Working life (GUM)
This page provides useful information about the roles and responsibilities of doctors in genitourinary medicine, where they work, who they work with and what they feel about their role.
“I was attracted to what is essentially an outpatient-based medical specialty that is rapidly developing. This field has always been focused around patient access, education and care, making it a very rewarding area to work in at all levels. The GUM units that I came across as a student and trainee also appeared extremely friendly places to work in.” GUM specialist.
Many patients in sexual health clinics are young adults so this specialty is almost unique in dealing largely with those who are fit and active; but the rates of sexually transmitted infection in older adults are rising.
Patients come from a variety of cultural and social backgrounds and from the entire spectrum of sexual orientations. Bacterial STIs can be cured, which makes this a particularly satisfying branch of medicine.
Although viral STIs can’t always be cured, they can be managed effectively and patients are usually extremely grateful for explanation and advice about issues such as partner notification and behavioural change. HIV and sub-specialty patients may have complex medical problems as well as various psychosocial issues.
How your time is spent
GUM is predominantly an outpatient or clinic-based specialty with most centres providing inpatient care on a consultation and shared care basis. Additionally, there are opportunities to be involved in outreach and community clinics.
A GUM trainee will perform a minimum number of GUM and HIV outpatient clinics each week. Specialists are likely to see 10-20 patients per clinic, with two clinics a day.
In major centres, you will normally undertake ward-based care for HIV inpatients, which includes regular participation in ward rounds with other doctors and nursing staff.
As with any doctor, part of your working week will involve administration and meetings, and may also include teaching, training, research and audit.
On call and working hours
Most GUM clinicis operate during normal working hours (usually 9am to 5pm) with a few late clinics (up to 9pm) in most services. Increasingly clinics are open on Saturdays.
You will normally participate in a GUM on call rota for advice and acute patient management – at least during some stages of training. On call is not onerous, and can often be done remotely, providing consultation and advice by phone. Just over 30% of consultants say they are routinely on call at weekends. Adequate time for administration, study, teaching, research and management training is provided.
Doctors in genitourinary medicine work alongside:
- specialist nurses
- health advisers
- health care assistants
- laboratory technicians
- social workers
- medical secretaries and administrative staff
They also work closely with:
- other medical specialties such as acute medicine, obstetrics and gynaecology, sexual and reproductive health, paediatrics, dermatology and A&E
- community specialist youth and HIV services
- public health services
- mental health services
Management of sexual health and HIV involves dealing with infections and practices which are stigmatised and somewhat still taboo in society. The ability to establish a rapid rapport with patients to facilitate full disclosure and allow appropriate management of diseases can be both challenging and rewarding when you are dealing with young people, refugees, people with psychosexual disorders and people who have been sexually assaulted or exploited. Self and social awareness is vital as the social, cultural, language and sexual orientation of the physician and the patient may vary.
The opportunity to work within a multidisciplinary team providing holistic treatment (care of the whole person) can be very rewarding. Bacterial STIs can be cured, making this a particularly satisfying branch of medicine.
Although viral STIs can’t always be cured, they can be managed effectively and patients are usually extremely grateful for explanation and advice about issues such as partner notification and behavioural change.
Being able to sub-specialise in a particular area of work and to have an impact on services at a local level can also be satisfying. There are regular opportunities to implement new sexual health initiatives such as 48-hour access targets for GUM, national chlamydia screening and antenatal HIV screening programmes.
HIV and sub-specialty patients may have complex medical problems as well as various psychosocial issues which can sometimes be challenging.
The field is rapidly evolving which provides opportunities to develop a varied role which includes research and audit.
Working in GUM provides flexibility in balancing clinics with teaching and research, management and personal commitments.