Senior registrar

A Senior Registrar is a type of doctor in the United Kingdom or Ireland.

Senior Registrars (SRs) were medical (or dental) practitioners who were undertaking, or had completed, several years of higher level training in a hospital specialty or Public Health but had not yet gained a position as consultant (either by choice or because the competition was too stiff), thus differentiating them from the modern day Specialist registrars who are still completing training.

Usually, but not invariably, a higher qualification such as the membership or fellowship of one of the Royal Colleges and, in the more competitive specialties, several publications in peer-reviewed journals would have been obtained at the Senior House Officer or Registrar level, a short or long time before obtaining the Senior Registrar post.

As well as gaining clinical, teaching and administrative experience, SRs were expected to do research: usually clinical, but sometimes laboratory-based, even in clinical specialties. Several publications were expected. Some tried to obtain a higher degree: in earlier days normally an MD or ChM (or the local variant), but in later times a few aimed at a PhD (which involved more formal supervision) instead. Research for a PhD could be done part-time. Sometimes a higher degree would have been obtained before the SR appointment. This was also the most convenient stage for a minority of psychiatrists to undergo personal analysis as part of their psychotherapy training.

The numbers of these posts were limited, with the aim of roughly corresponding to the numbers of vacancies expected for Consultant or Senior Lecturer posts in the National Health Service or medical schools, so in many fields competition was more severe at the level of entry to the SR grade than for consultant posts.

Latterly Senior Registrars each had a National Training Number (NTN), which they relinquished on leaving training on obtaining a Certificate of Completion of Training (CCT): later changed to Certificate of Completion of Specialist Training (CCST) and now replaced by CT. Sometimes the same department would contain both registrars with higher qualifications waiting for a SR post and a senior registrar with NTN, who could be doing similar clinical work and research. In some other systems, such as that of Canada, there was no such externally imposed limit on trainee numbers.

Full-time academics (lecturers and some research fellows) could sometimes be upgraded from Honorary Registrar to Honorary Senior Registrar (with NTN) at an interview, without the open competition otherwise required.

There was also a side pathway for academics with an international reputation (shown by publications and presentations abroad) to get onto the General Medical Council's Specialist Register (and thus become eligible for an NHS consultant appointment) on the strength of their research, without having the clinical experience normally required for any particular specialty. This was justified by the likelihood of such a person having a tertiary-referral post as part of a team in an academic centre.

SRs could, especially towards the end of their training, be given similar responsibility to a consultant, but there was normally a named consultant with clinical responsibility for each junior doctor’s activities. Locum consultant appointments could be taken by a SR (or sometimes a trainee at a lower grade, or an experienced person with no higher qualification) while retaining their SR post. It was also possible to go abroad to do research for a defined period.

Senior Registrars had their progress reviewed annually by a local committee of senior clinicians and academics: this was in force long before the other training grades such as Senior House Officer and Registrar had any supervision outside of their immediate superiors and has been continued in the successor grades of Specialist Registrar (SpR) and Specialty Registrar (StR).

The duration of an SR post depended largely on the level of competition in the field, and the kind of post sought after: sole consultant in the speciality in a country hospital, part-time consultant in a metropolitan centre with substantial private practice, academic in a university centre, etc. Women holding part-time SR posts could take twice as many years in higher training.

Those who stayed on too long could be under pressure to move on and allow others in. Some people changed speciality at this level (e.g. from cardiology to geriatrics), switched to general practice, or went abroad, though a certain amount of retraining might be required. After training in a subspecialty, the post obtained might be in a broader subject. In general practice a trainee might have to spend a year as a registrar as there were no senior registrars.

In contrast, in certain fields and at certain times it might be possible to make rapid progress: it was possible for psychiatric SRs to move into a consultant appointment “somewhere” after a year or so in the less regulated 1970s and 1980s.

The term “Junior Registrar” is sometimes encountered: this title was occasionally given to a Senior House Officer awarded enhanced responsibility.

In the USA, the title of “Senior Registrar” might be applied to a Senior or Chief Resident in Surgery.

The senior registrar post still exists in Australia.