General medicine is a diverse and challenging specialty. You deal
with a wide range of conditions and patients and every day is
different. The specialty is broad-based and allows you to keep your
options open, although there are many areas of medicine to explore
and take special interest in.
Communication is the most important skill, as it is vital that you
keep patients informed and listen to their concerns. You also need
to be able to work effectively with other health professionals
responsible for the ongoing care of the patient. You should be a
team player and a problem solver and you should possess common sense
and enthusiasm. It is also important to be able to live with
uncertainty since you may have to make diagnoses based on limited
clinical evidence.
Most general physicians in New Zealand public hospitals are involved
in the care of inpatients admitted with acute medical problems. They
supervise junior staff who are responsible for day-to-day patient
care, and are available on-call to provide advice for their junior
staff as required. The frequency of this commitment varies depending
on the number of physicians employed at the particular hospital and
on the volume of admissions. Typically it might involve one or two
days in the week.
Inpatient ward rounds normally take place after acute admitting
days and on at least two regular days during the week. Most
physicians hold between two and four general outpatient clinics per
week. In addition, some physicians also participate in specialty
clinics or private practice. Work that does not involve direct
patient contact is also a significant part of the daily schedule,
particularly for hospital-based physicians, and may include
undergraduate and postgraduate teaching, management responsibilities
and CPD ( continuing professional development) activities. Many physicians who work in general medicine are
also sub-specialists so their time may be divided between these roles.
General medicine remains alive and well within New Zealand. Recent
years have seen an increasing number of NZ advanced trainees dual training
in general medicine and a subspecialty, because many jobs require general
medical responsibilities in addition to subspecialty knowledge. As the
population ages there will be an increasing number of elderly patients
presenting with multiple co-morbidities, so the role of the general
physicians will become even more crucial.
One contributor commented that it is definitely worth trying out
general medicine and there are plenty of options once you have
completed basic physician training.
In New Zealand at present there are good employment opportunities
for physicians trained in general medicine. There will always be a
need for physicians who possess a broad-based approach to diagnosing
and treating cases, and general medicine complements subspecialty
practice in most areas of general medicine.
The system is reasonably flexible so it is possible to job-share
during training. After you have qualified there are opportunities for part
time work and job-sharing, particularly in private practice.
General medicine affords a better lifestyle than specialties such as
anaesthesia or surgery and it is quite common for consultants to have
weekends free. There is little likelihood of being called in to the hospital
after-hours, particularly after midnight. In smaller centres with less
experienced junior staff the after-hours work may be more onerous, though in
many places this is starting to be recognised in remuneration arrangements.
The FRACP Part I examination requires intense preparation for
up to nine months in advance. When you are deciding which
subspecialty (if any) to focus on, you should talk to consultants
and registrars who work in that field. If you are interested in
pursuing a subspecialty at a large hospital in New Zealand it is
advisable to gain work experience overseas after qualifying.
