Name: Sanjay Krishnamoorthy
Speciality: Acute Internal Medicine and General Internal Medicine
Role: ST5 AIM and GIM
Deanery: North West London Deanery
Why AIM and not another acute specialty?
I was a career cardiologist for most of my foundation and core medical training. The epiphany came when I finished a busy shift on take in my hospital. I went back home with a feeling of immense satisfaction of being challenged, and rising up to meet it successfully. As ST3 job applications were fast approaching, I sat down and looked at what I had achieved over my core training years. My natural inclination (because I WANTED to do it, rather than because I HAD to do it), was to take up leadership positions amongst trainees and design and deliver teaching programs. This was closely aligned with the career pathway of acute medicine. I submitted my application, and have not regretted a day since then!
Being a medical registrar puts a lot of people off – why not you?
Most people I speak to identify the medical registrar post as the “busiest job in the hospital” and that “everyone wants a piece of you.”
I find the challenges of acute medicine intellectually stimulating, and the most rewarding aspect of it. I start the day largely unaware of what challenges face me that day. I am required to think on my feet, make rapid decisions and communicate effectively within my multi-disciplinary team, amongst other specialities and with relatives. Acute medicine gives me a chance to hone a skill set, which if done right, will make you stand out as a clinician.
What do you see yourself doing as a consultant?
I am currently taking a year out to further my skills in medical leadership and management at the CQC, through the National Director’s Clinical Fellow Scheme. I will be following this shortly with a Master’s in Medical Management. Acute Medicine has given me an alternative career path, different from the well-trodden paths in a lot of other specialities. I see myself eventually splitting my job between acute medicine and a management post.
Are you just on take all the time?
This is a common misconception. As a registrar, you are on a medical rota and you are on take the same amount as any other registrar in any other speciality. Training in Acute Internal Medicine just means that you like it a lot more and you get to look after the patients you admitted, the following day.
Can you work flexibly?
Job plans includes regular sessions to pursue a specialist skill. In addition to this, the work required is predominantly shift work, and therefore allows for versatility in job planning as a registrar and in the future, as a consultant. This is particularly helpful if you want to train flexibly with a specific specialist interest or for family commitments.
Do other specialties regard you as “good” as them?
I have never come across a specialist who has spoken down at me because I am an acute medic. As I mentioned before, the skill set you will develop simply as a result of your job requirements will set you aside from other specialists. Increasingly, I find my clinical acumen highly regarded, if not more so than some of the other specialists. Most specialists depend a lot on the acute medical department functioning effectively, and therefore are quite grateful for your role in patient care.
Isn’t it just all old ladies with UTIs and DVTs?
On the contrary, junior doctors from other specialties are now complaining that they don’t get to do enough, because we have already done it! We get the first 72 hours of every acute presentation. The diagnostic dilemma rests predominantly with us. It is a procedure based speciality and I have had a chance to perform and supervise juniors performing a number of procedures ranging from drains to central lines.
You’re always on the Acute Medical Unit (AMU) aren’t you?
The job is predominantly on the AMU. However during training, you will spend time doing clinics of your own interest and sessions pursuing a specialist interest which can range from procedural to vocational.
What else can you special skill in?
Classically, trainees were asked to choose between a procedural skill (endoscopy/bronchoscopy/ultrasound/echocardiography) or training in leadership and management or education. One of the joys of acute medicine, however, is that it is a young specialty. Therefore trainees are increasingly carving their own paths. This is quite in contrast to other specialties where you generally tread down the trodden path. Colleagues of mine have branched out into patient safety, quality improvement, informatics, diabetes, stroke medicine etc. It is about what you want to do and convincing the training program directors, that this is worthwhile.
What research/leadership opportunities are there?
Opportunities are rich in both. The job profile of an acute medical consultant involves service development. Therefore, you are actively encouraged to seek out opportunities in quality improvement and leadership. Ranging from sepsis to acuity on presentation, there are plenty of opportunities for research as well.
What are AMUs like to work in?
It is a fast paced environment. Functioning effectively requires you to communicate efficiently with various team members. The days are never dull. There is a very strong team based approach to patient care, so you get to know the people you work with very well. As consultants are heavily involved in the day to day running of the AMU, hierarchies are largely horizontal. You are encouraged at all times to express yourself as a clinician and to question decisions.
Any regrets?
None whatsoever! I have enjoyed the ride so far and I am excited about the opportunities to personalise my career path going forward.
What advice would you give those thinking about AIM?
The fact that you are thinking about it, probably means that you have the skill set to thrive in it. Don’t be put off by what the “ologists” say about the specialty, speak to an acute medic and see if it is the thing for you. There are many opportunities within the specialty to branch out and do something that really interests you.
Have you been supported more/less than other specialties?
I think I have had more consultant support on a day-to-day basis than other specialty colleagues. I get to learn my trade every day when I accompany consultants on ward rounds. Consultants are very approachable to questions and are ever ready to give advice.
Who/what makes a great acute physician?
A genuine interest in the AMU. Ability to work in a fast paced environment and under varying amounts of pressure. Strong communication skills. Good team player skills. Ability to display clinical leadership.
Sanjay Krishnamoorthy