Medical Careers: Interview with Dr. Jonathan Fuld on specialising as a consultant in respiratory medicine
In a continuation of our series on medical careers, we’ll be focussing on the diverse specialisms available for those who choose to train in medicine. At the end of your medical degree you need to dedicate yourself to a field. Examples include a family physician, or specialties like paediatrics, psychiatry, surgery, academic medicine or respiratory medicine, to name a few. With a multitude of options, over a hundred — counting all of the subspecialties available, choosing the specialty that’s right for you may be a difficult task. We spoke to Dr. Jonathan Fuld, who has forged a successful career path as a consultant physician in acute and respiratory medicine, about what to expect.
Respiratory physicians specialise in the diagnosis and treatment of illnesses affecting the respiratory system - including the lungs, nose, trachea, pharynx and diaphragm. It is a hospital based position, and typically a hectic one, with a wide variety of diseases falling under the specialism. Many patients that are admitted to hospital as acute emergencies have a respiratory element to their illness. As a result, many respiratory specialists work closely with colleagues in Intensive Care Units (ICU’s). Other patients present themselves with ongoing chronic conditions in outpatients, so respiratory specialists typically experience a diverse patient case workload.
We spoke to Dr. Jonathan Fuld, currently Consultant in Acute and Respiratory Medicine at Addenbrooke’s Hospital, Cambridge, who provided key insights on his career path, motivators in choosing his specialty and the day-to-day challenges of his work.
Can you briefly describe your career path to date?
I studied medicine at the University of Sheffield, UK. I’d considered both Bristol and Sheffield as potential universities to study at, but since a family friend told me I’d be more suited to Bristol I opted to go for the alternative! Before I had completed my degree, a friend was working at the Glasgow Royal Infirmary, Scotland, and mentioned that it was a great place to work with a supportive atmosphere and colleagues. As a result, I applied there for my postgraduate training after graduating.
After starting, I completed medical rotations of 4 month periods in cardiology, gastroenterology, rheumatology, neurology and a final rotation in respiratory medicine. I really enjoyed the latter, due to the mix of medical challenges that the role involved, including acute and chronic disease.
I went on to choose respiratory medicine as my specialty, starting, what was referred to in Scotland as SHO3, where I was dedicated to one specialty for 1 year. Following that I completed a PhD., linked to Glasgow Royal Infirmary and University of Glasgow in exercise limitations in chronic lung disease. I was using strategies adopted by athletes, such as nutritional modifications, to see if they worked with patients. My first registrar post, also at Glasgow, in respiratory medicine followed.
My move to Cambridge came after a particularly sunny weekend, (a contrast to Scotland), visiting friends who worked there and enjoyed it. After relocating to the area, the first posts I took were at Papworth and West Suffolk Hospitals. I then applied for a 6 month locum position, which preceded a permanent consultant position in acute medical and respiratory medicine at Addenbrooke’s Hospital in Cambridge.
What were the key influencers for studying for medicine and choosing a medical career?
I came from a medical family. When I started looking for potential careers, I struggled to find an alternative to medicine, that would offer the parallel breadth of opportunities and interest.
"When I started looking for potential careers, I struggled to find an alternative to medicine, that would offer the parallel breadth of opportunities and interest."
There are a number of factors that influenced my choice to specialise in respiratory medicine. I had a great, supportive and friendly team during my rotation for respiratory medicine, whilst being a junior doctor in Glasgow. Additionally, I found the mix of problems patients face an interesting professional challenge. For example, they could range from acute severe illness to long-term lung health problems.
Moreover, there is an opportunity to learn technical procedures, as well as other specialist skills and an environment supportive of research. Respiratory medicine offers a range of further subspecialties to take if wished, so the opportunity to find the right role for me always felt available.”
Was it a difficult choice and did you consider other fields?
Yes, I considered gasteroenterology and diabetes specialisms as well. I think the key factor to note for anyone pursuing a specialty is there are always a range of opportunities available within it, so you will find something that is suited to you.
What were the key challenges involved in training for your specialism?
The postgraduate exams you take as a medical trainee can be daunting. You have to get to grips with the fact that failing and retaking these exams is commonplace. Many people have not failed before, so find this stressful. Additionally it can be very competitive trying to get your first registrar position in a place and speciality you wish.
What does your day-to-day work involve?
A typical day can be very varied, for example, today I have some clinical work with outpatients suffering from different lung conditions including chronic obstructive pulmonary diseases (COPD). Also, I’ll be helping provide ambulatory care to patients who have suspected blood clots or chest pain, that we manage as day cases to avoid hospital admission. At other times I am sometimes the consultant looking after patients admitted to the respiratory ward and am responsible for the team based decisions.
"A typical day can be very varied, for example, today I have some clinical work with outpatients suffering from different lung conditions including chronic obstructive pulmonary diseases (COPD). "
In addition, I have a clinical management aspect to my work in my parallel role as a Clinical Director. The latter involves team meetings to help troubleshoot specific issues in the department, and helping provide direction for the overall development of service.
I lead a clinical research group and this element of my role involves conducting research projects, applying for research grants and working with collaborators.
Addenbrooke’s is a teaching hospital and I currently work with the University of Cambridge to help co-ordinate suitable elective placements of undergraduate medical students with us and when our students go abroad. I also run a programme to ensure our students acquire core research skills whilst studying at Cambridge.
There are other aspects to my work which are unexpected and provide great variety. For example I am now preparing a grant to foster links between Addenbrookes, Papworth and the University with East African Respiratory researchers.
What experience and qualities do you need to work in your field?
You need to be confident in clinical practice, whilst being open and willing to learn from your mistakes. I think being a good communicator is essential, to ensure you are supportive and deal well with patients and your colleagues.
“You need to be confident in clinical practice, whilst being open and willing to learn from your mistakes. I think being a good communicator is essential, to ensure you are supportive and deal well with patients and your colleagues.”
What are the highlights of your working career to date?
Highlights include completing my PhD., and having the opportunity to present it, gaining a research grant and my consultant role. Also, being lucky enough work with wonderful colleagues along the way.
What do you enjoy most about your current role?
The people I have the opportunity to come into contact with at work.
What do you enjoy least?
I’m not the most naturally detail-oriented person, I have to try a lot harder with such tasks!
Key advice
- Remember that perseverance pays off, especially whilst training.
- The breadth of opportunities available to those in medicine is unparalleled.
- Even when you specialise, you should be aware that there are diverse roles available within specialties to match your interests.
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Useful links
- Dr Jonathan Fuld, Cambridge University Hospitals Profile: https://www.cuh.nhs.uk/corporate-information/services/non-clinical-services/centre-for-self-management-support/meet-team/dr-jonathan-fuld
- Addenbrookes Hospital, Respiratory Medicine Department: https://www.cuh.nhs.uk/addenbrookes-hospital/services/respiratory-medicine.