Becoming a Consultant: Things Nobody Ever Tells You
Pregnancies are divided into three parts called trimesters. I’m in my first trimester of being a consultant.
As an obstetrician and gynaecologist, it’ll be no surprise that I relate many things to pregnancy. Like the beginning of most pregnancies, the beginning of my consultant(attending) journey has been full of learning and adjustment, excitement at navigating new territory and above all, growth and development.
Before jumping into my reflections on the consultant journey so far, I paused to recall things about the end of training(residency) and the beginning of consultancy that I wish someone had told me.
The end of training can feel both like a climax and anti-climax. You reach a huge milestone in your life, but your daily life is still full of the mundane. Also after such a high, the comedown and realisation that your journey up yet another mountain has only just begun can feel very sobering. It’s ok. The feeling will pass. It’s normal to feel like this.
Celebrate yourself! Resist the urge to move on to the next goal post without acknowledging the momentous journey. It took me eighteen years to become a consultant! Mark it in some special way.
Take time off between the end of training and the beginning of consultancy. This will allow you to transition effectively into your new role mentally and physically. Budget for this to give yourself financial breathing room to take a break.
You have to pay to CCT. If you are a UK-based clinician budget for the surprise bill(£420) you will get from the General Medical Council(GMC) just to be added to the specialist registrar. This is different from your annual GMC fees.
Life does get better when you become a consultant. This may seem obvious to many. However, I’m not convinced enough consultants are sharing this message with junior doctors and residents. Being a consultant is brilliant and something to look forward to. Yes, it’s full of challenges. Our patients are getting more complex, and we face much more scrutiny today than ever before. There will be complications, new anxieties, low staff morale, rota gaps you must sort out, interpersonal dynamics chess games, workplace politics, and a never-ending soul-draining stream of admin. These multiple truths are not mutually exclusive. But being a consultant is great. Look forward to it, don’t fear it.
So, what has my first consultant trimester been like so far?
My first consultant trimester has been enjoyable. I’m one of those annoying ones who “didn’t have any morning sickness”. I’m working in a familiar and supportive unit where I have previously stepped up from being a junior to senior registrar( resident). They’ve seen me at my best and worst. So I’m lucky to be surrounded by people I trust and who care about me. I appreciate that’s not the case for many.
My first couple weeks were spent figuring out the logistics of IT, paperwork, computer systems, my schedule, regional clinical pathways, and re-acquainting myself with my team. I have had my share of challenges including surprising rejection and tough clinical cases.
I was intentional in giving myself grace and space to ease, stretch and expand into this new role. My only expectation was to settle in gently. So I created healthy buffers to support this. I’ve been paying particular attention to my physical, emotional and mental well-being during this important transition.
Thereafter it was a mental battle of overcoming the normal anxieties of encountering new consultant ‘firsts. Navigating my first on-call shift, my first theatre list, my first complex case and complication as a consultant were equal parts exciting, challenging, satisfying, and humbling. My last four months have been marked by highs and lows, huge successes, and some disappointments but most of all growth.
So What are My Top Tips for Thriving in Your 1st Consultant Trimester?
1. Learn How to Say No
Don’t take on additional responsibilities in your first three to four months.
Focus on settling in, building your confidence, experimenting with leadership styles, and studying your new clinical environment and culture before taking on additional roles and responsibilities within the department. Take time to understand the department’s interpersonal dynamics, priorities, and resources in the first few months. Armed with this knowledge, then explore departmental opportunities and needs that align with your strengths, priorities and values. For example, clinical governance, medical education, research etc.
2. Be assertive and set good boundaries early on
Healthy boundaries allow you to practice medicine safely and sustainably and protect you from burnout, poor mental health, and attrition.
Create boundaries. Stick to them. Do not expect applause.
Sadly, in medicine we have normalised unhealthy maladaptive work behaviours to the extent that healthy work balance behaviours (e.g. taking required breaks at work, using designated annual leave, timely handovers, not responding to e-mails 24/7 or outside normal work hours, resting following an on-call shift, etc.) may occasionally be perceived as deviant, lazy, not being a team player. Becoming a consultant is a great opportunity to reaffirm and re-assert healthy boundaries.
I am choosing to break deeply ingrained intergenerational medical curses by modelling healthy work-life balance so that my registrars, residents, junior doctors, and medical students see my example and courageously aspire for more. As a recovering people pleaser, some days it’s easy to hold these boundaries; other days it’s hard. However, I remember this quote from Dr Kemi Doll as a mantra to keep my boundaries solid. Create boundaries. Stick to them. Do not expect applause.
3. Celebrate all your firsts- your first theatre list, ward round, first complication, first complaint, first compliment, first argument with a colleague, first wrong call, first heroic save when you’re called in from home to fix things. It’s only been four months and I have had nearly all of these firsts.
Pause and mark them as an intentional way of learning from the experience(good/bad). Reflect on it and record it in your portfolio as evidence of your continuous professional development. This will come in handy for your annual appraisal. Express gratitude and move forward.
4. Go on lunch dates with your senior colleagues.
Getting to know senior colleagues can be a great way to get to know your department. Senior consultants, managers, midwives, and nurses hold the institutional memory and many words of wisdom. It’s also a good idea to identify a senior consultant as your informal or formal work buddy- a senior colleague you trust who can be a sounding board and moral support because they are likely to have been in your shoes at some point. Also, you may be able to bag yourself a free coffee ;D
5. Figure out an organizational system early!
The rumours are true. When you transition from trainee to consultant the admin goes from zero to 1000. In the time I have written this blog, I have probably received 10 additional work e-mails that need immediate attention. Sigh.
Get into the habit of reading, dealing with, filling emails into subfolders and deleting regularly. This will keep your colleagues, secretaries, and managers happy. Create a system to allow you to do this in a proactive rather than a reactive manner.
Multi-tasking is a fallacy( even for women).
A great tip a colleague once shared is to avoid doing admin in between patients during a clinic and I’ve stuck to this. If you are fortunate and have a lull in the middle of your clinic, grab tea, coffee or water or read through the latest publication from TOG, BJOG, ACOG, or listen to your favourite podcast etc. You’ll notice that in between patients you don’t truly have time to read a journal paper or listen to a podcast( semi-mindless tasks). So why are you busy rushing to do admin that requires your full attention at the same time?
6. As your pace slows down interrogate your “Why”
For most of us the pace of working changes. Our degree of autonomy increases. After decades of studying and training for the first time, you may find yourself at a loss for ‘what to do’ when you are no longer being told exactly how to structure your time. This is a great time to fine-tune your self-leadership skills. I wrote about this in a previous blog exactly a year ago. It was one of my most viewed blogs!
As physicians and surgeons our training prioritises technical skills. However, I believe that it is the non-technical executive-level functioning skills required to successfully manage and lead oneself and team that are ultimately what makes an excellent consultant. In honing these skills as a new consultant, I found it useful to ask myself two questions “How do I want to show up as a consultant?”” Why?” Beyond a list of desirable characteristics and abilities, understanding your “why” is a useful exercise in the emotional interrogation of one’s motivations, values and ultimately your ikigai. I believe that this is what you should focus on nurturing and cultivating during your career, as it is ultimately what will sustain you.
7. Give yourself some grace (build in some rest)
Confidence comes with time. I believe confidence is the reward you get from being courageous in life. Be brave and consistent in exploring your new role. It’s taken me eighteen years (since starting medical school) to get to this point and yet, I’m only at the beginning of my journey of being a consultant. There’s no rush. Ask questions! Be open-minded. Take on constructive feedback with grace and interest. Remember to rest- it’s your number-one superpower.
8. Finally, enjoy it!
One of the best things one of my mentors said to me was “Just enjoy it Isi. You made it and you deserve it!” Receiving that verbal affirmation and charge for joy from someone I deeply respect was liberating.
So far in my first trimester of being a consultant I have had several highs and several lows and I’m sure that will continue all through my career. I continue to expand into the role. And I am choosing to enjoy it all, the good, the bad and the ugly.
Bring on the second trimester! Stay tuned for more.
NOW WHAT?
Do you know a new or soon to be consultant(attending)?Share this with them.
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