The changing experience of work of consultants in NHS Scotland

This study was commissioned by the Scottish Consultants’ Committee of the British Medical Association and carried out by independent researchers at the Universities of Dundee and Glasgow during the period May 2014-March 2015. We sought understand changes in consultants’ work experience since the award of the Certificate of Completion of Specialist Training. More specifically we wished to understand the impact of these changes on consultants’ opportunities to exercise voice, trust in their organizations, engagement with their work and organizations, and, ultimately, on patient care. Our starting point for the study was the literature on the sociology of the professions, organization and management research, and especially the de-professionalization of medical careers, the last of which is widely discussed in medical and social science journals. To answer our research question on the impact of changes in consultants’ work experiences, we undertook an extensive interview and survey programme, to which there was an excellent response among Scottish hospital consultants. Our main conclusions are that de-professionalization, lack of trust in managers and a lack of voice and genuine participation in decision making are widespread and, if not acted on, may have significant consequences for system effectiveness. However, these perceptions and accounts of de-professionalization were not matched by doctors’ disengagement from their work, from each other in clinical teams, or from the values and aims of the NHS in Scotland. Indeed, engagement among most consultants was intense, a conclusion from which all stakeholders in the NHS in Scotland can take some comfort. However, one might reasonably infer from these conclusions that a healthcare system in Scotland is under significant strain and is currently being held together, in part at least, by consultants’ innate sense of obligations to patients and intrinsic rewards from their jobs, despite experiencing considerable dissatisfaction with many extrinsic factors in their working environment. The most significant of these ‘dissatisfiers’ are their perceptions of loss of autonomy through an increased emphasis on a financial logic governing decision-making, the accompanying managerialism and bureaucracy, and, to a lesser degree, increased internal regulation by elite medical bodies and medica