Ultimate Metamorphosis
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THE ULTIMATE METAMORPHOSIS: FROM REGISTRAR TO CONSULTANT!
Wednesday, 16 March 2005
After some reflection, I have decided that I must know something about this topic, as I have travelled the road twice. Many moons ago, I was a keen young anaesthetic registrar who became a consultant. For many years I enjoyed working as an intensivist and anaesthetist, but finally saw the light and became a psychiatry registrar. Sounds crazy, doesn't it? (And probably was.) Being a registrar became a semi-permanent state, as I struggled with age, poor memory, depression, lack of sleep and of course the college regulations, but after an epic 9 years I finally climbed out of the cocoon to again become a consultant, just in time to realise that most of my friends were taking early retirement!
Looking back, I hardly noticed becoming an anaesthetic consultant as my responsibilities did not change very much, apart from supervising multiple operating theatres instead of one at a time, and delivering intensive care on the run between anaesthetic cases. The big changes were a large pay rise, my introduction to the amazing world of private practice, billing patients, PBS prescriptions, provider numbers and accountants. Fortunately for me, I joined an established private practice (all male) who also did all the public work as well, so all I had to do was follow the instructions of the secretary as to what to do and where to go next. The downside was having no control over the volume of work as it all had to get done somehow, so frequent all night operating sessions just had to roll into the next day's work , not a safe thing to do at any age. I really appreciated having registrars as they kept me up to date, even when I had little time to read journals etc. Being around trainees is definitely the most painless way to keep up to date.
One of the things it took me about 15 years to learn was how to be assertive and say NO. I really only learnt how to do this after becoming mentally and physically burnt out, and being forced to urgently assess my communication and assertiveness skills. Prior to this, I would say yes to all requests as there was never a serious alternative option, but then would get overtired, resentful and eventually blow up like a volcano at the nearest surgeon;..not a useful thing to do! As a result, for five years I worked as a solo practitioner, which was extremely liberating, as I could say no for me only, without the guilt induced by a group.
The transition to being a psychiatrist was different, but not especially stressful, as I had already learnt some valuable lessons. Recognising my age, obsessionality and need for adequate sleep and relaxation, I decided early in my training not to go into private practice. This has been a good decision, as although I theoretically only work 6 sessions a week, I am very good at extending them to do the job as I think it ought to be done! So my sanity and sense of humour has been well preserved (well, I think so!). Many registrars expect the problems to all disappear when they become a consultant, but do remember being a consultant is not easier than being a registrar; there are just a different bunch of problems.
So what can I say to help others to cross the magic line?
First, from the day you start training, think about each job and whether you would like to do it longterm. Try to get as much variety of experience as you can, even if jobs are more difficult. Then by the time you get to advanced training, you should have some idea as to what area(s) of psychiatry you would really like to follow later on. I can't stress how important this is in order to make intelligent, fulfilling choices for the rest of your career. It is important not to just take the first consultant job offered to you, unless you are clear it is a direction you are interested in. As a registrar, jobs just keep coming, so the transition phase can cause some insecurities that you haven't experienced before. Remind yourself of how many unemployed psychiatrists you have met! It is also important to let people know what you are interested in, as not even psychiatrists read minds.
Second, if you have become a bit paranoid about "The College", stop now as 99.9% of the college members are honest, hardworking, well-meaning folk who genuinely want you to get through your training and become one of the 'in' crowd. Also, whether you like it or not, this soon will be your college. If you feel angry about college processes try not to whinge but get in there and make constructive suggestions, get on committees etc. and change what you don't like. I believe that you have no right to complain unless you are willing to be part of the solution. The same applies to hospitals : they will probably always be under-resourced and a bureaucratic jungle, so don't expect them to change miraculously. If you can't live with it, go into private practice
Third, be curious. Ask your consultant about their career choices, why they made them, what they like about their job, what they hate, why they chose private and/or public practice, what they would do differently if they did it again. Ask about practicalities of private practice, mixing public and private, practical matters like rooms, secretaries, solo or group practice etc. Start to think more widely and for the future, so by the time you are trained, you will know what you want to do, and what problems to expect.
Fourth, some things about being a consultant can seem a bit scary at first. How will I ever be able to supervise a registrar? Who will I ask when I don't know what's best? What if I get it wrong? Remember you don't have to know it all, in fact, you don't even need to know half of it! But you do need to know who and when to ask and to have the humility to do so. Don't pretend to know it all, as it is exhausting and a bit intimidating for your registrar. Share your ignorance of an area and learn about it together. Make sure that you join a peer review group of colleagues with whom you can openly share your problems and questions. And don't forget your Medical Defence Insurance. Do remember that most of your knowledge will be out of date in 5 years anyway, and coupled with the fact that knowledge doubles every 5 years, you have already lost the race, so gracefully accept that you will never know it all: I find this quite cheering as I struggle with age and a poor memory!
Fifth, don't forget your registrar friends that you leave behind. Keep encouraging them, help them along the road as others helped you. Pass on hints on how to pass and survive. Give back some of what was given to you, and you will help to make this college and training program a better place.
Lastly, maintain some balance in your life. There is always time for a good laugh (even if at yourself!), and some time for yourself, even if only a few hours a week for a hobby, a bit of physical exertion and family. Pursue adequate sleep relentlessly, as I think we don't give it the priority it needs, and suffer accordingly.
So, in summary, get in there, be enthusiastic and curious. Consider your priorities and interests carefully before choosing a consultant job. And when you find it, don't forget to enjoy it! The grass is a different green on the other side.
Jenny Williams