The long road to consultant practice

Roganie Govender is an Associate Professor, and one of the few speech and language therapists (SLTs) working as a consultant clinical–academic. Here she shares her experiences of forming her professional identity during turbulent times in South Africa, and making a daring leap to the UK in the 1990s. How did she keep hold of her vision to be a clinician and researcher? 

1994 was a defining year for me. I felt great excitement and hope starting in my first job as a speech pathologist and audiologist at the Chris Hani Baragwanath Hospital on the outskirts of Soweto, South Africa. It was also the year of the first democratic elections: the first time that I and many other non-white South Africans had a vote and the first time I got on a plane flying from Johannesburg to Durban to see my family once I had earned some money and enough annual leave! 

Fast forward three decades, and I still feel great joy in the work I do, although I am less keen on plane travel these days. I am now a consultant SLT at University College London Hospital, a clinical-academic and Associate Professor at University College London and a fellow of the RCSLT.  

For me, it was important to understand what energised me and to know what goals I wanted to achieve: this gave me vision. 

Everything else was about acquiring the knowledge and skills and finding or creating the opportunities to support my vision. It’s always felt like a great privilege to work as a clinician directly in service of patients; I find this fulfilling and immensely rewarding, but I also experienced a buzz from being involved in research.  

I credit my enthusiasm for research to my training and early work experiences in South Africa. It is often said that adversity brings the greatest creativity, innovation and change, and this is certainly true of my experiences. Growing up under the apartheid regime meant that I lived in an Indian area, went to an Indian School, all my friends were like me, and I went to an Indian university – built because Indian students were not initially able to attend the government funded “white universities.”

Using a Euro-centric curriculum in an African country 

The main curriculum in my Speech Pathology and Audiology degree was Eurocentric, essentially qualifying me to work in most parts of the English-speaking world. This of course was less useful for most of the South African population, often described as the rainbow nation due to the cultural and ethnic mix of the people.  

I started to feel the tensions and mismatch of my training and practice quite quickly, particularly when I undertook my honours research project. My university teamed up with a non-government organisation to promote healthcare in an under-served semi-rural area of Kwa-Zulu Natal known as the Valley of a Thousand Hills.   

It became apparent that my carefully designed research project needed a massive overhaul. I had to start with understanding the local community and their needs. I learned about the structures and purveyors of health being the community health workers and traditional healers. I learned that there may not have been specific words in the native language that translated directly to what I was researching, and that outcomes of interest to me may not have been priority for the people I had planned to include in my research.

A world to be explored 

Back to the drawing board and I reframed, learning about participatory action research and ethnographic methodologies. Working in South Africa I saw the challenges and felt the discomfort of inequality and poverty daily in my jobs in Soweto and Johannesburg. All that while also grappling with my developing philosophy and ideologies at a pivotal time in South African history when the world had quite suddenly opened to me for exploration. 

I took the opportunity to come to England, initially on a working holiday visa in 1996 enabling me to work and travel for a few months. My initial nerves about whether I would cope working in a new country quickly dissipated as I knew I had the knowledge and skills; I just had to learn to navigate the system. Being research-minded I was always curious to get involved with projects, but as an overseas-trained new therapist this was not welcomed by most managers at the time.

Despite the challenges, I held on to my vision of wanting to be in a role where I could be both a clinician and a researcher.

Once in a permanent and more senior post, I took on the role as chair of the head and neck clinical excellence network in 2004. I saw the opportunity for collaborative multi-centre research work, initiating and leading on an eight-centre study that resulted in the development of the first patient-reported swallowing outcome questionnaire for people with total laryngectomy. We achieved this without funding, and there is now a great sense of pride that our questionnaire is being translated into other languages.  

Building a path to the clinical-academic role 

From a self-development point of view, I realised that once I started to ‘prove’ myself through taking every opportunity and working on projects in my own time, I was developing my skills and confidence and starting to build expertise. I recall wishing I could do a PhD, but I would have to pay fees as a foreign student, and I would certainly not have been able to get time out of my job. It was therefore quite fortuitous that the NIHR launched its fellowship scheme not long after I obtained British citizenship. I was in a senior clinical lead post by then and felt well positioned to take the next step in my career. 

I was successful in achieving a prestigious NIHR clinical doctoral research fellowship late 2013 while at the same time working towards a consultant role via the portfolio route. I was able to evidence all four key pillars (research, education, clinical practice and leadership) at national level. This was not easy: it required sacrifices of working many extra hours, taking opportunities to learn through gaining experience on work led by others, and often without credit and acknowledgement. My vision for my future role of being able to combine clinical work and research within a single post kept me focused.  

Support for SLTs looking for consultant roles 

I recently completed my NIHR post-doctoral clinical lectureship which supports such a clinical-academic route, and I am grateful that I have been able to successfully achieve funding to continue this trajectory as a consultant clinical-academic.

The pathway for clinical-academics is now more supported with several funding streams available right from undergraduate level, including but not limited to the NIHR funding schemes. Equally, opportunities for advanced practice leading towards consultant roles are more established.  

I strongly encourage anyone looking to achieve a consultant level post to carefully consider the opportunities that are available for the taking.

Discuss your ambitions with your managers and be prepared to accept some level of uncertainty in the short term while staying agile and staying focused on your long-term goal.

It takes time, and the process is just as important to acquiring the skills and resilience. I hope that my journey is an example that such roles are achievable: perseverance with small steps, willingness to put in the work required making use of support funding that can buy-out clinical time and finding mentors and champions to support you along the way.