With advancing years this common question, often from an anxious patient undergoing a rectal examination, has ambiguously changed to ‘whatever led you into this area?’. I still haven’t thought of the right answer. I usually muddle through with vague comments about enjoying practical procedures, lots of young healthy patients and interesting challenges, but the truth is that after 20 years as a consultant I don’t really remember. One thing I am sure about is that it was a hugely fortunate choice and I have no regrets even though I will never be a Professor, write a textbook or be awarded a ‘national platinum’.
I realised early on that I wanted to combine lots of children with a career in a branch of hospital medicine, and gastroenterology was a very appealing area. Taking a patient from a parlous state through endoscopy and rapid recover with effective treatment was, and still is, hugely rewarding. Perhaps I have a short attention span, but our patients do often get better quickly and gastroenterologists are a very friendly bunch so asking advice is easy.
I’ve written previously about how the arrival of children, and caring responsibilities, risked derailing my career. But gastroenterology is a shortage specialty and well suited to sessional work, both of which allowed me to change my working pattern several times both as a trainee and a consultant. Memorably, and embarrassingly, there were times when I had to acknowledge that I simply couldn’t manage the combination of sleepless nights as consultant ‘on’ for general internal medicine with raising a child with special needs. But by coming up with options and presenting them to our Medical Director, a workable job plan developed and by ‘treading water’ professionally for a few years I quickly returned to taking on new professional challenges.
Clinical gastroenterology is an excellent career choice for those who need their career path to be adaptive to the changes in their circumstances. Practical solutions such as time off the bleeding rota, a chair to sit on when scoping during pregnancy, a post where the conference circuit is non-essential and within a friendly department all help when you hit the ‘pinch points’.
Sometimes the main barrier is a cultural one, where we feel ‘wrong footed’ and afraid to ask for what we really need. And unfortunately some doctors settle for their second choice of specialty or leave the profession because this becomes too difficult. Several times in the last 25 years I have been told I’m not ‘one of the chaps’ for working part time or mentioning that I have other commitments outside of medicine. But once those commitments go into secondary school there is far more time and the skills you have learnt outside of medicine are eminently transferable.
The last ten years of your career can be hugely productive (I’m now the Deputy Chair of the BMA Consultants Committee and on BMA Council) and an enjoyable career in gastroenterology is a marathon, not a sprint. Take your time and enjoy the specialty.