From Larva to Butterfly: The Metamorphosis of a Consultant

Dawn O'Shea

August 05, 2021

A recent article in  BJU International  likens the development of a UK consultant urologist to the metamorphosis of a butterfly, from egg to butterfly.

The authors map out the path from "the short sharp sprints of the training years" to the “hardest, marathon, component,” in a series of four phases.

Years 0-5: The Egg Stage:

These are "tough years for recently graduated trainees," the authors say. "Ultimate responsibility looms, and the sense of being on your own with 'the buck stopping here', prevails."

Year 6-15: The Larval Stage:

Initially, these might seem like "the blissful years" as surgical confidence grows. But, as workload and responsibilities grow, this can place enormous stress on a urologist’s personal and family life.

"This imbalance culminates in the ‘perfect storm’ of overwhelming stress, which usually leads to considering alterations to the work environment to try and stabilize the consultant’s life,” the authors explain.

Years 15-20: The Pupal Stage:

This is when a profound disillusionment often kicks in at the beginning of this phase and burnout becomes an issue, the authors advise.

Years 21 - State pension: The Butterfly Stage

Contrary to this stage in nature, the butterfly stage of a consultant urologist’s career is "often far from being liberated." They point to changes in pension and tax rules, limitations in clinical freedom, health issues and burnout which are contributing to the early loss of the most experienced surgeons from the NHS.

They warn aspiring urologists that this phase, although short-lived in nature, is one of the longer stages of a consultant’s career and getting longer as state pension age increases.

First author Faith McKeekin called for revolutionary interventions and incentives to allow consultants to continue working as they age, with support to recognise symptoms of burnout at the pupal stage.

She said she hopes that a senior consultant mentoring pathway exists in 20 years-time "to guide eggs on the metamorphic path to become a long living, content, butterfly."

The article is co-authored by Miss McKeekin, consultant urological surgeon at Cheltenham General Hospital; Miss Jo Cresswell, consultant urological surgeon at the James Cook University Hospital Middlesbrough; and Prof Stephen Payne from Bournemouth University.


McMeekin F, Cresswell J, Payne SR. Four Phases in the Metamorphosis of The Consultant Urologist. BJU Int. 2021 Jul 22 [Epub ahead of print]. doi: 10.1111/bju.15557. PMID: 34291864

This article originally appeared on Univadis, part of the Medscape Professional Network.

Article image credit: Tim Graham/Hulton Archive/Getty


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