Onwards and upwards? The first few months as a consultant

Picture1You’ve made it. You have new shoes. You cut your hair and filed your nails.

What else do you need to do to get through your first few months as a new Consultant?

Well, nobody can tell you precisely how to survive your first few months as a consultant.  However, Ian, Vin and Helen do have a (quite a few) thoughts that you may find helpful.


  1. Be ready for the fact that it’s not everything you expected

Even with contracted training you’ll have spent at least seven years working towards a fairly single minded goal:  becoming a consultant.  When you get there, you’re likely to find that it’s pretty different from what you may have expected.  For us, it was the second most difficult career transition we’ve had to make – the first being the transition from being a medical student to being a doctor.  There’s a sense in which we all imagine that the appointment at consultant grade comes with the intellectual equivalent of the keys to the executive washroom – some sort of certainty and confidence, ability to deal with all problems as they arise, and the full package which you may have thought that the more senior consultants have.  It doesn’t.  The ability to be a consultant takes time.  Take time to cultivate it.  In fact, clinical situations that you would have hitherto managed with your eyes closed may send you scuttling back to the textbooks in search of added confidence, so prepare yourself for professional doubts and uncertainty.


  1. Bear in mind that you will be feeling all sorts of culture shock.

The culture shock comes in a variety of forms.  It may be the previously aloof elderly consultant greeting you warmly and insisting from this moment on that he or she is addressed by their given name; your peer group now spans decades rather than years.  It may be the fact that when you see a child in clinic the buck stops with you – or at least it feels that way.  It may even be the realisation that after a decade of moves every six months, now you’re going to spend the next two or three decades in pretty much same place.  Don’t underestimate the degree of disorientation that this can induce; be ready to reflect on it, sort out how you feel about it, talk about it, or whatever else works for you.


  1. Insist on a proper induction.

All trusts will require that you attend a formal trust induction.  The usefulness of this will depend on your trust.  It will, however, be mandatory and will, if properly organised be very helpful in avoiding the need to attend, for example, a fire lecture for the next year.


What we mean here is to give yourself the opportunity to meet the people you’re going to be working with, and work out how systems function in your organisation.  You should negotiate that you spend your first week on this – and if you think that this is excessive, it’s worth noting that many successful organisations spend weeks on induction, and that senior NHS managers – who will move more than you are ever likely to now that you have a senior post – will usually spend their first two weeks working out who is who in the organisation.


People to meet during induction should include:

  • All the people you met, or who you should have met, during your pre-interview visits.
  • Some people from less high up the managerial chain. This might include your directorate general manager or equivalent, or a service manager.  These will be good people to help you fix any problems.
  • Anyone else you can think of who might be helpful to meet. Examples of this might include the lead nurse or doctor for child protection, the trust lead for governance, the theatres manager – these will differ depending on the role you are taking.


The questions you ask in induction can range from the very simple – where do I find the toilets – to the potentially very nebulous – how do I begin to fit in with the strategy of this organisation.  Note that induction of this sort is as important – perhaps even more important – if you are just changing role from junior to senior or locum to substantive in the same trust.


  1. Don’t get too frustrated with infrastructure.

You might turn up on your first day and discover at least one or more of the following (all true examples from friends or colleagues):

  • No computer
  • No telephone
  • No desk
  • No clinics
  • No secretary

It’s easy to find this very frustrating, and we would agree that it hardly gives the impression that you are valued.  Nonetheless, however easy it is to take it personally, don’t.  It’s not intended; it’s just an occasional consequence of working in an environment as busy and complex as healthcare.  Just keep on asking the right questions of the right person – your directorate general manager would be a good person to start with.


  1. Get yourself at least one mentor

There are very many sorts of mentor.   We can’t tell you how to choose a mentor – you need to do this yourself, based on what your needs are, and how you like to discuss things.  If, for example, your preference is for a discussion over a pint, then you wouldn’t chose someone you know to be teetotal.  You don’t have to meet with them that often, but some advice from time to time can be very helpful.  It’s worth thinking of having two or more mentors:

  • A mentor from within your hospital but outside your department.

Ideally this will be someone who knows a bit about the hospital; somebody who has been in post for five years or more.  They don’t need to know your department – in fact, it can be an advantage if they’re unfamiliar with it.

  • A mentor from outside your hospital, but within your speciality. Many people will choose someone who was involved in their training, whose service they’ve previously rotated through.

Rarely you might find that you are provided with a mentor.  This is fine; you may well get a lot from them, and get along well with them.  However, you ought also to find somebody who you actually want to be your mentor too.

In addition, many people value the support they get from having another recently appointed consultant to meet up with regularly, either within their trust or from further afield.  An informal comparing of notes can be very helpful.


  1. Learn how to say both “yes” and “no” – and don’t stick slavishly to either.

Some senior consultants counsel their newer colleagues to “Say no to everything in your first year”.  There’s some sense in this, but it goes a little too far.  It is true that it is flattering to be invited to sit on senior committees, to be someone who people go to for their opinion and enthusiasm, and it is easy to regard the relative paucity of appointments in your diary in the first few months as an invitation to fill the time with each and every request.  Hence, “Just say no” can be quite protective against overload by the end of your first year.  However, if you’ve got through this first year and have done nothing but the very basic level of activity, then are you really fulfilling your potential?  Isn’t this just as bad – if less tiring – than just saying “yes” to everything?  Our opinion would be that it’s better to have a clear sense of what your values are, and what you want to do, and then to try to agree to the things that fit with this – and reject the things that don’t.


  1. Remember that the first complaint will feel a lot worse than you imagine.

Few of us are fortunate enough to have careers free of patient complaints, and we all have thoughts about what this might feel like when it eventually happens.  There are two main things to consider about your first complaint when you receive it:

  1. It may be sooner than you’d imagined. That doesn’t mean you’re rubbish; complaints don’t respect how long you’ve been in post, and that’s just the way they go.
  2. Despite how much people will insist otherwise, it will feel personal. Do not underestimate how this will affect you.  We’re used to taking responsibility as part of a clinical team, and you are still part of that team, but as a consultant you’re also a leader of the team, and complaints can make you feel pretty low.  Share this experience with senior colleagues, and be ready to take their advice and support.


  1. Plan to have an appraisal sooner rather than later.

Yearly appraisal is a mandatory part of your career as a consultant.  Most people in industry regard the idea undergoing appraisal just once a year as woefully inadequate, and waiting a whole year before having your first appraisal is probably too long.   You’ve got a big advantage – you’re used to appraisal and know, roughly, what to expect from it since it formed a major part of your training.  It’s not unreasonable to plan to have an appraisal four months into your new post.  It will serve as a useful point to sit down and discuss how you’re doing and any troubles you’re having.  It will also help get you used to the paperwork.  Note, also, that appraisal will feed into revalidation – which will be the process by which you will retain your right to practice, so you need to be on top of it.


Further reading

Now no-one can hope to be able to give advice about many of the issues we’ve faced in the years since we became consultants.  However, we found the following books useful – especially if you read lightly, dip in and out, and discard the parts you don’t like or don’t find helpful:


  1. Getting Things Done Dave Allen. This is the definitive time management book.  Some people love it.  Others find that they can manage without it.   Still others find that they don’t have time to read it…
  2. The 7 habits of Highly Effective People Steve Covey. The title makes this book easy to dismiss, but don’t.  There are very many helpful exercises for helping you to plan what to do – and importantly, what not to do – with your diminishing resource of time.
  3. The One Minute Manager meets the Monkey K Blanchard et al..


  • Ian Wacogne, Vin Diwakar, Helen Jenkinson

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