In a survey of 1794 UK NHS hospital consultants 1308 (73%) responded. Psychiatric morbidity (General Health Questionnaire-12 score > or =4) was present in 32% of responders, who were twice as likely to report drinking hazardous levels of alcohol, being irritable with patients and colleagues, reducing their standards of care and intending to retire early (all P < 0.001). Male and mid-aged consultants were also particularly at risk. Approaches that support consultants to practice medicine safely throughout their careers are required.