Tropics has it all for infectious diseases specialist

Infectious diseases consultant and microbiologist Dr Carly Hughes has seen her specialties come to the fore during the COVID-19 pandemic.

“People have realized what infectious disease (ID) physicians are and what they do,” the Townsville University Hospital (TUH) specialist says. “People are considering ID as a career, and it's a really rewarding one. It brings a lot of aspects of medicine together.”

Innisfail-born Dr Hughes graduated from James Cook University in 2007 and did her junior doctor and basic physician training in Townsville. She finished her five-year dual training program in ID and microbiology in Newcastle and Melbourne before returning to Townsville early in 2022 as a specialist.

COVID’s beginnings

Working as an ID consultant in Melbourne for the first two years of the pandemic, Dr Hughes was at the coalface when a returned traveller from Wuhan became Australia’s first confirmed case of COVID in late January 2020.

“We had the first ever COVID patient in Australia in my hospital in Melbourne,” she says. “Initially in 2020, when we had COVID wards full in Melbourne, we had nothing to offer patients. It was quite a shift for us. There were no treatments, and a lot of people were dying despite our best conservative measures. We weren't used to that.

“Now there are a few treatments that are effective, and the vaccines that have been developed demonstrate scientific research to practice. It just shows what the scientific community of the world can do when they have the right funding and the impetus to create new things.

“We're seeing fewer hospitalisations, but the patients we have here are still quite complex. TUH have done a great job in their COVID planning and the infectious disease unit is really well run. General medical and specialty colleagues are admitting their own patients with COVID as well, so there's both an inpatient role and an advisory role.”

The specialties

Dr Hughes is employed full-time as an ID consultant at TUH: “We manage inpatients with complex or difficult-to-manage infections, a proportion of COVID work, and consult on other specialties to provide assistance in managing infections.

“The second side of my training is microbiology, which is the lab aspect of diagnosing infections. Microbiologists work in the microbiology laboratory alongside scientists.  This is where they culture, for example, samples for bacteria, as well as the molecular diagnostics for pathogens, and serologic testing looking for antigens or antibody production in response to infections. 

“Microbiology is a laboratory-based specialty. They assist with diagnostic and management advice, as well as antimicrobial stewardship, infection control and intensive care rounds. Without it, the hospital would stop. Every diagnosis that doctors make usually has some pathology results behind it.”

The Royal Australasian College of Physicians (RACP) and The Royal College of Pathologists of Australasia (RCPA) work in tandem to deliver an education program that is split into three years of training in microbiology and two years of ID.

Infectious diseases in the Tropics

“I call ID a thinking specialty,” Dr Hughes says. “You have time to sit down and think about your patients and think about what could be going on and what tests would be best to diagnose that infection and then you know how best to treat them. Dr Robert Norton was one of my supervisors as a medical student and junior doctor and working with him and his colleagues and training under excellent registrars drew me down that path a bit. But I also really liked that it's one of the few specialties where you can cure people most of the time, there's usually a treatment and they usually get better.”

“I came from Melbourne in a very large metropolitan centre with a very busy caseload. When I looked at the consult list on my first day back here, there was such a spectrum of infections, some things I hadn't managed a lot of ever, really, and there were multiple cases ranging from tropical infections to very unusual presentations of infections to heaps of common ID things.

“The caseload here is fascinating. I think it’s a real drawcard for infectious diseases physicians to work somewhere like this. There are lots of different things going on, lots of really good intellectual things to get your teeth into, but also a large spectrum of work."

“Particularly if you want to work in the north, infectious diseases is really rewarding. It's a very interesting and varied specialty. You don't see infection presenting the same way twice and there's a potential for curing patients. There's a real need for further research and advancement of our specialty.

“Every specialty has their own infections, but we get the complex and difficult diagnostic ones and it can be really rewarding when you get that right and you can offer some treatment and the patient gets better.”

Training pathways

“You can do pure infectious diseases, which is a three-year training program through the college of physicians (RACP) after you’ve completed basic physician training. You can do dual training, which is the two specialties, infectious diseases and microbiology, in five years. You can combine infectious diseases with other physician specialties, so commonly people will do infectious diseases plus general medicine, which is a nice combo. You can do pure microbiology which is a five-year training program through the college of pathology (RCPA) so you don't have to do physician training first.”

Work and play

Dr Hughes is one of a number of early JCU medicine graduates who have returned to North Queensland as consultants recently. “My colleagues from JCU who are back here are the people I reached out to, to get the lay of the land of the hospital. They all encouraged me to come back and said Townsville was a great place to work, and perhaps even more importantly than that, a great place to raise a family.”

“It has a small-town hospital feel with every specialty represented. Training in big cities, you might not get your specialty of choice, and you might not meet half of the consultants in the team. For example, in Melbourne, there were between 20 and 30 ID physicians at my hospital, whereas here there are currently five. Here, the students are integrated into the team. The clinical experience here is superior to down south, especially for exposure to specialties they may not have considered, because they get access to every specialty here.

“It was difficult in Melbourne in lockdown with a young family. We really missed family contact, socialising, friends and the North Queensland way of life. When this job came up, it was a good opportunity and time to move home. Coming back here we've just noticed such a lifestyle change. We're out doing something every weekend and everyone's so welcoming and sociable. It's just a really nice place to live and work, and that's so important.”

‘Everything's available here’

Dr Hughes did placements in Mount Isa, Charters Towers and Townsville during her JCU studies. “Having a wide exposure to a number of different specialties here really helped consolidate my career path,” she says. “I had significant career uncertainty even though I knew I wanted to be a physician, I didn't know what type of physician. I did renal, neurology and ID here and enjoyed them, which made it a bit more difficult to come to a career decision. 

“There were fewer of us then, but Townsville is unique in that as a medical student, you get one-on-one teaching and tuition, and you get to develop mentor relationships with clinicians you admire. You have the opportunity to go and then train in any of the specialties. Everything's available here.

“Part of the reason I came home was that a lot of my colleagues from university are back here. I loved training here and I love the medical school. It has a good reputation, and I think the JCU students are recognised to be very competent doctors.”

NQRTH connects medical students, intern and junior doctors with a network of opportunities and resources designed to create a supportive and clear path to specialist (including general practice) training, and beyond, in our regions. Our network works together to strengthen medical specialist training with the view to build a health workforce prepared to meet the health needs of our regional and rural communities in Cairns, Central West, Mackay, North West, Torres and Cape, and Townsville. NQRTH is facilitated by James Cook University, who partner with hospital and health services and training providers to create a connected career pathway beginning at the medical undergraduate level right through to fellowship.