So, you've done the hard work: interviews, nightshifts, supporting juniors, passing exams, and maybe even moving country. Now you're eyeing the final hurdle, your first consultant post, and wondering how to secure it and what it will be like.
The truth is, like everything, it's a mixed bag. You will get the job in time, but it might not meet your expectations initially. Michael J Fox said, "My happiness grows in direct proportion to my acceptance, and in inverse proportion to my expectations."
Consultant roles, like many jobs, have changed over time and will continue to do so. Getting there is only half the battle, but there are some things you can do to prepare.
What do consultants do?
Consultants manage patients from start to finish. This can be a challenge when you realise that you have ongoing responsibility to patients over months and sometimes years.
Remember, you aren't expected to be an expert at everything right from the start. You're expected to manage the common things well and to recognise when you need help. That doesn't change when you're a consultant. Try not to take on big things too early - there will be time enough for that as you grow in experience.
Not only is it managing patient care, it's also all the administration around that: the clinics, the letters, the organisation of beds, and integration into one or more multidisciplinary teams. All these responsibilities require time, often more so than the simpler task of looking after patients.
On top of that, consultants handle various other administrative tasks such as helping to organise, support and even fund service developments, contributing to the appointment of junior colleagues and peers, dealing with relatives, managing deaths and addressing complaints. You might also engage in research and even an independent practice.
Whether or not you do this is not something you need to decide immediately, but all consultants will also have to ensure they are continuously developing and contributing to appraisal.
How being a clinical fellow might prepare you
Clinical fellow posts often expose senior trainees to aspects of clinical care they may not have experienced as juniors. They also provide a chance to demonstrate the skills needed to be a great consultant.
Being a good administrator, recognising the limits of your knowledge, supporting students and junior doctors, and fostering - rather than souring - relationships with different teams are key indicators of professionalism beyond the day-to-day care of patients.
If you can do this while remaining calm, professional, kind and responsible, you're demonstrating the hallmarks of what it takes to take on the top job.
What makes a good consultant?
'Good' is difficult to define and it will change depending on whose view you're seeking.
Consultants have many roles, both within their department and the wider organisation, so it's almost impossible to be good at everything. Concentrate initially on managing the basics well and consider approaching things in the way your mentors have shown you through training
Mentorship and learning
Mentorship isn't limited to training; we all need someone to turn to and discuss things with, and just because you're a consultant doesn't mean you don't also need support or someone to talk to. You may want to do this even more than you did as a senior trainee. Good consultants have good mentors, so find one and use them.
Being a consultant is the start of a new learning process, not the culmination of all learning, so keep reading, learning, and considering whether you might be wrong in certain views. A willingness to embrace uncertainty, and reasonable degree, is a strength, not a weakness.
Support and defence
Remember your medical defence organisation; things will inevitably go wrong in every career and having support on your side is vital. While defence organisations are excellent for reviewing medico-legal or ethical issues, organisations like the BMA are best placed to advise you on contractual issues.
Admin and time management
Given there is a huge amount to do in a 10-session job, the best consultants excel at time management and decisiveness. Developing and demonstrating personal management and organisation skills early on will help you in the long run.
One particularly helpful skill is ruthless administration of your email inbox. You'll get hundreds of emails a day and you don't want to miss the important things, so set aside a little time every day to go through them. Be prepared to delete, delegate or defer if things don't need to be dealt with immediately.
If you receive an email that triggers strong emotions, feel free to write the response you want to, but don't send it immediately. Leave it in your drafts and review it the next day - things often feel different after a night's sleep.
Leading and decision-making
Another crucial skill that's hard to develop as a junior is the ability to say no. You'll be offered many opportunities, and it's often better to take on fewer but complete them to the best of your ability. Remember, "if you never say no, what will your yes be worth?"
Your training may have taught you to be an astute clinician, but it may not have helped you develop the leadership skills that all consultants need to demonstrate. It's worth actively seeking out leadership training and opportunities. Your trainees and colleagues will be grateful you did.
Top tips to help you prepare
- Gain experience in the areas you wish to pursue and seek feedback from everyone, not just consultants. Nurses, juniors, and ancillary staff are important in the running of any team.
- Critically appraise your skills and actively address areas of improvement in your personal development plan (PDP).
- Be reflective when things go wrong; demonstrating that you've learned from adverse outcomes or events shows you're a thoughtful practitioner.
- Be prepared to network. Sometimes it can feel embarrassing, but introducing yourself to prominent figures in your field can open doors.
- Keep patients central to your decision-making as a doctor. Putting yourself in their shoes will often help you communicate better and manage difficult situations.
- Trust, but verify. As a senior trainee and junior consultant, it's sometimes necessary to check important details. For example, you don't want to discover a low platelet result just before surgery.
Advice for when you're appointed
- Ensure you have a formal induction and pay attention.
- Remember, even as a consultant, you are part of a big machine. Don't expect everything to be organised perfectly when you start.
- Don't run before you can walk; avoid taking on cases and challenges that the rest of the team are avoiding without careful consideration.
- Actively seek a mentor and use them. Even basic pathologies can become more challenging when you're fully responsible.
- Remember you have a life outside work. The best doctors manage both. Don't sacrifice important relationships for work; hand over your patients carefully to the right people and enjoy your time away.
This page was correct at publication on 18/07/2024. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.
by Dr Jerard Ross MDU medico-legal adviser
Jerard graduated from the University of Aberdeen in 1994. He then moved into surgical training in Edinburgh before completing his M.D. at the University of Manchester. Before joining the MDU he was a consultant in adult and paediatric neurosurgery in Edinburgh where he was the surgeon to the Scottish National Paediatric Epilepsy Programme. He is now the medical education lead and head of Scottish affairs for the MDU.