Junior doctors are now more correctly called foundation doctors, but most people still refer to them by their old title as this is perhaps more easily understood by the patient. Hours and working conditions have improved in recent years, beginning with the New Deal for Junior Doctors, which was implemented in 2000, despite being devised almost ten years before. This limited the working hours to 56 per week, but the more recent European Working Time Directive has cut them further to 48 hours, although more is allowed to be spent on call. This was a very sound move to improve patient safety and wellbeing, as sometimes doctors were so tired that mistakes could easily be made, and were.
The foundation doctor in their first year will have obtained their place by applying in their final year pre-graduation. The year generally starts in August, to coincide with results, and will consist of three four month placements, so that the junior doctor will have experience of surgery, medicine and a speciality which may or may not be of their own choosing. Some schools tend to try to place the junior doctors in specialities where there may be a shortfall of staff – there is no pressure on them to follow this into the second year, but is a good way of introducing potential registrars and consultants into what may be an under-subscribed area. It is in this segment that many junior doctors make their career choices.
The second foundation year is when the junior doctor will compete for a place on a speciality based course, the start of the road towards becoming a registrar and then a consultant. This year may be fairly broad, following a course of general medicine, but it may also become quite specialist, with training given in a surgical discipline or as a general practitioner. Every junior doctor has a mentor who will monitor their progress and assess their growing expertise. It is easy to be swamped with information in the undergraduate years and the foundation course is a good way to reach decisions on a future career in medicine, although choices made now are not necessarily cast in stone, but will give a firm basis for deciding on a path, if only to show the junior doctor what they don’t want to do in the medical field.
Doctors who are training in their foundation years get a rate of pay approximately equivalent to that of a newly qualified teacher, around £22k at present. There are extra payments for working overtime and also enhancements for working outside normally accepted working hours. There are still huge calls on the time of a junior doctor, although nothing like the anecdotal but largely true estimates of 100 plus hours per week of the eighties and nineties. Even so, the work load is very large, and the junior doctor is still very much on a learning curve. The exams at the end of the undergraduate stage of medical training are really just the tip of the iceberg – there is much more to come!