Junior doctors in the United Kingdom and Ireland are those in postgraduate training, starting at graduation with a Bachelor of Medicine (or Surgery) and culminating in a post as a Consultant, a General Practitioner, or some other non-training post, such as a Staff grade or Associate Specialist post.
|This section does not cite any references or sources. (September 2012)|
In 1991 the government, the NHS and the British Medical Association agreed a package of measures on working hours, pay and conditions which was called the New Deal for Junior Doctors. This restricted these doctors' hours to a maximum average of 56 hours actual work and 72 hours on call of duty per week, although it was not enforced until December 1, 2000. The European Working Time Directive required the average working week to fall to 48 hours or less by 2009.
The shortening of junior doctors' working hours means that the quantity of experience they can gain during training is less. This is countered by many who say that 48 hours per week is more than enough time to receive quality training and the hours worked in excess of this do not meaningfully contribute to quality training and actually result in poor patient treatment.
Roles in other clinical professions are blurring demarcation between what a doctor and, for example, some nurses can do. Shorter duty shifts demand closer teamwork across professions and effective handovers. Medicine is becoming more specialised, but more cross-cover between specialties at night is needed to preserve doctors' working time during days and evenings, when most patient care and learning under supervision takes place.
The number of years of postgraduate training is set to reduce under the 2005 plans for Modernising Medical Careers, which will require doctors to decide which specialty to follow sooner after graduation.
The interaction with health care managers (who are not usually doctors in the UK) has changed during recent years to involve doctors in the running of hospital specialty groups and community-based practice. More developed leadership and financial training is required to equip doctors with the skills to manage budgets and responsibilities.
The income of a junior doctor consists of a base salary plus a banded supplement. This banded supplement is based on hours worked over the standard contracted hours and the proportion of that overtime that is worked at antisocial hours.
In 2011/12 the base salary was £22,412 for the most junior hospital doctor post (foundation year 1), and £27,798 for foundation year 2. The most common banding supplement is 40% (a significant number of posts carry no banding). The average foundation programme (as of 2011/12) will consist on two 40% banded jobs and one none banded job, giving a total gross income of £28,388.
Annual fees to remain registered as a doctor are high and in addition malpractice insurance, exam costs, membership of the relevant Royal college, fees for training, and costs of attending courses are largely borne by the employee. This results in between £420-£3000 of professional fees annually depending on stage of training. Average student debt is over £40,000.
The starting salary for junior doctors has been falling sharply over time (especially with reference to cost of living). In 2005, the average starting salary for a medical graduate was £32,086.
As of 2008, first year junior doctors are no longer automatically entitled to free accommodation at their hospital. The British Medical Association claim this amounts to a £4,800 annual pay cut. Matthew Izett, a third year student doctor and British Medical Association rep said: "This accommodation makes up a significant proportion of the financial incentive for first-year junior doctors and we've taken what is effectively a 20% pay cut for junior doctors next year." The Department of Health have stated "Changes to the working patterns of junior doctors and new rotas make it unnecessary for them to be 'on call' meaning there is no residency requirement. It is therefore the case that free accommodation for junior doctors has not been a necessity for some time." Ann Keen, Parliamentary Under-Secretary for Health Services, stated "The provision of free accommodation for foundation year 1 doctors who are on call at night, is dependent on the contract of employment of the junior doctor, which is for agreement locally. The Junior Doctors Terms and Conditions of Service continue to provide that if a doctor is contractually required to live in hospital accommodation no charges should be made for the accommodation provided."
Junior doctors are eligible for the NHS Pension Scheme. The pension scheme is index linked and based upon final salary, providing an income of (1/80th career average salary x years employed) per year. At the point of retirement the pension also provides a tax-free lump sum of (3/80ths salary x years employed).
New doctors and mortality
The period when newly qualified junior doctors start working in August has sometimes been dubbed the "killing season" due to the measurable increase in the number of patient deaths. Research in England has established that there is indeed a statistically significant increase in patient mortality during August, the month when junior doctors start working - when all other factors are discounted, patients are, on average, 6% more likely to die in this month. For patients not requiring surgery or suffering from cancer, the death rate increases by 7.86%.
- Fitzgerald JEF, Caesar B, (2012). "The European working time directive: A practical review for surgical trainees". International Journal of Surgery 10 (8): 399–403. doi:10.1016/j.ijsu.2012.08.007. PMID 22925631.
- "Pay for doctors". NHS Careers. Retrieved 2009-09-23.
- "Memorandum of evidence to the Review Body on Doctors' and Dentists' Remuneration. Annex 1 - A comparison of graduate earnings". British Medical Association. 2005-10-01. Retrieved 2007-08-02.
- BMA. "Memorandum of evidence to the Review Body on Doctors' and Dentists' Remuneration, September 2007". Retrieved 2008-06-16.
- "Doctors in accommodation protest". BBC News. 2008-05-22.
- "Written answers: Junior Doctors: Accommodation". They Work For You. 2008-06-03.
- "Scottish NHS Pension Scheme Changes from 1 April 2008 Rules and Benefits Comparison". Scottish Public Pensions Agency.
- "'Deaths rise' with junior doctors". BBC News. 2009-09-22.