Intended for healthcare professionals

Careers

Becoming a consultant: how to succeed at interview

BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f1725 (Published 04 April 2013) Cite this as: BMJ 2013;346:f1725
  1. Oyeyimika Opaneye, recruitment officer
  1. 1Guy’s, King’s and St Thomas’ NHS Foundation Trust, London, UK
  1. yopaneye{at}gmail.com

Abstract

Applying to be a consultant can be a difficult process. Oyeyimika Opaneye looks at how potential candidates can improve their chances of success with the advisory appointments committee

Recruitment is always expensive, and when a consultant is appointed it is usually for the rest of his or her career, so a lot of investment is required. This article is designed to help you through the process and improve your chances of gaining a consultant position. It has been written to assist candidates in most specialties anywhere in the United Kingdom.

The advert

Most hospitals have strict advertising templates. These are often not very informative, but you should retain a copy for future reference. You are most likely to succeed if you study the advert, the job description, and the hospital’s website and annual reports, and try to have informal discussions with people who know the hospital and the role. At this stage you should ask yourself whether the job fits your goals and aspirations. If possible, you should also discuss the role with someone who knows your clinical experience and abilities.

Your application

Up to five people will review applications independently and decide which candidates should be shortlisted. Your application should cover all the essential criteria and, where possible, the desirable criteria listed in the job description. Make these easy for the shortlisters to find and understand. I recommend copying and pasting the criteria into a Word document, noting how you meet each criterion. Where possible ask a trusted appraiser to look through them too.

You should think about how you have demonstrated your understanding in key areas. These include the national and local patient population for your specialty and the hospital, the goals of the hospital and the department, the influential people, and the papers in your specialty published over the last five years. If the role contains an element of teaching, research, or mentoring consider your views on current teaching practices for medical students.

Meeting all these requirements, however, will not guarantee you are invited to an interview. At my trust, few people are shortlisted: five is considered a long list. If you are unsuccessful, always ask for feedback. The original advert should give you a contact, usually the hiring manager, and you should contact that person directly.

Before the interview

Most consultant assessments take the form of a panel interview, the advisory appointments committee. If you are selected you will be told who will sit on the panel and be given the opportunity to contact them. Wherever possible, you should do this. When I have been on committees where panel members had not been contacted beforehand, it reflected very poorly on the candidate.

Don’t just stop at the panel members, but use your initiative. I use the analogy of the “rising politician” to illustrate that this is an informal campaign to secure a job. Many comments from other people often get back to the panel, so contact a cross section of the workforce involved in your division and try to gain a comprehensive understanding of the daily operations. This is where internal candidates have the edge. To beat the favourite, understand the department’s practice and its current weaknesses and strengths. Bring to the panel lessons from other hospitals that work with their current goals, such as revenue generating or cost cutting ideas or initiatives and means of improving efficiency and patient throughput.

The interview

Your medical knowledge may be impressive, but it’s impossible to gauge your medical ability in this setting, so you will be tested on other aspects. This is where people are often caught out. Having thought exclusively about their clinical skills they forget the personal aspects of being a consultant. The panel includes important, non-clinical professionals, so don’t overlook them. The medical world is a relatively close-knit community, so if you’ve worked with someone prominent, mention it, especially if he or she is popular. It helps to have supporters on the panel.

The panel are likely to ask questions about your personality and your motivation for applying for the role. In terms of personality, expect panel members to ask you to tell them about yourself, to explain how you ended up in this specialty, and to explain your strengths and weaknesses. These questions test your self-awareness. Don’t focus too much on them—they are used to break the ice and are usually only important if a candidate claims not to have any weaknesses or highlights a frightening weakness.

A surprising number of candidates fail the interview when they describe their motivation for a specific role and why they chose the hospital or division, because their true motivations come out. Many hope to change the role, use it as a springboard to work in another area of the hospital, or just want to live in a particular city. Make sure the answers you give relate to the hospital’s objectives and your long term career ambitions.

You will also need to demonstrate your commitment to continuous learning. Focus on where you believe the field is heading, on your recent papers or involvement in research, and possibly any recent relevant news stories. For those seeking roles in tertiary hospitals your thoughts on and involvement with research are particularly important. If you haven’t published any papers recently, provide reasons why. At the very least, mention some research you would like to conduct.

As well as questions about personality motivation and learning, panels are also likely to ask about audits, leadership, and the safety and quality improvement agenda. It is worth considering what is meant by “conducting an audit.” Investigate the stages of the process. Perhaps look at topics such as project management, budgeting, quality and efficiency, and monitoring and control. Practise talking about the audits you have done and your specific contributions. Also mention the success of your audits against their objectives, if you learnt anything, and future project ideas.

A consultant needs strong leadership and management skills, and it is always obvious when candidates haven’t fully considered this. Experience does not automatically qualify you for promotion. Consider the experiences that demonstrate your leadership, resilience, and ability to network and collaborate. You also need to show evidence of mentoring and coaching experience.

A good consultant adds value through more than clinical practice. The NHS has been focusing on a service and quality agenda while trying to reduce costs. This relates to the demands of the Quality, Innovation, Productivity, and Prevention collection, the Care Quality Commission, Monitor, and revalidation. It is important that as a commercially aware employee, leader, and clinical practitioner you can provide input into these areas. Consider cost efficiencies and, better still, explain where you have previously implemented such measures.

Cost effectiveness includes reducing costs, increasing revenue, or controlling spending while improving effectiveness or efficiency. There is no need for innovation. A detailed understanding of the current process and insight into the practices of more innovative hospitals will do. It is more important that you show commercial awareness and a logical thought process.

Feedback

Most panels deliberate for between 20 and 30 minutes and will telephone with verbal confirmation at the end of the day. These two rules are rarely broken unless the panel is split between two candidates. The situation can be more difficult if one of the candidates is the locum in post.

For uniformity, feedback is usually given by one or two people, with comments agreed by the panel members. As you might expect, a lot is edited out when information is fed back to candidates. A candidate who was unanimously chided by the panel for her “childish, chatty” tone was told “to be more formal.” Another, who rambled, was told, “You might want to be more specific.” The lesson is to take every negative feedback and understand that it has been diluted to be more diplomatic. Good feedback sessions should include the positives, negatives, and means of improvement. If they do not, ask for constructive suggestions. If the panel says you were good at interview but were against other good candidates, make sure you ask what made the other candidates successful.

After the interview

The process after your interview will vary but does include some basics. The most fundamental of these are your pre-employment checks—disclosures and barring service clearance, references, proof of clinical competence, and contracts. All contractual queries should be directed to the medical recruitment (sometimes called medical staffing) department.

The area of most contention after an interview is salary negotiation. There is a scale for basic pay and it is simple to implement, but sometimes money makes people less logical than usual. You will start at the bottom unless you have previously worked as a consultant (locum or substantive) in the UK or abroad; have additional whole years in training as a flexible training scheme; or additional whole years to obtain dual qualification in dentistry.

Normally only full years are counted. If a new recruit has completed a locum consultant position for two years and 11 months, they will usually only receive two points on the scale. Several consultants have tried to negotiate their salary but the original figure is not usually negotiable. If you disagree with your salary, count how many full years you’ve served, ensure they match your salary, and communicate this clearly to medical recruitment or staffing. There are also other aspects, such as London weighting and on-call payment categories, so double check these to ensure you have been given the correct amounts. If there are errors, tell medical recruitment or staffing.

Clear evidence of previous positions will be needed. Items such as scanned payslips and references from your previous line managers help immensely. The NHS is connected with electronic staff record (ESR) software and a report can be generated on your last salary and position, but other evidence is often required.

Occasionally negotiations have dragged on for months. Sometimes, importunate negotiations can result in an offer being withdrawn. It is far less frustrating for you than it is for recruiters. Be patient and courteous; we are not trying to underpay you.

Future developments

By far the most important upcoming change in consultant recruitment is the increased use of multiple assessment methods. These are popular in business sectors because they are less subjective and have greater levels of reliability and validity. The most popular are personality questionnaires and scenario exercises.

Although only a few hospitals use personality questionnaires, many have considered implementing them. These assessments are used to provide insight into character traits such as ambition and emotional stability. There are no correct answers, only more desirable ones according to the interpreter, ie, the hospital. The specific traits to be measured can be determined by the hospital in conjunction with a designer. There is no need to study or prepare for these—you cannot alter your personality.

Scenario exercises are more common and cheaper than personality questionnaires. They may also be adapted to the role, testing what matters. These are sometimes explored during the interview, for example, asking how you would deal with a typical patient within the specialty. The more detailed scenario exercises provide a patient’s history and ask for a diagnosis or treatment.

By far the most common failure in responding to these exercises is a lack of concern for patients’ emotional health and their circumstances. A surgeon being interviewed stated repeatedly that he didn’t consider the aesthetic aspect when performing breast surgery. He was weeded out straight away. Make sure you consider the needs of the patient.

Finally, be smartly dressed, personable, and remain positive. None of these will get you the job, but not having them will certainly help you lose it.

Footnotes

  • Competing interests: I have read and understood the BMJ Group policy on declaration of interests and have no relevant interests to declare.

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