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Bug battlefield

Amanda Bryan
Med J Aust
Published online: 19 March 2012

The work of the infectious diseases specialist spans three different domains: the pathogens that infect us, the human bodies they invade and the broader community at risk of infection.

This calls for a broad skills set and paves the way for a variety of career opportunities. You could find these specialists battling bugs in the lab, consulting with other specialists in hospitals, working in outpatient clinics or employed in a public health capacity.

No matter where they work, infectious diseases specialists must be ready for the unknown because it’s never clear when the next big outbreak will strike.

A significant new pathogen or virus has emerged every few years, HIV being the most obvious example, says Professor Tony Cunningham, Director of the Westmead Millennium Institute and Research Centre.

He says this makes for a fascinating career. “We once expected to eradicate the world of them — but every time we think we are getting on top of things, a new bug comes along and bites us”, he says.

You also need to be prepared for an old foe to rear its head now and again, which leads to pressure to diagnose quickly.

“If someone comes in with meningitis, you need to diagnose that very quickly, as they can die within 12 hours. The great thing about this specialty is that people can be very near death and you can treat them quickly”, Professor Cunningham says.

The heavy diagnostic component of this specialty demands strong cognitive skills, rather than the technical or procedural skills of other specialties, and infectious diseases specialists also need a broad knowledge of the human body, rather than of specific organs.

Professor David Paterson, from the University of Queensland Centre for Clinical Research, says this is why the career originally appealed to him. “Any type of patient can develop an infection: orthopaedic patients, ICU patients, pregnant women, and children. We also work across a wide variety of medical subspecialties, even psychiatry. I’ve seen people who’ve became psychotic as a result of typhoid fever”, he says.

This is also why it pays for infectious diseases specialists to stay in touch with global developments. “Many infections are also public health problems and are still killing millions worldwide, so we have an obligation to lead policy in those areas”, Professor Paterson says.

As a result, infectious diseases specialists are often the ones implementing national, state or hospital-wide policies on anything from infection control, immunisation and antibiotic usage to HIV, hepatitis C virus and tuberculosis.
However, it’s the conditions that can’t be cured that provide the biggest challenge — as well as the most interest — according to specialists in the field.

Professor Cunningham, who moved out of diagnostic and clinical virology into researching viruses and vaccines, says a career in infectious diseases offers the opportunity to follow your interests in greater depth.

Professor Paterson agrees. “When I first started training, infectious diseases were viewed like orthopaedics. If it was broken, it could be fixed, or in our case cured with antibiotics. Then along came HIV and antibiotic resistance.”

He says this aspect brings plenty of opportunities for infectious diseases specialists to make their mark in medical education and research. One of his main research interests is the study of antibiotic-resistant bacteria. He is looking into how to optimise antibiotic therapy to prevent resistance and treat resistant infections.

“I also see patients every day and part of my research is to look at why patients are affected by resistant strains and what the risk factors are”, he says.

“A US mentor once advised me to ‘study what you see’ so with antibiotic-resistant bacteria emerging as a significant issue, that’s where I’ve focused my research.”

According to Professor Paterson, infectious diseases is ultimately an intellectual specialty because though bugs may lack brains, they do have the ability to mutate and evade our efforts to control them.

“They are clearly staying one step ahead and that is part of the intellectual challenge of infectious diseases”, he says

Amanda Bryan

Training

Those interested in a career as an infectious diseases physician need to complete 1 year as an intern followed by 3 years of basic physician training through the Royal Australasian College of Physicians (RACP). Following completion of these requirements, trainees may enter advanced training in infectious diseases.

Two programs are offered: a “single fellowship” program involving advanced training in infectious diseases through the RACP, or a “dual fellowship” program involving advanced training in both infectious diseases and microbiology through the RACP and the Royal College of Pathologists of Australasia (RCPA).

The single fellowship program takes 3 years, comprising 2 core clinical years in infectious diseases. Typically this involves inpatient and outpatient clinical consulting for patients with infections, 6 months in a clinical microbiology laboratory, and 6 months elective training in another clinical discipline relevant to infectious diseases, research or further microbiology training.

Dr Geoffrey Playford, specialist advisory committee chair for infectious diseases at the RACP, says trainees get exposure to a diversity of related areas including infection control, sexual health, hospital epidemiology and public health.

Those interested in clinical microbiology can extend their training and combine infectious diseases and microbiology training. In the dual fellow program, trainees do the same 2 core years as the infectious diseases program and then another 3 years in clinical microbiology, leading to dual qualifications with the RACP and RCPA.

“About two-thirds of trainees do the single fellowship and a third do dual training. There are a reasonable number of positions in hospital microbiology labs, and public and private pathology companies take trainees”, Dr Playford says.

Registrar Q+A

Dr James Pollard is in his 3rd year of infectious diseases training and is a microbiology registrar at Barwon Health Geelong

Why did you choose to train in infectious diseases?
As a physician subspecialty, it is a great area for people who like problem solving. Infectious diseases is a great way to build highly specialised knowledge, while at the same time practise very general medicine. I enjoy seeing interesting patients, many of whom pose a diagnostic challenge.

What do you like most about it?
I like the options this specialty provides. For instance, my skills can be used in a broad range of settings spanning rural and remote medicine, strategic service planning and infection control, in quaternary hospitals or in field relief or international aid work. I also like the variety of work. I see patients with a mix of acute and chronic health issues, and these patients may be outpatient based or in intensive care.

What do you like about the training program and how does it differ from other specialties?
The 3-year advanced training program comprises 2 core clinical years, and 6 months of microbiology, but the remaining 6 months is considered
non-core, which means you have a wide range of options for how to best use this time. It is also relatively straightforward to extend your training and do combined infectious diseases and microbiology training for those who see their careers heading more towards mixed practice or laboratory medicine.

Is there anything you dislike about it?
Sometimes the conflict between balancing your own learning and “service delivery” to the hospital can be quite difficult to manage. Infectious diseases registrars are always busy, and the phone never stops ringing.

What are your future plans?
To complete my training and to always continue learning. I hope to find work in a tertiary centre, and one day to be able to use my skills in emergency relief work.


  • Amanda Bryan


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