Junior doctor
Encyclopedia
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.
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 of duty per week, although it was not enforced until December 1, 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. 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. Many suspect that the resulting cut in doctor salaries is the main reason for their unhappiness .
New and extended roles in other clinical professions are blurring demarcation between what a doctor and, for example, some nurses can do. Shorter duty shift
s 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.
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% (pre 2009, since then most jobs carry a 40% banding, with a significant number of posts carring no banding), which provides an actual income for most junior doctors of £33,285 in foundation year 1, and £41,285 in foundation year 2. The average foundation programme (post 2009) will consist on two 40% banded jobs and one none banded job, giving a income of £28092.54, with between £420-£900 of professional fees to pay out and an average student debt of over £40,000 (source BMA). A junior doctor in specialist training on a 50% supplement will earn from £44,117 to £69,369. In 2005, the average starting salary for a medical graduate was £32,086.This has fallen to between £28092 and £31066, in 2011 (based on having two or three 40% banded jobs).
According to the British Medical Association
, junior doctors have a lower starting salary than the average for graduates on other courses despite longer training.
As of 2008, first year junior doctors are no longer automatically entitled to free accommodation at their hospital. The British Medical Association claim this amounts to a £4,800 annual pay cut. 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." 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." 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."
After 5 years the average junior doctor will have advanced to specialist registrar
grade, earning an average salary of £48,000.
. 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).
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...
and the Republic of Ireland
Republic of Ireland
Ireland , described as the Republic of Ireland , is a sovereign state in Europe occupying approximately five-sixths of the island of the same name. Its capital is Dublin. Ireland, which had a population of 4.58 million in 2011, is a constitutional republic governed as a parliamentary democracy,...
are those in postgraduate training, starting at graduation with a medical degree and culminating in a post as a Consultant
Consultant (medicine)
In the United Kingdom, Republic of Ireland, and parts of the Commonwealth, consultant is the title of a senior doctor who has completed all of his or her specialist training and been placed on the specialist register in their chosen specialty...
, a General Practitioner
General practitioner
A general practitioner is a medical practitioner who treats acute and chronic illnesses and provides preventive care and health education for all ages and both sexes. They have particular skills in treating people with multiple health issues and comorbidities...
, or some other non-training post, such as a Staff grade
Staff grade
In the United Kingdom, a staff grade doctor is one who is appointed to a permanent position as a middle grade doctor. Doctors may have been appointed to this position based on experience and not all doctors will have done postgraduate examinations to reach this position. In the past Staff grades...
or Associate Specialist
Associate Specialist
In the United Kingdom, an associate specialist doctor is one who is appointed to a permanent position in the middle ranks. The rank is the highest that a doctor not seeking to be made a consultant may achieve, and is usually conferred upon staff grade doctors after several years experience In the...
post.
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
National Health Service
The National Health Service is the shared name of three of the four publicly funded healthcare systems in the United Kingdom. They provide a comprehensive range of health services, the vast majority of which are free at the point of use to residents of the United Kingdom...
and the British Medical Association
British Medical Association
The British Medical Association is the professional association and registered trade union for doctors in the United Kingdom. The association does not regulate or certify doctors, a responsibility which lies with the General Medical Council. The association’s headquarters are located in BMA House,...
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
Working Time Directive
The Working Time Directive is a European Union Directive, which creates the right for EU workers to a minimum number of holidays each year, paid breaks, and rest of at least 11 hours in any 24 hours; restricts excessive night work; and makes a default right to work no more than 48 hours per week....
requires the average working week
Working week
Working week may refer to*Working Week , a British jazz-dance band of the 1980s and 1990s.*Working time, the period of time that people spend in paid labour*Workweek, referred to as the Working Week in the UK....
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. Many suspect that the resulting cut in doctor salaries is the main reason for their unhappiness .
New and extended roles in other clinical professions are blurring demarcation between what a doctor and, for example, some nurses can do. Shorter duty shift
Shift work
Shift work is an employment practice designed to make use of the 24 hours of the clock. The term "shift work" includes both long-term night shifts and work schedules in which employees change or rotate shifts....
s 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
Modernising Medical Careers
Modernising Medical Careers is a programme for postgraduate medical training introduced in the UK from 2005 onwards. The programme replaced the traditional grades of medical career before the level of Consultant. The different stages of the programme contribute towards a "Certificate of...
, 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.
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.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% (pre 2009, since then most jobs carry a 40% banding, with a significant number of posts carring no banding), which provides an actual income for most junior doctors of £33,285 in foundation year 1, and £41,285 in foundation year 2. The average foundation programme (post 2009) will consist on two 40% banded jobs and one none banded job, giving a income of £28092.54, with between £420-£900 of professional fees to pay out and an average student debt of over £40,000 (source BMA). A junior doctor in specialist training on a 50% supplement will earn from £44,117 to £69,369. In 2005, the average starting salary for a medical graduate was £32,086.This has fallen to between £28092 and £31066, in 2011 (based on having two or three 40% banded jobs).
According to the British Medical Association
British Medical Association
The British Medical Association is the professional association and registered trade union for doctors in the United Kingdom. The association does not regulate or certify doctors, a responsibility which lies with the General Medical Council. The association’s headquarters are located in BMA House,...
, junior doctors have a lower starting salary than the average for graduates on other courses despite longer training.
As of 2008, first year junior doctors are no longer automatically entitled to free accommodation at their hospital. The British Medical Association claim this amounts to a £4,800 annual pay cut. 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." The Department of Health
Department of Health (United Kingdom)
The Department of Health is a department of the United Kingdom government with responsibility for government policy for health and social care matters and for the National Health Service in England along with a few elements of the same matters which are not otherwise devolved to the Scottish,...
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." Ann Keen
Ann Keen
Ann Lloyd Keen is a British Labour Party politician, who was the Member of Parliament for Brentford and Isleworth from 1997, until she was defeated by Conservative candidate Mary Macleod in 2010.-Early life:...
, 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."
After 5 years the average junior doctor will have advanced to specialist registrar
Specialist registrar
A Specialist Registrar or SpR is a doctor in the United Kingdom and Republic of Ireland who is receiving advanced training in a specialist field of medicine in order eventually to become a consultant...
grade, earning an average salary of £48,000.
Pension scheme
Junior doctors are eligible for the NHS Pension SchemeNHS Pension Scheme
The NHS Pension Scheme is a large pension scheme for people who work for the English NHS and NHS Wales. It is administered by the NHS Business Services Authority, a special health authority of the Department of Health of the United Kingdom....
. 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. 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. For patients not requiring surgery or suffering from cancer, the death rate increases by 8%.External links
- The junior doctors' contract
- Modernising Medical Careers
- 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