The following was originally written for SURG by Mr Alan Turner, Retired Consultant Urologist and Medical Director, Peterborough Hospitals NHS Trust but still remains relevant for BSoT today.
"When I was looking for a Consultant post my then chief advised me:
“ Choose your hospital more carefully than your partner. Sadly, it is easier to separate from a partner and establish another relationship than it is to leave a hospital post and get another one. Be very careful about an appointment to a hospital where you have been at the end of your SpR training. It is very flattering to be asked to join the Consultant staff but you may always be the SpR in the eyes of your Consultant colleagues, with all that that entails."
"After many years of observing Consultants and their progress I am sure these comments still hold true. The sections below will take you through the more important aspects of the Consultant interview."
Choosing the hospital
Remember: as a Consultant you should be very important to them. They will depend heavily on your ability to earn their income and enhance their reputation. You should, therefore, be "courted" to join the hospital.
Look at the information that you are sent with the application. Does it make you feel that you want to work there? If it does not, and the description is rather dull, that might reflect the attitude of the hospital. In this day and age, hospitals should be selling themselves; they do it to primary care, so they should also do it for prospective Consultants.
Find out what you can about the Hospital (e.g. on the "grapevine" at SURG meetings) and look at the Care Quality Commission website where there should be reports on indivdual hospitals. We may not agree with the concept of hospital ratings but they do give you a guide as to the state of a hospital. Beware the "failing" hospital.
Visit at a weekend, and wander in, to see what it feels like. See how you are greeted if you ask for, say, the Postgraduate Centre. It is surprising how much you gain from first impressions. Were they really welcoming and helpful? If so, it is a sign of a happy staff; if not, would you really want to work there?
Look around the geographical area with your partner, look at what facilities are available for recreation (work-life balance), look at schools, connections to other parts of the country (can we get away to friends or family easily), houses and their cost (can we afford a decent life here?).
Remember: if you or your partner does not like some things, do not apply for the post because you might, of course, get the job. Be realistic though: life is about compromise.
The post itself
You should receive an application pack containing the following:
- a job description (which should include a model timetable),
- a person specification,
- information about the Trust,
- staffing and relevant services,
- teaching commitments, and
- terms and conditions of service.
If any of these are missing, ask for them to be sent to you. You may be referred to the Department of Health website for Terms and Conditions of the post and this is, of course, acceptable practice.
All Consultant Posts should be suitable for those wishing to work less than full-time. If not, then the Trust should clarify why not. It should also outline how the post, as advertised, fits in with the department and any sub-speciality interest that may be needed. If not ask; the hospital may just be on a "fishing trip" to see who applies and this can lead to all kinds of problems.
Visit the Hospital officially. You should try and meet the following:
- possible Consultant Colleagues in the same speciality,
- possible Consultant Colleagues in an allied speciality e.g. anaesthesia, radiology, nephrology, gastroenterology etc, to see what they feel about the new appointment,
- possible colleagues in the support services e.g. physiotherapy,
- the Medical Director: you may get a slightly different view than from potential colleagues, and
- the Chief Executive: you should get the same view as the Medical Director; if not, you need to get a clearer view of the relationships within management and where is the Trust heading.
Questions to ask
You need to find out what is expected of the new appointment:
- is it a replacement? Maybe all that is expected is to maintain the status quo; this could be boring if you are not allowed to develop
- is it to increase the capacity of the department? Is the department very busy, does it have a good reputation and do they want another pair of hands to complement everyone else?
- is it to increase the capability of the department? This is your chance to develop a sub-speciality interest
- is it to increase the portfolio of the Trust? This means that it is designed to develop a completely new speciality
These questions will give you a flavour of what will be expected of you in the post. No matter what, you need to establish that the Trust has thought about the implications of the appointment especially around costs for:
- equipment - especially if you are replacing a retiring consultant. They will not necessarily be using modern techniques e.g. minimally-invasive kit,
- support departments - any special investigative procedures that are needed for you to provide a modern service, which the hospital may not currently have,
- support staff - if they are increasing numbers, are the support staff available e.g. junior medical staff, theatre sessions, anaesthetists, physiotherapists etc?
- medications - there may be new non-operative treatments that require a substantial investment in drugs.
It is vital to ask about the above. If the Trust has not thought these matters through, or you you could find yourself spending the first few years of your Consultant life fighting for what you consider the bare essentials of a modern service.
They may, of course, seem very receptive to new ideas, but, if you get the impression that there will be little support in the broadest sense for new ideas, then be careful.
Every candidate should have completed urological training, so you have to try extra hard, so that your application stands out and gets selected. Make it interesting, try and tailor it to what the hospital wants (e.g. make sure that your training specific areas is prominent and well presented).
If, in your spare time, you do something different (e.g. sailing across the oceans), make sure it stands out as well. All this looks as if you are the correct person for the post and, also, as if you are someone who has that little bit extra to offer.
The interview panel
Congratulations! You have been selected for the interview.
You may not done one for several years, so it may be helpful ask your Chief if he would give you a mock interview, to see if you have any bad habits which might make the panel not want, and to give you some feedback as to how you come over. You have one chance to impress the panel, so do not waste it.
You may be asked to give a short presentation. You will always be informed of this in advance, given the subject and told how long the presentation should be. Try to research the audience to whom you will be presenting, and tailor your presentation to that audience. Keep it clear and succinct.
There will always be a local and medical majority on any "standard interview panel" when all the panel members will have the chance to ask questions. Before the interview starts, the questions that will be asked, and by whom they are asked, will have agreed by the panel so that all candidates are asked the same questions by the same people.
Be mindful of a few tips:
- give short answers - do not meander,
- try to look as if you want the post,
- keep the panel interested,
- try to engage all the panel members,
- watch their body language - if someone is yawning or looking away, you may need to work at getting them interested again, and
- watch your own body language.
The questioning usually follows a set pattern and in the following order:
He/she is there to see if you are appointable, to check you have the appropriate CCST and to ask specifically about your training in relation to the post for which you are applying. This is your chance to tell the panel that you are just what they are looking for, since your training in what they want is more than adequate, and, in addition, you have done other related things e.g. have been involved in trials.
- a University Representative
He/she will only be present if there is a major teaching commitment, when you are likely be asked about audit, research & teaching, and about ways in which you know you are a good teacher e.g. feedback from students, pass rates at exams. Try to tell the panel all this before they ask you so it does not have to be dragged out.
- Hospital Consultants (usually two)
They usually want to know what you have done and why you want to join their department. This is your chance to tell them why they should select you, how your training fits into their department to strengthen it and how you can help them make it a department to be proud of. Be positive: it is surprising how few people can sell themselves effectively.
- the Medical Director, Chief Executive and Lay Chair
It can be difficult to forecast their questions but, in general, the Medical Director will want to know how you interact with others, the Chief Executive will want to be convinced that you wish to come to his hospital and that it is not just the next in line. The Lay Chair may want to know a bit about you outside medicine.
Any of the following questions could be asked:
"What are your strengths and weaknesses?"
Anyone can attend a management course or read a book that explains what this is about, and what answers are expected. Do NOT say that you have no weaknesses; everybody has some ... Do not, for example, say you don't like doing paperwork; it might be true but it's not what the panel wants to hear.
"How do you deal with a difficult colleague?"
Not an uncommon problem; try to think of, for example, a junior who had problems and tell the panel how you dealt with it.
"How do you deal with a failing colleague?"
Obviously, they are trying to ensure that you are not involved in "cover ups". You must deal with such problems honestly and by involving more senior people; you are too inexperienced to resolve these matters alone. To avoid being accused, at a later stage, of a cover-up, you must go higher in the organisation. Remember: if you know about something, and do nothing, you you too will be in trouble if an enquiry takes place.
"Why this hospital?"
You must think of good reasons e.g. you will be joining a good department. Tell them you know it is a good hospital with a excellent reputation and say how you know. What they need to determine is that you have looked at the hospital positively and said "Yes! this is where I want to be for the rest of my career". This gives the Chief Executive a warm glow!
"How do you relax?"
It's amazing what I have heard: reading medical texts is not a good answer. If you enjoy watching television, try to be specific about what you like to watch. If you play a sport, tell them who you play for or how often. There are many ways in which people relax, so try to be specific about whatever you do.
"Where do you think your speciality will be in 5 years?"
There have been so many changes in the last few years, they want to determine whether you have any forward vision as to how things may change, and how you are going to adapt.
"How would you get to know the GPs?"
You will need to be able to sell yourself to the GPs. Ideally, you would do this by giving presentations, involving them in audit meetings etc. "By inviting them to dinner parties" is not the most sensible answer.
"What would you want from the hospital?"
This is your chance to tell them what you would need to build up the department and for you to develop. They should not want someone who thinks, once he / she has a Consultant Post, that nothing more need be done until retirement. Try and express how you would like to develop yourself.
"Are you a team player?"
The answer should, of course, be "Yes", but give examples of how you know e.g. feedback from your boss at appraisal.
"What audits have you been involved with and did they change practice?"
Tell them what you have done.
"What is your most favourite paper you have written and why?"
Again tell them what you have done.
"If I was to phone your junior staff and say what are you really like what would they say?"
Try and get in a bit about team player, being approachable etc. Remember: your references may say different?
"Why this area of the country?"
Apart from the hospital, and how great it is, you can say that you have looked around the area and like what you see. Try and give examples of good points even if it is good connections with major centres or good schools etc.
If there is a recent article that significantly affects the NHS, try to get a feel for its implications; examples in recent years would include the Bristol Childrens' Heart Surgery Enquiry, the Shipman Enquiry, the surgical mesh scandal etc. It may also be worth visiting the Department of Health website to see what is "hot" or currently on the agenda. There may be numerous other questions, but these are the commonest.
You can also read the latest political news, as it affects urological practice, elsewhere on this website ... click here to read more.
Do NOT try to crack jokes; the panel may find them amusing but jokes can also go horribly wrong.
There was a vogue, a little while ago, for starting your answer by saying "That was a good question". Generally, the panel knows what a good question it was; that is why they are asking it. They do NOT wish to be complimented on their question - they just want it answered!
The end of the interview
At the end of the interview, you will always be asked if you have any questions. You may want to clarify some points about, for example, funding of the post or you can simply say "No, thank you; I have had the chance to talk to everyone I wanted to." No one will be offended by your failure to ask questions.
You will also be asked if, were you to be offered the post, if you would accept it. It is probably best that you answer in the affirmative; saying "no" means that you have been wasting everyone's time.
Remember: if you do not want the post, do not come for the interview. Interview panels do talk to others in the speciality, and the fact that you have declined a position soon gets round.
The successful candidate
Congratulations! You have been called back and told you will be offered the job.
Do NOT sign a contract at this stage; most hospitals will not ask you to do this, but some will. It should, of course, be a standard contract, but do go away and read it to make sure. Equally, do NOT resign from your training programme until your new Consultant contract has been agreed and signed off.
The job description should lay down the number of PAs (programmed activities) and there is nothing that you can do to increase these; you may be able to negotiate them down, once you are in post, if you wish to go less than full-time.
You could try asking for a pay increase above the minimum but you will probably be unsuccessful, unless you are in a shortage speciality.
There is a duty for your referees to tell the truth. It is no longer acceptable for anyone to give a good reference to "get rid of you". Ask them what they are going to say about you; it may come as a suprise. If there is a problem, you need to try and rectify it at the earliest possible opportunity.
I have seen references that say a person is less than adequate for many reasons; there is little chance of getting a Consultant post with such a reference. Ask your referees for an idea of what they are going to say about you; the RITA assessments should, of course, give you some idea.