Working life (AIM)
This page provides useful information about the roles and responsibilities of specialists in acute internal medicine, where they work, who they work with and what they feel about their role.
“Acute Medicine tends to attract dynamic individuals who enjoy the wide variety of medicine that can be seen on take and the diagnostic challenges that it may pose. Working in a fast-paced environment, Acute Medics tend to be quite ‘hands-on’ and enjoy working as part of a team; multidisciplinary team working is key to an effective AMU.” The Society for Acute Medicine.
How your time is spent
The working day varies according to the way the local AMU (acute medical unit) is run and the unselected nature of medical admissions. Most AIM doctors will spend a large part of their working day in the AMU but they will also see patients in the emergency department and on other inpatient wards.
Consultants will spend at least part of their day reviewing newly admitted patients, ensuring that assessment, investigation, diagnosis and treatment is progressing in a timely way. This is a hands-on job – urgent intervention may be required if a patient is critically ill.
Another key role is liaising with other specialties to determine whether a patient needs to be admitted to a downstream specialty ward or whether early supported discharge might be feasible. Meetings with the multidisciplinary team (MDT) to discuss these decisions are an important part of daily work.
Many AMUs will run an ambulatory care facility or rapid access outpatient clinics which will also need input from the AMU consultant.
Other activities will depend on the career interests of the individual doctor. Specialising in certain procedures, teaching and training, management and clinical leadership are just a few examples of the roles undertaken by medical staff in AIM.
On call and working hours
In keeping with the other emergency specialties, AIM operates 24 hours a day and all year round. The AMU does not shut at night, at the weekend or during holidays! Medical staff are increasingly working in shifts in order to allow adequate coverage for the out-of-hours period. At the moment, most consultants still work to an on-call system where they are available from home but this may change in the future. Over 80% are routinely on-call at weekends.
The EU Working Time Directive limits the working week to 48 hours.
Specialists in acute internal medicine work alongside:
- AIM colleagues (eg consultants, junior staff, trainees)
- acute medicine nurses
- medical secretaries and administrative staff
They also work closely with:
- A&E and critical care staff
- surgical teams
- allied healthcare professionals such as physiotherapists and occupational therapists
- physician associates
- social workers
Many AMUs now incorporate a GP service as well to deal with ambulatory medical patients requiring access to rapid investigations.
The clinical variety in AIM is one of the things that makes it so enjoyable. Trainees become experts in assessment, investigation, diagnosis and management across multiple disciplines. The challenge of diagnostic decision-making and the practical hands-on approach to treatment are also rewarding aspects of the role, eg a patient may have surgical or psychiatric diagnoses which have been attributed to a medical cause. There is a lot of satisfaction to be gained from working as part of a multidisciplinary team (MDT) whose primary aim is to improve the health and wellbeing of patients.
The fast pace and high intensity of the specialty is not for everyone. The high turnover of patients and the challenge of providing seven-day continuity of care makes this a busy specialty. You'll thrive in this role if you have the ability to work (and enjoy working) under pressure.