I have been a consultant surgeon, working in Leeds, since 2003. Each day in the life of a surgeon can be quite different. I will set out here a brief overview of the work-pattern of a surgeon in the UK, drawing on some of my own experiences.
A surgeon’s job does centre around the operating theatre (a popular scene of excitement in the media!); yet, in fact, it has various facets. Most surgeons in the UK will work in an NHS hospital. A surgeon’s NHS job, like that of a consultant in any specialty, is governed by a contract, and surgeons will work according to defined job plans. A job plan sets out the number of contracted programmed activities (PAs) and the type of activity that is to be delivered in each PA (or fraction thereof). A PA is a unit of time, and each PA represents 4 work-hours. A full-time NHS job plan has at least 10 PAs (40 hours) per week; a job plan of 9 PAs, or less, is a part-time job.
The PAs in a NHS job plan are typically split between direct clinical care (DCC; for example, operations, out-patient clinics and ward rounds) and supporting professional activities (SPA; continuing professional development, governance meetings, research, teaching and training). Some surgeons will have PAs allocated to additional NHS responsibilities (managerial roles, such as clinical lead or clinical director) or to external duties (roles in a Royal College, professional society or other external bodies). For the average surgeon, the job plan will have about 7.5 PAs of DCC and 2.5 PAs of SPA (although, of course, there can be significant variations). This usually translates in to spending only about 1½ days per week in the operation theatre; contrary to some popular myths of surgical lifestyle!
Notably, the DCC PAs are usually divided between elective or planned activities and emergency or on-call duties (typically involving out-of-hours and night-time work). For emergency work, a PA constitutes 3 hours (as opposed to 4 hours for elective work). Also, an elective working day is not necessarily limited to 8 hours: in some cases, one or two days of the week could extend to 10-12 hours. As a result of the combination of emergency work and longer-than-usual elective-working days, a 40-hour week does not usually translate into a surgeon being at his NHS hospital for all 5 weekdays. For most surgeons, a 10 PA job plan will be delivered in about 3½ days per week. It is important to be aware of these limits of a surgeon’s NHS contractual obligations in the context of clinical negligence litigation: an individual consultant simply cannot be expected to deliver continuous, hands-on clinical care.
The NHS consultant contract permits work outside the NHS, provided that such outside work is conducted in time that is not included in the NHS job plan. Many surgeons will work in private hospitals, in addition to their NHS job. As explained earlier, a 10 PA job-plan usually allows for 1½ weekdays to be free of NHS work. Consultants can do private practice (or anything else that they might choose to do) during periods that are not time-tabled in their NHS job plan (although, the private practice sessions have to be specifically stated in the NHS job plan). Some consultants will also work in the evenings, after completing their NHS duties; and others might choose to work on Saturdays, too. A surgeon with a full-time NHS job-plan and a well-developed private practice can, in this way, have a busy week: in some cases, up to 60 working-hours per week.
In the context of negligence litigation, it is important to note that a surgeon’s private practice will almost invariably mirror her or his NHS practice. If a surgeon undertakes an operation, which he does not do in the NHS, in the private sector, then the circumstances require close scrutiny. It is also noteworthy that the vast majority of private hospitals in the UK will simply not match the infrastructure or facilities of the local NHS hospital; and so, if complications develop, then private patients will often be transferred to the NHS hospital. It can be debated whether it is fair for the NHS to be obliged to support and subsidize privately-funded treatment by covering for complications; but, such, at least presently, is the reality.
Apart from private clinical practice, some surgeons (such as myself) will also have a medico-legal practice, that is, expert witness work. As with private practice, the medico-legal practice has to be conducted outside the NHS job plan. I have now been doing expert witness work for over 10 years, and I deal with a variety of clinical negligence cases within my specialty of upper gastrointestinal surgery. Bariatric (weight loss) surgery cases constitute a large proportion of my instructions; followed by cases pertaining to gallbladder, hernia, acid reflux, cancer (oesophagus and stomach) and emergency surgery. Since upper gastrointestinal surgery is a relatively small specialty, it becomes important to remain alert to conflicts of interest because close relations can develop over time with several colleagues. In the wake of recent judgments that have sharply rebuked experts for overlooking conflicting interests, I would recommend all experts, but particularly those whose professions are not large, to be watchful.
The combination of full-time NHS work, private work and medico-legal work can lead to high-pressured and conflicting demands on time: careful diary planning and work-life balancing are essential. ‘Burn-out’ can be a real problem for surgeons, and some will actively seek out leisure activities; yet, for many others, surgery remains the only passion. A mentor once said to me: ‘Surgery is neither an occupation nor a profession; it is a way of life’. To appreciate the distinctiveness of surgery from other medical specialties, consider that surgery involves the critical element of a craft—doing something with one’s hands—over and above the science and art of all branches of medicine. It is this craft that makes surgeons passionate about what they do; and it is also this craft that make it so difficult—nigh impossible—to opine on negligence in the performance of an operation. Two surgeons may write the same narrative of an operation, yet the difference of skill in the execution might be that between a master and a new apprentice.
In conclusion, a day in the life of a surgeon is highly demanding, yet varied and immensely satisfying. For myself, I could not imagine another way of life.
Abeezar I Sarela MBBS MS MSc MD PhD (Law) FRCS
Consultant Surgeon, The Leeds Teaching Hospitals NHS Trust
a.sarela@leeds.ac.uk