MJA THE MEDICAL JOURNAL OF AUSTRALIA NUMBER 3 • 2 AUGUST 2010 Careers Careers In this issue C1 Pathology paths explored C3 Q&A with Professor Simon Chapman C7 Coin honours ophthalmologist Fred Hollows Pathologists push for greater numbers Careers C8 – C9 Locums C10 – C11 Executive Appointments C11 Hospital Appointments C13 GP Opportunities C15 Marketplace C1 IF THERE are as many corpses littering the streets as television detective programs would like us to believe, then there should be a pathologist on almost every street corner too. The reality is that pathologists are in short supply. And very few deal with corpses. Indeed, the field of pathology is experiencing tremendous change with new specialties evolving rapidly as knowledge of human genetics grows. Modern pathology is not an invisible role spent in isolation in a laboratory in a hidden part of a hospital. While that may have been the case in the past to some extent, it also partly explains the shortage now. Pathology was targeted for cuts some years ago when medical administrators were looking at ways to slash budgets. That translated into more than 100 positions being lost in this country, according to Dr Debra Graves, chief executive of the Royal College of Pathologists of Australasia (RCPA). “The same thing happened overseas too at the same time, so there’s a worldwide shortage. Pathology was an easy target compared with front-line doctors. “Hospitals could cut those positions more easily, and they thought automation would fill the gap,” she says. The college is pushing for more training positions, and is hopeful the Australian Government will extend funding further in recognition of the fundamental shortage, which it has acknowledged. Traditionally, there are 600 pathologist trainee positions overall in Australia. While the majority are funded at state level, the federal government is funding 53 additional positions because it is perceived as an area of high priority. There are also about 80 trainee positions within the private sector. The situation is urgent because many of the 1460 medical pathologists in active practice are ageing. Some 10% are older than 65, and 22% are over 60. Dr Graves says many are holding on through dedication, but would like to retire; and if too many choose to do so before trainees complete their programs, the number of pathologists could fall again. Within pathology, there are 10 areas of specialisation, ranging from the smallest discipline of oral pathology through to the biggest, anatomical pathology. In between come chemical, clinical, forensic, general, and genetics pathology, haematology, immunopathology and microbiology. Training involves 5 years in accredited laboratories. The college accepts applications from registered medical practitioners, usually with 2 years’ or more postgraduate experience; however, applications are also considered after 1 year’s experience. Applicants must be employed in an accredited laboratory before seeking registration. Training involves sitting three exams, starting with basic pathological sciences, which is usually taken in the first year of training. It can also be undertaken before starting by any intern, medical or dental student in their final year, as well as by registered trainees. There are also two sets of discipline specialty exams, the first usually taken in the third year, and the final exam in the fifth (or final) year. Training can be undertaken in general or clinical pathology, or in one of the specialties. The RCPA training program is linked to training programs of the Royal continued on page C4
Transcript
MJATHE MEDICAL JOURNAL OF AUSTRALIA
N U M B E R 3 • 2 A U G U S T 2 0 1 0
CareersCareers
In this issueC1 Pathology paths explored
C3 Q&A with Professor Simon Chapman
C7 Coin honours ophthalmologist Fred Hollows
Pathologists push for greater numbers
CareersC8 – C9 Locums
C10 – C11 Executive Appointments
C11 Hospital Appointments
C13 GP Opportunities
C15 Marketplace
C1IF THERE are as many corpses littering the streets as television detective programs would like us to believe, then there should be a pathologist on almost every street corner too.
The reality is that pathologists are in short supply. And very few deal with corpses.
Indeed, the fi eld of pathology is experiencing tremendous change with new specialties evolving rapidly as knowledge of human genetics grows.
Modern pathology is not an invisible role spent in isolation in a laboratory in a hidden part of a hospital. While that may have been the case in the past to some extent, it also partly explains the shortage now.
Pathology was targeted for cuts some years ago when medical administrators were looking at ways to slash budgets. That translated into more than 100 positions being lost in this country, according to Dr Debra Graves, chief executive of the Royal College of Pathologists of Australasia (RCPA).
“The same thing happened overseas too at the same time, so there’s a worldwide shortage. Pathology was an easy target compared with front-line doctors.
“Hospitals could cut those positions more easily, and they thought automation would fi ll the gap,” she says.
The college is pushing for more training
positions, and is hopeful the Australian Government will extend funding further in recognition of the fundamental shortage, which it has acknowledged.
Traditionally, there are 600 pathologist trainee positions overall in Australia. While the majority are funded at state level, the federal government is funding 53 additional positions because it is perceived as an area of high priority. There are also about 80 trainee positions within the private sector.
The situation is urgent because many of the 1460 medical pathologists in active practice are ageing. Some 10% are older than 65, and 22% are over 60. Dr Graves says many are holding on through dedication, but would like to retire; and if
too many choose to do so before trainees complete their programs, the number of pathologists could fall again.
Within pathology, there are 10 areas of specialisation, ranging from the smallest discipline of oral pathology through to the biggest, anatomical pathology. In between come chemical, clinical, forensic, general, and genetics pathology, haematology, immunopathology and microbiology.
Training involves 5 years in accredited laboratories. The college accepts applications from registered medical practitioners, usually with 2 years’ or more postgraduate experience; however, applications are also considered after 1 year’s experience.
Applicants must be employed in an accredited laboratory before seeking registration. Training involves sitting three exams, starting with basic pathological sciences, which is usually taken in the fi rst year of training. It can also be undertaken before starting by any intern, medical or dental student in their fi nal year, as well as by registered trainees.
There are also two sets of discipline specialty exams, the fi rst usually taken in the third year, and the fi nal exam in the fi fth (or fi nal) year.
Training can be undertaken in general or clinical pathology, or in one of the specialties. The RCPA training program is linked to training programs of the Royal
continued on page C4
C2
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www.mjacareers.com.au • Number 3 • 2 August 2010MJA Careers
Professor Simon Chapman is a rebel with a cause; a dedicated antismoking campaigner whose passion for public health started with a successful campaign to reduce the impact of tobacco advertising in the late 1970s. He was also involved in graffi ti attacks on advertising billboards as part of the BUGA UP movement. A former director and chair of the Australian Consumers’ Association, which publishes Choice magazine, Prof Chapman made the move into public health after starting out with a degree in media sociology. He takes addiction seriously. Not content with stopping the advertising of tobacco products in Australia, Prof Chapman hopes his work can be extended to developing countries where smoking levels are climbing in tandem with prosperity.
Name Simon Chapman
Job title Professor of Public Health
Time in position
At the University of Sydney since 1986
What aspect of this job appealed to you most when
you applied or were appointed? And now?
Then it was the opportunity to work directly
with Professor Steve Leeder. Now it’s academic
freedom and learning from great students.
Career highlights? Any lowlights/disappointments
you’d like to share?
Being able to look back over 30 years and
seeing the end of tobacco advertising, all
indoor public smoking gone, massive pack
warnings and, soon, plain packaging.
My research played a part in some of this,
as did my advocacy along with others’.
The 1996 gun law reforms were also
magnifi cent. Disappointments? The academic
day never ends.
What have been the biggest surprises in your working life?
Learning early that most research is never read or cited by anyone but its authors. And learning how not to make that be said of my own.
What do you hope to be doing — or have achieved — in fi ve years’ time?
More involvement in international tobacco control to assist with the take-off phases of what Australia experienced in the past 30 years.
The person/people who have had the greatest infl uence on your career — mentors, sources of inspiration or unexpected opportunities
The late Professor Henry Mayer, Department of Government, University of Sydney; Dr Nigel Gray, for his worldliness; and Michelle Scollo, Australia’s most consummate, but camera-shy tobacco control researcher.
What interests do you have outside public health?
I have a vast collection of contemporary African music. I keep koi fi sh and sing in a covers rock band, the Original Faux Pas (http://www.facebook.com/pages/The-Original-Faux-Pas/116370731720721).
Any career tips or suggestions for young doctors or others interested in this fi eld?
Politicians don’t read your research, but they hear you on the radio and read about it in the press. Forget the Ferrari. Work–life balance is so important.
What was your fi rst paid job?
Excluding bob-a-job with the Scouts, working in the menswear section of Myer–Western Stores, Bathurst.
Greatest indulgence during working hours?
Working without interruptions; Campos coffee; quiet jazz on in the room.
What are you reading now, for business and pleasure?
The galleys of an 800-page book by a colleague in the US on the history of tobacco control. Lionel Shriver’s So much for that, about the impact of illness on relationships.
If I could change one thing in the world of medicine or research it would be …
To get politicians to take chronic disease as seriously as they take “the rule of rescue”.
MJA Careers profi les interesting and important jobs and the people who do them
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C8 C4
www.mjacareers.com.au • Number 3 • 2 August 2010MJA Careers
Australasian College of Physicians in some disciplines, allowing joint training and fellowships of both colleges upon completion.
The college is actively promoting careers within pathology, with swathes of information on the broad range of careers available on its website. It also has a program of lobbying, planned to ensure government ministers know what pathologists do and the important role they play in delivering good health outcomes, particularly with an ageing population. It wants to ensure that 500 extra places over 5 years are delivered, in line with assurances made in 2004.
Dr Graves also says the profession has some strong drawcards. Part-time training is an option and not uncommon, particularly in Queensland where training can be very fl exible.
“There’s also not as much on-call work as in other specialties,” she says.
In some years, up to 60% of fi rst-year trainees are women. Dr Graves says it is a good career for
both sexes though, with fl exibility in training, combined with generally more civilised work hours than in some other specialties. However, pathologists working in blood-banking and organ transplant areas do face more out-of-hours work.
Medical pathologists are also fortunate that automation has delivered considerable benefi ts by reducing the amount of mundane work they need to do. Within laboratories, there are also scientists and technicians to share the workload, and to ensure medical pathologists are not distracted from more interesting work.
Associate Professor Paul McKenzie, President of RCPA, who works at the Royal Prince Alfred Hospital as an anatomical pathologist, says pathology has changed considerably since he started his career in 1979.
“The work has become more important as treatments have changed, particularly with cancers. It’s a direct clinical role. Communication skills are important; pathology is part of a team
process and certainly not isolated.“For medical students considering
the fi eld, it still allows them to have an overview of the entire patient and a global knowledge of the disease process.
“You are operating as a doctor, as a team member, and you are important,” he says.
Anatomical pathology deals with
tissue diagnosis of disease, which may
Prof Paul McKenzieCare
ers
continued from page C1
continued on page C5
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C5
be biopsy material taken from a patient in an operating theatre, on the ward, or from an autopsy.
A large part of the work involves the detection and diagnosis of cancers. The tissue diagnosis determines what combination of surgery, radiation or drugs is most likely to be effective and help patients avoid the worst side effects of some treatments. This is followed by ongoing monitoring of the response to treatment and progress of the disease.
Anatomical pathology means having a broad knowledge and understanding of the pathological and clinical aspects of many diseases, Prof McKenzie says.
“Pathology is always interesting because it deals with such a diverse range of conditions. There is the old-fashioned view of pathologists doing autopsies, but that fi eld alone is becoming increasingly specialised.”
Prof McKenzie cites pathologists who specialise in looking at fetus deaths, along with other emerging areas of specialisation, ranging from skin pathology through to genetics.
Some of the biggest changes have
happened within treatment for cancers, as chemotherapy strategies are tailored to the patient’s precise genetic make-up or the presence of specifi c mutations. An example is the effectiveness of the use of Herceptin (trastuzumab) for breast cancer treatment.
Indeed, genetic pathology is the most recent discipline to evolve within pathology. It has been underpinned by rapid advances in recombinant DNA technology, allowing the sequencing of the genetic make-up of individuals.
Using this knowledge are two main branches of laboratory genetics: clinical cytogenetics, which involves the microscopic analysis of chromosomal abnormalities such as those associated with Down syndrome; and molecular genetics, which uses the tools of DNA technology to analyse mutations in genes. Genes have been identifi ed that are associated with such diseases as cystic fi brosis, breast cancer and diabetes mellitus.
Dr Graves says this fi eld is an extremely exciting one as the genomic revolution would impact on so many areas of disease management.
Linda DrakeMJA Careers
continued from page C4
www.mjacareers.com.au • Number 3 • 2 August 2010MJA Careers
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C7
THE work of ophthalmologist Professor Fred Hollows has been recognised with a new $1 coin.
The coin, released by the Royal Australian Mint, shows Prof Hollows holding an intraocular lens that was subsequently implanted into the eye of an Eritrean patient with vision impairment due to cataract.
The late Prof Hollows worked extensively with Indigenous Australians and in developing countries to provide eye treatment and surgery to those who were blind or visually impaired, usually because of cataracts.
Passing on skills by training doctors and others to perform the surgery was an integral part of his approach. His work continues through the Fred Hollows Foundation, which was founded in 1992, the year before his death.
Last year, the foundation restored sight to 190 000 people in 18 countries, and trained 5000 eye health workers.
Prof Hollows arrived in Australia from
New Zealand in 1965, and soon became involved in improving Indigenous health services. He was concerned by the low standards of eye health among Indigenous people in remote
towns and communities and, in particular, high levels of trachoma.
Prof Hollows headed the National Trachoma and Eye Health Program in the late 1970s, which screened 100 000 people in 465 communities, treating about 27 000 people for trachoma.
His work expanded to developing countries after trips to Nepal, Burma, Sri Lanka, India and Bangladesh with the World Health Organization in 1985, where he saw great need for cataract surgery. He visited war-torn Eritrea in 1987, where blindness was widespread because of the effects of bright desert light and poor nutrition combined with a lack of basic medical resources.
Prof Hollows developed plans to build an intraocular lens factory in Eritrea to reduce the cost of the lenses which, at the time, was about $US100 ($A115) each. He hoped
to bring the cost down to about $US10. Another factory was built later in Nepal.
At the time, Prof Hollows said: “By signifi cantly increasing the supply of high quality intraocular lenses to developing countries, we will reduce one of the barriers to disadvantaged people having their sight restored.
“They are the most expensive little bits of plastic in existence,” he said.
The uncirculated Fred Hollows coin, which is aimed at collectors, is based on a portrait by photographer George Fetting. It was sculpted by mint engraver Vladimir Gottwald and is the third in the mint’s Inspirational Australians series.
Gabi Hollows, co-founder of the Fred Hollows Foundation and Prof Hollow’s widow, says it is ironic his face is now on a coin considering he spent so much time asking people for money to fund his work in blindness prevention.
“Fred would probably tell everyone to buy the coin, but then donate it to the foundation,” she says.
The coin is available through the Royal Australian Mint in Canberra.
Eye surgeon honoured with new coin
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Schwartz’s Principles of Surgery 9th Rev EdWorld renowned Schwartz’s Principles of Surgery provides a solid grounding in basic science, anatomy, and operative techniques so critical to the education and success of any surgeon. Offering the most modern and complete approach to surgery and written by the world’s foremost academics and practitioners, this is a necessary resource for surgical education and a cornerstone of any clinical practice. New to This Edition:
signated as critical for thics, and surveys specific
issues in surgical and professional ethics, the general principles and considerations of palliative care, and care at the end
of surgical video clips.
The Australian Medico-Legal Handbook The Australian Medico-Legal Handbook
accompanying software an ideal content delivery method. Key features include:the most commonly
S
Mosby’s Dictionary of Medicine, Nursing and Health Professions 2nd ANZ EdIncludes Online Companion
on, a thorough ecise and clear entries,
plus encyclopaedic definitions of significant terms; generous illustrations and apt use of tables; a detailed colour atlas of anatomy enhances the comprehension of anatomical terms; local spelling conventions and phonetic pronunciation guides; fully revised etymologies. The online resources
Key features include:New to this edition:
tal of 73 new and and incorporate many
New Oxford Textbook of Psychiatry 2nd Rev Ed
fostered closer ties with philosophy, and these are leading to healthy discussions about how we should diagnose and treat mental illness. This new edition recognises these and
the underlying science, and to the evidence for the efficacy of treatments. Physical and psychological treatments, including psychodynamic approaches, are covered in depth. The history of psychiatry, ethics, public health aspects, and public attitudes to psychiatry and to patients
education and reaccreditation, and as a specialist’s reference.
MJABookShop Price $67.00*
MJABookShop Price
$93.00*
To ORDER, or for further information, contact the Book Sales Coordinator: AMPCo, Australasian Medical Publishing Co Pty Ltd ABN 20 000 005 854
Schwartz’s Principles of Surgery @ $285.00* The Aust. Medico-Legal Handbook @ $67.00*
Mosby’s Dictionary of Medicine, Nursing and Health Professions @ $93.00*
New Oxford Textbook of Psychiatry @ $595.00*
*Prices include GST *10% discount for AMA Members and Students*PLUS Postage and Handling $7.65 (Aust), *All prices subject to change without notice
To: Dr/Mr/Ms: ....................................................................................................................................
Suit one energetic or two part-time Doctors. Excellent position. For value of real estate only (contents and goodwill included).
Tel. 0428 600 633 for further information.
MELBOURNESuite 2, 517 St Kilda Rd, Melbourne
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together with separate large general office plus reception area, special disability toilet/bathroom, large kitchen with dishwasher. There is a garage with attached storage room and parking for a further five cars.This property has access to Highway and has a rear lane. There is also a council approved large front sign. Contact the landlord on 0418 160 898 or email to [email protected]
Seeking a caring medical family for Simon 16 y for one year in Sydney.
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