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Endocrinology and diabetes

This page provides useful information on the nature of the work, the common procedures/interventions, sub-specialties and other roles that may interest you.

Nature of the work

The main glands of the endocrine system are the adrenal glands, ovaries and testicles, pancreas, pituitary gland, parathyroid glands and thyroid gland. These glands secrete hormones (chemical messengers) into the circulation which have an effect on specific organs of the body.

Endocrinology and diabetes is predominantly an outpatient specialty but a number of patients require hospital admission for complex investigations or the management of complications. Furthermore, at least 15% of hospital inpatients have diabetes mellitus or other endocrine conditions. Increasingly, hospital-based specialists manage diabetes patients jointly with colleagues in primary care and training has been adjusted to reflect this. Patients usually have chronic conditions and management is holistic and long term often in a multidisciplinary team fashion.

Endocrinologists and diabetologists treat conditions such as:

• diabetes mellitus
• thyroid disease
• lipid disorders
• endocrine disorders of the reproductive system, such as polycystic ovary syndrome
• adrenal disease
• bone and calcium disorders
• pituitary disease
• endocrine late effects of cancer treatment

Common procedures/interventions

These include:

• programmed investigations for complex endocrine disorders
• pre and post-operative management of endocrine patients and patients with diabetes
• management of diabetic and endocrine emergencies such as ketoacidosis and hypercalcaemia
• management of diabetes and endocrine conditions during pregnancy
• multidisciplinary working with colleagues including specialist nurses, allied healthcare professionals, and other specialist clinicians

Sub-specialties

Many endocrinologists and diabetologists develop sub-specialty interests such as:

• diabetes in pregnancy
• paediatric and adolescent diabetes and endocrinology
• diabetic renal disease
• diabetic neuropathy and foot problems
• diabetic eye disease
• thyroid problems
• pituitary and adrenal disease
• reproductive endocrinology
• endocrine late effects of cancer treatment
• lipid disorders
• bariatric medicine
• metabolic bone disease
• neuroendocrine tumours

Want to learn more?

Find out more about:

• the working life of someone in endocrinology and diabetes
• the entry requirements and training and development

• Pay and conditions

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  This section provides useful information about the pay for junior doctors (doctors in training), SAS doctors (specialty doctors and associate specialists) and consultants.

  Find out more about the current pay scales for doctors, and there's more information on the BMA website.

  NHS Employers provides useful advice and guidance on all NHS pay, contracts terms and conditions.

  Medical staff working in private sector hospitals, the armed services or abroad will be paid on different scales.

• Where the role can lead

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  Read about consultant and non-consultant roles in endocrinology and diabetes, flexible working and about wider opportunities.

  Consultant roles

  You can apply for consultant roles six months prior to achieving your Certificate of Completion of Training (CCT). You will receive your CCT at the end of your endocrinology and diabetes training.

  Managerial opportunities for consultants include:

  • clinical lead - lead NHS consultant for the team
  • clinical director - lead NHS consultant for the department
  • medical director - lead NHS consultant for the Trust

  Most NHS consultants will be involved with clinical and educational supervision of junior doctors.

  Here are some examples of education and training opportunities:

  • director of medical education - the NHS consultant appointed to the hospital board who is responsible for the postgraduate medical training in a hospital. They work with the postgraduate dean to make sure training meets GMC standards
  • training programme director - the NHS consultant overseeing the education of the local cohort of trainee doctors eg foundation training programme director. This role will be working within the LETB/deanery
  • associate dean - the NHS consultant responsible for management of the entirety of a training programme. This role will be also be working within the LETB/deanery

  SAS doctor roles

  SAS doctors (Staff, Associate Specialists and Specialty Doctors) work as career grade specialty doctors who are not in training or in consultant posts. You will need at least four postgraduate years training (two of those being in a relevant specialty) before you can apply for SAS roles.

  Find out about the SAS doctor role.

  Other non-training grade roles

  These roles include:

  • trust grade
  • clinical fellows

  Academic pathways

  If you have trained on an academic endocrinology and diabetes pathway or are interested in research there are opportunities in academic medicine.

  For those with a particular interest in research, you may wish to consider an academic career in endocrinology and diabetes. Whilst not essential, some doctors start their career with an Academic Foundation post. This enables them to develop skills in research and teaching alongside the basic competences in the foundation curriculum.

  Entry into an academic career would usually start with an Academic Clinical Fellowship (ACF) and may progress to a Clinical Lectureship (CL). Alternatively some trainees that begin with an ACF post then continue as an ST trainee on the clinical programme post-ST4.

   Applications for entry into Academic Clinical Fellow posts are coordinated by the National Institute for Health Research Trainees Coordinating Centre (NIHRTCC).

  There are also numerous opportunities for endocrinology and diabetes trainees to undertake research outside of the ACF/CL route, as part of planned time out of their training programme. Funding bodies and charities offer fellowship schemes for trainees to undertake a dedicated period of research towards a PhD. Find out more about academic medicine.

  The Clinical Research Network (CRN) actively encourages all doctors to take part in clinical research.

  Other opportunities

  At consultant level, many specialists continue to make significant research contributions.

• Job market and vacancies

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  This section provides useful information about the availability of jobs, finding vacancies and where to find out more.

  Job market information

  The demand for specialists in this specialty is likely to increase to meet the needs of an ageing population and the increase in diabetes linked to rising obesity.

  Endocrinology and diabetes mellitus had 652 consultants and 431 medical registrars in England (NHS Digital, 2016).

  Women make up 31% of the consultant workforce, 51% of higher specialty trainees in the UK (2014/15 RCP census, 2016).

  In 2012-13, the consultant workforce contracted by eight in England, Wales and Northern Ireland.

  In 2016, the competition ratio for CT1/ST1 Core Medical Training was 1.53, and for ST3 Endocrinology and Diabetes was 1.96 (NHS specialty training 2016).

  The ratio of applicants to ST3 posts in 2015 was 1.8 (153 applicants for 74 NTN and 12 LAT posts) (JRCPTB, 2015).

  Find out more about the Centre for Workforce Intelligence’s profile of the endocrinology and diabetes mellitus workforce in England.

  On this section we have information for England only. For information regarding Scotland, Wales and Northern Ireland please click on the links below.

  NHS Scotland medical and dental workforce data

  NHS Wales medical and dental workforce data

  Department of Health, Social Services and Public Safety workforce information for Northern Ireland

  Where to look for vacancies

  All trainees apply through the online application system Oriel. You will be able to register for training, view all vacancies, apply, book interviews and assessment centres, and manage offers made to you.

  All jobs will be advertised on the NHS Jobs website.

  The BMJ Careers website also advertises vacancies.

• Further information

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  Organisations

  Royal College of Physicians

  Royal College of Physicians of Edinburgh

  Royal College of Physicians and Surgeons of Glasgow

  Association of British Clinical Diabetologists

  Diabetes UK

  Society for Endocrinology

  Young Diabetologists and Endocrinologists

  European Association for Diabetes

  Real-life stories

  Clinical Careers in Endocrinology and Diabetes (Society for Endocrinology)

  Careers in diabetes and endocrinology (BMJ)

  Profiles of people working in different areas of endocrinology (Society for Endocrinology)

  Dr Kelly Cheer, consultant in diabetes and endocrinology (RCP)