Resident doctor (United Kingdom)
In the United Kingdom, a resident doctor, known until 2024 as a junior doctor, is a qualified medical practitioner who is either engaged in postgraduate training or employed in a non-training post. The period of being a resident doctor starts when they qualify as a medical practitioner following graduation with a Bachelor of Medicine, Bachelor of Surgery degree and start the UK Foundation Programme. It culminates in a post as a consultant, a general practitioner, or becoming a SAS doctor.
The term resident doctor currently incorporates the grades of foundation doctor, core trainee, and specialty registrar. Before 2007, it included the grades of pre-registration house officer, senior house officer and specialist registrar. During this time, resident doctors will do postgraduate examinations to become members of a medical royal college relevant to the specialty in which they are training, for example membership of the Royal College of Physicians for doctors specialising in internal medicine, membership of the Royal College of Surgeons for doctors specialising in surgery or membership of the Royal College of General Practitioners for doctors specialising in family medicine. Doctors typically may be resident doctors for 8–20 years, and this may be extended by doing research towards a higher degree, for example a Doctor of Philosophy or Doctor of Medicine degree. In England, there are around 71,000 resident doctors.
Replacement of the term "junior doctor"
There had been controversy about the historical term "junior doctor", with many organisations and individuals voicing concern that it created misconceptions about their work and did not do justice to the skills and experience acquired by these doctors, many of whom have been working for several years.The British Medical Association voted to discontinue the term "junior doctor" from all forms of communication at their 2023 annual representative meeting. The motion was presented to the BMA Representative Body by Dr Sai Pillarisetti, a foundation year doctor. After a debate and vote of members, it was passed in full and made BMA policy. References to junior doctors in BMA policies and communications are due to change to "resident doctors" from September 2024.
An independent report for Health Education England authored by Prof Scarlett McNally found more than 75% of those surveyed found the term "junior doctor" inappropriate, and almost half thought "trainee" should be avoided. The report recommended a shift towards "postgraduate doctors" instead.
In December 2023, then Health Secretary Victoria Atkins faced criticism for using the term "doctors in training" as an alternative to "junior doctor" in a TV interview on BBC Breakfast. This was followed by a spokesperson for the Department of Health and Social Care stating they respected the profession's decision to move away from the term "junior doctor".
In July 2024, as part of a deal between the BMA and the UK government to settle a long-running dispute about junior doctors' pay in the NHS in England, it was announced that the term "junior doctor" would be changed to "resident doctor" within the English NHS. This deal was accepted by the BMA on 16 September 2024, and the name change took effect on 18 September 2024. A similar agreement was made between BMA Scotland and the Scottish government covering NHS Scotland in October 2024, with this agreement coming into effect in November 2024. Separately, the Northern Ireland executive agreed to start using the term "resident doctor" in Health and Social Care from the same date as in England, while the Welsh government agreed to start using the term in NHS Wales from November 2024.
Working hours
In Europe and the US, there has been some reduction of the working hours of doctors who are in postgraduate training, in line with recommendations and legislation aimed at improving patient safety and doctors' working conditions. 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. The doctors' duty hours, which were felt to be excessive, were reduced to a maximum average of 56 hours' actual work and 72 hours' on call duty per week, although the change was not enforced until 1 December 2000. The European Working Time Directive sets out minimum health and safety requirements for the organisation of working time. The EWTD required the average working week to fall to 48 hours or fewer by 2009.The shortening of resident doctors' working hours had implications for how training programmes are organised, especially for specialties such as surgery, where there was a tradition of maximising the hours of experience. Most studies that have looked at a reduction of resident doctors' working hours have found either a beneficial or neutral impact in terms of measures of patient safety, clinical outcomes and postgraduate training.
The reduction in number of hours worked by resident doctors is one of the factors leading to blurring distinctions between them and other clinical professions, such as nurse practitioners who also perform complex tasks.
Migration
An Organisation for Economic Co-operation and Development survey in December 2015 showed that 35.4% of NHS doctors, 34,000, were born abroad compared with 5% in Italy, 10.7% in Germany and 19.5% in France. The UK was the second highest exporter of doctors, second only to Germany, with 17,000 British doctors working in other OECD countries. These figures are for all doctors in the NHS, not just resident doctors.According to the Career Destination Report published by the UK Foundation Programme Office in 2019, an increasing number of UK resident doctors are seeking to take up work abroad. A report by the General Medical Council described a number of "push" and "pull" factors, including seeking a better work-life balance and wanting to take advantage of other opportunities abroad. Most doctors who complete foundation training do eventually return to specialty training in the UK within three years.
Modernising medical careers
In 2005, postgraduate medical training was significantly changed in the Modernising Medical Careers programme. A two-year Foundation Programme was introduced for newly qualified doctors, the number of years of postgraduate training changed in some specialties, and doctors needed to decide which specialty to follow sooner after graduation.There were later initiatives to engage resident doctors in NHS leadership; resident doctors are seen as essential to the drives to achieve efficiency savings in the NHS since 2010.
Pay and conditions
The NHS Careers website stated in 2023:The basic salaries outlined are defined for a contract of 40 hours per week. Salaries are increased proportionally for any extra hours worked on average per week. Any hours outside "social" hours, namely between 9pm and 7am, are supplemented by a 37% enhanced rate. Weekend duty is paid as a percentage bonus, up to 10% of the basic salary for working alternate weekends. Other bonuses are also available for being non-resident on-call, for recruitment into academia and undersubscribed specialties, and for doctors living and working in London. In 2015, NHS Employers reported the total annual earnings for foundation doctors in England averaged just over £36,000. While the basic starting salary for doctors in specialty training was £30,002, NHS Employers were reporting that average earnings in this group of doctors was nearly £53,000.
In 2013, graduates who had studied medicine or dentistry were the most likely to be employed and had the highest average gross annual pay when compared to graduates who studied other subjects. In 2015, the average starting salary of resident doctors was the third-highest of all graduate starting salaries, after dentistry and chemical engineering. In 2016, it was reported that after 10 years of employment, medicine graduates had the highest salary of all degrees. Research conducted in December 2014 showed that across a range of other jobs, almost a third of graduate programmes at Britain's best known and leading employers paid starting salaries of more than £35,000; however, 83% of these leading employers reported that they were recruiting for jobs in London where salaries are higher, whereas NHS salaries are set on a nationwide basis, with doctors in London given an additional payment known as London weighting to compensate for increased cost of living.
Since 2007, resident doctors have been receiving below inflation salary rises. The Independent Review Body on Doctors' and Dentists' Remuneration takes evidence from a range of sources and makes recommendations around pay; in 2015, they recommended a 1% pay increase. In 2005, the average starting earnings for a medical graduate was £32,086. In an inflationary environment, all wage-earners, including doctors, may find the buying power of their income becomes less; some describe this as a real-terms cut in pay of 15% between 2007 and 2014. In 2019, the British Medical Association came to an agreement with NHS England to settle for a guaranteed 2% annual pay rise until 2023.
In 2023, resident doctors in England initiated their longest-ever strike, protesting against pay disparities within the National Health Service. The strike, which began on 13 July 2023, continued for five days and led to the postponement of appointments and disruptions in healthcare services. While emergency care remained accessible, patients were advised to seek alternative options for minor health concerns. The ongoing dispute revolved around the demand for a 35% pay increase to address below-inflation salary increments over the past 15 years. The impact on patient care, NHS costs, and waiting list reduction was a matter of significant concern.
Expenses
Doctors pay professional annual fees to maintain registration with the General Medical Council and medical indemnity cover. Resident doctors also incur costs associated with training courses, preparing for and sitting exams and college membership; training can be associated with £420-£3,000 of professional fees annually, depending on stage of training and level of income. English students embarking on a medical degree could in 2015 expect to pay £40,000 on university tuition fees alone. Student loans are available to meet these costs, with repayment starting as soon as individuals begin working as resident doctors. University tuition in Scotland is free for students ordinarily resident in Scotland, and grants and loans are available to help with living costs.Changes to working patterns of doctors meant there was no longer a requirement for first-year resident doctors to be resident, and from 2008 free accommodation was no longer provided by employers. The British Medical Association said that this amounted to a £4,800 annual pay cut for those who might have previously lived at the hospital rather than independently, but the numbers of doctors involved was not clear. Ann Keen, Labour 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 resident 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."