From Volume 8, Issue 4, October 2015 | Pages 126-130
This article aims to outline some of the things one can do to ease the transition into becoming a contented and successful consultant. The first part concentrates on how to be appointed to the post you would like. The second part focuses on how to steer your career once you have been appointed to your dream post.
'Congratulations! You have gained your Certificate of Completion of Specialist Training (CCST), now the hard work begins.'
The chance to become a consultant was the result of years of hard work and I could not appreciate the truth in my trainer's statement.
Being a consultant is very different from being a trainee. As a trainee there is more focus on improving your clinical skills and management. You are less involved with managing people, teaching, the politics and pressures than when you are in a position of responsibility as a consultant. You may not believe it now, but you will be able to carry out your clinical duties completely unrestricted, but ‘the buck stops with you’. There will be other non-clinical pressures including cost improvements, efficiency savings, conflict resolution and also dealing with colleagues who are no longer transient but are potentially with you for the rest of your career. It is vital to select the right job for you, so you can have an enjoyable and fruitful career.
In this article I hope to outline some of the things one can do to help ease the transition to becoming a contented and successful consultant. The first section concentrates on how to be appointed to your ideal post. The second part focuses on how to steer your career once there.
Which one are you suited to? You would probably be shortlisted for either unit but which one will you be happiest in for the long term? I did most of my training in DGHs and felt that I would have more autonomy in one. However, I wanted to continue teaching and wished to have the option of being involved in research. I therefore chose to apply for a DGH post with a medium-sized orthodontic department with two senior consultants who would potentially be good mentors. I also wanted the chance to carve out a niche for myself. The unit supported three Specialty trainees (StRs), a post CCST consultant trainee, two therapists and two dentists with a special interest in Orthodontics, which meant that I could get involved in training at a number of different levels straightaway.
You may have personal and family reasons for needing to settle in a certain part of the country. Ensure that you give sufficient emphasis to your work/life balance, especially if relocating. Discuss potential locations in some detail with your partner and, if you have no knowledge of the area, visit on a number of occasions before applying. This is where you and your family might spend the rest of your lives. It is a critical decision.
Consider whether you wish to work full-time or part-time. I was aware that after all those years of training, we were hoping to start a family and hence opted for a part-time consultant post. You may not be able to fulfil your role as a consultant if you opt to work less than 5 sessions a week.
Orthodontics is a small specialty and people may know of posts coming up with retirements.
Read the adverts on the NHS jobs website: www.jobs.nhs.uk, the BMJ and BDJ job sections. The British Orthodontic Society (BOS) has a list of consultant vacancies and there may be merit in contacting the lead consultants in hospitals that have advertised unsuccessfully before, to say that you may be interested in working at that unit. Hospital management may welcome the approach.
Read the job description carefully. They always contain general information about the Trust but also important specific information about the role itself. You need all the details about the working environment and also to ensure that most elements of the job plan are largely to your satisfaction. The job plan is unlikely to be perfect – this takes years of honing.
Update your CV regularly and then tailor it to the person specification of the post for which you are applying. Some posts now use electronic application forms and parts of your CV can be pasted in quickly and efficiently. Ask your trainers to review your CV and suggest any changes. This sounds basic but make sure that there are no spelling mistakes and it is easy to read.
Always visit the unit on a number of occasions before applying for a post. Only visiting the hospital the day before, or even the day of the interview, is madness. This is where you might work for the rest of your career and where your family will settle too. The pre-application visits are your chance to determine if this is really the job for you.
Try to arrange meeting with your potential colleagues, surgeons and hospital management. They need to know that you are interested in the hospital as a whole and what you are able to offer them. I tried to see all the consultants in the Head and Neck Unit, the Clinical Director, the Medical Director, the hospital managers including the Chief Executive, the Surgical Director and the Financial Director. It is always a good sign when the team makes time to meet a potential consultant colleague. This is the perfect time to glean discreetly what issues are most important to the Trust. You should bring up any queries you may have about the proposed job plan. If possible, speak to the previous post holder to get a complete idea of what the Trust expects. Research the area, the Hospital Trust and the unit in which you might end up working. This is also the time to impress your colleagues with your enthusiasm and drive. You are unlikely to be appointed to a competitive position if you have made no attempt whatsoever to contact the team prior to interview.
Only apply for posts you want. Dental specialties are small and word will get around if you are not really serious about the posts for which you are applying. It is best to withdraw from the post before the interview if you do not want the post rather than going through the interview process then turning it down. The only exception would be if you were seriously concerned about an issue that has arisen following the interview and that cannot be resolved. Match yourself against the person specification and thoroughly read through the job description and draft a list of things that you need to know.
The consultant interview is still an old style interview panel, although it may be preceded by a presentation by the candidates. The main members of the panel and their potential questions are listed in Table 1.
| Interviewer | Topic |
|---|---|
| Lay Chairperson | Usually introduces you to the panel and may ask you what attracted you to the area |
| Consultant from your specialty | May ask about your training, experience and career aspirations |
| Another consultant, possibly from your team | May ask about experience in other areas of medicine/dentistry |
| Royal College representative | May ask about medical training |
| University representative | May be present and can ask about teaching undergraduates |
| Clinical Director | Asks about contentious changes in medical management |
| Medical Director | May ask about a broader subject such as Clinical Governance, Re-validation |
| Non-medical managers | Usually ask similar questions to the medical director; how to save the Trust money, etc |
Preparation and practice are paramount. There are sample interview questions on the Internet and circulating amongst trainees. It is useful to have mock interviews with senior colleagues if you want to perform at your absolute best. Interviewers are looking for a person who has a clear understanding of the role and its responsibilities, is passionate about the job and will do it with initiative and enthusiasm. They are also looking for a colleague with whom they will get on.
The interview is neither the time nor the place to thrash out minute negotiations on the job plan or the salary level at which you want to start.
Presentations have become more common and these must be well prepared in advance. You must ensure the specific question is answered, is relevant to the Unit and Trust and the presentation runs to time. Run through your presentation with your training consultant – he/she is likely to give some helpful tips.
If you are appointed be prepared to accept the job. It is worth having a reason prepared if you wish to delay the start date significantly. If you are not appointed, one of the panelists should be available to give you immediate feedback. Don't worry about rejections; it was probably not the right place for you if you were not successful.
After a job offer has been made, there are several questions you need to ask yourself before signing a contract. It is better to agree to a job plan prior to a start date. Consultants are not obliged to work more than 10 Programmed Activities (PAs), which amounts to 40 hours a week. You may be offered more PAs to maintain the service requirements of the department but you do not have to agree to this. At present all new consultant posts are based on the 2003 Consultant Contract, but the contract is being reviewed.1
It is tempting to sign the contract without having it checked but, in the current competitive market, some Trusts may make changes to the model contract. Ensure that you have been allocated sufficient supporting professional activity (SPA) time as Trusts are always looking to reduce this. The standard 10 PA contract used to have 7.5 direct clinical care (DCC) PAs and 2.5 (SPAs).
Examples of DCC activity include all clinical work, clinical administration (including all dictation and phone-calls or discussions about clinical matters), multidisciplinary meetings, treatment planning and meetings with your technicians. SPA activities include teaching, continuing professional development (CPD), research, audit, department meetings, dealing with non-clinical emails and appraisal. Contact the British Medical Association (BMA) or the Hospital Consultants and Specialists Association (HCSA) to review your contract and to discuss anything you are not sure about.2
In the first year keep an eye on your job plan and ensure that you are being paid for the work you are being asked to do. Keep a diary of your activities over several weeks. At many Trusts, job plan reviews are held separately from appraisals. Get everything agreed in writing and, if they won't write to you, you need to send them a letter documenting your understanding of the discussion. You do not have to accept a job plan immediately, especially if you feel you cannot achieve the tasks in the contracted time. Take it away and study it and discuss all issues with experienced colleagues.
Consultants are placed on a pay threshold determined by their seniority. Newly appointed consultants are normally placed on the first pay threshold but may be placed on a higher threshold if they have consultant level experience, for example having been a locum or having additional qualifications or experience. Everything is negotiable until they have your signature on the job contract.
Trust Induction may be held a few weeks after your start date. On the first day, I started with the basics and obtained my ID badge and security pass, car park badge, computer access and passwords for various programs. With the help of my invaluable secretary, I found my office, the coffee area and my schedule for the next fortnight. I was given a list of meetings I should attend and local societies to join.
Always keep a record of attending a formal Trust Induction as you may be asked to confirm this at some point during your career. Several of the talks are part of your mandatory training.
People are extremely important. You will deal with some very helpful but also many difficult people throughout your career. Whether you like it or not, you will need to be a leader so lead by example. A happy team is a productive and effective team. That includes juniors, nurses and all other allied professionals such as therapists, laboratory technicians, secretaries, receptions and your cleaners. It is important to know your entire team by name, and make sure everyone understands the common goal. Work with your colleagues to identify the culture you wish to convey. With regards to conflict, you cannot always change a person's behaviour. You can, however, change your reaction to them. Always be professional, particularly when confrontation arises.
Your senior colleagues have probably checked that all of the department activity is being recorded on the appropriate system. However, it is worth checking this yourself. Keep abreast of your activity summary. It is worth keeping a log of your activity within the department as the hospital ‘coding’ system may not be as accurate. Information is the key; you cannot dispute their data unless you have the evidence.
You will most likely want to make some changes to the service you have inherited. It is best not to change things too soon. Spend time evaluating where the problems lie and what the best direction to take is. It also allows you to determine whether there is enthusiasm or resistance to change. There may be good reasons why things are done in a certain way.
For any changes you wish to make, ensure you support your plans with evidence to demonstrate how things could work better. Use relevant clinical guidelines to help you. Ensure that you back your plans up with research and evidence to demonstrate how things could work better. Use relevant clinical guidelines to help you. Ensure that you are aware of the financial implications of the changes you are proposing. Carry out a pilot study and then evaluate the effects of the changes you have introduced. Be prepared to admit if there are no improvements to the service and don't waste your time on useless projects.3
Consultants should always have enough time in their job plans for non-clinical work. Clarify what is required in these sessions and whether or not you can be off-site. Consultants with fewer than 2 SPAs may find it difficult to take an active role in teaching, research, training or management unless they intend doing this ‘pro-bono’. These activities are, however, important when applying for Clinical Excellence Awards. Always keep a record of your activities in a diary to strengthen your case for getting rewarded for all the work you do.
The main focus of the first year should be settling into your clinical role. It is always tempting to take on too many responsibilities. There will always be people looking to off-load some of their duties but, unless it is an incredible opportunity to do something you really want to do, you are allowed to refuse the task. Find out about the time commitment involved and whether you have the right skills for the role. Don't agree to sit on a committee that only ever meets when you have a clinic.
Later on, you can put your name forward for a role within the department/hospital. With time you may want to get involved with the Royal Colleges or your specialist society.
The key to completing the appraisal forms easily is to be organized during the year. Always maintain your logbook and CV. You will have an annual appraisal and will need to provide evidence of participating in Clinical Governance, teaching, dealing with complaints, and audit. It is vital to recognize achievements in order to build ownership and pride. Use the feedback from your 360 Degree Appraisal and patient satisfaction surveys to improve your performance as a Consultant. Try not to overreact to the comments and instead reflect on the feedback from your team. Keep a full write up of each audit in your appraisal folder.
When meeting your appraiser, have an idea what you want to discuss. Do not set your goals too high as the next appraisal is only a year away and you do not want to discuss why you have not achieved them.
Follow your Trust policy regarding consent. As a consultant who supervises trainees, you are ultimately responsible for each case. It is imperative to ensure each patient has given informed consent and that it is given voluntarily. Make sure that the clinician can consent the patient. Are StRs able to describe the procedure and associated risks at the start of their training? It is wise to reconfirm that the patient is fully informed and gives his/her consent at the start of treatment and then countersigns the consent form. Keep thorough records of all matters concerning the matter of consent.
It may seem that you have already learnt everything about consent and confidentiality during your training, but there may be situations that you have not come across. It is easy to breach confidentiality and get caught out. Never talk to relatives without knowing that you have recorded the patient's consent to do so. It is always best to talk to relatives with the patient present so that there is no confusion between the two parties. As a consultant you may be more likely to answer phone enquiries. It is always best to try and arrange a further meeting rather than divulging information over the phone. You may not be talking to the patient him/herself.
Be careful about showing personal identifiable data in teaching presentations if the patients have not consented to this. Do not assume that this has been obtained because they agreed to the photos being taken. Register with the Information Commissioner's Office (ICO) if you are keeping any patient information on your laptop/memory stick. In addition, ensure that all files are password-protected.
Within a few months of being appointed as a new Consultant, I received a letter of complaint from a disgruntled parent. I was devastated even though the complaint was about the services within the hospital not my clinical practice. I responded immediately apologizing for their grievance and explained the situation again.
In most instances, acknowledging the problem in a friendly manner and apologizing that the complainant felt that way is all that is needed. It is better to prevent complaints by acting on potential problems whilst the patient is still in your care. Be open and honest with colleagues and patients. Don't make empty promises. The entire team should be trained to report any unhappy patients/guardians. Ensure all complaints go through the right channels.
Women make up about 75% of the NHS workforce,4 so do not panic if you find yourself taking maternity leave early in your consultant career as I did. However, it is wise to pre-empt any potential conflicts before they occur. Your clinical director and even line manager may not be familiar with the details of maternity leave. There are enough stresses and strains on new consultants and being pregnant may exacerbate these.
In England, at the time of writing this paper, the standard maternity leave is 12 months. This consists of 26 weeks ordinary maternity leave (OML) at 8 weeks full pay, 18 weeks half pay. This is followed by 26 weeks of additional maternity leave (AML) with 13 weeks of statutory maternity pay (SMP) and 13 weeks of unpaid leave. Of course, you can always choose to return earlier.
The transition from being a trainee to becoming a consultant is dramatic. You have reached one of the pinnacles of your career. It is worth spending time and effort selecting the right job for you and to ensure that the terms and conditions of the post are fair.
Once in post you need to accept that you will always have something in your in-tray. You also need to learn that you cannot please everybody and there are times when you need to say ‘no’.
I hope these tips taken from my personal experience help make your first year as a consultant an enjoyable one!
