One of the most immediate aspects of becoming a consultant in any specialty is having non-clinical responsibilities thrust upon you. Running a well-functioning and progressive intensive care department requires that certain additional duties that do not involve direct patient care are taken on. It’s no fun being given a set of duties that you have no real interest in, as this makes it a chore to be endured, rather than an objective to be accomplished. So, though you may not get a choice the first time around, it’s worth giving a bit of thought towards the types of non-clinical portfolios that are available in a specialist department, so that when you take on your consultant role, you can opt for something you might be interested in championing. The following is a list and brief description of the common portfolios that are generally available.
1. Department Director
OK, so you might want to aim big from the start. Good for you. Increasingly, most of the individuals holding this position have additional non-medical qualifications, such as a Masters of Buisness Administration (MBA), but not always. Essentially, the director is responsible for overseeing all of the clinical and non-clinical activities that the department engages in. He or she also has there eye on the future directions of the department, in terms of physical layout and capacity, staffing, introducing new clincal, research, training and other activities. There is a significant committment to attending meetings both within and between the ICU and other departments. the director bears the responsibility, not only for the actions of the junior staff, but also the other consultants and nursing staff and is answerable directly to the general manager, CEO and hospital board. It’s a big role, but if you enjoy the politics, have a talent for leadership and a vision for your department’s future, this might be the job for you. there is financial loading for the position, but do it for the goals that you want to achieve.
Audit is a feature of daily department life. Everything is audited at some stage; from handwashing by staff to adherence to OH&S policies. In bigger departments, there may be specific administrative staff employed to conduct the data collection and crunch the numbers, while in smaller departments nurses often take on an audit as a professional development project, but one of the department’s consultants is usually appointed to oversee the processes and outcomes. The end result is often presenting the data and subsequent recommendations to the department director and/or hospital administration. It also generally involves overseeing the implementation of new processes that are generated from an audit and subsequent measurement of their outcomes as part of a quality improvement process. Morbidity and mortality meetings are a form of audit and are often a large enough workload that a consultant will take this on as a portfolio in its own right.
3. Representation on Hospital Committees
It is important for a department to have representation on any descision process that might affect the workload of the department or its ability to conduct its buisness. So, one or more of the department’s specialists will usually provide a voice at relevant meetings. Typically, representation is desireable on the following committees:
- Resuscitation – Pace calls, MET calls (or other versions of MET and PACE calls), training of staff within the ICU, ED, anaesthetics and the wards in resuscitation procedures.
- Blood Bank – Use of blood bank products and developing processes that minimise barriers to treating patients; e.g. implementing a massive blood transfusion protocol. This portfolio may come under the banner of resuscitation in some hospitals
- High Risk Surgery
- High Risk Obstetrics
- Planning and Development – A really crucial area. You don’t want to wait excitedly for the opening of the new hospital wing only to find that your unit has been relegated to a windowless basement, cut off from theatre, radiology and the ED.
- Policy and protocol development and review – This may come under one of the above groups or may form its own portfolio. It generally involves a continuously cycling review of departmental policies and protocols to make sure that they are up to date with best practice recommendations.
Any decent department needs to have some type of research going. It even forms part of the College policy on ICU standards (IC-01 Minimum Standards for Intensive Care Units – Operational Requirements IC-03 Guidelines for Intensive Care Units Seeking Accreditation for Training in Intensive Care Medicine – section 3 Teaching and research). If research is your thing, this portfolio could be quite rewarding, giving you a platform for generating your own research as well as being involved in other multi-centre trials. There is also the plus of having an excuse to travel in order to attend research meetings locally, around the country and internationally. Depending on the size of the unit, there may be enough willing volunteers who need to complete their formal projects or nursing professional development portfolios that you can oversee projects while someone else collects and crunches the numbers. You might even have paid research staff.
Training and Education
Again, core buisness for an ICU and mandated in the same two CICM policies (IC-01 Minimum Standards for Intensive Care Units and IC-03 Guidelines for Intensive Care Units Seeking Accreditation for Training in Intensive Care Medicine) along with IC-13 Recommendations on Standards for High Dependency Units for Training in Intensive Care Medicine.
This role involves developing an educational program and its content, conducting performance reviews with trainees and providing advice for exam and career preparation. There is also a disciplinary function where someone has overstepped the boundaries of reasonable practice. If you want to influence the future generations of intensivists, this is a good place to do it. A good educator is an invaluable resource for a department. No only do they improve the quality of the staff currently working in the department, but if word is put about regarding the quality of the teaching, the quality and quantity of staff apllying to work at your department improves too; which can only be good for job satisfaction and quality of life. This role usually falls to the Supervisor of Training (SOT), who along with their responsibilities to the department’s director, also has responsibilities to the College and is required to attend SOT specific College functions and meetings. The College also provides SOT training and direction.
This has become a big area and there are now local and area organ donation coordination representatives. Most larger hospitals have an ICU consultant whose portfolio involves the facilitation of organ donation in the appropriate setting.
It is worth giving some thought to these non-clinical aspects of your position, as it is better to have chosen an area of interest that can sustain you through the next 25 – 30 years of your career, than be lumbered with a chore.