It was often said in days gone by that consultants working in hospitals were like barristers working in chambers – they shared a set of professional rooms but otherwise did their own thing. Each was responsible only for their own performance and speciality service. They rarely met together and there was little sense of corporate responsibility. They may have shared administrative services and offices but otherwise they tended to act independently. Their relationship with the hospital in which they used these professional offices was characterised as somewhat distant – they tended to think of themselves as more or less independent contractors.

In 2014 consultants and barristers remain star performers with their own specialty expertise but I suggest that that is where the similarity ends! The relationship between the independent consultant and the employing organisation has changed – consultants are now employees working in a managed organisation. As such their responsibility is to their own specialty and career AND also for the service as a whole. That is, they now share responsibility for running the service and for providing their own unique brand of clinical care. They are expected to work in multi-disciplinary teams respecting the leadership of these teams whether the lead is another surgeon, a nurse, or a radiologist. They are expected to contribute to the running of their service together with the nurses and the managers. The service must be designed around the needs of the patients and not around the needs of the star performers – the stars are no longer simply entitled to have things done their way. They are expected to adhere to organisation norms and expectations just like any other employee.

For some people whose personality inclines them towards independence and autonomy this is difficult. For those who are inflexible and set in their ways it can feel uncomfortable to change. But this is the employer’s expectation of its employees. Adapting, accommodating and compromising is far easier, less tiring and emotionally draining than resistance, reluctance and combat.

by Dr. Megan Joffe