Junior doctors in the United Kingdom and the Republic of Ireland are those in postgraduate training, starting at graduation with a medical degree 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.
| Old system | New system (Modernising Medical Careers) | |||
| Year 1: | Pre-registration house officer (PRHO) - one year | Foundation House Officer - 2 years | ||
| Year 2: | Senior house officer (SHO) a minimum of two years, although often more |
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| Year 3: | Specialty Registrar (StR) in a hospital speciality: six years |
Specialty Registrar (StR) in general practice: three years |
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| Year 4: | Specialist registrar four to six years |
GP registrar- one year | ||
| Year 5: | General practitioner total time in training: 4 years |
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| Years 6-8: | General practitioner total time in training: 5 years |
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| Year 9: | Consultant total time in training: minimum 7-9 years |
Consultant total time in training: 8 years |
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| Optional | Training may be extended by pursuing medical research (usually two-three years), usually with clinical duties as well |
Training may be extended by obtaining an Academic Clinical Fellowship for research. |
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The ways in which these doctors work and train is undergoing significant changes in the UK. Average hours worked per week are falling as a result of pressures from junior doctors themselves and concerns about fatigue resulting in medical mistakes. 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 duty per week, although it was not enforced until December 1st 2000. The European Working Time Directive requires 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.
New and extended 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 specialities 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 plans for Modernising Medical Careers, which will require doctors to decide which speciality 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 speciality groups and community-based practice. More developed leadership and financial training is required to equip doctors with the skills to manage budgets and responsibilities.
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Salary
The income of a junior doctor consists of a base salary plus a banded supplement based on the intensity of the work and working more than 40 hours a week.[1] In 2009 the base salary was £22,190 for the most junior hospital doctor post (foundation year 1), and £27,523 for foundation year 2. The most common banding supplement is 50%, which provides an actual income for most junior doctors of £33,285 in foundation year 1, and £41,285 in foundation year 2.[1] A junior doctor in specialist training on a 50% supplement will earn from £44,117 to £69,369.[1] In 2005, the average starting salary for a medical graduate was £32,086 [2].
According to the British Medical Association, junior doctors have a lower starting salary than the average for graduates on other courses despite longer training.[3]
As of 2008, first year junior doctors are no longer automatically entitled to free accommodation at their hospital.[4] The British Medical Association claim this amounts to a £4,800 annual pay cut.[4] 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."[4] 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."[4] 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."[5]
After 5 years the average junior doctor will have advanced to specialist registrar grade, earning an average salary of £48,000.[citation needed]
Pension scheme
Junior doctors are eligible for the NHS Pension Scheme.[6] The pension scheme is index linked and based upon final salary, providing an income of (1/80th final 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).
Effect of newly qualified doctors on patient mortality
The period when newly qualified junior doctors start working in hospitals has sometimes been dubbed the "killing season" due to the perception of an increased number of patient deaths.[7] 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.[7] For patients not requiring surgery or suffering from cancer, the death rate increases by 8%.[7]
See also
References
- ^ a b c "Pay for doctors". NHS Careers. http://www.nhscareers.nhs.uk/details/Default.aspx?Id=553. 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. http://www.bma.org.uk/ap.nsf/Content/ddrbev2005~annex1. Retrieved 2007-08-02.
- ^ BMA. "Memorandum of evidence to the Review Body on Doctors' and Dentists' Remuneration, September 2007". http://www.bma.org.uk/ap.nsf/Content/DDRBevidence2007. Retrieved 2008-06-16.
- ^ a b c d "Doctors in accommodation protest". BBC News. 2008-05-22. http://news.bbc.co.uk/1/hi/england/cornwall/7415474.stm.
- ^ "Written answers: Junior Doctors: Accommodation". They Work For You. 2008-06-03. http://www.theyworkforyou.com/wrans/?id=2008-06-03a.207297.h.
- ^ "Scottish NHS Pension Scheme Changes from 1 April 2008 Rules and Benefits Comparison". Scottish Public Pensions Agency. http://www.sppa.gov.uk/pension_reform/NHSPENCOMPTABLE.htm.
- ^ a b c "'Deaths rise' with junior doctors". BBC News. 2009-09-22. http://news.bbc.co.uk/1/hi/health/8269729.stm.
External links
- JuniorDr Magazine - magazine for junior doctors produced by junior doctors
- The junior doctors' contract
- Modernising Medical Careers
- Improving Doctors' Working Lives - legislation, links and developments
- http://www.nhsemployers.org/pay-conditions/pay-conditions-357.cfm - contract and pay details
- http://www.healthcareworkforce.nhs.uk/TowardsWTDConference/default.aspx - achieving EWTD 2009 target
- Masterclass for Junior Doctors wanting to develop their skills and competencies
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