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The Royal College of Psychiatrists Improving the lives of people with mental illness

Career in Medical Management

To contact the Psychiatrists' Support Service please telephone: 020 7245 0412  or


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


The NHS has always involved doctors in leadership and management. Professional managers need the clinical help and expertise of doctors. Psychiatry skills are pertinent: we understand the needs of the population and we are comfortable dealing with systems and groups.


Why do it?


  • You might naturally enjoy leadership and political environments
  • You might become dissatisfied with managers not considering doctors’ views in mental health services and want to try to improve this 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


What is medical management?

All psychiatrists are involved with medical management. A clinical leader in a multidisciplinary team uses management skills for the population served by that team.


Clinical Lead

May advise managers about need within a service but doesn’t normally have operational management responsibilities


Clinical Director

Not always medically trained, the clinical director works in partnership with a professional manager and is normally responsible for part of a mental health service, including budget


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


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
  • supports the work of clinical directors, is often involved in clinical governance and is a professional lead for the doctors within the trust
  • has a corporate role, most obviously in foundation trusts



Relationships with Colleagues

A management role can be personally rewarding but 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.


Medical managers can be criticised for switching camps but most are valued and respected for their work. Having clinical programmed activities will help.



Practical steps if you’re considering a career in medical management

  • Talk to someone in a medical management role and get a mentor
  • Start with small roles and work 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 a way that you could readily return to full clinical activity
  • Make sure there’s 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 are answerable to the General Medical Council, which has clear expectations of the duties of medical managers
  • you are a psychiatrist who needs to meet the expectations of the Royal College of Psychiatrists



How old should I be before considering medical management?


In general, a newly qualified consultant needs to concentrate on their clinical work and get used to being a consultant before taking on extra duties.


How do medical managers get paid?


Either part of the programmed activities, i.e. by decreasing clinical sessions to enable the work to be done or by paying extra programmed activities or a responsibility allowance.


Will I get a clinical excellence award?


Clinical excellence awards are based on quality, not quantity, of work. Extra programmed activities for management work might not result in an award. To be successful you must address all five domains determined by the Advisory Committee on Clinical Excellence Awards. A medical management role makes it easier to complete the domains of developing medical services and managing clinical services. However, if you’re the medical director it may be more difficult to provide clinical services and undertake research and teaching.


What job can I do after being a medical director?


Some medical directors find it difficult to go back to being a clinical consultant psychiatrist.  However, the medical management skills are transferrable so there are interesting opportunities for former medical directors – either in the same trust or national roles at bodies including the Royal College of Psychiatrists, the Department of Health and the Care Quality Commission.


Sources of further help and support

Resource booklet



Medical Directors’ Forum

Royal College of Psychiatrists
Membership Relations Department
21 Prescot Street,
London E1 8BB
Tel: 020 7235 2351 ext. 289



Further reading

  • Young, A. E. (2003) The Medical Manager: A Practical Guide for Clinicians (2nd edn). BMJ Books.
  • General Medical Council (2006) Management for Doctors. GMC.



This information guide is intended for a consultant psychiatrist considering taking up a management role. The information can be used as a guide only and is not a substitute for professional advice. If you need further advice and support, please contact the Psychiatrists’ Support Service.


© Royal College of Psychiatrists 2016

If you require advice and support about a particular issue then please contact the Psychiatrists' Support Service at the Royal College of Psychiatrists on 0207 245 0412 or email

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