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The evolution of doctors: Why did "resident doctors" replace "junior doctors"
Within the National Health Service (NHS) in England, a resident doctor (formerly called a junior doctor) is a qualified medical practitioner who is working in the process of postgraduate training. This period of residency begins when they graduate with a Bachelor of Medicine and Bachelor of Surgery and begin the UK Foundation Program. The end of this period will give them the opportunity to become a consultant, general practitioner (GP) or become a SAS doctor, such as a specialist or professional position. The term residency currently covers the levels of foundation physician, core training physician (in certain specialties such as surgery, medicine and psychiatry), and specialist registrar.
Doctors typically remain in a residency role for eight to 20 years, which can be extended by pursuing higher degree research, such as a PhD or MD.
By 2023, there will be around 71,000 medical residents in the UK. During this time, residents will take postgraduate examinations to become members of the medical royal society associated with their specialty, such as the FRCP for physicians, the FRCS for surgeons, and so on.
Replacement of the term "Junior Doctor"
There is controversy over the historic title of "junior doctor", with many organisations and individuals expressing concern that it creates a misunderstanding of their work and does not fairly reflect the skills these doctors possess. and experience. The British Medical Association (BMA) voted at its 2023 annual general meeting to no longer use the term "junior doctor" in all communications. The motion was proposed by foundation year doctor Sai Pillarisetti and after discussion and voting, it was passed unanimously and became BMA policy.
More than 75 per cent of respondents to an independent report believe the term "junior doctor" is inappropriate and almost half think the term "doctor in training" should be avoided.
As the medical industry re-examines professional titles, the government and other relevant agencies are beginning to recognize this change. In September 2024, as a solution to a long-standing pay dispute, it was announced that resident doctors would officially become the new title on September 18, 2024, replacing the old title of "junior doctors".
Changes in working hours
In the United States and Europe, work hours for doctors in postgraduate training have decreased due to proposals and legislation aimed at improving patient safety and physician working conditions. In 1991, the UK government, the NHS and the BMA reached a set of agreements on working hours, pay and conditions, known as the New Resident Agreement. The agreement limits doctors' working hours to 56 hours of actual work and 72 hours of standby time per week.
According to the European Working Time Directive, the average working week is required to be reduced to 48 hours or less by 2009.
Reducing residents' work hours has a profound impact not only on the way doctors work, but also on their training programs, especially in specialties such as surgery, which have traditionally been accustomed to maximizing time on the job experience. Multiple studies have shown that the impact of this reduction in work hours on medical safety, clinical outcomes, and graduate training is generally positive or neutral.
Global Physician Mobility
According to a survey conducted by the Organization for Economic Cooperation and Development (OECD) in December 2015, 35.4% of NHS doctors were born abroad, showing the increasing diversity of the UK healthcare system. As more UK medical residents seek overseas work opportunities, many are looking to improve their work-life balance while also taking advantage of other opportunities abroad.
Transformation of the modern medical profession
In 2005, the Modern Medical Careers initiative led to major changes in postgraduate medical training, with the introduction of a two-year foundation programme, which obliges new doctors to choose a speciality earlier. Subsequent measures have drawn hospital doctors into leadership roles in the NHS and they are credited with significant efficiency gains since 2010.
Salary and working conditions
Based on 2023 figures, the basic salary earned by residents during their training ranges from £32,398 to £37,303. As you enter the professional training stage, the salary range widens to £43,923 to £63,152. Salaries are inevitably affected by inflation, and for residents since 2007, the purchasing power of real salaries has declined. In 2023, British medical residents began their longest strike in history, calling for a correction to 15 years of pay increases that have been below inflation.
They have demanded a 35% pay rise and prompted reflection on the quality of patient care and the cost of running the NHS.
Prognosis
Resident doctors have a clear progression path through their professional career, from specialist to consultant, with increasing salaries. For consultant doctors, the basic salary range is between £93,666 and £126,281, which is crucial for their future career development.
As the title changes and working conditions continue to improve, how will the new title of hospitalist affect the quality of medical care and the image of the profession?
