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6 July 2017
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What's the point in that?

When describing my ‘out-of-programme’ (OOPE) year as a leadership fellow on the future leaders programme to a clinical colleague, I was met with the response “what’s the point in that?” Despite growing recognition of the need for many more clinicians to be working in managerial and senior leadership positions in health and social care organisations, there are still considerable cultural barriers to this within the healthcare profession. Although the much-vaunted 'dark side' euphemism for management is somewhat tongue-in-cheek, underlying it are some very real prejudices and harmful attitudes.

From an early point in my medical career I have been interested in pursuing medical management and leadership. I was the mess president in my FY1 year and organised the SHO rota in my FY2 year. In the years following this I repeatedly asked my colleagues what I could do to further my experience and learning in this domain. Unfortunately, on almost every occasion I was met with a rather blank look and gently told to concentrate on my exams, or worry about that later. This reflects a genuine lack of structure when it comes to developing leadership and management skills as a doctor-in-training. Management is usually included in our training curricula, however these sections often include no more than vague statements, or somewhere you can link the rota co-ordinator role you took on. It also often reflects reluctance on the part of the clinician to become involved in managerial or leadership roles within organisations. A number of factors contribute to this. A lack of time to properly engage with managerial issues due to clinical workload is certainly one of them. Another is the chronic mistrust with which doctors often regard hospital management. This occurs as a result of a range of influences including organisational culture and lack of contact with managers, but it is compounded by rotational training, in which you are bounced (in my case on a six-monthly basis) from organisation to organisation.

As a result, a doctor-in-training feels no sense of belonging to any of the organisations in which they work. To compound this, often the only engagement a doctor has with their employing trust outside of their immediate department is the generic induction completed in the first few days. This is the foundation upon which a doctor starts their consultant career.

There is a clear need for rotational training to build experience for doctors-in-training. However, more thought to longer placements and better mechanisms for inclusion are needed for rotating doctors. This could include any number of options including pairing with hospital managers, trust-based courses adapted to include rotating doctors and local feedback mechanisms. The emphasis for providing these opportunities is very much on the employing organisations, however benefits to the organisations include better staff retention, morale and more applicants for future consultant roles.

Doctors are often so focused on the clinical aspects of their learning and development that they fail to see the relevance of leadership development to them. Often leadership is viewed as something for management or chief executives, but not as something relevant to every individual, every team and every organisation. There are a number of leadership schemes and OOPE opportunities such as the National Medical Director’s Clinical Fellow Scheme (mostly based in London), or the Future Leaders Programme in Yorkshire and the Humber. These schemes offer some fantastic opportunities, but are for a very small number of people relative to the wider workforce.

If we are to have a significant impact on the medical workforce as a whole, there is a need for more systemic, accessible and progressive opportunities alongside postgraduate medical training. Opportunities such as the emerging chief registrar role are a great idea, and offer not only a fantastic opportunity for personal development and learning, but also an incentive for applicants to plug ever-increasing rota gaps (not to mention efficiency savings and improved outcomes from potential improvement projects). 

Unless we address these issues by normalising management and leadership training alongside medical training it will remain very much part of the 'dark side’. And unless we continue to create opportunities to celebrate and support doctors interested in taking on leadership and management roles throughout their training, not only will we lose the enthusiasm and potential of these future leaders, we will perpetuate and support the view: “what’s the point in that?”

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