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. Training may be extended by pursuing medical research (usually 2–3 years), usually with clinical duties as well | ||
In the United Kingdom, junior doctors are qualified medical practitioners working whilst engaged in postgraduate training. The period of being a junior doctor starts when they qualify as a medical practitioner following graduation with a Bachelor of Medicine, Bachelor of Surgery degree and start the UK Foundation Programme, it culminates in a post as a Consultant, a General Practitioner (GP), or some other non-training post, such as a Staff grade or Associate Specialist post.
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The term junior doctor currently incorporates the grades of Foundation doctor and Specialty registrar. Prior to 2007 it 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 in which they are training, 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 England there are around 53,000 junior doctors.
Working hours
In Europe and the US there has been some reduction of the working hours of doctors who are in postgraduate training, in line with recommendations and legislation aimed at improving patient safety and doctors’ working conditions. In 1991 the government, the NHS and the British Medical Association (BMA) agreed a package of measures on working hours, pay and conditions which was called the New Deal for Junior Doctors. The Doctors' duty hours, which were felt to be excessive, were reduced to a maximum average of 56 hours actual work and 72 hours on call duty per week, although the change was not enforced until 1 December 2000. The European Working Time Directive (EWTD) sets out minimum health and safety requirements for the organisation of working time. The EWTD required the average working week to fall to 48 hours or less by 2009.
The shortening of junior doctors' working hours had implications for how training programmes are organised, especially for specialties such as surgery where there was a tradition of maximising the hours of experience. Most studies that have looked at a reduction of junior doctors working hours have found either a beneficial or neutral impact in terms of measures of patient safety, clinical outcomes and postgraduate training.
The reduction in number of hours worked by junior doctors is one of the factors leading to blurring distinctions between them and other clinical professions such as nurse practitioners who also perform complex tasks.
Migration
An Organisation for Economic Co-operation and Development survey in December 2015 showed that 35.4% of NHS doctors, 34,000, were born abroad compared with 5% in Italy, 10.7% in Germany and 19.5% in France. The UK was the second highest exporter of doctors, second only to Germany, with 17,000 British doctors working in other OECD countries. These figures are for all doctors in the NHS, not just junior doctors.
Modernising medical careers
In 2005, Modernising Medical Careers saw significant changes to postgraduate medical training. A two-year Foundation Programme was introduced for newly qualified doctors, the number of years of postgraduate training changed in some specialties and it was doctors were needing to decide which specialty to follow sooner after graduation.
There have been recent initiatives to engage junior doctors in NHS leadership; junior doctors are seen as essential to the drives to achieve efficiency savings in the NHS.