Transition from trainee to consultant
It is not easy to make the transition from trainee to consultant. Although trainees find they are well prepared for clinical work, the greater volume of work and new leadership/management responsibilities of a consultant are often challenging.
New consultants are expected to chair meetings, provide support and leadership to teams, deal with difficult colleagues, interview new staff, provide training and supervision, as well as prepare business plans and develop services.
Trainees are advised to obtain practical leadership and management experience and attend theoretical courses. Invaluable experience can be gained by undertaking a locum or ‘acting’ consultant post, especially a locum post where you hope to obtain a substantive post.
Your first consultant job should be a job that you really want to have, with colleagues that you like, and where you will enjoy working. It may be worth imagining what this ideal job would be like and then looking for a job to match your specification. Let senior colleagues know of your interests, in case a job is likely to become vacant soon.
There are several important factors to consider when applying for a consultant post.
Location
Location is important, especially if you have personal or family commitments. Moving home or commuting long distances, as well as isolation from family and friends when your work is far away from your home, can add stress during the transition to being a consultant.
Catchment area
Consider the catchment area carefully, taking heed of the level of social deprivation and the type of work. It is advisable to look for less obvious duties and responsibilities, e.g. care of asylum seekers and prisoners or the proximity to a port. All of these could affect the intensity and type of work you might be expected to do.
Person specification
Check to see whether you have the relevant experience. Clues about the intensity of work are often in the person specification such as ‘must be able to work well under extreme pressure.’ Are you excited about the job? Only apply if you really want it.
Colleagues and department
It is worthwhile to check the history of the post, including reasons for the vacancy. For a new post, consider the possibility that it may contain parts of the service that other consultants do not want. Ask yourself such questions as:
- How well does the service function?
- Who will be my manager?
- Will I enjoy working with the team?
- Do I like and respect my prospective consultant colleagues and are they likely to be supportive towards me?
Pre-interview visit
Read the information about a post carefully. Before you go to the interview, arrange to meet prospective colleagues and senior management, and visit the services. Even if you have worked there previously, the visit is likely to be time well spent.
Employment contract and job plan
When appointed, you will have to work according to a job plan. There will be fixed sessions for clinical duties, administration, continuing professional development (CPD), supervision of your trainee(s), and clinical audit. Information should be provided on the expected caseload, catchment area, on-call duties and frequency of on-call, study leave arrangements (including the number of days per year and study leave budget), the employment contract and salary. Administrative support should be provided (secretarial assistance, your own office, a computer or laptop, and access to IT support). Further information regarding job planning can be obtained from Mynors-Wallis (2012, see references below).
Before applying for the post, it is advisable to discuss the employment contract and job plan with senior colleagues and to obtain advice from a professional adviser, e.g. from the British Medical Association (BMA). If you have concerns, you should aim to address them before interview, although there may be opportunities following accepting a post in principle. Explore the financial situation of the organisation - is the service in debt, due for significant re-organisation or expecting cuts in services or staff?
Workload
The administrative workload is much greater for a consultant, with swathes of e-mails, government and local documents to read, and committee meetings to attend. Not only will you have to review patients but also you will probably have to organise clinics, manage waiting lists, keep the service on track, supervise trainees and build working relationships with a wide range of staff, many of whom may be new to you.
Management
Attending local management meetings will orientate you to service developments and local politics. You may have to bid for resources, write business plans and be involved in making decisions about cuts in services.
Organisational skills
Good organisational skills are needed to avoid being overwhelmed by multiple demands on your time. It is crucial to attend to fixed commitments, so you will have to prioritise, delegate, and manage your tasks. Key success factors include effective time management and the ability to plan ahead. Be prepared to say ‘no’ to taking on extra demands, especially in your first year as a new consultant. If you are being swamped with work, review your work pattern and seek advice from your mentor.
Administrative support
Apart from being pleasant and calm, an ideal secretary (or Personal Assistant) will have good organisational skills, type accurately and be able to take minutes for meetings. They may know how the organisation functions and can identify decision-makers. If you listen to their advice, they will tactfully guide you through the transition. You can help by giving clear instructions if a task needs to be completed by a deadline so they can prioritise their own work.
Responsibility
It is not unusual to worry and to wonder whether you will be able to cope. New consultants often feel isolated and may not know where to seek advice and help. Before you begin your new job, it is a good idea to identify someone you can turn to for advice. This person could be a previous trainer or a new mentor.
Interpersonal skills
It is important to maintain integrity and probity. Some new consultants have problems managing the increased power that comes with their new role. Remember you are being observed in your interactions with others. Unless you have worked in the organisation before, most people will know who you are well before you know them. Avoid making inappropriate comments, and remember that colleagues may be related to one another. Address issues promptly rather than leaving them, as you will not be moving on in the next few months as you did when training.
Mentor
The Royal College of Psychiatrists recommends that all new consultants have access to a designated senior colleague - a mentor, who can provide advice, support, and information, which is especially important in the early days of a new job. Many organisations can provide a new consultant with a list of colleagues who have volunteered to be mentors. It is not compulsory to have a mentor but having someone you can trust to talk to and who can offer sensible advice can help to reduce stress and uncertainty at this difficult time of taking up a new job. A mentor’s support can also help to broaden your skills effectively and quickly.
StartΨell is a consultant-led initiative for psychiatrists in their first five years as a consultant or locum consultant. It focuses on six elements to support psychiatrists in their first consultant role with the intention of establishing good habits for their careers:
- Making connections
- Continuous learning (CPD)
- Using support effectively
- Personal resilience
- Clinical leadership
- Career development
Find out more on our New consultants (Startwell) page.
Professional
- Be aware of your personal safety in your new environment. Learn about local policies and procedures, attend promptly to occupational health requirements, and take part in induction courses and essential training.
- Discover how your performance will be measured, e.g. whether it will be by the number of admissions, length of stay of inpatients, or the number of ward rounds you attended.
- Maintain confidentiality and keep good records. It takes only a few minutes to dictate or make a file note of telephone contacts, interviews, and meetings. Ensure appropriate entries are made in the clinical record each time that you see a patient.
- Obtain professional insurance by becoming a member of a medical defence organisation, such as the Medical Protection Society (MPS) or Medical Defence Union (MDU). Ensure that your name is on the Specialist Register (GMC) and that you are registered to implement relevant mental health legislation.
- In the first few months, arrange to join a local peer group, create your personal development plan, and start collecting the evidence of attendance at CPD events, which you will need for your annual appraisal. Book study leave in advance and arrange cover for any planned periods of annual leave.
Personal
- Hougton A, Peters T, Boulton J. What do new consultants have to say? BMJ Career Focus 2002, 325, S145a.
- Houghton A. Getting that all-important job. BMJ Career Focus 2003, 326, S143.
- Mynors-Wallis L. Safe Patients and High-Quality Services: A Guide to Job Descriptions and Job Plans for Consultant Psychiatrists (College Report CR174). Royal College of Psychiatrists, 2012 (www.rcpsych.ac.uk/files/pdfversion/CR174.pdf)
