Junior doctors in the United Kingdom and Ireland are qualified medical practitioners who are working whilst engaged in postgraduate training to become a consultant or a GP. The period of being a junior doctor starts when they qualify as a medical practitioner following graduation with Bachelor of Medicine, Bachelor of Surgery degrees, and culminates in a post as a Consultant, a General Practitioner, or some other non-training post, such as a Staff grade or Associate Specialist post. The term junior doctor now incorporates the grades of Foundation doctor, Specialty registrar; and prior to 2007 included the grades of Pre-registration house officer, Senior house officer and Specialist registrar. During this time junior doctors will do postgraduate examinations to become members of a Medical royal college relevant to the specialty they are practicing, for example Membership of the Royal College of Physicians for doctors specialising in Internal medicine, Membership of the Royal College of Surgeons for doctors specialising in surgery or Membership of the Royal College of General Practitioners for doctors specialising in family medicine. Doctors typically may be junior doctors for 5-15 years, and this may be extended by doing research towards a higher degree, for example towards a Doctor of Philosophy or Doctor of Medicine degree. In recognition of the fact that doctors may spend many years below consultant level, notwithstanding significant experience and expertise, the term non-consultant hospital doctor or NCHD also has currency in the Republic of Ireland.
|Old system||New system (Modernising Medical Careers)|
|Year 1:||Pre-registration house officer (PRHO) - one year||Foundation Doctor (FY1 and FY2) - 2 years|
|Year 2:||Senior house officer (SHO)
a minimum of two years, although often more
|Year 3:||Specialty Registrar (SpR)
in a hospital speciality:
minimum six years
|Specialty Registrar (GPST)
in general practice:
|Year 4:||Specialist registrar
four to six years
|GP registrar- one year|
|Year 5:||General practitioner
total time in training: 4 years
|Years 6-8:||General practitioner
total time in training:
total time in training:
minimum 7-9 years
total time in training:
minimum 8 years
|Optional||Training may be extended by pursuing
medical research (usually two-three years),
usually with clinical duties as well
|Training is competency based, times shown are a minimum.
Training may be extended by obtaining an Academic Clinical
Fellowship for research or by dual certification in another speciality.
|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 has been reduced under the 2005 plans for Modernising Medical Careers, which required 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 NHS Careers web site states:
|“||Doctors in training earn a basic salary and will be paid a supplement if they work more than 40 hours and/or work outside the hours of 7am-7pm Monday to Friday.
In the most junior hospital trainee post (Foundation Year 1) the basic starting salary is £22,636. This increases in Foundation Year 2 to £28,076. For a doctor in specialist training the basic starting salary is £30,002. If the doctor is contracted to work more than 40 hours and/or to work outside 7am-7pm Monday to Friday, they will receive an additional supplement which will normally be between 20% and 50% of basic salary. This supplement is based on the extra hours worked above a 40 hour standard working week and the intensity of the work.
Costs and concerns
Junior doctors have to pay for annual fees to remain registered as a doctor, malpractice insurance, exam costs, membership of the relevant Royal college, fees for training. This results in between £420-£3000 of professional fees annually depending on stage of training. Average student debt for a junior doctor is over £40,000.
All doctors have had a real terms cut in pay of 15% between 2007-2014
As of 2008, first year junior doctors were no longer automatically entitled to free accommodation at their hospital. The British Medical Association claimed this amounted to a £4,800 annual pay cut. The Department of Health 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."
The NHS Careers web site states:
|“||Doctors in the specialty doctor grade earn a basic salary of between £37,176 and £69,325.
Consultants can earn a basic salary of between £75,249 and £101,451 per year, dependent on length of service. Local and national clinical excellence awards may be awarded subject to meeting the necessary criteria.
Many general practitioners (GPs) are self employed and hold contracts, either on their own or as part of a Clinical Commissioning Group (CCG). The profit of GPs varies according to the services they provide for their patients and the way they choose to provide these services.
Salaried GPs who are part of a CCG earn between £54,863 to £82,789 dependent on, among other factors, length of service and experience.
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 patient mortality
The period when newly qualified junior doctors start working in August has sometimes been dubbed the "killing season" due to a potential increase in the number of patient deaths. Research in England established that while there is a statistically significant increase in patient mortality during August, the limited data collected over 8 years of two week blocks (one week prior to commencement, one week post commencement) meant drawing firm conclusions was unwise with correlation not implying causation. In the month when junior doctors start working - when other factors are adjusted for patients had a 6% increase in mortality. For patients not requiring surgery or suffering from cancer, the mortality 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. 2014-04-01.
- DDRB. "Review Body on Doctors’ and Dentists’ Remuneration Forty-Third Report 2015: Figure 2.3" (PDF).
- "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.