Authors: Lois Brand / Editor: Swagat Mishra / Codes: SLO9 / Published: 06/09/2022

There is mounting evidence of the challenges of retaining and maintaining the senior medical workforce within the NHS. The Academy of Medical Royal Colleges (AoMRC) in their analysis of retirement intentions of senior consultants in 20171 suggest that there is serious concern over the shape and demographic of the medical workforce in the years ahead, due to the potential drain of highly skilled and experienced clinicians whose premature loss will have a significant impact on the service. 

In Emergency Medicine there is the additional challenge of lack of precedent for later career evolution. In the 90’s and early 2000s there was a huge rise in EM consultant appointments and those appointees are now reaching their 50s and 60s. Prior to this, EM consultants had worked primarily as clinical managers, but this is the first generation whose work has focused primarily on delivery of clinical care. This work is increasingly intense, demanding and covers a huge breadth of knowledge and skills.

Few consultants set out in their careers with a plan to retire as soon as financially feasible, but this is what I am increasingly hearing from consultant colleagues even in their 40s. In order to address the challenges of career longevity in medicine, significant systemic change is needed, including more flexibility within senior medical careers. There also needs to be acknowledgement that more investment must be made in training within established consultant careers, in order to keep up with the rapid pace of technological development.  Emergency medicine is both broad and technical, and there is, of course, an immediacy to much of our work. Keeping up with techniques, complex equipment and rapidly developing knowledge is challenging within the current CPD framework.

On an individual level, we need to recognise the importance of taking time to proactively craft our career paths as we become more senior. Finding time for this alongside demanding clinical and often managerial roles can be challenging. Scott and Gratton in their book ‘The New Long Life: A Framework for Flourishing in a Changing World’2 provide some overarching principles for a creative approach to a long and fulfilling potentially multi-stage career:

1.     “Act pre-emptively – take responsibility for developing the skills and attributes needed to sustain your career.
2.     Orientate yourself to the future. Whatever your age you have a longer time horizon ahead of you than past generations. This puts a premium on being forward-looking, and thinking carefully about investments that can compound over time.
3.     Be aware of your possible selves. A longer life and more transitions open up a wider set of possible selves. Making the most of this will require exploring these possibilities and keeping your options open.
4.     Focus on malleability and recursivity. Both your age and how your time is structured and distributed have become more malleable. That means your actions now can influence how you age and your future options and choices.
5.     Accept Transitions. Whether under your instigation or forced upon you, substantive life changes can be difficult. Looking forward, these transitions will inevitably be more frequent and will form the knots that tie the threads of a multi-stage life together”

If you are a senior consultant, I’d encourage you to create some space and carve out some time to think creatively about what would make your work sustainable, meaningful and fulfilling for the years ahead.




  1. The Academy of Medical Royal Colleges. The Academy of Medical Royal Colleges Later Careers Survey Results. AOMRC, 2017.
  2. Scott A, Gratton L. The New Long Life: A Framework for Flourishing in a Changing World. Bloomsbury 2020.