How does an early career surgeon transition to independent consultant practice?

Comprehensive training is the core foundation to navigating your early career as a consultant

It is the biggest threshold an early career surgeon will cross: Moving from being under a consultant’s supervision to becoming the consultant in charge, bearing ultimate responsibility for the patient. This transition is one which is difficult to simulate and practise for.

As surgeons, we often train for up to 15 years, learning clinical and operative skills, how to manage services and lead teams. But the lived experience of being the ultimate person ‘in charge’ is something that you can only really experience when you step into the role and it is a time of immense change. This transition also tends to come along at a time when life and personal responsibilities are also evolving – including mortgages, relationships, parenthood, and other caring roles. For me, it came with pregnancy and becoming a mom for the first time.

Early Career Surgical Network

Recognising some of the more non-clinical challenges that uniformly exist in early career surgical practice, the RCSI Early Career Surgical Network (ECSN) was founded in 2024 to offer support, advice, and networking opportunities to surgeons in this phase of their working lives. The ECSN is based on the principle that there is much to be gained from each other’s experience and advice. Early career surgical practice tends to refer to those who are in the late phase of training, on international fellowship, and in the early years of consultant practice.

The new consultant surgeon faces many new challenges. The first is getting a consultant job. Navigating this process commonly occurs during a time of international fellowship which, in itself, can be a time of great uncertainty and geographical isolation from your previous surgical trainee peers, and also, often, from family members.

Then, when commencing in the role as a consultant, you are automatically viewed as a leader. You are expected to lead the operating theatre team, ward-level team, the emergency team, and the multi-disciplinary team. Frequently, there is an expectation to develop a new service, possibly lead an academic programme and a research budget – and this is the ultimate step from trainee to trainer.

For all, comprehensive training – both in surgical skills and professional skills – is the core foundation to navigating early consultant practice. Since 2022, I have worked as a Consultant General and Colorectal Surgeon with the University of Limerick Hospital Group. I feel that my training to this point has really prepared me for the step up to this role.

Fellowships

I started medical school in University College Cork (UCC) in 2006, graduated in 2011, and then undertook basic and higher surgical training in Ireland. I was awarded FRCSI (Fellowship of the RCSI) in 2020. During this time, I also completed a Master’s in Surgery at the RCSI, a basic science PhD at UCC, and qualifications in human factors and clinical leadership. I felt very holistically prepared to become a surgeon.

Following training, I was honoured to be awarded the RCSI PROGRESS Fellowship, which is a bursary awarded by the College to promote female participation in surgical training at fellowship level. It followed an RCSI report in 2017 that highlighted the scale of gender inequity in surgery. The purpose of this Fellowship is to ensure surgery is equally attractive for men and women, which will ultimately prepare a surgical workforce that better reflects the population in which we live.

As a female surgeon, it is very common to be asked questions about ‘how hard it is’ or about ‘the challenges for women in surgery’. I think the honest answer is that becoming an excellent surgeon and delivering high-quality surgical care is challenging for all regardless of gender, race, religion, sexual orientation, or socio-economic background. There are lots of characteristics in humans that can generate bias in society and bias – be it overt or subconscious – exists in all walks of life.

But I guess questions like these do highlight that there is still a perception of gender bias in surgery. While it is factually correct that the more senior workforce in surgery is predominantly male, there is also clear increasing female participation. There is also a responsibility on those of us in the specialty to continue to shine a light on that and to drive the change in culture. I do believe the PROGRESS Fellowship has given me that opportunity to continue the conversation about increasing female participation and success in surgery, particularly in surgical innovation and robotics, which are areas I am very passionate about.

My fellowship training experience really enhanced my surgical training in Ireland and I chose to go to the University of Bordeaux in France, as it is a cutting-edge rectal cancer surgery centre. There, I completed a European Society of Coloproctology Robotic Surgery and Advanced Pelvic Malignancy Fellowship. I really liked their ethos and approach and was grateful for the opportunity to learn from the world leaders in colorectal surgery, and to gain experience on embedding surgical trials into everyday practice.

My central goal was to develop a comprehensive clinical and operative skill set to offer high-quality complex care to Irish patients both in cancer and benign colorectal disease. I developed a new repertoire of operative techniques, which have enhanced the quality of care that I provide in my practice. The Fellowship also offered a valuable opportunity to deepen my clinical decision-making and academic skills, which has allowed me to take on academic roles as a consultant.

Connection

Becoming a surgeon and transitioning to independent consultant practice is challenging for all. In ways it needs to be challenging, as this ensures we constantly strive to get the absolute best out of ourselves to achieve the highest standards for our patients.

But I believe that we are all dealing with very similar challenges and the ECSN aims to connect us with others who are at the same career stage. It opens up opportunities for organic interactions, informal peer mentorship, and guidance and support. We can learn from one another about the interpersonal dynamics in different departments, or support one another when introducing a new practice or procedure in our workplace. It further allows opportunity for dissemination of relevant practical information and inclusion to support those at an early career stage with personal and professional development. We also aim to facilitate increased participation and inclusion in RCSI’s surgical community for those at an early stage of career across all specialties.

I believe that we are all dealing with very similar challenges and the ECSN aims to connect us with others who are at the same career stage

Building on the success of the launch of the ECSN at the most recent RCSI Millin Meeting, we delivered a key symposium at Charter Week 2025 entitled ‘Early career surgeon impact on practice and policy’. This symposium highlighted the exceptional impact of early career surgeons on both clinical practice and healthcare policy across six surgical sub-specialties in Ireland. It offered invaluable insights to current early career surgeons on how to develop similar initiatives and quality improvements in their daily practice. Over the next six months, we aim to develop a practical resource bank for early career practice as well as a webinar series on ‘How to…’ achieve success in various ways in early career surgery.

For all early career surgeons in Ireland, more information on the ECSN can be found on the RCSI members’ and Fellows’ portal (www.rcsi.com).

Author: Ms Christina Fleming, Consultant General and Colorectal Surgeon, University of Limerick Hospital Group, and Chair, RCSI Early Career Surgical Network