Consultant (medicine)

For other uses, see Consultant (disambiguation).

In the United Kingdom, Republic of Ireland, and parts of the Commonwealth, consultant is the title of a senior doctor who has completed all of his or her specialist training and been placed on the specialist register in their chosen specialty. Consultants accept ultimate responsibility for the care of all the patients referred to them,[1] so the job carries enormous personal responsibility.

A doctor must be on the Specialist Register before he or she may be employed as a substantive consultant in the National Health Service. This usually entails holding a Certificate of Completion of Training in any of the recognised specialties, 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.

Virtually all consultants in the UK are employed by the NHS, rendering the NHS a virtual monopoly of career opportunities for the senior hospital doctor community in the UK, and apart from one or two specialites there are virtually no opportunities for consultants to earn a living completely outside of the NHS.

A consultant typically leads a "firm" (team of doctors) which comprises Speciality Registrars, and Foundation Doctors, all training to work in the consultant's specialty, as well as other "career grade" doctors such as clinical assistants, clinical fellows, 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.[2]

The time required to become a consultant depends upon a number of factors, but principally the specialty chosen. Certain specialties require longer training, or are more competitive, and therefore becoming a consultant can take longer. Other specialties are relatively easy to progress through, and it is possible for a doctor to become a consultant much earlier in his or her 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.

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, etc.) exist for consultants who have particular responsibilities for the overall management of the hospital. Consultants have the right to undertake private medical work outside of their contracted hours of work for the NHS.

Other doctors - some without a CCT, a few who have only just obtained that qualification, and others who have retired from substantive appointments - may be employed as locum consultants, who have the same clinical responsibility, but are not responsible for management or training of junior staff, and are typically on fixed, short-term contracts.

NHS Medical Career Grades

	Old system		New system (Modernising Medical Careers)
Year 1:	Pre-registration house officer (PRHO) - one year		Foundation Doctor (FY1 and FY2) - 2 years
Year 2:	Senior house officer (SHO) a minimum of two years, although often more
Year 3:			Specialty Registrar (StR) in a hospital speciality: minimum six years	Specialty Registrar (StR) in general practice: three years
Year 4:	Specialist registrar four to six years	GP registrar- one year
Year 5:		General practitioner total time in training: 4 years
Years 6-8:				General practitioner total time in training: 5 years
Year 9:	Consultant total time in training: minimum 7-9 years		Consultant total time in training: minimum 8 years
Optional	Training may be extended by pursuing medical research (usually two-three years), usually with clinical duties as well		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.

See also

• Attending physician (The equivalent position in the United States of America)
• Modernising Medical Careers