Published: 06/01/2005, Volume II5, No. 5937 Page 29

Succession in medical management is a problem for trusts.

Many require a full-time medical director, but few consultants wish to give up clinical practice to take this on.

But offering the role as a job share enables consultants to continue their clinical work. In 2003, when the medical director at our trust retired, there were no volunteers for this fulltime role. Two of us independently suggested a job share. Under this arrangement one of us has six management sessions and the other four. There is regular overlap to improve communication and allow for meetings with the chief executive.

Consultants often see the role of medical director as a poisoned chalice because of the difficulties of uniting the often conflicting worlds of medicine and management. They also fear losing their clinical identity. There tends to be little financial benefit. Nor does the role automatically lead to higher rewards, deterring younger consultants.

A job share addresses many of these issues, as well as providing the benefit of shared experience. It is different from having one medical director and several associate medical directors.

While we only have one shared vote on the trust board, we both have equal decision-making ability.

Remaining on the shop floor puts us on an equal footing with our colleagues and makes us more realistic about what can be achieved in clinical practice and the deficiencies of services available to clinicians. We hope to remain clinically credible and, by retaining our skills, to return to full-time practice once our spell in management has finished.

What do you need to make a job share work? First, it must be based on mutual respect.

Second, you need complementary skills and knowledge. You need to develop different portfolios according to your background, areas in which one leads and the other stays informed. As well as time to do the job and be available for colleagues, you need time to exchange information. Clinical time also needs to be protected.

Both medical directors have to develop a very wide and overlapping understanding of the trust, which takes up more time than is allocated and requires good systems of dealing with appointments, letters and e-mails.

While you need to avoid becoming territorial, there also needs to be a recognition that different talents exist in the pairing. Attempts to play one opinion against another have been rare, but communication has to be good to prevent this becoming a problem.

Given the right people, a job share can be an enriching experience.

Vaughan Pearce, consultant physician and Iain Wilson, consultant anaesthetist, are medical directors at Royal Devon and Exeter foundation trust.