Consultant (medicine)

In the United Kingdom, Ireland, and parts of the Commonwealth, consultant is the title of a senior hospital-based physician or surgeon who has completed all of their specialist training and been placed on the specialist register in their chosen speciality. Their role is entirely distinct from that of general practitioners, or GPs.

For other uses, see Consultant (disambiguation).

The primary objective of a consultant is to use expert knowledge and skill to diagnose and treat patients while retaining ultimate clinical responsibility for their care.[1] A physician must be on the Specialist Register before they may be employed as a substantive consultant in the National Health Service (NHS). This usually entails holding a Certificate of Completion of Training (CCT) in any of the recognised specialities, but academics with substantial publications and international reputation may be exempted from this requirement, in the expectation that they will practice at a tertiary level. "Locum consultant" appointments of limited duration may be given to those with clinical experience, with or without higher qualifications.

The term consultant may also be prefixed to other non-medical high specialist leadership roles in UK Healthcare settings such as Consultant Nurse, Consultant Dietician, Consultant Paramedic and Consultant Pharmacist. These are roles undertaken by Non Medical Practitioners in posts agreed by the Department of Health.[2]

In South East Asian countries, practitioners who have at least post graduation degree like Doctor of Medicine and more than 10 years of clinical experience in treating patients are labelled as consultant.

Definition

CCSC/BMA

The Central Consultants and Specialists Committee (CCSC), which is a Standing Committee of the BMA, agreed the following as a very broad description of the role of consultants:[1]

"Primarily as the delivery of expert clinical care usually within a team, including the ability to recognise and manage the more complex end of the specialty spectrum (diagnosis, management decisions, difficult cases, including apparently simple cases which have a high incidence of complications in more inexperienced hands) but also involved in running departments, managerial decisions, teaching, training, researching, developing local services – generally being involved in the wider management and leadership of the organisations they work in, and the NHS generally."[1]

This report from 2008 describes how most consultants work now and it describes what the 2003 contract was intended (by BMA negotiators at least) to remunerate and develop (a consultant-based service).

Cohn

Cohn mentions that "the consultant should try to support the referring physician and comfort the patient."[3]

Responsibilities

A consultant typically leads a "firm" (team of doctors) which comprises Specialty Registrars and Foundation Doctors, all training to work in the consultant's speciality, as well as other "career grade" doctors such as clinical assistants, clinical fellows,[4][5] Speciality Doctors, Associate Specialists and staff grade doctors. They also have numerous other key roles in the functioning of hospitals and the wider health service.

Challenges

Consultation time vs. quality

In terms of patient care, consultation times are controversial ground, with quality of communication is key over quantity of time spent with the client.[6]

Multi-role skills

Sindermann and Sawyer conclude in their book The Scientist as Consultant, that a [scientific] consultant is successful if they have "achieved a viable mix of technical proficiency and business skills" with "technical proficiency" meaning excellence in competence, credibility, effective networking with colleagues, and ability to negotiate.[7]

Domain-challenges

Domain-specific challenges for consultants exist.[8] In palliative medicine consulting, emotions, beliefs, sensitive topics, difficulty communicating and prognosis interpretation, or patients expectations despite critical illness are some of the challenges faced by the consultant.[9]

Training

The time required to become a consultant depends upon a number of factors, but principally the speciality chosen. Certain specialities require longer training, or are more competitive, and therefore becoming a consultant can take longer. Other specialities are relatively easy to progress through, and it is possible for a doctor to become a consultant much earlier in their career. After Modernising Medical Careers came into operation (in early 2007), the length of training was fixed for the majority of doctors, at about nine years.

Contracts

Most consultants work on a long-term contract with one or more hospital trusts, and these posts are known as substantive consultant positions. Various titles (such as senior consultant, clinical director, medical director, lead consultant etc.) exist for consultants who have particular responsibilities for the overall management of the hospital or some part thereof.

In the UK all doctors including consultants have the right to undertake private medical work. Some make a career out of private medical practice. For others it is used to supplement their work for the NHS.[10]

Other doctors - some without a CCT, a few who have only just obtained that qualification, others who have retired from substantive appointments, and others who wish to use some of their annual leave to generate additional earnings - may be employed as locum consultants, who have the same clinical responsibility, but are typically on fixed, short-term contracts.

Medical career grades of the National Health Service
Year Current (Modernising Medical Careers) Previous
1 Foundation doctor (FY1 and FY2), 2 years Pre-registration house officer (PRHO), 1 year
2 Senior house officer (SHO),
minimum 2 years; often more
3 Specialty registrar,
general practice (GPST), minimum 3 years		 Specialty registrar,
hospital speciality (SpR), minimum 5 years
4 Specialist registrar,
4–6 years		 GP registrar, 1 year
5 General practitioner,
4 years total time in training
6–8 General practitioner,
minimum 5 years total time in training
9 Consultant, minimum 7 years total time in training Consultant, minimum 7–9 years total time in training
Optional Training is competency based, times shown are a minimum. Training may be extended by obtaining an Academic Clinical Fellowship for research or by dual certification in another speciality. Training may be extended by pursuing medical research (usually 2–3 years), usually with clinical duties as well

Pay scale (2022 contract)

Consultants in the NHS start £88,364 (Threshold 1) to £119,133 (Threshold 8) with additional "Clinical excellence awards" available.[11]

Further reading
  • Oxtoby, Kathy. "Professional Roles Are Blurring". BMJ (Clinical research ed.) (2009): a3163. Print.[12]

See also

References
    1. "The role of the consultant" (PDF). British Medical Association. Archived (PDF) from the original on 2016-03-29. Retrieved 2021-04-24.
    2. "UK Government Web Archive". webarchive.nationalarchives.gov.uk. Retrieved 2023-07-31.
    3. Cohn, Steven L. (2003). "The role of the medical consultant". The Medical Clinics of North America. 87 (1): 1–6. doi:10.1016/s0025-7125(02)00148-7. ISSN 0025-7125. PMID 12575881.
    4. Stebbing, Justin (2004-07-17). "How is the role of clinical fellow different from that of senior house officer?". BMJ. 329 (7458): s22.2–s22. doi:10.1136/bmj.329.7458.s22-a. ISSN 0959-8138. S2CID 80328092.
    5. "Clinical Fellow | NIH Office of Intramural Research". oir.nih.gov. Retrieved 2021-04-24.
    6. Oxtoby, Kathy (2010-05-26). "Consultation times". BMJ. 340: c2554. doi:10.1136/bmj.c2554. ISSN 0959-8138. S2CID 220115003.
    7. Sindermann, Carl J.; Sawyer, Thomas K. (1997), Sindermann, Carl J.; Sawyer, Thomas K. (eds.), "Conclusion", The Scientist as Consultant: Building New Career Opportunities, Boston, MA: Springer US, pp. 293–298, doi:10.1007/978-1-4899-5992-8_21, ISBN 978-1-4899-5992-8, retrieved 2021-04-24
    8. Caplan, Richard; Ramirez, Amanda; Graham, Jill; Richards, MichaelA.; Cull, Ann; Gregory, WalterM. (June 1996). "Stress in hospital consultants". The Lancet. 347 (9015): 1630. doi:10.1016/s0140-6736(96)91118-6. ISSN 0140-6736. PMID 8667901. S2CID 35785296.
    9. Partain, Daniel K.; Strand, Jacob J. (2018), Robinson, Maisha T. (ed.), "Common Challenges in a Palliative Medicine Consultation", Case Studies in Neuropalliative Care, Case Studies in Neurology, Cambridge: Cambridge University Press, pp. 8–12, doi:10.1017/9781108277365.002, ISBN 978-1-108-40491-4, retrieved 2021-04-24
    10. Oxtoby, Kathy (2012). "Is private practice losing its appeal?". BMJ. 345: e4446. doi:10.1136/bmj.e4446. S2CID 80439251.
    11. Singh, Purnendu (28 September 2022). "Pay scales for consultants in England". The British Medical Association is the trade union and professional body for doctors in the UK. Retrieved 2021-04-24.
    12. Oxtoby, Kathy (2009-01-07). "Professional roles are blurring". BMJ. 338: a3163. doi:10.1136/bmj.a3163. ISSN 0959-8138. S2CID 80554142.
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