In my last post I described my journey to taking the decision to become a medical director. I know that many of my colleagues, whilst being extremely generous in their congratulations and sincere in their wishes of good luck and fortune – may well be thinking along the lines “why would you do that?”. I know that is what I thought for quite some time, and a bit of me still does…

The Cost

The loss of clinical practice is the first barrier – it has direct cost to the individual doctor. Earning opportunities for supplementing ones basic NHS salary as a practicing clinician are legion, waiting list initiatives and private practice if pursued with dedication and vigour can easily surpass even a medical directors salary. As one becomes more and more embroiled in the maelstrom of medical leadership the loss of time (and vigour!) gradually closes off these opportunities – the arcane pay structures of the NHS are peculiarly bad at rewarding those that do choose to take that path; and when they do it results in a wholesale pillaging of ones pension by the tax man (that alone is enough to put many off).

Most doctors though are not wholly motivated by money (fortunately) – but there is a deeper and more personal cost to moving away from clinical practice and that is the less tangible but very real issue of status. The status of medical practitioner is hard earned but once achieved is gratifyingly well rewarded. Doctors are accorded a great deal of authority and privilege both within and outside the work place – with that comes much expectation and responsibility. One’s status as a trained practitioner in your chosen specialty, the time and effort put in to achieving it and the rewards it brings through the gratitude and respect of patients, colleagues and society results in it becoming an embedded part of one’s identity – giving it up is giving up a part of yourself and replacing it with….management (why would you do that?).

Now I’m not saying that becoming a medical director will result in a wholesale loss of status nor for that matter will I be impoverished by the move. Nevertheless I am giving up part of my identity (in my case I am giving up intensive care medicine), I am stopping doing something that on a good day is actually good fun, I am leaving behind colleagues and friends (who no doubt think me very disloyal) and replacing it all with a new and different status – one with uncertain benefits and certain risks.

Certain Risks

There is no doubt the climate is harsher the higher you climb the leadership pyramid (for the record I’m not a fan of hierarchical metaphors for leadership structures with all the value laden implications of rank – common usage though makes them hard to avoid…). Scrutiny is more direct, more personal and less forgiving. Failure is overt, public and consequential to one’s job. The safety net of return to clinical practice gets thinner and the holes bigger the more time you spend away from it. Exit strategies are unclear, career paths poorly defined, training and support hard to find (expensive when you find them). These are realities faced by almost anyone in positions of responsibility both in public and private sector organisations. The wind only feels chillier to a doctor because of the remarkably secure, well rewarded and unassailable position that being a consultant is.

Uncertain Benefits

You are paid more – though the pathway through clinical directorship and associate medical directorship on your way there is hardly littered with gold. Most Trusts struggle to release the time let alone the money to encourage doctors down the path – certainly insufficient to compensate for the opportunity costs outlined above. Your salary is a matter of public record and subject to scrutiny in a way no other consultant has to endure. Should this discourage you? – Absolutely not, the money is good enough that for the vast majority of us it is a non-issue, it’s ‘off the table’. The role brings a level of autonomy, self determination, sense of purpose and opportunity for personal development that no other leading to it can – for me this is the motivation.

So would you do it?

It doesn’t stack up well – and there are lots of things we could do to make it stack up better. Many outlined in this report. I am certain there are many doctors out there with the leadership skills that are needed that are reluctant to put themselves forward. My advice is take the plunge, change is good.