"I chose Endocrinology because I am interested in the effects of hormones and the unique interplay of negative and positive feedback mechanisms that regulate their secretion and function. Endocrinology is an evolving subspecialty in which research and clinical medicine run hand in hand. It is also an area in which physiology, pathology and pharmacology are nicely integrated in the diagnosis and treatment of common diseases. I am also interested in Diabetes because of the huge impact that it has on people's quality of life and hence our community. It is very pleasing to see how educating diabetic patients and providing them with the skills they need to manage it brings at the end very impressive results."

Dr Zaven Panossian, Endocrinology Registrar, Auckland District Health Board

Click on the questions below to view comments from clinicians.

Why did you choose this specialty, and what do you most like about it?

 

	One contributor identified a particular professor whose influence inspired him to pursue this specialty. Endocrinology is continually evolving, so it is an exciting and rewarding area in which to work.

 

	You should possess vigilance and circumspection combined with open-mindedness and flexibility. You must be prepared to monitor and correct, and to learn from colleagues and from the experiences of patients. Endocrinology has always had a strong scientific and research base and offers excellent opportunities for academic and research activities.

 

	For a hospital specialist a typical day might include outpatient clinics and telephone and ward consultations. You would expect to treat patients with diabetes, pituitary, bone and thyroid conditions, to review results and make diagnoses, and to engage in daily case-sharing meetings with colleagues. Some clinicians are heavily involved in fertility and female endocrinology, and others spend more time working with bone disorders. As well there are invariably administrative demands to attend to. Many endocrinologists in New Zealand cover some general internal medicine as well as their specialty area.

 

	The increasing proportion of ambulatory and online care in endocrinology has resulted in much less inpatient care for both endocrinology and diabetes. This trend will continue as well as dispersion of sub-specialists throughout the wider Auckland region. Advances in diagnosis and therapeutics and increasing speed of patient turnover bring their own challenges. Satisfactory tools for endocrine diagnosis, data analysis and retrieval are still not available in outpatient endocrinology.

 

	One contributor recommends that you should keep up your internal medicine skills, and that it is quite reasonable to complete much of your postgraduate training in internal medicine. It is also useful to spend time working in a diabetes unit. You should expect to acquire some of your training in a city with a population greater than one million, to gain experience in less common conditions. In terms of appointment as a consultant there are many niches in New Zealand in private practice and in smaller or larger district hospitals. A period of basic or applied research is desirable.

 

	There are continuing opportunities as many New Zealand-trained endocrinologists leave to travel overseas to complete further study and the incumbents are aging. Women’s endocrinology is experiencing insatiable demand in the private sector so there are excellent opportunities for female specialists. Diabetes remains a Department of Health priority area. However it is possible that opportunities could shrink as a greater proportion of diabetes and thyroid management is moved from the secondary to the primary sector, or become dispersed through endocrine departments throughout the Auckland area. There are no vacant FTE endocrine positions at Auckland Hospital presently. A number of specialists work partly in adult internal medicine and partly in endocrinology as well as the private sector, and there is also potential for combined positions in paediatrics or foetal-maternal medicine. Regional development in Auckland with the desire by Waitemata and Counties Manukau to provide strong local endocrine services has opened new opportunities for emerging endocrinologists.

 

	It is ideal that trainees spend at least some time overseas during training recognising that this may be impractical. The specialty lends itself to part time work once you are qualified as a specialist. Job-sharing arrangements while raising a family are entirely possible but largely untested.

 

	One contributor commented that the work has had a positive impact factor on his family life, and that the after-hours commitment is not as onerous as for other specialties.

 

	General physicians often feel that they are able to manage cases so patients are not always referred to specialist endocrinologists. On the other hand, by teaching and sharing knowledge, it is in the interests of the patient to empower both the primary and general physicians in this way.

 

	Before you apply it would be worthwhile discussing the specialty on an informal basis with an endocrinology consultant. Basic training should concentrate on internal medicine runs: maternal medicine, cardiology, or renal medicine may be useful specialist choices.