Do senior doctors need career development?BMJ 2005; 331 doi: https://doi.org/10.1136/bmj.331.7527.s229 (Published 26 November 2005) Cite this as: BMJ 2005;331:s229
John Adsett and Mike Roddis give different perspectives on the need for career advice for senior doctors
The authors will be running free workshops at the BMJ Careers Fair on 2 and 3 December
A human resources manager's perspective
Over the past two years a number of initiatives have been aimed at improving the work-life balance for doctors.
In autumn 2003 the Department of Health held a workshop as part of its Improving Working Lives initiative, which focused on improving working lives for doctors. The number of doctors who contributed “from the floor” and the type of matters that they raised at that event showed that there were a number of serious issues around work and work-life balance for senior doctors.
During early 2004, BMJ Careers and the BMA held a joint event on careers counselling for doctors, which focused on the guidance available to doctors. It was felt that there was an unfulfilled need for such advice for middle grade and senior doctors. Following this event, a working group was established to consider careers advice and counselling, but again this was confined to the needs of doctors in training.
A subsequent joint event focused on general practitioners, but this concentrated largely on the problems of attracting practitioners to the specialty rather than retaining those who may have become disaffected.
For the past three years, the excellent annual BMJ Careers fair has offered an individual advice service for doctors. Most of these sessions have been oversubscribed, and feedback from counsellors confirmed that there is a serious need for a more formal careers/life advice service for senior practitioners.
This comes as no surprise to some observers, given that the traditional medical career now produces GPs and hospital specialists in their early thirties. With recent debate in the national media about pensions and retirement ages suggesting that the workforce will need to work longer, past what is now considered to be normal retirement age, it is no wonder that senior doctors are pausing to reconsider their career options.
Concerns about pension provisions go alongside all the recent uncertainties that senior doctors have experienced regarding the various contract changes (for consultants, general medical services (GMS), personal medical services (PMS), and staff and associate specialist (SAS) doctors), all of which have prompted senior practitioners to question their lifestyle and work commitments.
The prospect of working in the same job for the next 35 years must be a scary thought for a newly appointed consultant in his or her early thirties. Similarly, a consultant or GP with 15 years' experience under their belt may find it difficult to contemplate another 15 years in the same routine.
Some doctors make a planned move to develop their careers to embrace a greater commitment to research, teaching, or management, but the opportunities to do so are often limited. And let's face it, greater involvement in management or teaching may not be everyone's idea of perfect professional development.
Little or no research has been carried out with consultants while they are still employed. Existing research focuses on the symptoms of lack of consultant career satisfaction: sickness, undiagnosed depression, alcoholism, or retirement aspirations.
A former medical director's perspective
On my first day as a consultant, the senior consultant in the hospital told me that I was expected to stay in the same job developing a local service in my specialty until retirement. In my case that would have been for 35 years—a life sentence. I soon learnt that those consultants who did move between jobs were a rarity and were often treated with some suspicion. What was wrong with them? Couldn't they get on with their colleagues?
It seems that for most doctors, becoming a consultant or a principal in general practice is seen as the pinnacle of their ambition, the fulfilment of their training. In fact, as they soon realise, it is the start of a new career, which may last for the next 35 years.
How many specialist registrars as they prepare to apply for consultant jobs, or newly appointed consultants as they are inducted into their new posts, have a career plan in mind? At appointments advisory committees, one of my regular questions to candidates aspiring to become consultants, possibly for the first time, is: “If you get this job, what will you be doing 20 years from now?” So far, all have earnestly told me, without a trace of irony, that they will be doing the same job in the same way and in the same hospital. Surely they cannot mean it?
New consultants need help in mapping out their careers
In my case, after 10 years as a consultant pathologist I began to get bored. I had achieved everything I wanted. My service was now stable, well equipped, in new premises, newly computerised, offering the best quality service, and feted both locally and regionally as an exemplar. What should I do now? I quickly realised that I was on my own in planning the future for myself. To discuss career plans with colleagues would be to destabilise the service. I chose medical management as a hobby to bring some variation into my routine. Some colleagues went down the educationalist route, others the royal college route, and others withdrew from the hospital and concentrated on private practice. Some varied the routine by baiting the managers. One colleague described to me how hopelessly she viewed the future of unending routine: “Every Thursday I wake up and dread the chest clinic—the same patients with the same problems in an unending line stretched out in my mind's eye until retirement.” She told me she was doing a part time maths degree with the Open University in her spare time.
At mid career, senior doctors need help in refocusing their jobs if they are to stay fresh and give of their best to the profession and the NHS.
Senior doctors need to plan career changes in the time up to retirement
For senior doctors in their late fifties other issues predominate. Can they continue to work safely under the same level of pressure as they did as youngsters? How can they ensure their knowledge and skills are effectively passed on to the next generation? What will their retirement bring? What unachieved ambitions remain, and how can they be fulfilled? Is the NHS still the right environment in which to practise? If they have become medical managers, what amount of time, if any, should be devoted to clinical practice? For me, after seven years as a medical director, the answer was to start a new career outside the NHS as a medical management consultant. This allows me to regulate when and how I work and gives me space for other aspects of my life.
Senior doctors need to be able to plan the way their careers change in the time up to retirement. Where will senior doctors get this help? The obvious answer is in discussion with their clinical manager at their annual job plan and/or appraisal meeting. After all, this is when their personal development plan (PDP) is formulated. I was recently privileged to work with the consultants at a major London teaching foundation trust. I saw all the PDPs associated with their job plans. Whatever else they were, they showed no indication that career planning or career development was part of the process. Where does a general practitioner turn for help and advice? GP Dr Tony Grewal recently explained why he wouldn't turn to this primary care trust with an emotional or health problem. In Doctor 28 June 2005 he said: “Accepting help from a PCT is like accepting fellatio from a crocodile.”
The NHS has traditionally placed people in jobs for 35 years without making provision for their career development, presumably on the assumption that the medical profession will take on this burden itself. Most doctors do not know whom to ask for help in this area, or feel that asking for help is either not possible or inadvisable. If the NHS is to retain, develop, and get the most out of its senior doctors it must learn to help them develop their careers. ■
Mike Roddis and John Adsett are leading a series of seminars on “Dealing with Difficult Doctors.” For more information, in the first instance telephone Jean Wolfe 01628 850082 or Mike Roddis 07970 202730.