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Consultant (medicine)

January 01, 1970

For other uses, see Consultant (disambiguation).

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 a general practitioner.

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 edit

CCSC/BMA edit

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 edit

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

Responsibilities edit

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 edit

Consultation time vs. quality edit

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]

Domain-challenges edit

Domain-specific challenges for consultants exist.[7] 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.[8]

Training edit

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 edit

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.[9]

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) edit

Consultants in the NHS start £88,364 (Threshold 1) to £119,133 (Threshold 8) with additional "Clinical excellence awards" available.[10]

Further reading edit

  • Oxtoby, Kathy. "Professional Roles Are Blurring". BMJ (Clinical research ed.) (2009): a3163. Print.[11]

See also edit

References edit

  1. ^ a b c "The role of the consultant" (PDF). British Medical Association. (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. ^ 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.
  8. ^ 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
  9. ^ Oxtoby, Kathy (2012). "Is private practice losing its appeal?". BMJ. 345: e4446. doi:10.1136/bmj.e4446. S2CID 80439251.
  10. ^ 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.
  11. ^ Oxtoby, Kathy (2009-01-07). "Professional roles are blurring". BMJ. 338: a3163. doi:10.1136/bmj.a3163. ISSN 0959-8138. S2CID 80554142.

January 01, 1970
consultant, medicine, other, uses, consultant, disambiguation, this, article, multiple, issues, please, help, improve, discuss, these, issues, talk, page, learn, when, remove, these, template, messages, this, article, needs, updated, please, help, update, this. For other uses see Consultant disambiguation This article has multiple issues Please help improve it or discuss these issues on the talk page Learn how and when to remove these template messages This article needs to be updated Please help update this article to reflect recent events or newly available information April 2021 This article needs additional citations for verification Please help improve this article by adding citations to reliable sources Unsourced material may be challenged and removed Find sources Consultant medicine news newspapers books scholar JSTOR April 2021 Learn how and when to remove this template message Learn how and when to remove this template message 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 a general practitioner 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 Contents 1 Definition 1 1 CCSC BMA 1 2 Cohn 2 Responsibilities 3 Challenges 3 1 Consultation time vs quality 3 2 Domain challenges 4 Training 5 Contracts 6 Pay scale 2022 contract 7 Further reading 8 See also 9 ReferencesDefinition editCCSC BMA edit 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 edit Cohn mentions that the consultant should try to support the referring physician and comfort the patient 3 Responsibilities editA 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 editConsultation time vs quality edit 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 Domain challenges edit Domain specific challenges for consultants exist 7 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 8 Training editThe 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 editMost 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 9 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 edit Consultants in the NHS start 88 364 Threshold 1 to 119 133 Threshold 8 with additional Clinical excellence awards available 10 Further reading editOxtoby Kathy Professional Roles Are Blurring BMJ Clinical research ed 2009 a3163 Print 11 See also editAttending physician equivalent position in the United States and Canada References edit a b c The role of the consultant PDF British Medical Association Archived PDF from the original on 2016 03 29 Retrieved 2021 04 24 UK Government Web Archive webarchive nationalarchives gov uk Retrieved 2023 07 31 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 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 Clinical Fellow NIH Office of Intramural Research oir nih gov Retrieved 2021 04 24 Oxtoby Kathy 2010 05 26 Consultation times BMJ 340 c2554 doi 10 1136 bmj c2554 ISSN 0959 8138 S2CID 220115003 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 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 Oxtoby Kathy 2012 Is private practice losing its appeal BMJ 345 e4446 doi 10 1136 bmj e4446 S2CID 80439251 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 Oxtoby Kathy 2009 01 07 Professional roles are blurring BMJ 338 a3163 doi 10 1136 bmj a3163 ISSN 0959 8138 S2CID 80554142 Retrieved from https en wikipedia org w index php title Consultant medicine amp oldid 1218464863, wikipedia, wiki, book, books, library,

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