BDI Resourcing had the pleasure of interviewing Consultant Geriatrician and the President of the British Geriatric Society, Professor Tahir Masud.
In this Interview, Professor Tahir Masud explains Geriatrics as a specialty, career opportunities within the NHS and how to specialise.
Geriatric Medicine is a branch of General Internal Medicine. It’s actually the most numerous. There’s more Geriatricians than there are Cardiologists or Respiratory Physicians and so on. In terms of the medical specialty in the UK, we’re one of the most numerous in terms of Consultant numbers
Many countries don’t have established Geriatrics. We do however rely on a lot of foreign Doctors at several levels. In terms of consultants, we do have Consultants. In terms of our own Trust, we have Consultants from Spain and Italy who’ve been trained as Geriatricians.
Geriatric services also rely heavily on Locums. These Locums could be experienced Physicians.
A lot of Geriatric Medicine is actually just Internal Medicine. So, for example in our own trust we have physicians that have not trained in Geriatrics but can do the job essentially. It’s up to Trusts, Trusts can employ these people, if they want to. They won’t be employed as permanent consultants, because they haven’t been through a training program but to plug the gaps Trusts can do that.
In own trust for example, 2-3 Physicians are not Geriatrician trained but do practice. Once you get a bit of experience in Geriatrics, it’s not that different from Internal Medicine, to work in Geriatric Medicine.
Yes! A lot of Doctors are coming over as young Doctors to be trust grade SHO’s. So after a year or two of experience there, they can start applying for other programs. For example, GP Training posts but also they can then start applying for ST training posts. Those first few jobs that they do within the NHS, quite a lot of them do in Geriatric departments because there’s lots of gaps in Geriatrics departments. In our department we have lots of SHO’s from abroad. If they want to settle in the UK, they will then go on to apply for GP training schemes or ST programs in Geriatrics.
The majority of International Doctors do start at that level and then they’d need to take their MRCP to work at a more senior level.
Geriatrics in the UK is a very popular specialty now. 30 Years ago, it was like a Cinderella specialty where no one was really interested. Now it’s very popular! Because of the aging democratic, there’s a huge expansion in Geriatrics but we don’t have enough trainees or Junior Doctors in many of the Geriatrics departments, meaning there are lots of vacancies and a great specialty to go into!
A lot of International Doctors start as Trust Grade Doctors and have MRCP; meaning they can be employed at a Registrar level. From then on, when they’ve got experience, they can then apply for a full training program post. So, they can apply for ST4 for a 4 year training program and then at the end of that they can become a permanent Consultant. So, that’s one way of doing it.
Another way, is by coming in and working as a Trust Grade Doctor and if they’ve got MRCP, they can then also sometimes be employed by several Trusts at a Consultant type level.
The other option is, the CESR program. So that’s another possibility. So one of our Doctors here for example, is a Locum Consultant from Egypt. He came over and worked at another trust in the NHS as a Trust Grade Registrar. When they realized he was quite good, he began work as a Locum in Geriatrics, then he came over to us as a Locum Consultant. We liked him so much that we helped him go through the CESR Program. I was appointed as his mentor. So within 2 years, whilst he was working as a Locum, we gave him a session a week to get his training that he needed to do and prove his equivalence. It is a laborious process and you have to be really organized. He was rejected the first time and then we filled in his gaps, and he now has his CESR and an interview coming up for a Consultant in Geriatrics. He has shown his competencies that are equivalent to the ST training program. So, you can do that.
I completed my SHO year and then I did a Medical Registrar rotation and in that rotation I did some Geriatrics and I really enjoyed it. I had my membership already and I originally thought I’d be a respiratory physician but I enjoyed the Geriatrics rotation so much that I decided to choose that as a career.
A lot of Junior Doctors find that when they do Geriatrics they enjoy it more than they ever thought they would and then choose it as a career. The CT program for example, in those 3 years, it’s mandatory to do 4 months in Geriatrics. So everybody who wants to be a physician has to do 4 months within their core training in Elderly Care. Many enjoy it and want to do it.
First of all, Geriatrics is the only old style medical specialty that is left. All the other specialties are highly specialized within themselves now. For example, within Internal Medicine there is Respiratory, Gastro, Nephro and more! The old style general Physician knew everything. So, we’re one of the only broad general Physicians left. A lot of people like that because you’ve got to know your medicine and all of the body’s systems.
Secondly, older people present in atypical ways. A younger person with a heart attack will come in with chest pain and an older person may not present like that; they present with falls and delirium. They present in different ways and that’s a diagnostic challenge and that’s quite enjoyable. To be able to find what’s wrong with an older person when they become confused or start falling over, it’s interesting and to be able to make older people better is quite rewarding.
If you don’t take a Geriatricians approach and somebody becomes a little confused and they say “What do you expect, it’s aging!”, then those people go to nursing homes. But if you take a Geriatricians approach, you’ll investigate them and make them better and instead of them being put into a home, they are able to go and lead a good quality of life.
The third thing is, Geriatricians work in a multidisciplinary team. We work with nurses, occupational therapists, social workers – it’s a real team approach. I enjoy being part of a team.
Geriatricians now are super specialized as well, a Geriatrician might specialize in Eating Disorders, Parkinsons disease, Stroke, Falls, Osteoporosis. There’s also community-based Geriatrics, like I do, which is people in care homes as well. There’s also front door Geriatrics, ED for example. So it’s a very varied specialty with huge expansion and subspecialising options.
In your Geriatric training program, you are rotated to do some of these things. So registrars when they’re being trained will have to do a few months of old age psychiatry, a few months of fall, a few months of stroke. So during your training program you can choose one of them to subspecialise in and spend a bit of extra time practicing.
Many people become a Geriatrician and subspecialise afterwards. So if there’s a job for a General Geriatrician with an interest in Osteoporosis for example, you could always develop that interest as you would have the necessary skills given to you during the basic training
It’s very similar to any other General medical specialty. You’ll be taking examinations and providing treatment.
It’s the least boring, monotonous job as we have to know all of the organs and experience cases with all diseases, neurological and psychiatric problems. It’s very varied.
10% of Geriatrics is ‘End of Life Care’ but that’s also very rewarding because ensuring a patient has a high quality and pain free death is important. If you do it well, it’s very rewarding. It’s called Palliative Care but there aren’t enough Palliative Care physicians to do that work, so Geriatricians do a lot of it as well.
So, it’s a society of over 4,300 members. The majority of members are Geriatricians and Geriatric Trainees but we’ve expanded recently to also include membership for Allied Health professionals; Physiotherapists, Occupational Therapists, Nurses and GP’s
We get involved in a variety of things to do with education and training; to help and develop guidance for trainees. We do Continual Professional Development through a variety of conferences and lectures for health care professionals to come and learn and meet other likeminded people. We have a research committee which promotes the research into older people and a quality of care committee, who write Geriatric guidelines to improve standards of Geriatrics.
The BGS also get involved in Policy and campaigning for Care of the Elderly within the UK. We work closely with the Royal College of Practitioners and other organisations or charities such as Alzheimer UK and Age Concern.
Firstly, I’d tell anyone aspiring to work in Medicine within the NHS, to get their MRCP!
Then a Doctor should start by looking at a Trust Grade SHO position in any Trust. I’d also tell them that there are lots of openings and opportunities in Geriatric medicine. Every Doctor should try Geriatrics! I’m not saying you must stay there, but it’s a great starting point – even for Doctors wanting to go into other specialties like Respiratory or Cardiology.
Geriatrics will get you into the system. It’s a great way to find out how the UK system works and then you can go on from there.
If you are a Doctor, looking to work in the NHS within Geriatrics, send your CV to us: [email protected]