“What does it feel like to have finally made it?”

Having recently been appointed as a permanent staff specialist at a public hospital, I have been asked this question fairly regularly by trainees I had previously worked with or mentored. They wondered what it was like, becoming a consultant. I would usually reply with something cursory like “It’s good”, before deflecting the conversation elsewhere. However, after 18 months in the job and much reflection, the truth is that life didn’t become instantly better when I had finally “made it” – something that others (including myself) had expected me to feel.

Going from trainee to consultant

The years spent in training can be gruelling and getting longer. Most jobs involve long working days, frequent overtime shifts, and stretches of night shifts. On top of this trainees are to somehow find time to study for exams and do extracurricular activities to be competitive for job applications. All which needs to be worked around personal and family life, friends and hobbies.

Once you become a consultant in your chosen field, you are somewhat protected from the frontline by your trainees. Admission and consult requests are vetted and repackaged with management already initiated by the time it reaches you. Your working hours are more flexible. You still have after-hours duties (on-call). But for most specialties, this can be done from the comfort of your own home with the trainee being on-site if needed. Any further study or extra-curricular activity is self-initiated and not assessment-driven. You can even get an allowance to pay for your conference trips. The proverbial grass seems much greener.

Perks and challenges

There are perks, however, there are also new challenges to face.

1. You are ultimately responsible for all patients admitted under your care

Both the complex ones as well as the routine ones. This accountability includes all management decisions made by you and your team. Including their consequences, complications and any errors or complaints made along the way. That’s a lot more responsibility! Thankfully, there are still people around you to ask for help and advice.

2. The money is not dramatically increased or easier to earn when you first start out

Public hospital staff specialist salaries can be found online in the NSW Medical Award.

Because it is a salary, not a wage, you are not paid overtime or callbacks. So, you may not end up being paid dramatically more than a final year trainee who has done a lot of overtime. If you go into private practice, there are many expenses to cover. Rent for rooms, secretaries, software, equipment, etc. Therefore, you need to fill your books (clinic appointments, theatre/procedure lists) with patients or else you don’t get paid.

This may involve visiting GP practices in your area and getting your name out there so you receive referrals. Young consultants starting out may have fractional appointments across several different places. This results in a lot of travelling until they are able to consolidate as their practice grows. All this can be a source of stress.

3. Trying to establish your research profile

For those in academic posts or if you have research interests, this is usually a time to build your reputation by:

• establishing your niche area,
• setting up a lab,
• supervising students,
• presenting at conferences,
• publishing papers, and
• securing competitive grants.

This in itself can be a fulltime job, but you also have a clinical load to juggle.

4. It is harder to avoid workplace politics

Depending on the people you work with, some degree of politics exists in every department. While trainees can (and should) be spared this, it can be harder to do as a consultant. Also, for those situations you were taught as a trainee to escalate to a senior person unless it was easily resolved (e.g. trainee in difficulty, conflict resolution between staff members) – you are now that senior person!

5. The studying doesn’t stop

You may not be studying to pass exams anymore. However, you still need to study in your private time to keep abreast of developments in your field and stay up-to-date.

What I am not saying

Don’t get me wrong. I’m not saying becoming a consultant is not worth striving for. It is certainly a great achievement to be proud of and celebrated. I enjoy turning up to work each day and would have done it all over again if I had the chance. But the same can be said for all my training years. And it should not be something to bank all your gratification, happiness and self-worth on.

What I would like to say

If you spend your whole training career thinking that “things will be so much better once I become a consultant”, you may be left disappointed or with a sense of anticlimax when you finally get there. The same applies if you pin your happiness on reaching any other milestone such as passing a certain exam or getting onto a training program, etc.

After each milestone, there will be further challenges to face as well as rewarding experiences. The pressures and stresses are still there but come in different forms now. Furthermore, having “made it” suggests you’ve reached the pinnacle. But there may be many other, sometimes greater, pursuits open to you in the future. You may take up a post in another hospital. You may go into hospital administration or university academia. Or you may work as an advisor to health organisations or industry, or leave medicine altogether.

Therefore, we should change our mindset and acknowledge that becoming a consultant is not, and should not, be the end goal of becoming a doctor. It is just another stop on the ongoing journey of your medical career.

So, perhaps my answer now to the original question of “What does it feel like to have finally made it?” is, “Oh it’s just as satisfying as it has always been and my journey is still ongoing.”