The benefits of sub-specialising as a GP
Dr Krystyna de Lange
THERE are two types of medical students, according to Dr Krystyna de Lange—the ones who know their career trajectory from day one, and the ones who walk through the door and have no idea what they want.
“The latter was me,” Dr Krystyna de Lange laughs, “so in the hospital, I was really pushed towards doing a hospital-based specialty.”
“You don’t get a lot of exposure to general practice in the hospital...it feels very distant.”
“Often the tendency can be to just continue on the trajectory towards a hospital-based specialty.” While Krystyna enjoyed obstetrics and gynaecology, she found herself sitting back and wondering, “is this something that I really want long term for my career?”
The continuity of care drew Krystyna towards general practice.
“I really yearned to develop those long-term relationships with patients. I really wanted to be able to make a difference to patients’ experience and journey through life.”
“Growing up we had a great GP who knew the whole family and she was very approachable and she was very thorough. That gave me an idea of what a GP could be.”
Nervous about entering GP training, Krystyna felt like she needed to know everything before she started.
“I stayed in the hospital for another year and I did six months of paediatrics and then six months of emergency medicine to really try and broaden my skillset. I felt more confident coming into general practice.”
One day a week, Krystyna works at a tertiary hospital in a sub-specialised gynaecology clinic. The clinic is designed to help reduce the public waitlist numbers; many patients wait a long time to see a specialist for conditions that can be managed by a GP with extra training—GPs such as Krystyna.
“From the beginning, I really enjoyed doing obstetrics and gynaecology. The problem was that I didn’t want to just do that.”
“I also found that I enjoyed the things that the specialists didn’t necessarily get to do, such as contraception and menopause.”
While GP positions in hospitals are uncommon, Krystyna says there is an increasing scope in this area. The key to pursuing any special interest, Krystyna says, is about putting up your hand early on and letting your interests be known in the hospital system.
“It’s very hard to go back to the hospital system once you’ve already left. “Any experience you bring with you into general practice is invaluable.”
“When you come out to your general practice terms, look very closely at the practice that you’re choosing. Ask yourself, ‘Does this practice have GPs there that can support me in this special interest?’.”
While obtaining extra qualifications during your GP training can be a “juggling act”, Krystyna says that extra education is worth the effort.
“Put your hand up for things as well...you just don’t know what that door will open.” Many doctors wonder, ‘Why sub-specialise as a GP when you can become a specialist in that area?’.
According to Krystyna, being a GP with special interests allows you to do more.
“I love caring for a woman during a pregnancy. But I also want to be the one that helps the baby.”
“I don’t want to have to say, ‘Oh sorry, you’ve had your baby now and your care goes to someone else’.”
“I want to be the one doing the six-week check for the baby, the vaccinations, talking about the child’s development, and supporting the mum.”
Krystyna says GPs have more flexibility to tailor their career in the long-term.
“As a GP I’m not stuck thinking, ‘I’m now in this specialty and I can’t really back away’. There is plenty of opportunity for me to then turn around and decide, ‘Well, actually I want to do extra training in dermatology and skin cancer and focus my practice there’.”