Career Focus

Starting a new consultant post

BMJ 1998; 317 doi: (Published 17 October 1998) Cite this as: BMJ 1998;317:S2-7165

Richard Hardern discusses non-clinical considerations for newly appointed consultants

  1. Richard Hardern, consultant in Accident and Emergency
  1. Leeds General Infirmary

    Newly appointed consultants are sufficiently trained for independent clinical practice; “Seeing patients is the easy bit” seems to be their mantra. The most challenging part of a post may be managerial, administrative, or educational. The aim of this article is to highlight issues we believe should be considered by anyone who has recently been appointed.

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    “Domestic” and social problems

    These are numerous and are likely to be greater with increasing family size (and in families where both partners are doctors). Even for those without a family, seeking housing is a task that few relish. You may find it necessary to live in hospital accommodation initially. Seek assurances from the hospital at interview about the quality and cost of such quarters. It may be preferable to rent a house of your own choosing, and then to commit to a purchase when you have acquired a little local knowledge. Renting does enable you and your family to test out an area. Most contracts require staff to live within a certain radius of the base hospital. With this information and an idea of the size and sort of property you want and the price you can afford, a good estate agent should be able to help. It may be useful to join the mailing list of several as soon as you are appointed.

    Housing, schooling, and transport


    • Within an appropriate distance of base hospital

    • Affordable

    • Consider temporary accommodation in a new area

    • Join mailing lists of estate agents

    Schooling or child care

    • Depends on area in which you will be living

    • Many creches and nurseries have waiting lists - apply promptly


    • Don't automatically assume you'll drive to work

    • Public transport may be the better choice

    • Walking and cycling are healthier and may be more convenient


    You should not assume that your application for a certificate of completion of specialist training (CCST) will be processed rapidly, despite the cost. Make your application as soon as you are eligible to do so. Although many people who work only in the NHS maintain membership of one of the medical defence organisations, it would be most unwise to undertake private or category 2 work without this cover (see later).

    If you are a member of the BMA, ask them to check your contract before you sign it. The job plan is a crucial component of this, and it should be supplied with the contract. Many professional bodies provide guidance on appropriate job plans for consultants in their specialty. It would be wise to read this guidance (there are model workload agreements for many specialties) before accepting a job plan.

    If you will be working part of an out of hours rota you should contact the person who draws up the rota if you wish to avoid being on call for your first weekend in a new hospital. Getting in touch as soon as you have been appointed will be worthwhile if you have already booked holidays or if there are other dates when you particularly do not want to be on call.

    You will need an office, no matter how much you dislike shuffling papers. Early liaison to establish where your office will be is a good idea, ideally before the interview: the proposed location may be inappropriate. An office is no use if it is not adequately equipped: at a minimum, you will need a desk, two chairs, a telephone, shelving, and a filing cabinet. If you know how to use one, a computer can be helpful. If you think you do need one, decide what software you will need and ensure that the hardware will be sufficient to spare you from staring at an hourglass for minutes at a time.

    Find out who is who as soon as possible. When you are starting everyone expects you to be relatively ignorant of such things, so make the most of the honeymoon period and ask early on. Most trusts have their management structures in diagrammatic form. Be particularly careful to speak with managers and other members of staff who will be able to help you to achieve your key objectives (for clinicians, this will probably include senior nursing staff).

    Self management

    Organising your own time and energies is possibly the biggest challenge once the first few weeks are over. A good secretary will help enormously, but you may find yourself training a newcomer. Since your enthusiasm will tend to involve you in many things, setting objectives for the year will stop you spreading yourself too thinly. These need to be agreed with whoever is involved in carrying out your job plan review. Setting objectives will mean prioritising: be realistic and remember that you have many years ahead to plough your furrow.

    Clarify with your consultant colleagues and general manager what managerial and administrative responsibilities you will have. Decide what training you need to meet these. Very few specialist registrars acquire sufficient training in management, and the competencies required of each job differ so much that it is reasonable to expect to train further as a new consultant.

    Getting organised

    • Set objectives

    • Clarify responsibilities

    • Agree on a diary system with your secretary

    • Decide on your own filing system

    • Use email if possible

    • Work collaboratively

    And tackle the paperwork that is irritating if postponed:

    • Security pass

    • Name badge

    • Access swipe card

    • Parking permit

    • Certificate of immunisation

    Organise your diary and office as early as possible. Procrastination in this area may cause difficulties later. Of particular importance is a filing system that works. Your secretary is the best person to keep copies of letters, and you should get into the habit of letting your secretary manage your basic paperwork.

    However, you will want to file items that you need ready reference to - such as documents from working groups or national initiatives. An A-Z drawer file is a good way to start, with box files for bulky items or collections.

    Your secretary will be frustrated if you use a personal diary for your work commitments, as he or she will need ready access to them. Using a computer based diary that is networked can be very effective, and some email packages come with a diary facility. However, if you have meetings coming up you need to be able to put your hand on agenda papers easily, and the computer will not help here. A date drawer in your filing cabinet, with files marked “1” to “31,” will help; relevant documents are simply placed in the file for that date. Your diary simply needs marking “See date file” or similar.

    Sharing information with colleagues is vital, and, again, an internal email system is of immense benefit. Shared directories can be set up for documents that several people need to work on, and this can obviate the need for a series of meetings.

    Most clinical environments depend heavily on teamwork, and few specialist registrars have needed to integrate into a clinical team. You may need to make a conscious effort, therefore, to work collaboratively with senior nursing staff or laboratory staff.

    Personal development

    Many new consultants tend to look to an older respected colleague to advise (and even mentor) them in their early years. This is usually very beneficial and gives you access to someone who can help in difficult times. Don't fall into the trap of using your position (that is, consultant) to demand respect or compliance from others. Everybody earns positive (or negative) responses from others with time, and it is often the difficulties that prove what you are made of.

    Private and category 2 work

    Take advice from a senior colleague, perhaps your predecessor. It is possible to make foes quickly by failing to adhere to recognised etiquette. Be patient, your practice will build up with time. It is probably sensible to find an accountant before long, and you may do well to start saving for tax. Keep accurate records of all you do.

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