Intended for healthcare professionals


Doctors should be able to pursue joint career in medicine and management, report says

BMJ 2008; 336 doi: (Published 15 May 2008) Cite this as: BMJ 2008;336:1095
  1. Zosia Kmietowicz
  1. 1London

A new career pathway that lets doctors straddle the worlds of clinical medicine and management in the NHS is needed to allow doctors’ careers to flourish in today’s healthcare system, a new report says.

The role of doctors is changing, states the report from the healthcare think tank the King’s Fund and the Royal College of Physicians, and other health professionals are taking responsibility from doctors for managing some aspects of patients’ care.

Consultations about the meaning of medical professionalism with more than 400 doctors at 10 events in England and Wales between May 2006 and April 2007 found that although many doctors are keen to develop new and better relationships with patients, NHS managers, professional leaders, and the government, they also want a clearer understanding of their distinct role in the modern NHS.

Ian Gilmore, president of the Royal College of Physicians, said that the findings echoed recommendations from John Tooke’s recent inquiry into Modernising Medical Careers to strengthen medical leadership and enable the profession to develop new relationships with government, patients, and the local community.

“Providing clarity of the doctor’s role is a key challenge and is fundamental to taking medical professionalism to its next phase,” Professor Gilmore said.

Steve Dewar, director of funding and development at the King’s Fund, said that most doctors had embraced the shift away from paternalism and towards partnership in their interactions with patients, which has been brought about partly by the information age.

“Many doctors told us that they are also looking for positive engagement with NHS managers,” he said. “They understand that their professionalism means understanding management too.” He suggested that new career pathways may be needed to allow individuals to practise both roles.

A recent Ipsos MORI poll conducted for the Royal College of Physicians found that British adults continue to hold their doctors in high regard. The poll found that 90% of adults trust their doctors to give accurate information, and almost as many trust them to have their interests at heart.

However, results of a straw poll conducted during the debates found that 86% of the participants, who also included nearly 400 professionals who weren’t doctors, considered the leadership of the medical profession in the past 10 years to be poor or worse than poor.

In addition, 60% of doctors and 65% of the other professionals believed that patients were not adequately protected from poor practice by doctors.

There was a broad consensus that the profession, especially the leaders of its national institutions, needed to have a stronger voice in public debates about health care. A “swift, effective and widely understood implementation of revalidation” is also needed, the report says.


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