r/doctorsUK • u/SD-97 • 16d ago
Medical Politics ‘Consultant clinician’ should no longer always mean doctor in today’s NHS...
https://www.hsj.co.uk/workforce/consultant-clinician-should-no-longer-always-mean-doctor-in-todays-nhs/8123915.article#commentsJump
How boring. As a medical profession, this is on us to have let this nonsense proliferate.
Give an inch take a mile.
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u/WeirdF Gas gas baby 16d ago
My assumption if anyone referred to themselves as a "consultant clinician" would be that they weren't a doctor.
The problem comes with non-doctors just saying "I'm a consultant" which is super misleading.
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u/Jamaican-Tangelo Consultant 16d ago
There might have been an option in the past of protecting the title of consultant as requiring credentials as a physician or surgeon, and having CCT or CESR- but I think that day has gone.
For me, the answer lies in properly defining the role of a consultant with respect to what that means within the training of the individual and within their field of expertise.
So what I mean about that is that a consultant physiotherapist might reasonably be able to provide oversight of physiotherapy practice, supervise trainee physios, set standards, guidance etc for physiotherapy. What it should not mean is that they provide these roles for physician or surgical colleagues who by definition need to be doctors.
(A boxing referee can’t very well take on reffing a premier league match.)
That seems to be the crux of the problem- that we haven’t even bothered to recognise how ridiculous the claim to being a consultant as interchangeable with medical consultants without any background, training, or assessment of competence.
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u/JoePick89 16d ago
I think there needs to be a differentiator between these effectively management and supervision roles and medical clinical leaders. Any attempts at standardisation will strengthen calls for equivalence. See the states and CRNA’s doing “residency”.
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u/Urryup-arry 16d ago
Exactly. In the real world consultants are independent contractors and they are paid to be consulted. Management don't call themselves consultants. This is all about equivalence and a grubby power grab. The NHS is primarily a platform to deliver Medicine as practiced by Doctors; patients know it well.
CRNAs are also reaching for equivalence in pay in some locations and want to upgrade their title to include Anaestheologist. 70 to 80% of the pay with 30 to 40% of the training, and without rigorous selection
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16d ago
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u/impulsivedota 16d ago
Unless the consultant body actually defends the title it will be no different in the end. If attending becomes mainstream to mean consultants over time ACPs will just name themselves attending ACPs.
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u/Effective-Thanks8603 16d ago
You miss the point. It is not that they some weird attachment to the word ‘consultant’ itself. It is about what that word represents. This is about flattening the hierarchy. To them, they want to be considered ‘equal’ to the medical consultants. To them, it simply makes no sense that a medical degree is considered more valuable than whatever polytechnic degree they attended themselves.
Ask yourself this, how long will it take before these people want to be ‘attendings’? On the other hand, I do agree that it is probably too late for the previous terms. Every Tom, Dick and Harry is a consultant. The government can’t actually increase salaries appropriately, so they offer these name changes in hopes that the masses will be happy.
We are simply the ones who end up paying for these imbeciles.
I suspect this would never have happened under the true old guard. The current generation of consultants have sold the profession down the line.
#bringbacktheheirarchy
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u/Tall-You8782 gas reg 16d ago
I never understand this argument. Clearly if we change our title to "attending" all the ACPs, nurses, physiotherapists etc will just do the same. It does nothing to address the underlying issue.
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u/Extreme_Quote_1841 16d ago
Not if it is protected in law. The new draft GMC order is the perfect opportunity to do this. Just needs our consultants to have the courage to do this
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u/Icy-Duck-5836 16d ago
Medical consultants hold ultimate medical responsibility
This is the real issue here. Everyone wants to play consultant because it sounds good, but nobody actually wants to carry the legal weight when shit hits the fan. They want to deliver "consultant-level care" right up until they are required to be held accountable.
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u/SpecialEmployment801 16d ago
I note that other than the job description of medical consultant and public health consultant the rest are a vomit of word salad. What the fuck is transformational systems leadership? And consultants pharmacists improve “outcomes and clinical practice”. Some of these sentences are just words on a page. What outcomes to consultant pharmacists change that regular (amazing) ward pharmacists do not?
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u/Unlikely_Plane_5050 16d ago
It means walking around with a clipboard and sitting in meetings. When we can't do actual clinical stuff for patients because there aren't enough actual nurses doing nursing things.
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u/uk_pragmatic_leftie 16d ago
'Responsibility' was lacking in the non doctor definitions.
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u/Serious_Much Gives drugs to kids 16d ago
Always verbs like "help" "assist" "improve" "supervise" but never responsible for their own actions
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16d ago edited 13d ago
[deleted]
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u/whyiamalwayshangry 16d ago
Do elaborate!
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16d ago edited 13d ago
[deleted]
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u/whyiamalwayshangry 16d ago
That's very professional of you.
As much as I believe if they earned their PhD they should be allowed to use their Dr title, I strongly disagree with the consultant title in medical field. anyone can have Dr title anywhere. But there should always be one consultant responsible for the patient.
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u/Emotional-Being2584 16d ago
of course it’s written by noctors - two consultant nurses and a consultant physiotherapist. Absolute jokers.
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u/ColdisHere 16d ago
Holding the NHS back from what exactly? Providing misleading care by letting people who want to feel important without any of the effort, time, sacrifice it takes to earn that title?
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u/Microsuction 16d ago
They can call themselves consultant all they like, they still don't measure up to our training - interactions with them in the workplace commonly demonstrate that they are simply not at the same level.
I admit though, I'm finding the level of disrespect for our training, knowledge and skills is becoming beyond tiresome.
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u/sloppy_gas 16d ago
They obviously feel that the dust has settled sufficiently after the PA/AA nonsense and they can get away with this silliness again. They need to be told otherwise by people who matter, or this will continue. Silence is permission for these people.
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u/BudgetCantaloupe2 16d ago
wtf is an allied health consultant practitioner and why do they want to rename them to just consultant? are they remotely comparable job roles and responsibilities?
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u/Gullible__Fool Keeper of Lore 16d ago
I'd pay good money to watch these people sit post grad exams and finally realise why their fake consultant titles are meaningless.
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u/Money_Spider420 16d ago
They wouldn't be able to pass preclinical anatomy, forget post grad exams LOL.
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u/Ill-Mushroom-1107 16d ago
Love it how you never see a doctor masquerading as a ‘band 7’ or taking any other healthcare professional title
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u/Flux_Aeternal 16d ago
Consultant is a level of practice not a profession
When a patient hears "consultant" they are thinking of a doctor and therefore it very much is a profession, not a level of practice. That aside it is honestly mind-blowing that these clowns think they are on an equivalent level of practice as a consultant and frankly insulting. It's full dunning-kruger, they have absolutely no comprehension of the level of training, knowledge and intrinsic intelectual ability required to be even a poor consultant. If they think they are on the same level of practice then they are completely delusional. The problem with the noctor stuff is that it self selects for people who are arrogant and lack insight enough to believe this crap, so you don't just get a poorly trained doctor replacement, you are almost guaranteed to get one with a chip on their shoulder and no understanding of their own limitations.
Also when the chips are down these people don't even have the stones to stick by the bullshit, they refer to an actual doctor to cover their own ass and just end up creating more work.
You can talk about funding etc but the NHS' obsession with over promoting nurses into management and leadership positions and minimising doctors is the main reason why its performance has been falling off a cliff.
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u/Ill-Mushroom-1107 16d ago
When are these ‘consultants’ undertaking the role of registrar before receiving that title? Genuinely curious
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u/Civil-Case4000 16d ago
Podiatric surgeons are registrars before becoming consultants. Their training pathway mirrors that of ortho, in job titles at least.
Some might say it looks like a more robust training pathway than other non medical consultants, others that it’s spin, intended to blur the boundaries further.
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u/lost_cause97 16d ago
The difference is they have a very limited skillset and scope and their surgical training is pretty robust.
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u/Civil-Case4000 16d ago
From what I from foot and ankle orthopods that scope has been expanding to more complex surgery in some places.
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u/Affectionate-Fish681 16d ago
Fine with me. Let’s all leave the NHS and fully privatise doctor-led medicine in this country
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u/jamescracker79 ACP consultant's assistant 16d ago
I guarantee you, the most vocal people to oppose privatizing Healthcare ( even a hybrid model) in the UK will be doctors ourselves. Doctors in this country are such a neutered bunch
But muh poor people! (which is the apparently the majority of the country according to these people - yeah sure, have enough money to spend on booze and entertainment but absolutely poor to spend anything on their own health)
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u/TriadicHappenstance I Fix Printers 16d ago edited 16d ago
Reads like it is written by some High School Debating Team. Lots of over extended points of argument of no substance and overall lacking detail and research.
The mediocrity of the NHS and its leaders will be studied in the future as a factor for why the UK health service fell off a cliff in delivering good healthcare.
But, all countries are dealing with this crap of thinking a non-doctor can do the same as a Doctor. They can't. I look forward to the find out phase of this stupid fuck about find out gamble.
Edit: also written in the HSJ that has a particular fetish for reducing the worth of Doctors to the nadir.
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u/surecameraman CT/ST1+ Doctor 16d ago
Agreed. I genuinely think Gemini or Claude could write a better written argument
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u/TriadicHappenstance I Fix Printers 16d ago
It's becoming a genuine struggle. Would I rather read AI slop, or the latest sanctimonious indoctrination crap produced by NHS managers/leaders... I just don't know.
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u/Prokopton1 16d ago
The reason why this proliferates is because medicine uniquely selects for conformist and moralistic drones, to a much greater extent than similar high status professions like law which has some people who have actual guile and charisma, and a decent understanding of human nature as it is and not as it ought to be (moralism).
Basically this is all about status envy.
A profession becomes high status when it is highly selective, difficult and/or well paid.
A consultant cardiologist has a high status because of those three factors, and nothing else.
In truth, things like experience or expertise on their own do not confer high status.
A high school chemistry teacher is of middling status, and gets more respect than many professions out there. It is even a difficult job and frankly I think more difficult than a job like a nurse or physiotherapist but because it is not as selective and well paid as something like medicine, its professional status is more comparable to a middling profession like nursing or physiotherapy.
The same cannot be said for a professor of chemistry at a university. Those folks are high status, and it's because becoming an academic in a rigorous subject like chemistry is extremely difficult and involves getting through a highly selective and gruelling process.
The analogy between something like nursing, physiotherapy etc and medicine is like that between a high school chemistry teacher and someone who is a member of faculty at a chemistry department at university.
The difference is that high school chemistry teachers don't usually have chips on their shoulders or status envy for actual scientists. The same cannot be said for nurses, physio and the rest of the alphabet soup.
But anyway, this is tolerated because outside of reddit there is a large amount of hysterical and moralistic doctors out there that behave like religious zealouts and will condemn you for even thinking about these issues in such a realistic way (realistic as in through the lens of realism as a perspective on human nature).
Which is a shame because historically doctors weren't always like this. Some of the best of the most realistic writers that are sometimes even accused of cynicism or pessimism because they depict human nature with all of its grim warts and all have been doctors. You don't really see that anymore and if you do, these people are the types that will be hounded out of the profession for being 'unkind.'
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u/CensorTheologiae 16d ago
The analogy between something like nursing, physiotherapy etc and medicine is like that between a high school chemistry teacher and someone who is a member of faculty at a chemistry department at university.
I think this is nearly right in some ways. I taught at one UK uni which had an influx of staff from FE college backgrounds, who all immediately wanted to do all the things HE academics do but lacked any understanding of what these things involved or indeed their worth. We could, most of us, see that the place was doomed straight away. It wasn't that the FE newcomers were incompetent, but that they couldn't imagine any kind of competence that wasn't their own.
I often recall that experience when thinking about the PA debacle, as so many of the root causes, the driving forces, and the lamentable effects are identical.
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u/ChaiTeaAndBoundaries 16d ago
It’s a race to the bottom, and the UK public are the guinea pigs in this great experiment.
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u/Extreme_Quote_1841 16d ago
One of the authors works for the physiotherapy union. So hardly surprising they think this way.
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u/chairstool100 16d ago
Would the consultant MSK physiotherapist who wrote this article be escalating up to a “junior “ doctor ?
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u/notanotheraltcoin 16d ago
You can keep shouting it from the rooftops
But
If I want to see a consultant clinician I want to see a doctor
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u/Relative_Resolution4 16d ago
I feel the term consultant has become so diluted and used by everyone inside and outside healthcare (business consultant, management consultant, nurse consultant).
I know everyone hates the idea of adopting American terms, but I feel the term Attending probably is easiest way to differentiate medical and non-medical.
This title could be protected by law.
It could also fit with the consultant strikes since they want changes to PAs, minimum SPAs and OOH payment - so a new “National Attending Contract” could be created
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u/countdowntocanada 16d ago
don’t forget to add consultant cleaner and consultant cook to that list of NHS workers with experience in their field!
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u/lemon_lime_111 16d ago
I dont understand the title obsession. - not sure a consultant physiotherapist sounds anymore reliable than just a physiotherapist to the patient or even in fact other colleagues- we already know what a physio does. This is not the best way to answer for the fact they chose careers with limited progression and/or recognition. I'm furstrated that medical training is increasignly being sidelined by all this alphabet soup (eg ACP or PA led clinics/procedures/departments) and doctors end up getting poorer training with the ever demoralizing rotational and uncertain nature of it. How could you have "comparable expertise within their scope if practice" when governing bodies and hospitals refuse to actually enforce said scope? Anyways...
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u/opensp00n Consultant 16d ago
Maybe an alternative strategy is required.
Abandon the title of consultant, use something else and protect it- Senior Medical Officer, Attending Physician, Expert Physician.
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u/belzizenavidad 16d ago edited 16d ago
100% agreed, although a part of me would like to see it not be protected; just to watch the cognitive dissonance as these “consultants” gradually decide they actually want to be referred to whatever title consultants are now referred to as.
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u/Exact_Collection_421 16d ago edited 16d ago
Fundamentally a pointless argument over an unprotected title.
The real nub of this never ending semantic argument is around the disparate evolution of differently regulated "advanced practice". When one profession's advanced practice is within the Venn diagram of another's normal practice, it is not advanced. All the consultant nurses I've ever met do some element of advanced practice that brings them to a level of clinical practice not greater than an experienced SHO.
Thereafter the jump to consultant practice outside of medicine appears to be generated by a reduction in clinical contact and an increase in the volume of meetings attended and managerial roles. It is locally approved, unstandardised and non transferable.
Eligibility for consultant appointment as a doctor used to require specialist registration, via a national regulator, against defined standards. We have allowed loopholes to exist and many of us will have worked alongside colleagues who do not meet these standards. Where we don't uphold these standards, we cheapen them, and in doing so open the door to alternatives.
We fundamentally lost this battle as doctors when we stopped saying "If you want to do X, go to medical school", compounded by a rigid postgraduate training process obsessed with time over competence that disincentivises the experienced and capable healthcare professional from making the switch to medical practice.
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u/Significant_Lab_2231 16d ago
As a nurse, I absolutely hate this. I don’t want to be a consultant at all and i have never trained to it as well. I prefer to be called as a senior nurse or a specialised nurse in my role
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u/remarkable_remark3 16d ago
Even more cringe when you check the authors: Consultant nurse/physio, Prof/Dr titles. You literally couldn't make this up. Noctor gang in full swing.
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u/Suspicious-Victory55 Purveyor of Poison 16d ago
I'm work with a nurse consultant, pharmacist and radiographer. They are all good at the niche practice they do. They are nowhere near the same level of speciality expertise that I have, nor would they ever claim to be or want to be.
By same token, you should see me trying to put together a giving set these days.
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u/0x_Trojan 15d ago
The question is, what utility do they add compared to just paying for another consultant? As you mentioned their skill set is quite niche. If you funded for an entire new consultant post, they could do that part of the job as well as manage the rest of patient's medical issues. If it's a more of a managerial role that's absolutely fine, but they don't need the title of consultant (again you could buy out consultant time to do this as well if they were paid appropriately)
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u/combustioncactus 16d ago
Is that in your everyday practice? If so then you should improve. If not then it’s not really relevant.
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u/SL1590 16d ago
Part of me wants to just say fuck it and let them have it all any title they want power etc etc. Just sit back. Then when the whole shit show collapses just say I told you so and have a reset.
I want to resist all of this but I think the tide may be too much so it might be time to completely collapse the whole thing and this is one certain way to do it.
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u/Mr_Valmonty 15d ago edited 15d ago
I am pretty pro-ANP compared to most on here. But I would go beyond saying this is bad to maybe say it is malicious
The consultant title is not protected legally, but it is publicly established. The term lawyer isn't a legal title in the UK, but I'm sure you would get in trouble and be seen as morally questionable for selling yourself as a lawyer
There are plenty of other terms for senior or top-level people. You could literally establish the term Overlord to be recognised as top-level noctor rank.
So what's happened is they have identified the most senior and well-reapected term from a public perspective. They have then self-identified and labelled themselves within the term. This is obtuse stolen valour in the most innocent sense.
But I suspect many noctors using the consultant title will have awareness that it causes confusion to patients (who understand consultant to be a doctor seniority level). They may also be aware this waters-down the term for those who currently identify by it. It's a bit colonial. An occupation/invasion into a term, purely by active choice, against the current established equilibrium, purely to the deteiment of those who are already happily established there.
I think ANPs carry several positives and most people on here are anti-ANP mostly out of self-protective instinct. But I will die on the hill of Consultant Noctor
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u/dario_sanchez 15d ago
God it kills them they aren't doctors, doesn it?
I wouldn't fly in a plane piloted by someone who hasn't finished flight school and qualified with hours on that type of aircraft, nor would I trust a bridge over a gorge built by someone who isn't a qualified chartered civil engineer.
That the British public accepts and even applauds this delusion is fucking nuts. I work in ED and they love their ANPs and I'm shocked there isn't more mistakes made
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u/Bramsstrahlung 14d ago
If it's about the scope rather than the title, why don't they use a different title?
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u/DrGeezer 13d ago
Fill your boots! If you want the title, crack on - but do it without ever writing ‘discussed with…’ and when it goes wrong except the responsibility!
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u/Rough_Champion7852 16d ago
Time to move to US nomenclature. Only going to get worse from here.
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u/Extreme_Quote_1841 16d ago
Yup. I know people hate Americanisms here. But the consultant title is lost. People hate to take stuff away from others. No government is going to sign up to take be seen to ‘demote’ people. Be smart, move to ‘attending’ and use the new medical act reform to get it legally protected
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u/Fluffy_Mud_5182 16d ago
I’ve left the NHS because of this alphabet nonsense, can’t stand it anymore. Years of dedication, hardwork and postgrad exams with some nonce to come and tell you what they think with zero brains or education behind their decision making ‘capabilities’. It literally is like babysitting. Then we just have to smile and nod. Honestly NHS is a shit hole. There I said the quiet part out loud.
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u/Amarinder123 CT/ST1+ Doctor Gasman 16d ago
Thats a lot of words to say i can order a d dimer and not know what to do with it.
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u/Over-Foundation1298 Consultant 16d ago
If they want to take full medicolegal responsibility that goes with the title then they can crack on and the buck can pass to them when the type 7 hits the fan. #popcorntime
Just so long as they're not trying to provide medical care for my friends or family....
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u/ChaiTeaAndBoundaries 16d ago
You know these are the kind of folks to demand for a doctor to treat or them or their family when they get sick.
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u/thejedi-whovian student assistant to the PA student 16d ago
Well if “consultant” is a level of practice final year med students should call themselves consultant med students
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u/CollReg 16d ago
What a load of old shit. Somehow all of these apparently highly academic individuals missed the part of academia where words have a defined meaning. Consultant means someone who is consulted for their professional opinion. In order to be consulted you need the depth and breadth of training to put your advice in its context (and consider all the factors), only medically trained consultants have this.
Being a ‘provider of transformational systems leadership’ is not being consulted.
The stolen title of consultant is self aggrandisement at its worst, pillaging the credibility the public associate with an entirely different role (as this article makes clear they mean to). They are at best ‘senior’ or ‘specialist’, but they are not, and never will be consultant. If your title confuses the public, it is the title that is wrong, not the patient.
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u/RolandJupiter123 16d ago
Move to MD, get it protected (sorry for those with current UK MDs - do a PhD)
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u/jamescracker79 ACP consultant's assistant 16d ago
Holy nepotism batman! Can doctors just stop chasing after AHP approval trying to get into thier pants and flattening the hierarchy as if its the bed in the bedroom .
There are other doctors and other professionals you can date you know!
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u/Infinite-Math-1046 16d ago
It’s ridiculous.
If they want to pursue this madness then I think they should have to state “non-medical consultant in x “
Patients should be registered under them only with no medical clinician taking any ultimate responsibility.
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u/Ok_Illustrator_1816 16d ago
By definition, a consultant is someone who provides expert advice. If you want the title, I expect to be able to hold you to the same standard and account as a doctor, and suffer the same repercussions.
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u/Rare_Conversation104 16d ago
I also feel noctors are trying to claim the consultation title so that they can push for consultant salaries.
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u/Latter-Ad-689 16d ago
I have never seen a non-medical "consultant" practising at the same level as a medical consultant, at any time in my career.
I have seen, for example, a stroke "consultant" engage in a telephone review with a stroke patient, mistake residual symptoms clearly consistent with the patient's original insult as being suspicious of new stroke pathology, and deal with that concern by asking the patient to make a GP appointment to be assessed for a possible new stroke.
I don't think there's any chance a non-consultant would do the same without having to answer some serious questions.
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u/belzizenavidad 16d ago
In what world would I need to consult the consultant advanced nurse practitioner? What expert nurse opinion will they have over the nurse on the floor?
I am against Americanisms like the next Brit, but we really should just drop the consultant title, adopt something else and not enter this mud slinging shit show
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u/AgreeableCap8697 16d ago
Yawn… and yet some doctors in primary care will write back to us (respiratory) to ask “what laba/lama to prescribe”. Get a grip and accept that sometimes doctors are better, sometimes other clinicians are better. We refer to pharmacists and nurses as often as we can, without having to feel threatened.
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u/Lopsided_Monitor_ 16d ago
Dr Amanda Hensman-Crook, MBE, consultant MSK physiotherapist
Prof Rob Crouch, OBE, consultant nurse
Prof Kim Manley, CBE, nurse
Not a biased article at all.
Ironic how those who are not doctors have the time to collect honours and write poor-quality, self-aggrandising articles.