“Junior doctor” is an outdated and unhelpful term
Authors: Tom Ratcliffe
Publication date: 16 Nov 2012
Tom Ratcliffe argues that the term diminishes the contribution that “junior” doctors can make to patient care
After spending years among the ranks of doctors in training, I am tired of being referred to as “one of the juniors.” The Oxford English Dictionary defines “junior” as “of relatively low rank or little experience.” This word, however, does not acknowledge the breadth of experience among junior doctors; it fails to fit the modern career structures of doctors; and it promotes an old fashioned hierarchy.
Presently, many newly qualified doctors who step on to the bottom rung of the medical career ladder may have had careers in other areas of health or social care, senior posts in non-healthcare industries, degrees in arts or science subjects, or considerable postgraduate academic achievements. As graduate entry becomes an increasingly popular route into the profession, “junior” doctors can be surprisingly senior in terms of age and life experience. After qualification, the term “junior” is used to refer to practitioners with highly varied competence and ability. Newly qualified foundation year 1 trainees and doctors who have accumulated years of experience overseas or in one or more specialties are lumped together under the junior doctor banner, which seems inappropriate and can lead to a wealth of potential being overlooked.
In the context of the traditional medical firm—a small band of doctors with varying experience caring for a defined group of patients—the term junior made more sense. Nowadays, it is common for doctors in training to float across wards and departments, with less continuity of supervision. In this environment the term is unhelpful to consultants as it provides no information about the competence of doctors working with them. This makes it harder for non-consultant grade doctors to earn the trust needed to practise in what medical educationalists call the “zone of proximal development”—that elusive level of practice lying around the limits of competence, where new skills and knowledge are acquired most effectively.
Looking back over my short medical career, the most valuable learning experiences I have had were the occasions when I was left to manage acutely unwell patients independently, to communicate bad news for the first time, to deal with diagnostic uncertainty or where I was the only doctor caring for a dying patient. The situations where I was deemed too junior to cope or felt compelled to seek senior assistance because it was expected (rather than necessarily required) were less helpful, to me as a developing practitioner and to my consultant colleagues, who might otherwise have been able to focus their high levels of skill on more complex problems. We need to adopt terminology and an approach to training whereby non-consultants are regarded as doctors who have a contribution to make, but we need labels that allow us to practise safely rather than lumping us together into a homogeneous group. The distinction is important and not helped by the “junior” tag.
At an organisational level the collective term junior doctor embeds a rigid hierarchy in the NHS that baffles my peers in other professions—have you ever met a junior teacher, a junior accountant, or a junior lawyer? In medicine, management roles are reserved for senior doctors, and the whole management structure of healthcare organisations can prevent doctors in training from having a real say in healthcare. Would any business organisation survive for more than half a century by not engaging a large, highly educated, motivated, and enthusiastic section of its workforce in improving its performance? Surely, junior doctors, particularly those nearing completion of training who have years of experience on the frontline, can bring drive, intelligence, and determination to the process of organisational improvement? Perhaps this does not happen routinely because junior doctors feel too junior to make a difference and are perceived as too junior to possess the skills to make a change.
So what term could we use in place of junior doctor? I am not sure I have an answer and would instead ask: do we need a collective term at all? I think the response should be an emphatic no. Whatever we call doctors in the early stages of postgraduate training, banding together a vast and diverse swathe of the medical workforce diminishes the contribution these doctors can and do make to patient care and fails to encapsulate their status in a way that has educational and organisational meaning. Removing this unhelpful term from the medical lexicon would help the NHS tap into an important resource and ensure that recently qualified doctors gain the experience they need to graduate as clinically excellent consultants and general practitioners.
Competing interests: None declared.
Tom Ratcliffe general practitioner registrar (specialty trainee year 3)
Holycroft Surgery, West Yorkshire, UK
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