The term junior doctor encompasses all doctors from their first Foundation year (first job after medical school) to the final year of training before becoming a consultant or a qualified GP.
I want this blog post to explain a little about the career trajectory of doctors as I think it can be so confusing for people outside of the medical profession, never mind for us lot actually trying to navigate it!
A typical pathway
The descriptions in brackets are old terms that you may still hear used on the wards.
CT stands for core trainee and ST for specialist trainee.
Foundation Year 1 (FY1)
(houseman, house doctor, Junior house officer)
Foundation Year 2 (FY2)
(senior house officer)
CT or ST 1/2 GP ST1/2
(senior house officer)
CT or ST 3/4/5/6 and beyond GP ST3
(Registrar, SpR) (GP registrar)
Consultant Qualified GP
To start with there is medical school; this can be a four year course if the student has done another degree prior but the majority of medical students complete at least five years at university. In the final year of medical school, all students are invited to apply in a national process for their foundation jobs, this is for Foundation Year (FY) 1 and 2. There is also now the option of an ‘FY3’ year for those doctors that are undecided which training scheme is for them.
Each year includes (in general) 3x four month rotations; every job will be in a different speciality or department. For example, my FY1 in Grimsby included rotations in: rheumatology, general surgery and respiratory medicine. My FY2 year in York involved four months in General Practice, then orthopaedics and finally gastroenterology. It is encouraged that each year should be in different hospitals within a local area and involve a breadth of medical specialities.
A foundation doctor has many roles on a ward and within a team and it would be so difficult to list them all. If ward based, they are expected to be up to speed on all their patients and after a ward round with their seniors may be asked to do some ‘jobs’ which could include: ordering or taking blood tests, inserting cannulas, writing up drugs in the chart, ordering tests such as X-rays or CT scans, writing discharge letters and talking to patients and their family members.
When on call, for example in the acute admissions medical unit or the surgical assessment unit, the foundation doctors will admit patients to the ward; taking a history, doing a physical examination and ordering tests as appropriate. They will then discuss this case with a superior which may be a more senior trainee or consultant.
During the FY2 year, doctors are able to apply for ‘speciality training’ and this means that they can apply to do any of the following (am sure I have missed a couple so forgive me…):
Core medical training and ACCS acute medicine
Core surgical training
Obstetrics & gynaecology
The recruitment process and duration of training are different for each speciality and it is way too complex for me to go in to in depth here. General practice is a 3 year training scheme, psychiatry is 6 years and general surgery can be well beyond 8 years. Each doctor applies to a specific locality for their speciality training and will do different rotations across various hospitals in that patch.
At the CT/ST3 (or registrar) level of core medical and surgical training doctors will then choose which specific area they want to work in. This may include respiratory or sports medicine, microbiology and cardiology for the medics or vascular, urology and cardiothoracics for the surgeons. Not all specialities follow the same path, for example, in psychiatry it is the CT4 level that is know as the start of the ‘registrar’ years.
Registrars are experienced clinicians, you may come across them overseeing wards, on-call nights or seeing patients in clinic. Within each speciality there is also the option of further or higher specialism – eg neonatology for paediatrics.
To make medical jobs more confusing there is also the option to choose not to continue ‘training’ but to remain at a certain level as a ‘staff-grade’ or ‘speciality doctor’ (see, as I said, confusing). This usually comes with a more structured rota and better working hours (potentially less pay). Training jobs can be tough; needing to move house and hospitals often, getting rotas on short notice, exams and e-portfolios to complete.
I remember finishing medical school and thinking ‘phew, I’m glad all that studying is over with’….how wrong was I! All training schemes require their trainees to pass exams, usually a mixture of written and clinical/practical exams. They are hard and they are expensive (my GP exams cost £2000), it is common to have to do them more than once. The exams have to be passed in order to progress within training and then the doctor becomes a member of their specific royal college – e.g. Royal College of Physicians or Royal College of Psychiatrists. Did you know that once a surgical trainee has completed their exams and become a member of their college they can be known as Mr/Miss/Mrs rather than Dr?
You can see why it may be an attractive option to leave training and work on a ward where you know the people, know the job and can stay for years without having to rotate elsewhere. Rotations can include hospitals 1-2 hours apart so changing hospitals can mean a huge change in the length of the work commute.
Within GP training there are generally 18 months of ‘hospital jobs’ and 18 months of ‘GP jobs’, split into 4-6 month rotations. My first year involved 6 months in general practice and 6 months in community psychiatry. I went on to do 6 months in elderly medicine in the hospital and then on to obstetrics and gynaecology. My final year (which was longer as I went back ‘less than full time’ after having my daughter) was in two different GP practices. As a ‘GP registrar’, the doctor has their own clinics supervised by a qualified GP that is an experienced GP trainer.
If a training doctor opts to reduce from full time hours to allow for childcare, illness or other reasons, we call that being ‘less than full time’. Shift patterns for a lot of NHS workers make childcare provision tough, certainly for me being 50% time for the year after having my daughter made life manageable and bearable. This elongated my training but it was worth it. I now work 75% time as a GP partner and this is the perfect balance for me.
As you can tell, junior doctor is an all encompassing term and it does not imply lack of knowledge or experience. It is important that we all introduce ourselves to patients, their families and our colleagues to not only make it clear what our name is, but also our job/role and level too. As I mentioned in my Too Young post, it can be so easy to incorrectly assume who people are in a ward or practice environment.
After completing training and gaining a CCT certificate, a doctor can then either be a consultant or a qualified GP.
General practice is further complicated by the fact a qualified GP can be:
- salaried – employee of a practice, can work any amount of sessions (a session is a half day).
- retainer – similar to a salaried but a more protected role with more time allocated for learning and mentorship. Usually work a maximum of two days. Called a retainer as they may be GPs that have thought about leaving the profession and the NHS want to ‘retain’ them.
- locum – may be long term, eg for maternity leave or due to difficulty recruiting permenant staff or more short term/ad hoc to fill rota gaps.
- partner – business owner of the practice, not an employee – usually several partners and they make decisions about how the practice is run.
- There are also other roles for GPs; working in Out of Hours, private GP or doing online/telephone consult work remotely for non-NHS companies.
I often get asked whether I would recommend medicine as a career to family members and the answer is still yes but I would discuss their expectations about the job. I felt like the first couple of years involved more admin tasks and running around the hospital than I expected. It is hard and it feels like a long process at times. When you find a role and speciality that you love, it makes it all so worthwhile.
We do not have enough doctors, less are being trained and of those that do finish medical school, not all stay in the UK to practice medicine. Being a doctor comes with so many challenges but it is so rewarding, we all have a responsibility to enthuse the younger generation and show them what a great career it can be. My post ‘declining’ explains a bit about the challenges in recruitment and why I think a career in GP is well worth considering.
In August there was a hashtag #mytipsfornewdocs around social media, here are mine (a touch late I know!):
- Make friends. These docs around you are the ones that know how it feels. You will have huge highs and huge lows. Talk to them, debrief. Be sociable. Find the doctors mess.
- It is OK to cry. It will happen in the toilet, on the stairs or in to your pillow.
- Be nice to nurses. They have been on the ward a lot longer than you and know SO SO SO much. Don’t steal their pens.
- Stop to have a cuppa and a wee.
- Snacks go down well. Share.
- My husband will testament to the fact that I was the worst person to be around at the changeover time of year. I mourned losing a job I loved and felt useless on the new rotation (it is a doctor trait to hate feeling incompetent). It passes. There will at least be part of the new job that you love and will take forward to your next phase of medical education.
- Write good discharge letters. It makes our job in the world of General Practice so much easier.
- Don’t feel like you have to rush any decisions about job applications. Take your time. You can change your mind months and years down the line. Do what you enjoy, don’t do a job just because it is convenient.
- Invest in good footwear.
- Join twitter. There are loads of great CPD learning opportunities on there #medtwitter #FOAMed #teamGP