The mid-career crisis: how to engage consultants

Loss of motivation and burnout

The trainees I speak to seem to have a good grasp of the changing world of medicine and what will be expected of them as portfolio psychiatrists in the brave new world of the NHS after the Health and Social Care Bill. They don’t expect to be in one role for all of their careers—but this idea may be more of a challenge for mid-career doctors who have settled into a pattern of work.

The main issue for mid-career professionals is how to keep motivated in their clinical roles. The European Working Time Directive means that consultants in mid-career who were not expecting to take part in much emergency and out of hours cover now find that they may have to. This may create perceptions that workloads are heavier, for effectively lower pay, and that younger consultants and trainees are being offered more opportunities. Burnout is another risk that doctors midway through their careers might face, not least because of the stresses of having to manage difficult clinical situations.

Other potential risks include the sense that the job offers no new challenges and having to cope with relentless change in the NHS. For psychiatrists, the development of separate community and inpatient teams may create a sense that they cannot offer continuity of care, which could affect their job satisfaction.

So what might help?

At the Royal College of Psychiatrists we have put more focus on supporting a consultant’s first five years by developing a bespoke package of mentoring and support. We have also considered how best to support those approaching the end of their careers. But what about the middle years?

One thing I hope I can persuade mid-career doctors to do is to take on new and different roles outside their main hospital work, even if only once a month. New interests can help to energise consultants and remind them of their innate creativity.

By mid-career, consultants have developed high levels of expertise that can support undergraduate and postgraduate medical education. For others, moving from a purely clinical role into a leadership position may take their careers in a fulfilling new direction. Maintaining an interest in research is another way that consultants can enhance their careers. This may be through supporting trainees, taking part in multicentre research trials, or doing their own smaller scale research.

I would like to see consultant psychiatrists take on public engagement work to explain the importance of mental health. Psychiatrists help to improve the health of the nation, but not enough people appreciate that.

Another way to curb waning enthusiasm is to seek opportunities in professional or personal development. Revalidation means that doctors must reflect regularly on their practice and how it might be improved; and the need to get feedback from colleagues and patients should help doctors become more aware of their strengths and weaknesses. I hope that the process will offer protection to doctors, ensuring that they are given the time and resources needed to keep up to date and motivated.

Role of the royal colleges

How can a royal college best support its members in facing such challenges? Over the past year as president I have visited members in hospitals and trusts around the United Kingdom and have seen some themes emerging. Mentoring and coaching, for example, are ways that we can support mid-career consultants who wish to enter more specialist leadership roles.

Many consultants would like some form of educational supervision that cannot be provided within a single hospital or trust—in other words, they want to be able to seek advice and support from someone working in another hospital in their own specialist field. Some members speak of the usefulness of Balint groups, which offer consultants time to meet for reflective thinking and to review the complexities and ethics of their work, as well as providing support in dealing with complex, high risk issues. As a college we have made these groups available to medical students through our medical psychotherapy faculty; I hope that we can do the same for mid-career psychiatrists.

The college also offers consultants the chance to become examiners or media spokespeople to promote the profession. Speaking engagements and college campaigns offer other opportunities, as do the ongoing continuing professional development, conferences, and training we provide.

We know that the mid-career point in any profession is a risky time in terms of job satisfaction. However, by seeking new roles and opportunities, and being supported by their college, it is possible for doctors to maintain and reignite a passion for their profession—the best profession to be in.