A career in medical management
‘Doctors can and should be involved in the management of the NHS at all levels, for they are the most appropriate group for the task.’ Anthony E. Young (2003).
The National Health Service (NHS) has always involved doctors in leadership and management. Professional managers need their clinical help and expertise, and psychiatry skills are pertinent: we understand the needs of the population and we are comfortable dealing with systems and groups.
All psychiatrists are involved with medical management. For example, a clinical leader in a multidisciplinary team uses management skills for the population served by that team. Other medical management roles include:
- A clinical lead may advise managers about need within a service but does not normally have operational management responsibilities.
- The clinical director works in partnership with a professional manager and is normally responsible for part of a mental health service, including budget. They are not always medically trained.
- The associate medical director is a deputy for the medical director and is normally primarily involved in the professional management of doctors, although some have operational responsibilities.
- The executive medical director sits on the trust board and provides professional medical advice to the board and its officers, provides medical input to strategy development and communicates the trust’s perspective to clinicians and supports the work of clinical directors. The executive medical director is often involved in clinical governance and is a professional lead for the doctors within the trust and has a corporate role, most obviously in foundation trusts.
- You might naturally enjoy leadership and political environments.
- You might become dissatisfied with managers in mental health services not considering doctors’ views and want to try to improve the situation by getting involved.
- You might think the best way to improve patients’ mental health is by looking at the whole population.
- You might want another career path after becoming bored, frustrated, or tired of clinical work.
- You might have a specific reason - personal development, championing your own services, or financial reward.
If you are considering a career in medical management:
- talk to someone in a medical management role and get a mentor.
- start out with small roles and work your way up so you gain confidence in yourself and from colleagues.
- make sure you have clear training: the British Association of Medical Managers can help develop skills; generic negotiating skills training can be particularly helpful.
- ensure that any management role is clearly within your job plan in such a way that you could readily return to full clinical activity.
- make sure there is a job description that can be fulfilled within the time allowed.
- ensure you have practical support within the trust (e.g. administration, finance, HR) and professional support outside the trust (e.g. regional medical managers’ meetings).
- You are a doctor and answerable to the General Medical Council, which has clear expectations of medical managers’ duties.
- You are a psychiatrist who needs to meet the expectations of the Royal College of Psychiatrists.
A management role can be personally rewarding, but it can cause tension with other consultant colleagues. Consultants value their autonomy, so management arrangements with medical directors can create difficulties.
Medical managers balance responsibilities to patients, the profession and the organisation where they are senior managers. This can be challenging when managing close colleagues on performance difficulties or service changes/development, but it is also where good medical management is vital.
