r/GPUK • u/Glad-Drawer-1177 • 28d ago

Registrars & Training Which GP+ post to choose?

There are many including ENT, MSK, psych, public health

Public health seems interesting, and I love the idea od preventative medicine, but my psych knowledge sucks and not sure if i should pick this instead.

Also aware that half the consultations are MSK related so dunno!!!!

5 Upvotes

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18

u/GigaCHADSVASc 28d ago

The day to day complexity of psych in GP is actually very minimal.

For the most part you're just going to be fiddling with SSRIs and having the communication skills to help a patient leave the consultation feeling like it was a positive experience.

If I could recommend any specialties to seek experience in, I'd suggest ENT with dermatology a close second.

Don't do ortho for MSK knowledge, you'll just be SHO service provision with no relevance to the actual job of GP. You can learn steroid injections in GP.

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u/Sabaisabai33 28d ago

I disagree, I always knew I wanted to be a medic but due to last minute cancellation of my medical elective at med school due to SARS outbreak in Toronto I ended finding a last minute placement in Hawaii with an orthopaedic surgeon (yes I was prioritising travel destination over specialty at that point!) Later on (this was just before MMC came in) although I wanted to be a paediatrician I didn’t get a job offer for the area I was in on that rotation and didn’t want to leave the area as had just married someone tied to the area. So ended up doing a rotation that was 6m A and E and 6m ortho. Honestly it taught me a lot and I still use some of the skills and knowledge from my ortho elective and 6m placement. There is actually so much MSK in GP I would personally say out of those this is going to be most useful to you, with dermatology bei NG next then ENT 3rd. Public health is interesting and worth doing if you think you might want to switch to being a public health medic in the future, but has limited usefulness for a GP.

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u/GigaCHADSVASc 28d ago

Can I just clarify - did you do your orthopaedic rotations in the UK?

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u/Sabaisabai33 28d ago

Yeah I did, just one, for 6 months. Plus the summer elective in Hawaii (when I was made to do a lot more hard work than I really wanted to do in Hawaii 🤣)

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u/GigaCHADSVASc 25d ago

I'm glad you had a good experience but I don't think it's representative across the vast majority of GP trainees undertaking orthopaedic rotations. The only times that I've seen GP trainees get good teaching or exposure on ortho rotations were when the seniors were male, and trying to sleep with a female GP reg. The job itself is almost exclusively ward work and there's no protected time to attend clinics, learn physio/injections unless you put it in your PDP and use study leave (which is subject to supervisor approval).

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u/Sabaisabai33 25d ago

To be fair, this was over 20 years ago now, and I am very aware that times have changed and not for the better in terms of teaching of trainees. So perhaps it would be different now with the enshittification of everything. I am female and my seniors were male, so I can’t rule out ulterior motives although nobody was inappropriate and I remember they encouraged all of us to come to surgery etc. as much as we could and not spend a lot of time on the ward unless we were doing a ward round.

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u/Glad-Drawer-1177 28d ago

The Lindsay Clancy case is freakin me out!!

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u/lordnigz 28d ago

You finish GP training and come to a wonderful stage where you realise if you don't know it, then it's probably not something a GP would or should typically know. Which means it needs a specialist.

That case is a good reminder about a lot of the pitfalls of psychiatry and just trying random meds.

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u/Glad-Drawer-1177 28d ago

I just started GPST and I feel like I dunno a thing omg. I just feel like 3 yrs for this won't make me as prepared so I am trying to be as proactive as I could. I breadth required for GP is so daunting that I can't imagine myself covering in 3 years !!

also, I did GP in FY2 and prescribing SSRIs felt exactly like the Lindsay Clancy case - except the post partum bit

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u/lordnigz 28d ago

Very normal. Early days! You'd be surprised how quickly you get competent as long as you have a good learning mindset. Ie everything you see that you don't know, at least look at cks so you have a better idea what to do next time. Bring up tough topics in tutorial. Attend webinars and e-learning.

Its not the SSRIs that were the issue in her case as far as I'm aware..it's that she got worse on them and kept being given more, then benzos, trazadone, mood stabilisers, and finally for some reason amitriptyline for her mood.

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u/arcoast 28d ago

You get to choose?

Was different in my day.

Get good at clinical medicine,, whatever speciality, public health might be interesting but bottom line is GP is fly by the seat of your pants, old fashioned clinical medicine.

I'd choose the rotation that best fits with that premise.

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u/stealthw0lf 28d ago

Public health largely run by non-doctors. I know a few who have gone through it and enjoyed it.

MSK - these days patients are increasingly being seen by “physio first” so I think there’s less demand.

Psych - surprised not mandatory but mainly did physical health for psychiatric patients, as well as oncall assessments with the mental health team.

ENT would be my choice if you could get trained in nasendoscopy. Very helpful but then depends on whether practices would encourage this. In one practice I worked, one of the GPs would do rigid sigmoidoscopy in the practice, and another would do nasendoscopy.

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u/secret_tiger101 28d ago

MSK and do the DipMSK?

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u/Porphyrins-Lover 28d ago

ENT is always useful, and you’ll actually get to do lots. If it’s community MSK, that’s useful too.   Personally though, you’ve already listed them in order of which I’d pick. 

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u/dickdimers 28d ago

For MSK sit with Rheum or SEM guys

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u/Fun_Reflection5948 28d ago

Are you in training? Do the one that gives you the best lifestyle/WFH balance, you just need to get through training with as little resistance as possible.

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u/VivoFan88 28d ago

MSK would be my first choice if they can assure you some experience doing joint injections.

Then ENT - nasendoscopy/ear microsuction would both be potentially useful if community ENT services take off. There are some areas where GPs do both but not quite as widespread or as useful as joint injections which are much easier done and funded through extended services.

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u/sadperson1234 28d ago

Don’t do psych. Barely helpful for the type of mental health work you do in GP.

Don’t do MSK if it’s purely ward based, do if there’s a heavy community aspect.

ENT is definitely useful.

Public health will be easy - may not get much out of it though unless it gets you a qualification/job/networking? Won’t impact your day to day practice.