Hepatology offers many rewards in research and patient care
Associate Professor Amany Zekry’s love of hepatology dates back to her medical student days in the early years of antiviral therapy for hepatitis C.
Under the guidance of Professors Geoff Farrell and Bob Batey at Westmead Hospital, she enjoyed exploring ways to eradicate the virus.
“I knew then that if I specialised, that would be my specialty”, says Associate Professor Zekry, who is now director of the Department of Gastroenterology and Hepatology at St George Hospital in Sydney.
After completing advanced training, and working her way through a PhD in Sydney and postdoctoral research in the United States, Associate Professor Zekry now enjoys a combination of academic and basic research roles at the University of NSW and in clinical medicine at St George Hospital. She is also active in the community, raising awareness of viral hepatitis among the migrant population.
Hepatology offers many rewards, Associate Professor Zekry says. In the research area, there is immense scope, and it is satisfying working in a field in which Australian doctors are international leaders.
“In terms of patient care, there are many aspects of, and many layers to, the clinical work. It is not just the disease but also the associated social issues.”
Associate Professor Zekry, who established a multidisciplinary hepatology service at St George Hospital, enjoys the chance to work in a team to manage liver disease, including viral hepatitis and liver cancer.
As well as the rewards, there are challenges when patients don’t respond to treatment. “Like any specialty, it is hard to give patients bad news when therapy doesn’t work”, she says. “It is very disappointing when patients who have hepatitis C, for example, go through an extensive journey of treatment, but are not cured, or respond initially then relapse.”
Melbourne hepatologist Dr Paul Gow says there are enormous changes in hepatitis C therapy, with new drugs now available and more being developed.
“These drugs will change the face of what we can do, so it’s gone from an incredibly boring area to an incredibly exciting area”, says Dr Gow, who is deputy director of gastroenterology at the Austin Hospital.
Liver cancer is also a changing area, he says, with the disease becoming more common, but there is a variety of treatments that didn’t exist a decade ago.
One misconception about hepatology is that it mostly involves looking after patients who have issues related to drugs and alcohol, Dr Gow says.
“That’s not the reality of my job”, he says. “Most people I look after have complex causes of liver failure, some of which are related to drugs and alcohol but not the majority.”
The inside story
Hepatology training begins with advanced training in gastroenterology.
Associate Professor Amany Zekry, who works with advanced trainees at St George Hospital, says there is tough competition for places in the training program — there were 41 candidates for 11 first-year training positions in gastroenterology in NSW this year. Dr Paul Gow says there is similar competition in Victoria.
Candidates who present a curriculum vitae with “something extra” will have an edge, Associate Professor Zekry says.
While being published is an obvious advantage that shows the candidate is driven to succeed, she says there are other ways to stand out. “I interviewed someone who was studying a Masters of Education because they were aiming for an education role in gastroenterology”, she says. “One of the people I interviewed found some outdated information in a textbook and brought it to the attention of the publisher. The publisher then acknowledged that person in the next edition. It doesn’t have to be just research, but any examples of initiative and leadership.”
Dr Gow agrees that candidates need to differentiate themselves. “You can’t change your university marks”, he says. “The only thing you can change is your current CV, and the easiest thing to change is to get some publications and these will put you further up the ranking.”
For those who go on to focus on hepatology, Associate Professor Zekry says they need to be truly interested in the clinical challenges of liver disease. While most hepatologists also practise in other areas of gastroenterology, the subspecialty is not as lucrative as areas that focus on procedural work, such as endoscopy. “A dedicated career in hepatology doesn’t provide the financial security of endoscopy, where doctors can establish a practice away from the public system”, she says.
Dr Gow urges all his trainees to head overseas after their fellowship to train further.
“I spent time in the UK and it was great fun and a fantastic learning opportunity”, he says. “It changed my career, but it was also a great life experience. Only a minority of people do it, but they love it and probably end up with better jobs in the long term because they subspecialise.”
The training program
The Royal Australasian College of Physicians offers combined advanced training in gastroenterology and hepatology.
Doctors who have a major interest in liver disease will do extra training in hepatology after gaining their FRACP. This training could include overseas clinical experience in a large hepatology centre and/or a research degree in hepatology.
Doctors aiming for an academic role in hepatology are expected to gain strong research experience in addition to their clinical experience.
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