Who cares about "juniors"?
Authors: J. O. Drife
Journal: BMJ (1982)

The profession's attitude to  hospital doctors badly needs bringing up to date. Thirty years ago, Simon Sparrow accepted long periods of incarceration in miserable residencies for little money, partly because it was the route to affluence and prestige as a consultant, but more because it was his natural place in society. Britain has changed since then, but time has not altered the public's view of non-consultant doctors. The patronising term junior has perpetuated a comic undergraduate image, but the reality is that these doctors deal with nearly all emergency admissions to hospital, with most outpatient follow-up consultations, and with a large part of NHS inpatient care. The proportion of  doctors born overseas has now fallen to 32% and the pro? portion of women has risen to 25%. Those who manage to become consultants will finally lose their junior status at an average age of 37. The Review Body on Doctors' and Dentists' Remuneration has just published a survey1 of work load in the  grades. The latter term seems another misnomer: according to the survey over 70% of trainees' clinical work is un supervised and they spend only 3% of their time attending teaching sessions. They do, however, work hard?at least in the acute specialties.2 For example, 45% of trainee surgeons are on duty for more than 110 hours a week and 17% spend more than 80 hours actually working. What purpose is served by such a Dickensian work pattern? A trainee must spend time on call to gain experience, but sleep deprivation and excessive stress are the techniques of brainwashing rather than education. The BMA reminded3 the Review Body that consumerism, the increasing use of advanced techniques, and an aging population have all increased the consultants' work load recently, and the same applies to trainees. In 1982 the 100-hour week is more than a social anachronism: it is an unacceptable danger to patients. Recognising this, the Review Body has urgently asked doctors to discuss how trainees' excessive work loads may be reduced. There are four ways of doing this. One?reducing the standards of patient care?is unacceptable. The second is to appoint more trainees. This is unsatisfactory because career prospects in the worst-affected specialties are already grim, and to train more specialists without providing jobs at the end of training is, to say the least, illogical. The third possibility is outside help, either from a subconsultant career grade (which is rightly rejected by the profession4 whenever it is suggested) or from general practitioners, nurses,5 or paramedics6?who would probably be unable to offer sub? stantial assistance. The fourth option is that consultants should undertake some of the work traditionally done by trainees. This idea is attractive: more consultant participation in clinical care should benefit patients?who, as consumerism grows, are going to demand it anyway. It will also please the Government (which is already proposing to double consultant numbers by 1990), and it should increase consultants' job satisfaction. Trainees often hear consultants complaining about excessive administrative duties, and consultants in private practice maintain that total patient care keeps clinical skills well honed. Nevertheless, the change will be resisted by many doctors? even by trainees themselves, who cope with their sometimes intolerable work load by looking forward to the day when they can shed work on to trainees of their own. Some con? sultants will be unhappy, believing that their job is to be consulted not by patients but by less experienced colleagues, and having taken on heavy commitments to administration, college affairs, private practice?or all three. Though the Short Report7 and the Central Committee for Hospital Medical Services8 have rejected the concept, older consultants for whom routine clinical work becomes arduous or un?