||The examples and perspective in this article deal primarily with the United Kingdom and do not represent a worldwide view of the subject. (December 2010)|
|This article needs additional citations for verification. (April 2014)|
In the United Kingdom, Republic of Ireland, and parts of the Commonwealth, consultant is the title of a senior hospital-based physician or surgeon who has completed all of his or her specialist training and been placed on the specialist register in their chosen speciality. Their role is entirely distinct to that of general practitioners, or GPs.
Consultants accept ultimate responsibility for the care of all the patients referred to them, so the job carries significant personal responsibility.
A physician must be on the Specialist Register before he or she 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.
Virtually all consultants in the UK are employed by the NHS, rendering the NHS a virtual monopoly of career opportunities for the senior hospital physician community in the UK, and apart from one or two specialities there are virtually no opportunities for consultants to earn a living completely outside of the NHS. Their salaries are dictated by the UK Government, who are the ultimate employer of UK Consultants, and who wield considerable power over the pay and conditions of hospital doctors.
|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 (GPST)
in general practice:
|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:
total time in training:
minimum 7-9 years
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.
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, 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.
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 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, lead consultant etc.) exist for consultants who have particular responsibilities for the overall management of the hospital or some part thereof.
UK 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, 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.
- Attending physician (The equivalent position in the United States of America)
- Junior doctor
- Specialist registrar