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Specialty spotlight – respiratory medicine

Dr Graeme Wilson, consultant physician in respiratory medicine, and Dr Laura-Jane Smith, ST6 respiratory and general internal medicine, share why they love working as respiratory physicians and what advice they have for getting into respiratory medicine.

Introduction to respiratory medicine

Respiratory medicine is concerned with the diagnosis, treatment and continuing care of adults of all ages with a wide range of respiratory and related conditions. It is an exciting and diverse specialty, blending a grounding in general medicine with expert respiratory knowledge and interventional skills. It draws together elements of many other specialties including:

  • oncology 
  • infectious diseases and public health 
  • immunology
  • sports medicine
  • palliative care.

Every subspecialty area involves a multidisciplinary team, which may include doctors (including respiratory physicians, oncologists, thoracic surgeons, pathologists and radiologists), specialist nurses, physiologists, physiotherapists, dietitians, smoking cessation advisers and psychologists.

Respiratory physicians have varied roles and deliver care from tertiary centres, acute hospitals, day centres, outpatient clinics, community clinics, and, with the growth of integrated care, the patient’s own home. You will deal with everything from airway emergencies to chronic care of patients over many years. There are research opportunities to work with stem cells and immunotherapy, genomics, pleural procedures, and breathlessness interventions. In addition there are roles in education, training and quality improvement.

If you love a practical challenge you can become an expert in bronchoscopy, endobronchial ultrasound and thoracoscopy.

There is something for every trainee. If you love a practical challenge you can become an expert in bronchoscopy, endobronchial ultrasound and thoracoscopy. If you are excited about imaging and diagnostic challenges you may find satisfaction in interstitial lung disease (ILD) and, for those of you who value connecting with patients and forming long-lasting relationships, you will be well suited to caring for those with chronic obstructive pulmonary disease (COPD).

Respiratory physicians around the UK are working on interesting and innovative projects to improve respiratiory care and services. Some examples of this can be found on the Future Hospital Tell us your story webpage. The RCP Future Hospital Programme is currently also improving respiratory services on two different development sites: Central and South Manchester and Sandwell and West Birmingham.

Training and working in respiratory medicine

Five key facts about training in respiratory medicine from the Specialty Advisory Committee (SAC) for Respiratory Medicine:

  1. Almost all respiratory trainees also train in internal medicine and complete their training with a CCT in each specialty. The basic ST programme is 5 years but many trainees spend additional time during their training 'out of programme' either doing research for a higher degree or gaining extra experience and training in a specialist area.
  2. A typical training programme will include placements in district general hospitals and teaching hospitals and will also include a 3–4 month placement in an intensive care unit. There will also be attachments to highly specialised teams treating patients with cystic fibrosis, pulmonary hypertension and lung transplants.
  3. All trainees will become skilled in bronchoscopy and pleural ultrasound together with the use of non-invasive ventilation to treat respiratory failure.
  4. The curriculum is flexible and able to be modified to accommodate less than full-time training (LTFT and academia). Currently, 12% of respiratory trainees are in LTFT training.
  5. General medicine is a key part of the job as our patients often have a number of co-morbidities. In addition, some diseases such as COPD and tuberculosis are more common in those with social problems such as poverty and poor housing. Respiratory physicians take pride in being able to care for the whole patient, not just one organ system.

You can find more information on the training pathway from the Joint Royal Colleges of Physicians Training Board. Learn more about the recruitment and interview process by visiting the ST3 recruitment page.

Respiratory medicine resources

RCP resources

Historical highlights from the library, archive and museum collection

There have been many distinguished specialists in respiratory medicine among the RCP fellowship. However, a report produced by the RCP in 1962 might be able to claim more benefit to the country’s lungs than all their individual efforts. You can read more about the respiratory health of the nation on the library, archive and museum blog.