Young doctors wanting to specialise in diabetes care should consider advanced training in a regional area such as Cairns
For a young doctor contemplating a career in endocrinology and diabetes care, Dr Ashim Sinha can think of no better training ground than his home town of Cairns in far north Queensland.
Dr Sinha, the coordinator for training with the specialist advisory committee in endocrinology of the Royal Australasian College of Physicians (RACP), says registrars based in Cairns and other regional centres have a unique opportunity to be exposed to a variety of medicine rarely seen in a metropolitan centre.
Endocrinology registrars should think about spending at least a year of their training in a regional area, says Dr Sinha, who is also director of diabetes and endocrinology at Cairns Base Hospital and Diabetes Centre.
He says regional training provides wide exposure to general endocrinology and diabetes, including an opportunity to care for Indigenous patients, both in hospital and in outreach clinics.
Dr Sinha says regional centres, such as the Cairns Base Hospital Diabetes Centre, are well set up for advanced trainees.
“We have a very good stand-alone diabetes centre, staffed by 25 people, including diabetes educators, dietitians, podiatrists — everything that’s available in a metropolitan centre”, he says.
“When trainees leave here, they have a broad idea of general endocrinology and diabetes, and they don’t miss much, but what they get in addition is Indigenous health.”
Clinical research opportunities are available and more recent trainees have taken up these opportunities. The other advantage of training in regional areas is that trainees often return as consultants to work permanently.
Caring for Indigenous people has been a major part of Dr Sinha’s role since he set up the diabetes program in Indigenous communities in far north Queensland and the Torres Strait in 1999, which serviced 20–25 communities.
Despite offers to work in capital cities, Dr Sinha has stayed put in Cairns because of the mix of opportunities in endocrinology and the chance to be a jack of all trades, which he enjoys.
In Sydney, endocrinologist Dr N Wah Cheung says working in diabetes has allowed him to focus on both the narrow — he has a special interest in gestational diabetes — as well as wider issues, such as initiatives to stem the rising tide of diabetes.
“My work is not restricted to consultations with individuals”, says Dr Cheung, who is president of the Australian Diabetes Society. “I am also involved in public health work, so I can do things that improve people’s health in general.”
Another major drawcard for Dr Cheung is the opportunity to work in multidisciplinary teams.
“It’s not only about what I do with patients, it’s how I work with the diabetes educator, the dietitian, the podiatrist”, he says. “You don’t always get to work within a team in medicine, but you do in diabetes care, and I find that rewarding. You can achieve more together than you can by yourself.”
The big issues
Dr Cheung says the epidemic of diabetes means the profession has to be more innovative. One example is efforts to ensure diabetes specialists work closely with general practitioners.
“It’s more important now than ever for diabetes specialists to communicate with GPs”, he says. “You can’t be a specialist in an ivory tower who just does his bit and sends the patient back to the GP when he wants to. We have to share our care with GPs and support them.”
Dr Cheung says the Diabetes Society is working closely with the Royal Australian College of General Practitioners to improve diabetes training for GPs. The Society conducted GP training days last year, which were well received and will be held again in October/November this year.
Another important issue in the diabetes field is the opportunity to be involved in research, building on progress over the past decade, Dr Cheung says.
“There have been many exciting developments, such as islet cell transplantation, exploring the genetics of diabetes, understanding the mechanisms of insulin resistance, programs to prevent diabetes, novel drugs and the changing epidemiology of diabetes”, he says.
Training in endocrinology/diabetes care
As in other medical specialties, endocrinology trainees must first complete basic physician training at a hospital and pass part one of the physicians’ exam to be accepted into an advanced training position. The endocrinology training program lasts for three years: the required clinical year, the core year and the elective year. Trainees are actively encouraged to take up research opportunities in their third year of training and many go on to complete a PhD program.
Landing a training position: the inside story
Dr Wah Cheung says there are always more candidates for endocrinology training than positions available.
“It is competitive and most of our trainees are strong”, says Dr Cheung, president of the Australian Diabetes Society.
To stand out from the crowd, candidates should demonstrate an obvious passion for endocrinology and diabetes. “If you’ve been actively involved in something to do with the specialty, for example if you’ve done research or been engaged with diabetes organisations or have done public health work, that helps to confirm your passion.”
Communication is vital in diabetes care, Dr Cheung says, and applicants for the training program need to show their ability to relate to patients.
“Doctors who work in diabetes need to have empathy and understanding”, he says. “You have to be able to build that relationship with patients to better support their diabetes care.”
For those considering regional training, Dr Sinha says the program is looking for people who are flexible and who are committed to working in Indigenous outreach clinics. More generally, he says, candidates for the endocrinology training program who stand out are those who have a clear commitment to clinical work and to future development as a scientist/clinician.