First Year as Consultant

In short: The first consultant year is about establishing sustainable working patterns, learning local systems and building the relationships that make the job work. The clinical work is familiar. What changes is that the decision, and the responsibility, are yours.

Written by Yiannis Skarparis, Consultant Interventional Radiologist. Last checked: 23 September 2026.

What changes

• Autonomy. You are the final report.
• Responsibility. Discrepancies, complaints and governance now have your name on them.
• Workload. Usually heavier at first while you find your speed and learn local protocols.
• Teaching. Registrars now ask you.

What does not change: you will still ask colleagues for a second opinion, still learn every day, and still feel like an impostor for a while. That is universal.

First three months

• Learn the department's systems, protocols and escalation routes
• Meet the secretaries, the radiographers and the clinical leads you will work with in MDTs
• Set up your reporting environment and dictation properly
• Understand local MDT expectations before you chair one
• Say no to extra projects for now

Building your practice

• Take ownership of your subspecialty area and become the reference point for it
• Attend the relevant MDTs consistently
• Contribute to teaching and to audit and quality improvement
• Use study leave deliberately

Protecting your time

• Set boundaries in the first months; they are harder to establish later
• Use supporting professional activities for their purpose
• Do not take reporting home by default
• Protect recovery after on call
• Recognise the early signs of burnout and use the support that exists

Financial and contractual

• Understand your job plan and how it is reviewed annually
• Review NHS pension arrangements; get advice, particularly on annual allowance
• Understand the local clinical excellence or equivalent award scheme
• Do not rush into private practice

Common questions