Intensive care is a young, growing discipline and its role is still
being established so there is opportunity to be involved in actively
determining its course. It is a challenging and varied specialty and
its ‘hands-on’ nature suits people who like procedures. You deal
with a wide variety of patients and are able to develop and make use
of non-medical skills such as counselling. Strong team spirit exists
among colleagues, and opportunities are afforded to interact with
specialists in many other areas of medicine. It is also possible to
practise part time intensive care medicine, so the rest of one’s
time is spent doing another specialty (e.g. anaesthesia) or non
clinical work (e.g. directing an ambulance service, research,
hospital quality management etc). The generalist medical abilities
and communication skills necessary for intensive care medicine
definitely assist in these other jobs.
You need to have excellent general clinical skills with meticulous
attention to detail. Good knowledge across broad areas of medicine
and surgery is important, as is the ability to plan ahead and to see
the ‘big picture.’ You need to have stamina, confidence and the
ability to think on your feet. Communication skills are essential
during difficult resuscitation episodes and also when interacting
with the patient and their relatives and friends. You must be able
to work effectively with other specialists as part of a team
involved in the patient’s care since a significant degree of liaison
is required with anaesthetists, surgeons and physicians. A level of
technical skill is also essential for procedures such as intubation
and inserting vascular lines.
There is a mixture of clinical work, research, training and
administration. On the clinical side you make frequent ward rounds,
attend family meetings, supervise registrars and are directly
involved in work in the ICU. Every day is different.
There are huge clinical challenges regarding what should be done and
what can be done. Supply and demand problems regularly affect the
quality of patient care in this specialty.
Although it is recommended that you should try out the specialty as
a house officer if you are interested, very few such runs are
available and most people only have the opportunity to experience
intensive care as a registrar. All of the specialists and trainees
surveyed would choose this specialty again, citing it as a very
rewarding discipline. However, they suggest that you think it
through extremely carefully as the hours can be long and the role is
demanding. Working in emergency situations is a regular part of the
job: the specialty is not for the fainthearted. It is advisable to
maintain interests outside medicine so that you can disengage
yourself from work during time off.
The opportunities seem good since there are few trainees currently
working in this area and many leave for Australia after qualifying.
A greater number of intensive care specialists will be needed in the
future.
Travelling as an intensive care specialist is easy, particularly if
you are involved in the academic aspects of the discipline. There
are at least nine women currently practising in New Zealand, but the
specialty is said to be no better or worse than most with regard to
part time work or arranging maternity leave.
Intensive care medicine is particularly demanding on family life
during the training period as the hours can be long and you have to
be available for on-call responsibilities.
Clinical genetics is a growth area so the infrastructure in New
Zealand is not fully developed. As yet, the specialty is not
officially recognised in this country for the purposes of vocational
registration.
It is possible to combine intensive care with anaesthesia or
general medicine or emergency medicine as a dual training programme
(see below),. Almost all New Zealand intensive care specialists have
another specialty qualification, usually in anaesthesia.
