Early years as an orthopaedic consultant: Navigating challenges and embracing opportunities

By Yaser Ghani  

Consultant Orthopaedic Foot & Ankle Surgeon
Divisional Governance Lead - SWNS Surgical Services, Anaesthetics & Critical Care Homerton University Hospitals NHS Trust

Becoming an orthopaedic consultant is a momentous occasion. After years of training, countless hours spent mastering techniques, and learning the ins and outs of patient care, you finally earn that title that felt so distant at the start. The transition from trainee to consultant is a major step, but in many ways, it feels like stepping onto a new playing field altogether. Suddenly, you are in charge of making the decisions, leading the team, and being responsible for outcomes. It’s a combination of excitement, a sense of accomplishment, and (at times) a bit of fear. If you’re reading this as a newly appointed consultant or perhaps someone gearing up for the journey, I hope my reflections from these early years can give you a glimpse of what lies ahead.

The initial realisation: The buck stops with you

Let’s start with the obvious—you’re now the one in charge. It’s funny, but no amount of training quite prepares you for that first day as a consultant. You’re ready, of course—you’ve had brilliant mentors, you've studied cases backward and forwards, and you know your field inside out—but that first clinic or theatre list as a consultant brings a new perspective. Suddenly, the decisions are yours alone. No senior consultant will drop by to sign off on your plan. It’s liberating but also a bit daunting.

In those early days, I found myself questioning my own decisions far more than I did as a trainee. “Am I making the right call here?” or “What if this patient doesn’t respond as I expect?” But here’s the thing—trust yourself. Yes, there will be challenging cases. Yes, things will not always go as planned. But you’ve trained for this. Trust your instincts, and when in doubt, don’t hesitate to reach out to your colleagues. Even though you’re a consultant, you’re never alone in this profession.

The importance of building your own team

One of the first things that surprised me as a new consultant was how critical teamwork really is. It’s no longer just about doing your job well—it’s about building a network around you that helps everyone perform at their best. From junior doctors to nursing staff and even the secretaries who keep the entire operation running smoothly, every member of the team plays a role in patient outcomes.

The early years as a consultant are a prime opportunity to shape the kind of atmosphere you want in your clinical practice. This means fostering a culture of respect, open communication, and mentorship. Don’t underestimate how much of an impact you can have on the culture of your department, and on the careers of the juniors you’re training. I make it a point to be approachable, encourage questions, and lead by example. The team works better when we all know that we’re in it together, no matter the hierarchy.

Embracing the role of mentor

One of the most rewarding aspects of the transition to consultant is becoming a mentor. During training, we all had those key figures who influenced us—surgeons whose style, skill, or way of managing patients we admired. Now, you have the chance to be that person for someone else. It’s strange at first, realising that others now look up to you in the same way, but it’s also incredibly fulfilling.

Mentorship doesn’t have to be formal. Sometimes it’s about those small moments—answering a junior’s questions after surgery, or giving them the chance to try a challenging part of a procedure under your guidance. It’s easy to get caught up in your own workload, but taking the time to teach others is vital. It not only helps them grow but also forces you to keep your knowledge fresh and articulate your thought processes clearly.

Balancing clinical practice and innovation

One of the challenges I’ve faced early on is finding the balance between the bread-and-butter work of orthopaedics and staying at the forefront of innovation. As a trainee, you are often exposed to the latest research, techniques, and technologies. But once you become a consultant, you realise that day-to-day practice is very much about refining the core skills you’ve mastered. Bunion surgeries, hip replacements, knee arthroscopies, fracture management—these will make up the bulk of your cases.

But don’t let that routine prevent you from pushing boundaries. In my early years, I made it a point to attend conferences, stay involved in research, and collaborate with colleagues who share a passion for innovation. This keeps me engaged, helps improve patient outcomes, and ensures that I’m continuously evolving as a surgeon. Staying curious and embracing opportunities to learn are key to a long and fulfilling career.

The shift in patient relationships

As a consultant, you develop longer-term relationships with patients, and this is something I’ve come to truly appreciate. In training, you’re often only involved in one stage of a patient’s journey—either pre-op, surgery, or follow-up. Now, as a consultant, you get to see the entire arc of a patient’s treatment, from the first consultation to their post-surgical recovery. This continuity allows you to build trust, and patients come to see you not just as a surgeon, but as someone deeply invested in their well-being.

These relationships are powerful. They remind you that being a surgeon is about more than just the technical aspects of the job. It’s about understanding your patients as people—what they want to achieve, their concerns, their goals—and guiding them through difficult decisions. That’s something I wasn’t fully prepared for when I first started, but it has become one of the most rewarding aspects of my work.

Navigating the work-life balance

This one’s tricky, and I don’t think any of us ever fully master it. In the early years as a consultant, it’s tempting to throw yourself into your work. You’re building your reputation, establishing a practice, and wanting to make sure every decision you make is the right one. But burnout is real. I learned quickly that while it’s important to work hard, it’s equally important to take time for yourself and your family.

It’s about setting boundaries. Early on, I found myself checking patient notes late at night or constantly thinking about cases over the weekend. Over time, I realised that in order to give my best to my patients and my team, I also needed to take care of myself. Whether it’s hobbies, exercise, or simply taking time to disconnect, don’t neglect the things that bring you joy outside of medicine.

Final thoughts: Enjoy the journey

The early years as a consultant are a whirlwind—of growth, learning, and self-discovery. You’ll face challenges you didn’t expect, make decisions that will stay with you, and build relationships that define your career. But through it all, remember to enjoy the journey. There will be ups and downs, but you’ll never have another time quite like this in your career. It’s a time of establishing who you are as a surgeon, and as a leader.

Be patient with yourself. Not every case will be perfect, and not every decision will be easy, but each one is an opportunity to learn and grow. Stay curious, stay humble, and never forget the reason you chose this path in the first place: to help people.

Good luck to all those just starting out on this incredible journey—you’ve got a lot to look forward to.