Doctors working in stroke medicine provide acute care and on-going rehabilitation to patients who have suffered from a stroke. They provide accurate diagnosis and use investigations to provide safe and appropriate management of this condition.
This page provides useful information on the nature of the work, the common procedures/interventions and other roles that may interest you.
Nature of the work
A stroke is caused when there is interruption to the blood supply to the brain, which is often the result of a blood clot in a cerebral (brain) artery (ischaemic stroke). It may also be caused by the rupturing of a blood vessel in or near the brain (haemorrhagic stroke).
Some patients may suffer from a transient ischaemic attack (TIA), which is sometimes known as a “mini-stroke”, because the symptoms last less than 24 hours.
Stroke results in a range of debilitating symptoms and is the most common cause of death and disability in the UK, accounting for over 5% of NHS resources. This is likely to increase, given Britain’s growing ageing population.
Helping patients to regain their strength and recover function is an important part of stroke rehabilitation. Movement and sensation on either side of the body may be affected, and patients may also have problems with breathing, swallowing, balance, vision and communication. Helping patients to adapt to the impact of their health problems following stroke and to manage their own condition are all vital aspects of the work.
Stroke physicians work very closely with vascular surgeons, referring patients for surgery where necessary. They also work closely with neurosurgeons, referring patients for surgery where necessary and increasingly with interventional neuroradiologists, referring patients for clot retrieval therapy.
Stroke medicine is a sub-specialist branch of medicine in its own right and has only been recognised as such since 2007. The nature of the work can vary, as stroke medicine is a sub-specialty of the following areas of medicine:
- geriatric medicine
- rehabilitation medicine
- clinical pharmacology and therapeutics
- general internal medicine
- acute internal medicine
For example, a neurologist with sub-specialty training in stroke medicine may contribute to the provision of an acute stroke service and TIA clinic. Within geriatric medicine, the stroke physician may focus on a rehabilitation stroke unit, though there is considerable overlap.
All doctors working in this sub-specialty develop treatment and management plans for patients living with stroke illness. This includes rehabilitation, health promotion, secondary prevention and long-term support.
Doctors working in stroke medicine may also become consultants in another specialty. See the training and development section for more information.
Stroke medicine benefits from an exciting range of new techniques and treatments that have greatly improved recovery rates.
Common procedures and interventions include:
- thrombolysis – injecting a medication that dissolves blood clots with the aim of restoring blood flow to the brain
- using a catheter that is inserted though an artery in the groin to remove a clot, insert a stent and/ or deliver medication to the area of the brain where the stoke is occurring
- administration of drugs to lower pressure in the brain, lower blood pressure and prevent seizures
- using detailed CT/MRI scans to assess damage to the brain
- ECG, ultrasound and blood tests to aid diagnosis
New techniques are continually being developed, such as brain-cooling techniques that can be used in the early stages of a stroke to protect the brain from further damage.
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- Pay and conditions Expand / Collapse
This section provides useful information about the pay for junior doctors (doctors in training), SAS doctors (specialty doctors and associate specialists) and consultants.
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 Expand / Collapse
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 more about the SAS doctor role.
Other non-training grade roles
These roles include:
- trust grade
- clinical fellows
If you have trained on an academic pathway or are interested in research there are opportunities in academic medicine.
If you are interested in an academic career, consider applying for an academic clinical fellowship (ACF), particularly one that provides exposure to stroke medicine. This would enable you to develop skills in research and teaching alongside the basic competences in the foundation curriculum .However, it is not essential to take the academic foundation route if you are interested in pursuing an academic career.
Some trainees use their academic time to prepare an application for funding for a research fellowship leading to a PhD and subsequently apply for an academic clinical lecturer appointment.
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 trainees to undertake research outside of the ACF/CL route, as part of planned time out of their training programme. Find out more about academic medicine.
The Clinical Research Network (CRN) actively encourages all doctors to take part in clinical research.
- Job market and vacancies Expand / Collapse
Job market information
This page provides useful information about the availability of jobs, finding vacancies and where to find out more.
Stroke medicine is a small sub-specialist area of medicine. There are currently 197 stroke consultants in England (2014/15 RCP Census, 2016). Some of these also undertake work in areas other than stroke medicine. Women make up 25% of consultants, 67% of higher speciality trainee workforce in the UK (2014/15 RCP census, 2016).
Demand for stroke physicians across the UK is greater than supply and about 25% of vacancies remain unfilled. The high demand is partly due to the expansion stroke services and corresponding advances in technology.*
* Source: RCP Census of Consultant Physicians and Higher Specialist Trainees in the UK, 2013-4
In 2016 the competition ratio for Core Medical Training (CT1), the first stage in the training (post-foundation) was 1.53 (NHS Specialty Training, 2016). There are no available competition ratios for stroke medicine itself.
For information regarding Scotland, Wales and Northern Ireland please click on the links below.
Where to look for vacancies
All candidates apply through the online application system Oriel.
Local education and training boards (LETBs) will have details of training vacancies. Not all LETBs will offer new training posts in all specialties in all years.
All jobs are advertised on the NHS Jobs website.
Northern Ireland has its own recruitment process. For further details please visit the Northern Ireland Medical and Dental Training Agency website.
- Further information Expand / Collapse