Junior doctor

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Junior doctors in the United Kingdom 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. The term junior doctor might be considered misleading. It includes skilled doctors with years of National Health Service experience of treating patients.

**NHS** **Medical Career Grades**
	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		Foundation House Officer - 2 years
Year 3:			Specialty Registrar (StR) in a hospital speciality: six years	Specialty Registrar (StR) in general practice: three years
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: 5 years
Year 9:	Consultant total time in training: minimum 7-9 years		Consultant total time in training: 8 years	General Practitioner total time in training: 5 years
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.

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, of necessity, the amount of experience they can gain during training is less, which poses significant challenges if quality of training is to be maintained.

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 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 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.