AUTHORS: Dr Sanketh Rampes and Dr Anvarjon Mukhammadaminov
In this series the Medspire team interviews doctors about their career, their specialty, the choices they have made and their advice for doctors and medical students.
Here the subject is Dr Simon Broughton, a general paediatrician and Director of Child's Health at King's College Hospital. Dr Broughton holds multiple senior roles in education and training, including the recruitment lead for the Royal College of Paediatrics and Child Health.
A podcast of this interview is available here:
How did you get to where you are today?
Like most doctors, I think my journey's reasonably interesting. I qualified from medical school in Southampton. When I finished, I said I definitely don't want to work in a teaching hospital, I definitely don't want to do any research, and I definitely don't want to be a specialist.
I just want to be a general paediatrician. I managed to fail in all three of those. I did end up in a teaching hospital, I did end up doing research, and, initially at least, I was a specialist paediatrician, but I've loved my journey.
After qualifying I went into standard training. I did a two-year SHO rotation, and then I thought, what things do I find the scariest? For me, it was hearts and kidneys, so I went off to do a cardiac and a renal SHO job. This was in the days when you could choose your jobs and apply for them.
I then got onto a standard registrar training programme. After two years on that I went to spend a year in Australia working in Sydney doing retrieval, flying out over the whole of New South Wales in helicopters and planes and jets and ambulances.
I've got some fantastic stories and memories from that year. Then I came back to some organised research, which was initially going to be an MD but then rapidly became a PhD. I ended up back at King’s as a consultant in general paediatrics and high dependency.
Through my career I've given up the high dependency and just do paediatrics, which I love, and I've moved into management. I've done other things along the way, like set up a master's and run that for ten years, which was great. I think I've had a very varied career path, which helps when giving advice to people about their career choices as they go through their life.
What attracted you to paediatrics and when did you make that choice?
I actually made that choice before medical school. I’ve always felt more comfortable speaking to children because children don't lie. I'm not saying adults lie, but they sometimes overcomplicate the truth, and there's this extra layer of complexity about their life that can make finding the underlying problem more challenging, whereas most children, once they can speak, will just tell you what the problem is.
It's very clear. Also, working with children and their parents, and being part of that triangle of communication, is very satisfying actually, to get that right and always keeping the child and the family at the centre of everything that you do. I chose it before medical school. I did one year of house jobs in adults, and other than that I've been in paediatrics since 1995. For me, I've not regretted a day. I think I've got the best job in the world.
What makes a great paediatrician?
There are 17 specialties in paediatrics, so there's pretty much the same number of specialities as there are in adults, everything ranging from rheumatology to neurology to renal to cardiology, to paediatric intensive care, neonatology, community paediatrics, and general paediatrics, which is what I do. I think the key thing about all paediatricians is that they enjoy working with children and families.
They put those at the centre of everything they do, and mostly, I would say probably 99%, paediatricians have got excellent communications skills. Ironically, the profession that's most like us is care of the elderly, which again is that multidisciplinary team working together, putting the patient first and centre with lots of conversations that can cover things that people might consider to have an ethical dimension.
We have those in paediatrics, and they do in care of the elderly. So, strong communicators, a wide range of different personalities, and people who just enjoy coming into work and working with children and their families.
How did you get involved in research?
I rapidly grew up after my ideas about what I didn't want to do after medical school. I wanted to work in a hospital a bit like King’s, where I am now, where there was everything that was available, including all of the sub-specialities that make it interesting, as well as being a general paediatrician, which I knew I wanted to be.
I was appointed in 2007 when having a postgraduate degree was essential for most consultant jobs, and having a PhD or an MD was almost certainly essential for King’s. When the opportunity came around in an area which I was particularly interested in, which was bronchiolitis and its long-term effects on prematurely born babies, I took that opportunity.
There are some people that go through life and have everything mapped, and of course you have to have a plan, but then sometimes life offers you opportunities. For me it's about recognising opportunities when they arise and taking them.
I got offered the chance of doing a PhD, which I absolutely loved, and it has enabled me to really value and help to motivate the researchers of the future. I've supervised some other PhD students since then and remain at least partially involved in academia. I would highly recommend it for anybody who's got an inquiring mind.
What are the biggest changes you have witnessed within paediatrics?
I've been doing paediatrics since 1995. The most significant changes have been in the workforce, where there are now significantly more junior doctors and consultants than when I started, but I don't think the work intensity is any less.
If anything, I would say the work intensity at the front door is more, driven by public expectations and by perhaps having a slightly more educated population than we had when I was growing up. Also everyone's now got a smartphone and has information at their fingertips.
When I started, people used to carry around books with them, now everybody just has all of that information at their fingertips. Before it was about access to information, now it's about application of information, and making that patient-centred.
They're the key things: workforce; work intensity; and the effect of the virtual world.
You're the recruitment lead for the Royal College of Paediatrics and Child Health. What does that involve?
I got involved in recruitment a long time ago, actually, a year or so after I was appointed as a consultant. I helped out at a recruitment round for London, and the consultant who was running the process was a wonderful lady called Hillary Cass, who then became the president of the Royal College later in life.
I guess she must have recognised something in me, and offered me a role being the recruitment lead for London. This was one of those sliding doors serendipity moments that you just need to recognise and take advantage of.
I ran London's recruitment for about ten years, and we went from interviewing about 150 to 180 SHOs every year up to interviewing about 300 at one point for about 100 jobs.
When the opportunity of getting involved in national recruitment arose at the Royal College, I applied for it and got it, and was initially the deputy lead for training, but the main lead for recruitment. Now I've got a full officer role for recruitment and lead a team at the College.
It’s a vital role. When a trainee or a medical student looks at the front face of the College - on the website or on social media - we need to offer a message about what we offer as a career. Hopefully we are inspiring the next generation of paediatricians.
What advice would you offer someone thinking about a career in paediatrics?
We created a video about four or five years ago. It's called Why Paediatrics? and you can find it on YouTube. We asked about 20 paediatricians why they wanted to choose paediatrics, and they probably answered more eloquently than I will just now. One of the things to consider are the colleagues you'll be working with for the next 25 to 30 years.
If working with paediatricians puts a smile on your face then clearly that's what you need to do. Equally, working with children, young people, and their families needs to put a smile on your face.
It's perfectly reasonable to try these jobs, and it used to be that we had the opportunity following foundation jobs where you could spend two years doing paediatrics, emergency medicine, general practice, and obs and gynae.
Unfortunately that's been removed, but hopefully it will come back. Doctors are very young - about 25 or 26 - at the time they have to choose their career.
Are there any tips or recommendations that you can offer about how to prepare a strong application?
The number of applications going into paediatrics has varied a lot over the last five years, and at one point we weren't able to achieve a 100 % fill rate but, recently, we've been very close to 100 % fill rate.
We have about 450 places across the country in paediatrics at ST1 level, of which about 100 are in London. This year we had about 800 applicants, of which we interviewed 600.
The application process is an application form, carrying out the MSRA test, which is similar to the UCAT test with a situational judgement test as well as clinical reasoning, and then the interview.
In terms of the application form, you certainly have an opportunity to demonstrate your commitment to paediatrics. Put down any courses that you might have done such as a safeguarding course or a resuscitation course, or an audit or a quality improvement project, on anything really that's relevant to paediatrics.
I remember one applicant who said to me that she had deliberately not done any paediatrics during foundation years because she knew she was going to be a paediatrician.
She wanted to get as much experience in everything else before becoming a paediatrician, which was a fantastic answer. It's about demonstrating on your application form that you've got the attributes that we're looking for, which are quite difficult to train.
Those attributes are strong communication skills, wanting to work with children and their families, the ability to be creative in the way you think, and most importantly, the ability and desire to work as part of a multidisciplinary team. That can be demonstrated through child health experience, or any experience really.
What does your role as clinical director at King’s involve?
At King’s we're across Denmark Hill and the Princess Royal Hospital. We have about 90 consultants. We have a budget of about £85 million and about 700 employees. When you're clinical director of a division like that you need to almost think of yourself as the chief executive for running that, and treat it as your own personal business that you've helped to create.
The key thing is really valuing your workforce. We are absolutely dependent upon the people that we work with, and you need to look after them. You need to be focused on what it is that you're trying to deliver, which is excellent care for all children.
King’s is a bit different from other hospitals: we've got the biggest liver service in Europe for children, with the biggest number of liver transplants in Europe and one of the biggest in the world with truly world-class outcomes.
We have the second-biggest neurosurgical department in the UK for operating on paediatric brain tumours. And we have lots of other specialties like respiratory, gastro, endocrine, neurology, haematology, as well as having a big general paediatric department and a big neonatal and paediatric intensive care.
Effectively, we're a bit like a district general hospital for our general paediatric provision, and a teaching hospital for all of the specialties. I think the magic of King’s is pulling all of that together, and making it more than the sum of its parts.
What made you decide to get involved in management?
I never saw myself as a manager but one of the key things to be a successful manager is you need to have good people skills. You need to want to make the service better and be absolutely committed to it.
I think humility is a real great strength in leaders, and see my job as empowering the clinical leads to make their services better. I certainly never thought I would stick it out for as long as I have.
I've been involved in management for about five years and one of the key reasons I've managed to persevere is that I tend to not worry too much about things.
I do my best, absolutely my best for the whole team when I'm at work, but when I go home I can separate work from home to some extent. Having that work-life balance is so important, and I can sleep at night.
When you get to a situation where it's affecting your home life, or it's affecting your sleep, that's probably the time to give it up. At the moment I'm still enjoying it. It's the people, the people skills and making things better which is what inspires me.
Do you have any suggestions on how to get involved in management?
I think there's lots of managerial opportunities for medical students and certainly for trainees. I just met an SHO for whom I'm the educational supervisor. We were talking about managerial opportunities and he's going to take on running the teaching rota for the department.
In any of these roles, the key thing is that you're dealing with people and you're negotiating with them to come up with a plan to organise them and make the service better.
The things you really learn are negotiation skills and an ability to compromise and move things around. Any opportunities where you can do that will pay off with your career in management, and it doesn't need to be in medicine. If you're involved in a sporting organisation, a musical organisation, and you're doing anything managerial that will really stand you in good stead for a career in management.
The key thing is: always learn. I do lots of reading, and you need to read around the subject of leadership, learn from the leaders who inspire you and take on the bits that you think are relevant for you. Obviously, there are certain aspects of some leaders who you probably don't want to take on.
Steve Jobs was amazing, but clearly a very difficult person to work with, so I have no intention of wanting to be anything like Steve Jobs, but I can 100% recognise what an amazing organisation he created. Learning from others, I think, is key.
Would you recommend any extra qualification in business or management?
My true leader role model was a guy called John Moxham, who used to be the medical director at King’s. He was the dean of the medical school. He was the head of strategy for King’s Health Partners.
The key thing about him was that he was just wonderful to everybody, and always made you feel valued. I heard him give a talk on this, and the first thing he said was that he'd never had any course or training in management, and it was just something he learned going through life.
Doing a course is fine. I didn't do a formal course in management, but I run the service delivery management and leadership module on the MSc that I helped to create. You have to accept that with any course there's an element of brainwashing, that you're going to learn stuff that is going to affect you as you move on.
The key thing is to get the tools that those courses offer and work out how to use them, and then work out how to create what it is that you're looking for using the tools that you've learned from the course. The course is not the be-all and end-all. The be-all and end-all is actually doing the job and learning from the people that are around you.
What are the challenges of being a clinical director?
It won't surprise you that a key problem is finances and managing the income and the expenditure. Planning for the future is challenging, and if you stand still you're effectively going backwards.
You do need to plan for the future and think about how you're going to develop and improve the services you're involved with.
The hardest thing has been some interactions with certain individuals. You really need to have many different ways of working with many different people.
Not everybody sees the world as you do. However, if you work with them effectively you can make things a lot better. Learning different ways of working with different people is the greatest skill, but it can be quite challenging.
Do you find combining a management job and a clinical job difficult?
Not really. When I am clinical I try to separate myself completely from my managerial responsibilities, and I've got a deputy who helps me to keep that going. I think you see the world differently when you're a clinical manager because you're always thinking about quality, about risk, about governance, about finances, and about people and workforce.
Ultimately, you're a paediatrician, and finally you're doing the bit of the job that you were trained to do. I love being the general paediatrician consultant of the week and on the wards. I'm on this weekend and actually looking forward to it. Certainly, still the bit of the job I love the most is being clinical.
How has Covid affected the care of children?
It's been a real difficult journey, as it has for everybody. In terms of the degree of the clinical service being affected by Covid directly, paediatrics was relatively spared. We did have lots of admissions in wave two but, because of social distancing, we had far fewer admissions with bronchiolitis, and other infections, than we would normally have.
The actual number of patients that we had coming through paediatrics was significantly less than we would have in a normal winter. However, like everyone else, we had to deal with our workforce becoming unwell, the redeployment of juniors, consultants and the nursing staff, the stopping of the elective surgical operating lists, and the stopping of routine paediatric outpatients. That has left us with a massive hill to climb to get back in control of our waiting list for surgery and for outpatients.
Many of our consultants helped out in adult intensive care, helping communicate with relatives or being clinical on the shop floor. We managed to create some space in paediatrics that adults could use. Our paediatric intensive care became mainly an adult intensive care, and it was the paediatric staff that were doing all of the care. You had paediatric consultants and nurses caring for elderly patients, and doing an absolutely brilliant job.
Both the adult and the paediatric clinical teams really learned a huge amount from each other. It's been a challenge, but we've got through it. What we've got to cope with now is a really tired workforce, and we have to help them to regain their energy, make sure that they've got the resources that they need to recover, and then start to think about the other systems that we need to put in place that are going to help us to get back to where we need to be.
What are your proudest achievements?
Professionally, finishing my PhD was a massive achievement for me. And passing my membership exams. I still remember the day I passed my clinical membership and I knew that I was going to be a paediatric consultant. Getting a consultant job at King’s was phenomenal. I grew up near King’s, and I was born at King’s, so to come back as a consultant really felt like a closure of a circle.
Personally, nothing will ever beat getting married and having a child and having a wonderful family life. It's about the balance of both, really. Probably the thing I enjoy most at work is celebrating other people's achievements. I think that's the thing that really gets me out of bed with a smile on my face.
If you could give some advice to your younger self, what would you say?
I'd say, 'Do paediatrics. You made the right decision. Stick to it, you're going to have an amazing career and it will just be brilliant. You're going to meet some incredible people and enjoy the ride.' I'm not sure if I would change anything. I loved the year in Australia. I loved doing the research. I've loved the people that I've met along the way.
Are there any habits that you have that have helped you to excel?
If you're going to be a full-time clinician, take on managerial roles, take on extra roles such as research, teaching, working across boundaries, working with other organisations, one of the key things is that you need to be up for working hard.
You can’t get away from that. You need to learn when you work the best. I'm a morning person. I'm very happy to get up at 5:30 in the morning and do a couple of hours work before I come in. I find working in the evenings at eight, nine o'clock more challenging.
A home-life / work-life balance or integration is so important, and when you're away from work you need to really try and be away from work, and really enjoy it.
When you're at work you need to be really at work and try to enjoy it as much as possible. Make every moment count. That's a key thing, and get the most out of everything you possibly can. But there's no getting away from the fact that it is hard work.
What's your favourite book?
I've loved so many books. I'm a bit soppy. I do love a romantic story, so Captain Corelli's Mandolin was always a favourite, and The Alchemist, but a lot of people choose them.
When I was growing up I loved science fiction, so Lord of the Rings was a big favourite when I was a teenager. I guess the book that I go back to is Captain Corelli's Mandolin.
I like reading sports-based books. I'm reading a book at the moment by - what's his name? Simon. I can't remember his surname. He's a cricket sports commentator, and he's talking about the journey of the England cricket team through to the Ashes in 2005. I was there on the last day of the Ashes at the Oval, you see.
What's your favourite children's book?
I loved reading the Julia Donaldson books to my daughter, so Room on the Broom, and The Gruffalo. Probably my favourite was Room on the Broom. I just think she's managed to capture that ability to tell a story, use language, and portray it really well for children.
The Hairy Maclary stories are good. They're written by a lady from New Zealand, and they're about a dog and his friends. They're good children's books.
Medspire podcasts are produced by Dr Sanketh Rampes and Dr Anvarjon Mukhammadaminov, both full-time junior doctors. They aim to inspire the next generation of doctors and scientists by exploring the career journeys of leading clinicians and researchers.