Professor Rachel Crowley is a consultant endocrinologist at St Vincent’s University Hospital Dublin and a Clinical Professor at University College Dublin in Ireland. In our interview, she tells us about her career, shares her thoughts on the future of endocrinology and considers the possible improvements patient care.
Tell us a bit about your current position
My job is a mix of clinical work, research and teaching. Ours is a busy centre for neuroendocrine tumours and adrenal pathology, and I run the rare bone disease service which is a national Orphanet clinic. I also cover pituitary, gonadal, thyroid and general endocrine clinics, inpatient diabetes and endocrinology consults and general internal medicine. I love endocrinology because for each patient I assess and reason from scratch, it’s never boring.
What are you proudest of in your career so far?
I’m proud of how the trainees I have worked with on my team have progressed in their own careers and how they have kept in contact. The Christmas cards, emails and WhatsApp messages from around the world are lovely to receive. I gave a talk at virtual ENDO this year and a trainee in Canada realised I would be getting a train home late from work after the panel discussion – she messaged me to be sure I got home safely! These personal connections make a big difference.
How much has your work changed since you started your career?
The general internal medicine commitment has increased, even in the relatively short time since I have been a consultant. The developments in endocrine genetics and in adrenal medicine have happened quickly in the last 10 years so it can be challenging to keep our practice up to the standards we expect of ourselves. The increased contact with patient advocacy groups is very welcome and rewarding – that was something that we didn’t learn about as undergraduates or have much exposure to as trainees.
What do you think have been the major milestones in clinical practice during your career?
There is far more insight into the impact of genetic profiling on the clinical care plan for individual patients. Immunotherapy has had a huge impact on clinical oncology but has generated a whole new cohort of patients for us as endocrinologists. Improvement in oncology patient survival has also generated a cohort of survivors who have a wide range of endocrine late effects we need to address, as well as recognising the psychological impact of their experience.
What do you think are the biggest challenges in endocrinology right now?
I think the big challenge is reconciling the need for specialisation with the need for good basic care. Endocrinologists are often committed heavily to general internal medicine and I think we’re very good at it, because our specialty is broad and our training makes us excellent problem solvers. Our specialty contribution should not be overlooked because of our general medicine contribution. And of course we need to recognise when we need expert input and when we need to step up and become that expert ourselves.
What are you most looking forward to as part of the future of endocrinology?
I’m looking forward to more recognition of our specialty by outside stakeholders – because I think that will lead to more robust funding of doctors, nurses and research by national bodies. I think we’re working hard towards that increase in profile. The more access we have to genomics and proteomics, the more I think we’ll be able to deliver an individual treatment plan for the patient sitting in front of us – I think that’s really attractive to patients and satisfying for us in our own practice.
Who has inspired you most in your career?
I have had the benefit of lots of mentors over my career. Chris Thompson supervised my MD in craniopharyngioma and I learned the importance of intellectual rigour and patient-focused intervention from him. His colleague Mark Sherlock was a peer mentor, if such a thing can be said; Mark’s value for collegiality and networking to deliver better patient outcomes has led to ongoing clinical and research collaboration today. In my time at the University of Birmingham Paul Stewart and Wiebke Arlt led by expecting the highest standards from all of us – everybody raised their game – and Neil Gittoes was a key link with the Society for Endocrinology and my career development after completing training.
Do you have any words of wisdom for aspiring endocrinologists?
Keep reading. Keep asking questions. Keep going to meetings and thinking – how does this apply to my patients? Keep talking to your patients and telling them about these new developments you’re hearing about. Keep in touch with your former colleagues and be a good collaborator. Keep an open mind, apply scientific rigour and make up your own mind.
The Society for Endocrinology is 75 years old in 2021. As part of our celebrations, we are collecting members’ opinions, with a focus towards the future – after a particularly hard year for us all!
We are keen to reflect the diversity and breadth of our discipline by hearing from members across all backgrounds, career stages, career types and geographical locations, to get a true flavour of the range of views, needs and challenges faced by our Society members.