Career Focus

Finding the right consultant job

BMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7064.2 (Published 26 October 1996) Cite this as: BMJ 1996;313:S2-7064

Look at yourself, then the post, says Harrogate paediatrician and career counsellor Doug Gillies


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After higher specialist training most consultants remain loyal to a single organisation for the whole of their working life, which maybe 25 years or even longer. You might think, therefore, that the choice of consultant post would be one that was made with the utmost circumspection; a decision on a par in importance, for example, with deciding whom to marry. Yet prospective candidates for consultant posts generally devote less energy to thinking through the potential realities of a particular post than they do in deciding on their lifelong partner.

Even with enormous initial enthusiasm and commitment more than one third of marriages end in divorce. Many consultant appointments start with the same aims of fulfilment as those taking the walk down the aisle. But for some the grand plans and dreams prove illusory, and the relationship between consultants, their colleagues, and the employing trusts end in bitter acrimony. Ultimately there may be a divorce of kinds with early retirement or prolonged withdrawal from the workplace.Look around your trust or hospital-you will not find it hard to find disillusioned consultants.

Knowing yourself and having a realistic view of the working life of consultant will enable you to anticipate the problems and challenges that will face you from the first day of your appointment and allow you to make the best choice of post.

Team working

Consultants are members of teams, and an awareness of how the differing skills, abilities, and priorities of team members relate to your own is essential. If you are unable to feel an integral part of a particular team life can become, at the very least, uncomfortable.Practising medicine can be a demanding pastime. It is all the more so if you feel an outsider in team meetings and discussions. Indeed, in such circumstances, the likelihood is that ways will be found to marginalise your contribution, which can rapidly lead to disenchantment with your working environment.

The opposite is also true. Being a valued team member will heighten self esteem and bring added value to the organisation where you work.It is prudent to look for opportunities to participate in team working where your contribution will enhance the team's effectiveness.Hospital consultants are an integral part of many teams and this aspect of work can make or break a career. Some knowledge of your preferred modes of operating will help you to position yourself effectively in the workplace.

Personality

Doctors share many common aspirations but their personalities can be very different. Learning a little about your own personality and assessing that of your prospective colleagues can help in the process of making the difficult decision of where to apply for a consultant post. Discovering the organisational ethos of your prospective employer and finding out whether it matches your own individual aspirations will pay dividends.

The final years of training are a good time to assess your personality and review past assumptions. You may find management courses helpful;target those which will involve you closely in interactions with others. Psychometric questionnaires and exercises give you an opportunity to assess your personality more directly (see box), and if you have the opportunity to undergo such assessment you should take it. Good management courses will allow you to compare your scores with others while retaining confidentiality. You might wish to discuss the results with the course organisers or a trusted colleague, junior or senior.

Knowing the results may help you decide what kind of job to apply for.The best teams consist of individuals whose personalities and skills complement each other. All hospital consultants must necessarily be capable of autonomous behaviour, but an excess of this trait can make it difficult for a person to integrate, particularly if other colleagues share a similar need for independence. Such a person might function best in a large group of consultants, where differences can be smoothed over or in a position where team working and multidisciplinary decision making are not prominent. Similarly, an individual with highly developed leadership traits would need to find a job where that potential can be maximised.

Even knowing basic personality traits such as introversion and extroversion can help in making choices. The introvert will function best in an environment where silence and contemplation are possible at some time during the working day, whereas the extrovert will thrive on frequent contact with others.

Personality clashes

These can be highly destructive, causing widespread unease throughout a department, and have been responsible for many consultants' disenchantment with their career. Clashes should be avoided by considering carefully your team role. Are you a natural leader or a contributor? If you persistently clash with another member it may be because you are too similar or too disparate in nature. It is vital that you find your niche and are complementary to the team as a whole. Find out what kind of team member you are and play that part to the best of your ability.

Clinical skills

These are acquired through a long period of medical training,ranging from the highly practical such as siting drips to less concrete skills such as dictating effective letters. These skills are best learnt with support and supervision and should be built on when you become a consultant. Continuing support for skill development is a factor that you should be looking for when assessing a job. Some type of monitoring or supervision might be desirable.

Be realistic about your skills. If you struggle with potentially stressful practical tasks in the middle of the night acknowledge this to yourself and seek out an opportunity where this scenario will not present itself or get trained better so that it will not be a problem.If you choose to ignore this problem you may get by for a while but,before long, problems will arise and stress levels will mount.

Management skills

At the trainee stage, management development might involve the “small m” skills- for example, goal setting, developing realistic aims, and time management. People skills-for example, effective negotiation and handling aggression- will also prove invaluable in future clinical and managerial areas. Landing a consultant post brings the opportunity to participate insignificant “big M” management roles-sitting on a hospital committee or being a representative of a group of colleagues.Traditionally the new consultant inherited these by default. Resist this as far as possible; seek out those areas where you are interested and can contribute. If you do not you may find yourself bogged down in endless meetings of dubious benefit or acting as a representative of a group whose opinions differ widely from your own. If possible find roles which will give you the opportunity of observing effective chairmanship and creative group working in action.

Later in your career there will be the chance to be involved in various regional and national organisations as well as taking on a formal role such as a clinical director. Again, choose wisely, basing your choice on what fits best with your unique personality, interests, skills, and abilities. If you do take up a formal management role try to ensure that you are given appropriate training, support, and time to do the job successfully. This aspect of medical management is rarely considered in depth by those undertaking managerial positions.

It may be helpful to separate skills and abilities, regarding skills as predominantly learnt activities and abilities as areas where you have always shown an aptitude. Perhaps you are a person who has always had a talent for leadership or for organising others. If so seek out opportunities to enhance this. Similarly, if you are a contemplative type and an intuitive thinker do not become saddled with chairing a boring and pedantic committee. You should be the best judge of where those talents and aptitudes will be best placed. If you can do this both you and the organisation you work for will flourish.

Psychometric assessments of personality

  • 16 PF This questionnaire identifies 16 sets of personality factors that are analysed in three sections and have been widely used in recruitment and development. A questionnaire is scored to yield ‘criterion scores', which reveal areas of personal preference such as creativity and leadership-'career theme scales' give information on preferred patterns of working-for example, ‘analytical-investigative'. The third section deals with management team roles-for example, team worker or chairman. In addition there is an overview of personality plus comparisons with other groups. This questionnaire has been widely used in recruitment and career development.

  • Belbin's roles in groups This self administered questionnaire was developed to give a simple means of assessing an individual's best team roles. There are eight potential roles identified including “company worker,” who sorts out objectives and pursues them logically and the “plant,” who provides the team with original ideas, suggestions, and proposals.Your preferred mode of operating together with a ranking for other ways of working in groups are identified. Most people will recognise their preferred style.

  • Myers-Brigg indicator Introduced in the United States in 1975 this has become one of the most widely used personality indicators in general use both in the public and private sector. It reveals fascinating insights into the way individuals tick and the ways they interact with others. For example, an intuitive doctor might be having difficulty persuading nurses to give intravenous drugs.Nurses often have a personality which favours a ‘step by step' approach to this type of issue. If this difference is ignored, thinners may withdraw support feeling that the doctor, more interested in the result than the process, has shown no regard for the steps necessary to complete the task effectively. Common ground can be found if they both realise that the other sees the same issue from a different personality base.

Getting the wrong job

Although there is increasing mobility among the consultant ranks,most remain in a single organisation for their working life. Beware of flattery when applying for a post and speak to as many people as possible, not just those who you think you will like. A pleasant place to live or the possibility of a large private practise will not compensate for poor relationships with colleagues or a feeling of stagnation in your parent organisation. Knowing yourself and others will allow you to have the best chance for career satisfaction; an innovative person will choose an innovative trust, which the deeply conservative person will sensibly avoid.

If you do eventually find that you have made the wrong choice it is best for yourself and others to reconsider early on in the appointment.The decision might well be an emotional one and is no less valid for that. Ask yourself, do Ireally belong here? If the answer is no and the situation cannot be changed it might be best to leave. A realistic assessment of yourself and your prospective employer will hopefully make this unnecessary. Good hunting!

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