The chief medical officer

Authors: Rachel Hooke 

Publication date:  07 Apr 2007

Sir Liam Donaldson has had a diverse career pathway, culminating in the ultimate position in the medical hierarchy

Did you go straight into a surgical rotation after house jobs?

I did an anatomy lectureship, including an extra year of laboratory research leading to the degree of MSc (Anatomy).

What did surgical colleagues think about your move to public health?

I was resigned to the idea of being regarded as a “failed surgeon,” even though it wasn't true. The public health interview panel welcomed me with open arms—they weren't used to having applications from FRCS qualified candidates.

Has public health changed much?

Public health is more central to the NHS than it was when I trained. It is of greater public interest (for example, childhood obesity, pandemic influenza, smoking in public places) and there is much more cross government commitment. The non-medical public health professionals have enhanced the specialty.

When did you decide becoming chief medical officer was a realistic option?

When I was regional director of the NHS (Northern and Yorkshire, appointed in 1994) people said to me that I would be a strong contender for future CMO. I never planned my career around it because it is only one job and I have seen too many people who have set their hearts on a particular job being disappointed.

How was the transition from medicine to management?

In my role as regional director of public health I had a good opportunity to understand how to manage a regional health authority. The transition wasn't so difficult but the world of management is much tougher and more ruthless than medicine and you need to learn to survive as well as deliver results.

The public health interview panel welcomed me with open arms—they weren't used to having applications from FRCS qualified candidates

Can medically qualified managers ever be credible with clinical colleagues?

I would like to see many more doctors as chief executive officers. That's certainly the case in North America and I think the model works well. With the right training and development, a medically qualified manager can be very credible.

Do you think it is essential for the CMO to be a public health doctor?

It helps to have clinical and public health experience, but I have also found my senior management experience (chief executive of a region) very valuable.

What is the most challenging aspect of your job, and why?

The depth of the responsibilities is huge and the burden of accountability is ever present, even out of hours. But the job is fascinating and a privilege to do.

How will you be revalidated?

Through a mixture of the Department of Health's scheme and the Faculty of Public Health, where my continuing professional development is focused.

Who inspired you and why?

Sir George Godber, one of my predecessors (CMO 1960-73). A giant of his time. He mastered the three qualities needed by a good CMO—the ability to command the confidence of ministers, the skill to negotiate the complexities of Whitehall, and the gift of communication. Finally, he was a man of great integrity. If people do not trust you, you are lost.

What has changed in medicine?

The extent to which the profession has adapted to tighter accountability to the requirement of clinical governance is very positive. I am sorry that morale has been low in recent years. Medicine in this country is still a beacon of excellence and I hope it will regain the sense of pride for everything that it stands for.

Do you think that doctors are practising more defensively nowadays?

I don't see much evidence of defensive medicine. Protocol driven medicine is often used as a pejorative term, yet across the developed world there is a big gap between evidence and practice in some fields of care. If they were patients most doctors would be examining the evidence and asking questions if their treatment departed from it. That should tell us something.

Is there a role for locum junior doctors under MMC?

Yes, as there will always be unexpected or short term vacancies that need to be filled. We have two aims. First, through my review, to do better at safeguarding the quality of locums. Second, as MMC is a competency based system, we can offer locums who take up posts of reasonable duration the opportunity to get training that could help them progress and possibly, in time, count towards access to the specialist register.

What advice would you give someone wanting to become a future CMO?

Get broad experience in clinical medicine (including primary care), public health, and management. Spend time with a government department, and understand international health.

Further information Department of Health. Chief medical officer: [Link]

Rachel Hooke freelance medical journalist Leicester  rhooke@doctors.org.uk

Cite this as BMJ Careers ; doi: