extraordinary nurses and HCAs wherever I have worked however the nurses on the acute unit are especially good - they can work under pressure and support doctors when they are overworked. They know the relevant details about their patients and they have helped me a lot when it came to unwell patients or complicated cases.
6. AMBULATORY CARE:
I love how patients can walk in, get their treatment and then walk out. Pathway patients like deep vein thrombosis, pulmonary embolism, cellulitis, etc are some examples.
https://omarsguidelines.blogspot.com/2020/05/working-in-ambulatory-care.html
Ambulatory care is expanding rapidly as the pressure on the NHS grows and the ambulatory care team works closely with GPs and the ED team to maintain patient flow.
7. TECHNOLOGY:
Some AMU consultants have all sorts of fancy equipment such as this lovely portable USS probe:
https://www.butterflynetwork.com/
8. ULTRASOUND:
Quite a significant number of acute medical registrars and consultants are becoming trained in focused ultrasound:
https://www.acutemedicine.org.uk/what-we-do/training-and-education/famus/
9. SPECIALIST INTERESTS:
There are a variety of specialist interests AIM trainees can acquire mentioned here:
https://www.acutemedicine.org.uk/what-we-do/training-and-education/skills/
10. NO CLINICS:
As mentioned above, the only clinic we have is ambulatory care clinic as a consultant ( unless we have a specialist interest like stroke). I tried my best to attend clinics in different specialties when I was a non trainee SHO and core medical trainee ( cardiology, respiratory, stroke, neurology, elderly, renal, gastro ) and I never enjoyed them.
11. MORE DEMAND THAN SUPPLY:
Almost every trust is in need of AMU consultants. The management is very open to negotiating a good salary and job plan based on your needs. Locum posts are easily available ( the rate varies from 100 to 150 GBP an hour!).
12. MANAGEMENT:
Acute medicine is a very important specialty to ensure patient flow is maintained. Hence the management is willing to bring about changes you suggest which can help improve patient flow - so if you have a reasonable business case, it is highly likely to be accepted.
The AMU consultants work closely with management to ensure ambulatory care and the acute medical unit is as efficient as possible.
SOME MYTHS ABOUT ACUTE MEDICINE:
1. AMU CONSULTANTS HAVE A VERY TOUGH ROTA:
AMU consultants have a very reasonable rota - I know an AMU consultant who does 0900 to 1700 AMU shifts once to twice a week, ambulatory care once a week , admin day half a day and off for 3 to 4 days. You can increase this or decrease it depending on what your job plan is like. This rota can vary from trust to trust but AMU consultants have a reasonable work-life balance (provided they enjoy their job). You can also talk to the AMU consultants in your trust and see what their job plan is like.
2. ACUTE MEDICINE IS NOT SATISFYING AT ALL:
This is certainly not the case. You get to see a variety of cases, you make immediate decisions and can see patients improve /being taken over by other specialties/ walk in and walk out of ambulatory care.
3. AMU CONSULTANTS ARE NOT HAPPY:
I have met some extremely friendly and supportive consultants throughout these past few years who have mentored me to pursue this specialty.
There are happy and unhappy people in every specialty, every profession and in every country. So please do not use this as a deciding factor.
4. AMU CONSULTANTS CANNOT WORK IN ANY OTHER COUNTRY:
This is not true. I know a few acute medical consultants who are working in the Middle East - in 'Internal Medicine' departments.
5. ACUTE MEDICAL TRAINING IS VERY HARD AS YOU ARE BASED ON AMU DURING THE WHOLE 4 TO 5 YEARS:
This is not true - You rotate in different specialties like cardiology, respiratory, intensive care, etc. as part of AIM training as a specialist registrar. These rotations are for 4 to 6 months each and AIM trainees are given ample opportunities to learn enough.
6. ACUTE MEDICINE IS BORING AND YOU LOSE INTEREST:
This is not true. You see a variety of cases and after the ED team , you are the parent team to look after these patients from the next 24 to 48 hours.
I have seen loads of interesting cases - from thrombotic thrombocytopenic purpura to Creutzfeldt-Jakob disease - and in all of these cases, I had support from the relevant specialties.
7. YOU ARE NOT PAID ENOUGH IN ACUTE MEDICINE :
This is not true, the pay is the same for all consultants and increase with the number of hours they put in.
Also, in a lot of trusts there are vacancies and you can do locums if you wish ( which can be anything from 100 to 150 GBP an hour).
8. ACUTE MEDICINE IS NOT A "PROPER" SPECIALTY :
This is again not true. Those who work in the NHS would appreciate that this is a very important specialty as this department maintains patient flow. AMU consultants are specialized in acute internal medicine and general medicine and can work in internal medicine all over the world.
9. ACUTE INTERNAL MEDICAL REGISTRARS ARE EXTREMELY STRESSED ON AMU
This is not true. This is what we do when working on AMU:
- Attend the morning handover
- Assess unwell patients ( max 1 or 2 ) - supported by ITU and usually taken over by specialist teams
- Assess patients who have been seen by consultants the day before for discharges
- Do procedures , supervise SHOs/ foundation trainees.
- Attend huddle at midday
- Have lunch with the AMU team
- Carry on ward rounds, jobs, help with clerking if on call team very busy
- Leave at 1700.
This routine and timing may vary from trust to trust.
In the trusts I have worked in there is consultant cover from 0830 to at least 1900 and some even stay till late if necessary to support the team. If it is not busy, they may leave at 1800.
Either way, there is always consultant support on AMU on a daily basis unlike other wards ( where there might be consultant ward rounds twice or thrice a week).
They may also cover ambulatory care as mentioned here:
https://omarsguidelines.blogspot.com/2020/05/working-in-ambulatory-care.html
Overall, I thoroughly enjoy acute internal medicine a lot and have looked up to a lot of acute medical consultants as mentors over the past few years.
Every specialty has its charm and there is no 'best specialty' to work in. In my opinion, if you choose a particular specialty and enjoy your training and then life as a consultant, it is the best specialty for YOU but not for someone else.
SOME USEFUL LINKS:
https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/medicine/acute-internal-medicine
https://www.acutemedicine.org.uk/
https://www.takeaim.org.uk
https://www.st3recruitment.org.uk/specialties/acute-internal-medicine
Dedicated to the amazing acute medical registrars, consultants, managers and nurses I have worked with who made me love acute medicine.
When I came to the UK, I wanted to do gastroenterology. In core medical training (CMT) year 1, I wanted to do respiratory and then in CMT year 2, I wanted to do renal. I changed my mind again as I found the acute elderly unit a joy to work in . I ended up applying for acute internal medicine (AIM) and geriatrics, got selected in both in my deanery of choice and ended up taking acute internal medicine.
Everyone has their reasons of why they choose a particular specialty. Some reasons seem completely stupid and some tend to stick in other peoples' head paving their way to the same specialty.
Before you read this, please remember that every specialty has its own charm. Also read this blog:
https://omarsguidelines.blogspot.com/2018/12/what-is-best-specialty-for-me.html
Here are some of my reasons:
1. THE ACUTE PART OF AIM:
I came to the UK in January, 2016 and was put on the on call rota in June, 2016. Since then, I have always looked forward to my on calls on the acute medical unit. I loved how we could treat unwell patients and discharge them/ transfer them to the respective specialties.
2. ITU SUPPORT:
The critical care outreach nurses, ITU doctors are always available to help on the acute medical unit ( and of course, other wards as well). They take over care where appropriate and transfer the patient to ITU when necessary. A few acute medical registrars also take up intensive care as a specialist interest and as consultants, they can even cover ITU and use this experience on the acute floor.
3. PROCEDURES:
I learnt everything from doing ABGs to ascitic drains and lumbar punctures on AMU. You get plenty of opportunities to do all of these as a SHO and then as a registrar, supervise foundation trainees and SHOs.
4. NO FUSS:
This is the best part of the acute medical unit. You treat them, discharge them or transfer them to appropriate wards. There is a very high turn over in the acute medical unit.
5. AMAZING NURSING TEAM :
I met extraordinary nurses and HCAs wherever I have worked however the nurses on the acute unit are especially good - they can work under pressure and support doctors when they are overworked. They know the relevant details about their patients and they have helped me a lot when it came to unwell patients or complicated cases.
6. AMBULATORY CARE:
I love how patients can walk in, get their treatment and then walk out. Pathway patients like deep vein thrombosis, pulmonary embolism, cellulitis, etc are some examples.
https://omarsguidelines.blogspot.com/2020/05/working-in-ambulatory-care.html
Ambulatory care is expanding rapidly as the pressure on the NHS grows and the ambulatory care team works closely with GPs and the ED team to maintain patient flow.
7. TECHNOLOGY:
Some AMU consultants have all sorts of fancy equipment such as this lovely portable USS probe:
https://www.butterflynetwork.com/
8. ULTRASOUND:
Quite a significant number of acute medical registrars and consultants are becoming trained in focused ultrasound:
https://www.acutemedicine.org.uk/what-we-do/training-and-education/famus/
9. SPECIALIST INTERESTS:
There are a variety of specialist interests AIM trainees can acquire mentioned here:
https://www.acutemedicine.org.uk/what-we-do/training-and-education/skills/
10. NO CLINICS:
As mentioned above, the only clinic we have is ambulatory care clinic as a consultant ( unless we have a specialist interest like stroke). I tried my best to attend clinics in different specialties when I was a non trainee SHO and core medical trainee ( cardiology, respiratory, stroke, neurology, elderly, renal, gastro ) and I never enjoyed them.
11. MORE DEMAND THAN SUPPLY:
Almost every trust is in need of AMU consultants. The management is very open to negotiating a good salary and job plan based on your needs. Locum posts are easily available ( the rate varies from 100 to 150 GBP an hour!).
12. MANAGEMENT:
Acute medicine is a very important specialty to ensure patient flow is maintained. Hence the management is willing to bring about changes you suggest which can help improve patient flow - so if you have a reasonable business case, it is highly likely to be accepted.
The AMU consultants work closely with management to ensure ambulatory care and the acute medical unit is as efficient as possible.
SOME MYTHS ABOUT ACUTE MEDICINE:
1. AMU CONSULTANTS HAVE A VERY TOUGH ROTA:
AMU consultants have a very reasonable rota - I know an AMU consultant who does 0900 to 1700 AMU shifts once to twice a week, ambulatory care once a week , admin day half a day and off for 3 to 4 days. You can increase this or decrease it depending on what your job plan is like. This rota can vary from trust to trust but AMU consultants have a reasonable work-life balance (provided they enjoy their job). You can also talk to the AMU consultants in your trust and see what their job plan is like.
2. ACUTE MEDICINE IS NOT SATISFYING AT ALL:
This is certainly not the case. You get to see a variety of cases, you make immediate decisions and can see patients improve /being taken over by other specialties/ walk in and walk out of ambulatory care.
3. AMU CONSULTANTS ARE NOT HAPPY:
I have met some extremely friendly and supportive consultants throughout these past few years who have mentored me to pursue this specialty.
There are happy and unhappy people in every specialty, every profession and in every country. So please do not use this as a deciding factor.
4. AMU CONSULTANTS CANNOT WORK IN ANY OTHER COUNTRY:
This is not true. I know a few acute medical consultants who are working in the Middle East - in 'Internal Medicine' departments.
5. ACUTE MEDICAL TRAINING IS VERY HARD AS YOU ARE BASED ON AMU DURING THE WHOLE 4 TO 5 YEARS:
This is not true - You rotate in different specialties like cardiology, respiratory, intensive care, etc. as part of AIM training as a specialist registrar. These rotations are for 4 to 6 months each and AIM trainees are given ample opportunities to learn enough.
6. ACUTE MEDICINE IS BORING AND YOU LOSE INTEREST:
This is not true. You see a variety of cases and after the ED team , you are the parent team to look after these patients from the next 24 to 48 hours.
I have seen loads of interesting cases - from thrombotic thrombocytopenic purpura to Creutzfeldt-Jakob disease - and in all of these cases, I had support from the relevant specialties.
7. YOU ARE NOT PAID ENOUGH IN ACUTE MEDICINE :
This is not true, the pay is the same for all consultants and increase with the number of hours they put in.
Also, in a lot of trusts there are vacancies and you can do locums if you wish ( which can be anything from 100 to 150 GBP an hour).
8. ACUTE MEDICINE IS NOT A "PROPER" SPECIALTY :
This is again not true. Those who work in the NHS would appreciate that this is a very important specialty as this department maintains patient flow. AMU consultants are specialized in acute internal medicine and general medicine and can work in internal medicine all over the world.
9. ACUTE INTERNAL MEDICAL REGISTRARS ARE EXTREMELY STRESSED ON AMU
This is not true. This is what we do when working on AMU:
- Attend the morning handover
- Assess unwell patients ( max 1 or 2 ) - supported by ITU and usually taken over by specialist teams
- Assess patients who have been seen by consultants the day before for discharges
- Do procedures , supervise SHOs/ foundation trainees.
- Attend huddle at midday
- Have lunch with the AMU team
- Carry on ward rounds, jobs, help with clerking if on call team very busy
- Leave at 1700.
This routine and timing may vary from trust to trust.
In the trusts I have worked in there is consultant cover from 0830 to at least 1900 and some even stay till late if necessary to support the team. If it is not busy, they may leave at 1800.
Either way, there is always consultant support on AMU on a daily basis unlike other wards ( where there might be consultant ward rounds twice or thrice a week).
They may also cover ambulatory care as mentioned here:
https://omarsguidelines.blogspot.com/2020/05/working-in-ambulatory-care.html
Overall, I thoroughly enjoy acute internal medicine a lot and have looked up to a lot of acute medical consultants as mentors over the past few years.
Every specialty has its charm and there is no 'best specialty' to work in. In my opinion, if you choose a particular specialty and enjoy your training and then life as a consultant, it is the best specialty for YOU but not for someone else.
SOME USEFUL LINKS:
https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/medicine/acute-internal-medicine
https://www.acutemedicine.org.uk/
https://www.takeaim.org.uk
https://www.st3recruitment.org.uk/specialties/acute-internal-medicine
Dedicated to the amazing acute medical registrars, consultants, managers and nurses I have worked with who made me love acute medicine.
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