What does it mean to be a consultant in 2014?

This year, the relatively stable position that many consultants have occupied for years may begin to change. The contractual framework governing consultants’ pay and conditions will be renegotiated, and working arrangements will start to change in an effort to deliver seven day patient care.

Consultants are often regarded as the most senior members of clinical staff in a hospital. It is in that capacity that they are expected to lead a team, whether it is a team of doctors or a multidisciplinary team including nurses and other health professionals.

Andrew Goddard, a consultant gastroenterologist and Royal College of Physicians registrar, says that without effective leadership, consultants would not be able to do their job. “To give good patient care a consultant needs to be a strong leader,” he says.

This leadership is often seen as a perk of the role, but being a consultant also means taking ultimate responsibility for patients and their care. Barbara Jemec, a consultant plastic, reconstructive, and hand surgeon, says that becoming a consultant means that you are responsible not only for yourself but for the rest of your team as well. “All the years as a registrar you thought everything was your responsibility, and of course you carry responsibility for what you do, but as a consultant you carry responsibility for yourself and everyone else,” she says.

In addition to, or perhaps because of, this extra responsibility, being a consultant can also bring respect from others. Paul Flynn, a consultant obstetrician and gynaecologist and chair of the BMA’s consultants committee, says the respect awarded to consultants does not come from being a particular grade but from how consultants conduct themselves. “What engenders respect is consultants’ relentless focus on quality and improvement for their patients and that’s what will earn them greater respect as time goes on,” he says.

Diana Tait, a consultant clinical oncologist, says that the situation has changed over the three decades that she has been a consultant. “When I started out people had more respect for those more senior to them,” she says, “Now we have to earn the respect. It’s different. It’s still a respected role but I don’t think that respect is automatic.”

Consultants must earn respect not only from juniors and patients but also from peers, as they increasingly work in teams with other consultants to achieve the best outcomes for patients. Tait sees the practice of consultants working in teams as a positive step away from the situation where consultants were working almost as independent practitioners. “It’s very much more supported than it was,” she says. “You aren’t going out on a limb and making decisions on your own. All decisions are scrutinised by other people, and there’s much more checking on the quality of the treatment that you’re delivering. It’s good for patients and it’s also good for us.”

Working with colleagues can not only help to improve patient care, it can also make the job itself more enjoyable, says Goddard. “We have doctors’ messes, where the juniors all get together and they can whinge about us and that makes them feel better, but often consultants don’t have that environment,” he says. “Peer support in what is a highly stressful and difficult job is something that perhaps not as much is made about. There has to be a way that consultants can talk to each other that is easier and more relaxed because it creates a happier and, I think, a more effective workforce.”

In addition to taking on the responsibility of leading a team with the support of peers, one of the driving factors behind many doctors’ desire to become consultants is the power the role can give doctors to make changes for the better. For many, being a consultant means being able to make changes that can improve patient care.

Flynn says, “Being a consultant is not just about seeing the patient but also always thinking, ‘How can we do this better? Is there anything to think about, any advances in treatment that I can introduce for my patients? Is there a better way of doing this?’ and to be advocating for change that enables them to have better and more effective services.”

The role of the consultant extends beyond clinical care into management and teaching, something that consultants often do not realise before they take on the role. Dominic Carmichael, a consultant in emergency medicine, says the role is much more varied than that of a registrar. “We expect registrars to spend a vast majority of their time doing clinical work seeing patients. When you’re a consultant there is much more of a balance between that and other things, such as management work, training, teaching and supervision, and time spent on professional development.”

Donald Macgregor, a consultant paediatrician, believes teaching is an integral part of what consultants do, whether that entails educating patients or other doctors. “Within the NHS that’s what you do day to day—you’ve always got someone around who you are showing the way to.”

Medical training is, in many ways, an apprenticeship, with consultants acting as trainer and mentor to their junior colleagues. But Goddard says this role is changing, as junior doctors’ hours are restricted by the European working time rules and consultants are often left to pick up the slack.

“Sometimes when I’m on call at the weekend I may well do a ward round on my own,” he says. “You would never have conceived of that 20 years ago, probably even 10 years ago, but there are not enough junior doctors around to support seven day services.”

Goddard says that, in the future, consultants will be expected to provide a seven day service and to work increasingly flexibly, as more consultants choose to work part time. “The job is likely to become less Monday to Friday nine to five, it’s going to become a lot more five days spread over the week,” he says. “There’s going to be even more team working with other consultants.”

Tait believes consultants will become less specialised and work more closely with the community. “To be a consultant won’t be as clear an entity as it has been,” she says. “There will be more grades of doctors within hospitals that aren’t consultants and there will be more of a crossover between primary and secondary care.”

David Woolf, a clinical oncology trainee, believes the future will bring a move away from the traditional consultant model, with one individual providing clinical care, managing, and teaching. “I think we will realise that not everybody is good at teaching, or good at management. I think we’ll see people having far more defined roles within a larger organisation . . . some would argue that that is a sub consultant grade but I don’t think it is, I think it’s just defining more what consultants do.”

Hesham Abdalla, a consultant paediatrician, expects one key change to consultants’ jobs will be that they will become more difficult. “I think it will be harder to get that work-life balance,” he says. But he can’t imagine finding another job as rewarding and as intellectually challenging as being a consultant. “It is harder and harder to develop that balanced life that I think we’re all searching for, but the actual job itself is immensely rewarding.”

Goddard also says that, despite the long hours, he wouldn’t do anything else. “Every job is always going to have its tough bits, but as a whole the role has certainly met my expectations of being a very rewarding job that keeps me stimulated and allows me to interact with people on a professional level, but also to interact with patients and their families. I wouldn’t do anything else. Give me the chance again and I would still do it.”