What to expect working in Acute Medicine in the NHS

Many international medical graduates don’t know what to expect regarding the acute medicine specialty in the NHS. That’s because it’s not a recognised specialty in most places worldwide. In fact, it only became a recognised specialty in the UK in 2009. Since then, it has grown quickly, providing many doctors with a fulfilling and fast-paced career and patients with high-quality care when they need it most.

The reason acute medicine became its own specialty is largely down to better organisation in UK hospitals. The need became apparent to separate trauma cases and general medical cases from urgent acute medical emergencies in order to maximise patient flow through the hospital. Patients needing immediate medical care for severe yet broad medical problems can be seen in the acute medical unit – a multidisciplinary unit full of many healthcare workers who can assist.

Are you an IMG interested in specialising in acute medicine? First, you should understand what’s involved with being an acute internal medicine (AIM) doctor – and that’s what this article will help you do. If you just want the key points we have created this video that tells you the headlines or you can read on for the full detail:

What’s the Salary?

The basic salary for ST3+ level doctors specialising in acute medicine is £55,329 a year and you’ll receive additional uplifts depending on the additional hours that you work on your rota. However, you can earn a much higher salary than that, with consultants in acute medicine earning up to £131,964. The more training and experience you have, the more senior role you can get, which equals increased pay.

Compared to the UK’s average salary of £30k per year, the salary of an AIM doctor is high and you will be able to afford to live comfortably in all areas of the UK.

Where Will You Work?

As an acute medicine specialist, you will often spend most of your time in the Acute Medicine Unit, the Same Day Emergency Care (SDEC) Unit, as well as potentially treating medical patients in the Emergency Department and medical inpatient wards. Remember that acute medicine – although closely linked – is separated from Emergency Medicine as a specialty in that you are not treating largely trauma patients, instead you are focussed on medical emergencies (e.g. Stroke, MI, Respiratory Failure, etc.).

In the acute medical unit, you’ll be working alongside and working in a varied team of experts, including Acute Medicine consultants, specialist nurses, a wide range of advanced healthcare professionals, as well as clinical teams from other medical sub-specialties.

What it’s Like to Work in the Acute Medical Unit?

So, what can you expect day-to-day when working in the acute medical unit? Your primary responsibility will be admitting, assessing, monitoring, and treating patients. These patients will have urgent medical conditions that are severe, rapid onset, or life-threatening, meaning they need treatment straight away. You’ll see them from the moment of admission for initial treatment, after which they will be discharged or referred to the relevant department in the hospital. Patients do not usually stay in an AMU beyond 72 hours, so it is a fast-paced sub-specialty.

To treat these patients, the most common treatments you’ll provide include:

• Lumbar Puncture
• Paracentesis
• Thoracentesis

You will see a wide variety of patients with various conditions, such as heart attacks, stroke, asthma attacks, liver failure, and gastrointestinal bleeding. While the conditions will vary in type, they will all have one thing in common: urgency. You’ll treat patients who need immediate medical action. Due to this, doctors working in acute medicine need to be emotionally and mentally resilient, as the work environment can often be busy and highly stressful.

Another huge responsibility will be liaising with your colleagues, such as emergency department staff and consultants. The acute medical unit is a multidisciplinary effort, which means high levels of communication is necessary for it to work. One example of using your communication skills as an acute doctor is when your patient has been in acute care for 72 hours. Once those 72 hours have ended, the patient must either be dispatched from the hospital or transferred to another hospital department. If the latter, you will need to communicate during the handover to ensure the next doctor understands the patient’s case thoroughly. That will require high levels of both written and verbal communication.

A day in the acute medical unit is varied and exciting. That means it requires high levels of energy and coordination for the patients to receive quality care, which is why training is so rigorous.

GMC Registration for Acute Medicine Doctors

To work as an acute medicine doctor in the NHS, you first need to get on the GMC register. GMC registration is a must-have for any doctor in the UK, as it proves that those on the register have the skills and knowledge to practise medicine safely.

As an IMG, the standard route to GMC registration for a specialty like Acute Medicine is MRCP (Membership of the Royal College of Physicians). It consists of three separate exams – part 1, part 2, and PACES – and you’ll need at least twelve months of medical postgraduate experience to take the first exam. All three exams are rigorous, but completion grants access to GMC registration; plus, the qualification allows you to start an NHS post that reflects your senior experience. With MRCP, you can start at level ST3+ in the NHS, and from there, you can further your training in your chosen specialty (Acute Medicine).

As well as a postgraduate qualification like MRCP, you will need to prove your English language skills to earn GMC registration. To do this, you’ll need to either pass IELTS or OET.

Acute Medicine vs General Medicine: What’s the Difference?

The NHS has a different system to many other healthcare systems around the world. Many overseas hospitals do not distinguish between general and acute medicine quite as strongly, so you might be slightly unsure how they differ.

The most significant difference between acute and general medicine is the type of patients you treat. Both areas treat a wide range of patients, but acute care only works with urgent need patients for up to 72 hours. On the other hand, general care typically takes place in a ward with non-urgent outpatients and inpatients.

Many IMGs wanting to start at ST3+ level in the NHS choose between general and acute medicine. The NHS is a highly specialised system with medical sub-specialties often being divided into separate wards and teams, meaning ‘General Medicine’ doesn’t exist very commonly in the NHS. Therefore, Acute Medicine is a great way to join in a sub-specialty where you’re treating a wide range of medical cases.

The Benefits of Working in Acute Care

Working in acute care is no walk in the park – it’s fast, intense, and emotionally straining. However, it can provide a wonderfully fulfilled career for the right person. Here are the benefits:

Lots of Variety

Every day in the acute medical unit is different. While other specialities are very focused on specific conditions, acute medicine sees patients from across the breadth of general internal medicine. Therefore, it will be hard for you to get bored with your work when you choose this specialty.

An Open Future

Beginning your NHS career in Acute Medicine can open many doors to training and CESR in other medical sub-specialties. Working in an AMU means treating a broad range of medical conditions, so it’s a great way to be exposed to how these conditions are dealth with in the NHS, particularly if it’s a new healthcare system for you. Further, as most medical sub-specialties require Acute/General Medicine on-calls, honing these skills in your first NHS role can be very attractive when transitioning into another sub-specialty.

Help People in Need

Many people working in acute care find that helping those who really need it is the best part of the job. Working in the acute medical unit, you help people that need it most, which is a job you can feel proud of.

Plenty of Vacancies

It’s no secret that the NHS needs doctors working in acute care. As you can see from this article from PubMed, the NHS is dealing with a high level of emergency department admissions. One primary reason for this is the UK’s evolving demographic; with people living longer, there are more patients to treat. As such, NHS trusts are constantly looking for acute doctors, which means you’ll have a high chance of getting a job in acute care once you arrive in the UK.

The Challenges of Working in Acute Medicine

As you can see, an acute medicine career provides plenty of benefits. Of course, there are also challenges. If you plan on becoming an acute medicine doctor, knowing what to expect is essential.

The major challenge of working in acute care is how busy it can be. In acute care, you work with urgent-need patients that require immediate evaluation, diagnosis, and treatment. It’s incredibly fast paced, requiring quick decision making. There’s also the chance that you will have to deal with challenging patients during your time in acute care. To handle this, emotional resilience and empathy are crucial.

Is Acute Care the Right Specialty for You?

If you’re still deciding which specialty to choose, you should consider whether acute care works for you. To succeed in both the training and the career itself, you’ll need the following skills:

High levels of communication

You’ll be liaising with colleagues and talking with patients and patient’s relatives. Due to this, you must be an excellent communicator.

High Energy Levels

As mentioned, working in the acute medical unit is fast-paced and intense, so you need to have lots of energy to keep up with the pace of the day.

Emotional Resilience

Working in acute care often means caring for patients at the end of their life. Emotional resilience is necessary to be able to handle this.

Organisation Skills

For the acute medical unit to run as it should – that is, keeping a fast pace while treating every patient with dedicated, high-quality care – every AIM doctor must have exceptional organisation skills.

Teamwork

Acute care only works because of a multidisciplinary method. That means, to work in acute care, you will need to work well in a team. Throughout the day, you’ll be liaising with many other NHS staff members, all of whom make it their goal to give patients the best possible care. By working well alongside them, that goal is far more achievable.

Choosing a Subspecialty

One great thing about working in acute care is that it provides plenty of development opportunities, especially regarding choosing a subspecialty. While working in acute medicine, you can pursue specialty training to attain your CESR and eventually work at a consultant level.

Luckily, you have many options for a subspecialty, including gastroenterology, dermatology, cardiology, haematology, geriatric medicine, and more. Many IMGs choose a subspecialty based on their clinical experience in their home country. For example, you might have specialised in geriatric medicine before but didn’t have the qualifications/experience to work at a consultant level in the UK. By taking the CESR, you can work towards specialising in that field while working in acute care.

Relocating to the UK

As an international medical graduate considering an acute medicine position for the NHS, you have to consider the prospect of relocating to the UK and what that might mean. After all, there might be a culture shock, especially when comparing your old medical experience to working for the NHS.

Dr Hafiz Muhammad Imran, Locum Consultant General Internal, acute and geriatric medicine and GP trainee, has this to say about the difference;

“It’s quite different in many aspects, especially multidisciplinary team approach, palliative care, geriatric care, community care, and advance care planning, plus discharge planning. Duties are managed by other teams, not just by doctors.”

You might not be used to the way it’s run. However, you might find that rather refreshing – working for the NHS often involves a collaborative effort. You can rely on your colleagues, and they can depend on you.

In Summary

Specialising in acute medicine means pursuing a fast-paced, intense NHS position involving various conditions. Many international medical graduates find success after going into acute care. Not only does the role allow you to get to grips with the NHS system through building experience and learning the ropes, but it is also an excellent starting point for eventually specialising in your chosen field.

If you have the necessary skills – including communication and emotional resilience – it can make an excellent role, especially if you want to develop in your medical career.