Specialty career profile: diabetes and endocrinology

Diabetes and endocrinology is a varied and interesting specialty combining a mix of complex specialist problems with general internal medicine. In any week you can face various clinical challenges such as acute presentations of diabetic ketoacidosis, engaging with teenagers with type 1 diabetes or helping someone with an endocrine condition through pregnancy. Problem-solving skills and an open, enquiring mind are essential. You can also be quite inquisitive during consultations.

The balance of patients and conditions means that you get to know some patients on a long-term basis. It can be really satisfying to see them doing well when they come back. When dealing with longer-term conditions you often get the luxury of time to consider or discuss treatment options with the patient. Other specialties often struggle to find this time with the pressure of a general medical on-call.

As the number of patients with diabetes increases, the role of the diabetes physician will inevitably change. I see this as an exciting time to be entering the speciality.

Candidates need to complete their foundation training and CMT, and pass their MRCP(UK) exams. It would be beneficial to have spent some time during foundation or CMT attached to an endocrinology or diabetes team. It is also possible to gain exposure to patients with complex diabetes problems in many areas of the hospital, such as acute admissions units, coronary care units, surgical or orthopaedic wards or antenatal clinics. Endocrinology is mainly an outpatient-based specialty so it would be beneficial to go to a couple of clinics if possible. This will help you to gain an understanding of the wide range of clinical problems and the impact that these often lifelong conditions can have on patients’ lives.

Once you have secured an ST3 post in diabetes and endocrinology, you will have a further 5 years of specialist training in a selection of placements across teaching and district general hospitals. These placements will give you a wide exposure to diabetes and endocrinology as well as general internal medicine. Almost all trainees decide to dual-qualify and for most placements you will be part of the general medical rota.

In my opinion the calm and methodical approach needed to deal with some of the problems in our clinics is ideally suited to be transferred to an on-call setting. This reduces a considerable amount of the anxiety that can be associated with the role.

Patients with diabetes are often in hospital with other problems, but the fact that they have diabetes is associated with increased lengths of stay and rates of complications. As such, diabetes physicians get to interact with physicians from a number of specialties across the hospital, as well as primary care. Many of our activities are multidisciplinary, such as the antenatal clinics in collaboration with obstetricians, or ‒ for patients with foot ulcers ‒ involvement with vascular or orthopaedic surgeons, podiatrists, orthotists and microbiologists.

In endocrinology we liaise closely with neurosurgical specialists and radiologists when managing pituitary disease, and with thyroid surgeons or with oncologists to help people dealing with endocrine effects of their cancer treatments. The day-to-day management of patients with endocrine conditions is truly a multidisciplinary experience.

I very much enjoy working within this specialty and as such it is quite difficult to pick out the best aspects. As a diabetes and endocrine trainee the variety in my workload is immense and no two days are the same. The make-up and daily activity differs from one place to the next. Many consultants in this field have scope within their job plans to be involved with different elements of medicine, from management and service delivery to teaching and research.

I have the opportunity to work as part of large multidisciplinary team who are all working to enhance patient care. We are able to make a real difference to a patient’s quality of life, especially those living with long-term conditions ‒ such as diabetes or endocrine conditions ‒ who sometimes have to wait a long time for a conclusive diagnosis. I consider myself lucky to work with such a variety of patients, from teenagers and transition patients to the oldest members of society.

The main challenges of training in diabetes and endocrinology are the same as in any other medical specialty: managing the time required for general-medicine ward work, on-call and training, within the constraints of the European Working Time Directive. However, I would say that this is a small price to pay for the improved work‒life balance registrars have as a result of restricted working hours (48 hours per week). There are still plenty of learning opportunities to be utilised, although a trainee must seek these out and maximise their educational value.

The majority of posts on the endocrine training scheme are part of a general medical rota that involves some time on call, both at weekends and nights ‒ a pattern that continues when you become a consultant. However, it is possible to schedule a lot of the activity for standard working hours. Clinics are usually scheduled for 9am‒5pm, with the exception of transitional diabetes clinics which tend to run in the late afternoon or early evening. Generally speaking it is felt to be a fairly family-friendly speciality and many of my colleagues are able to work part-time or in job-share situations.

There are wide and varied opportunities for lecturing and teaching. I have been involved in undergraduate and postgraduate teaching, in both formal and informal situations. What is perhaps unique to this specialty is the increasing need to teach patients how to manage their own conditions, as they see healthcare professionals on an infrequent basis. This means that the rest of the time it is down to them to manage their care and it is inherently satisfying when you are able to witness this working well.

Yes, there are opportunities for research but this depends on your own interest and the special interest of those local to you. It is increasingly recognised that high-calibre research ideas need to be supported. A number of initiatives are being set up to match trainees to potential research supervisors, although it will largely be the responsibility of individual candidates to set this up. However, it is not essential to do research and it is becoming increasingly important to spend time undertaking other qualifications such as those in education or management.

Yes, it is important to recognise and understand the contribution of a wide range of healthcare professionals to our patients’ care. I frequently work with (and learn from) specialist nurses in both diabetes and endocrinology, along with dieticians, podiatrists, orthotists, community teams, specialist midwives and many other individuals.

My advice would be to get yourself exposed to the specialty as much as you possibly can. This should involve time spent on the wards and with diabetes teams. However, you should also try to attend some outpatient clinics to gain a flavour of different aspects of the specialty. Most deaneries have local educational meetings arranged by endocrinology and diabetes teams, which they would be happy for you to attend. The Young Diabetologists Forum runs a series of local taster evenings around the country to enable you to get some insight into the specialty, see the YDF website for details. Try to do something that makes you stand out from other trainees and show that you have an interest in the specialty; this could include undertaking a specialist audit with your local team, or attending a national event arranged by Diabetes UK or the Society for Endocrinology.