Specialist-based medicine is a positive career option providing for a very satisfying working life. However, in retrospect at least, many medical specialists reflect on how stressful the first years of becoming a consultant were. Some would rate the difficulties as exceeding those of the internship, when one maintained the collegiality and friendship of the same graduating class. There is now a burgeoning interest in improving the conditions and work/life balance for junior doctors and an emerging awareness of the needs of new consultants.1–3

The newly appointed consultant is likely to carry the self-expectation of being fully trained and ready to shoulder the new personal responsibility that goes with having your name “on the end of the bed”. This may be peculiarly burdensome, given the background of the culture of medicine which assumes strength, independence, misguided omnipotence and workaholism.4

The new consultant’s work pattern includes being alone at clinics and in private practice, and conducting ward rounds with frequently changing junior doctors, all of which can promote the sense of isolation. Contact with other consultants in the clinical scene may be infrequent and cursory, with true opportunities to discuss clinical difficulties being scarce in many busy clinical settings.

As the new consultant, full of up-to-date knowledge and drive, you will be asked to undertake any number of commitments including running departmental in-service training, hospital quality/audit committees, college work, specialist societies, teaching at all levels, start or join a private practice, continue the research themes from your previous senior registrar/MD/PhD experience, and present at and organise conferences.

We suggest a number of strategies to assist the new consultant (Table 1). Firstly, find a colleague you respect to use as a mentor (not necessarily within your department), and meet regularly by scheduling appointments.

Secondly, take your role in your multidisciplinary team meeting and not defer this to juniors. Your “team” will support you and provide you with the necessary information and feedback to perform your role. In turn you should endeavour to be inclusive, respectful, and accessible.

Thirdly, meet with your departmental clinical leader/director individually, not just at departmental business meetings. Your personal development “plan” and Continuing Medical Education (CME) requirements are a priority. It is important to carefully negotiate your clinical commitments to around 70% of your total work time.5

The requirements for non-clinical time are increasing, and we propose a table of likely clinical and non-clinical duties for the new consultant to consider when structuring his/her job and time (Table 2). Clearly this job-sizing is variable over the range and diversity of services but the principle of work-based time management is the key to survival during this period, because there will be many calls upon your time. Ensure there is adequate secretarial support.

Fourthly, when you get to your new post/hospital, it is vital that you have a proper orientation programme, despite the fact that many hospitals and new consultants assiduously avoid this matter. You should familiarise yourself with relevant hospital policies, information systems, and the wider team (including managers) with whom you will be working.

In this context you must work closely with your clinical departmental head and seek their leadership and assistance in brokering arrangements. Junior consultants are often ill equipped for leadership, clinician/managerial interface issues and frustrations over resource allocation, and procuring of newer medical devices may emerge.6 Currently many DHBs offer training in clinical leadership and management skills, and doctors should be involved.7,8

Finally, self-care of your mental health is vital during this period of medical practice. It is important to get a general practitioner, have a life outside medicine and put in place a personal programme to preserve your mental/physical health (Table 3). The new consultant will often be in a setting of geographical change with young children adding to recognised work stresses.

Work/life balance plans become submerged and your personal health can be jeopardised. Indeed, the setting may be just right for the doctors’ three Ds—depression, drugs (alcohol), and dimming (burn-out) to emerge4,9—particularly if a significant medicolegal issue arises early in your consultant years.

In summary, the difficulties of the new consultant position may be major, yet are often neglected. Recognition of the potential difficulties is essential if strategies are to be put in place to lessen their impact.10–12

Author information: Geoffrey Robinson, Chief Medical Officer and Consultant Physician1,2; Johan Morreau, Chief Medical Officer and Paediatrician3, Marion Leighton, Junior Consultant1,2, Richard Beasley, Director1 and Consultant Physician2

Correspondence: Dr Geoffrey Robinson, Medical Research Institute of New Zealand, PO Box 10055, Wellington 6143. Fax: (04) 472 9224; email: Geoffrey.Robinson@mrinz.ac.nz