Understanding Titles of NHS Doctors
Explaining something which is often misunderstood and confusing
When I first started working in an NHS hospital the perplexity of titles, progression, and the hierarchy of doctors was not to be underestimated. I wrote myself a guide and thought, if it would be helpful for me, it would be helpful for others. The way doctors identified their level of training changed in 2007, I have only included the current terms, however, some older websites and books still use the old terminology.
Getting into medical school
In the UK students attend college between the ages of 16–18, it is at this point they take A-Levels to get into university, the next stage of education. But to get into medical school specifically, they will also need to take the UCAT (University Clinical Aptitude Test), and sometimes the BMAT (BioMedical Admissions Test), depending on the specific schools' requirements.
They will then be able to apply to 4 medical schools and one university for a different subject.
As well as the medical-specific tests, the application process also involves writing a personal statement and interviews.
Being a medical student
In the UK, you can attend medical school from 18 onwards, which means it isn’t a postgraduate course as it is in some countries. The standard length of medical school is 5 years. It is possible to take an accelerated 4-year course if you are taking it as a graduate. Having said this, most students take 6 or 7 years to complete medical school. This can happen if they take an extra course in addition to completing the standard 5-year course. The extra courses available, are; an introductory foundation year, or a relevant master's degree, or an intercalated degree, which involves an extra year of study and gives you a BSc (bachelor of science degree). Being a medical student involves attending lectures, and traditionally from the 3rd year onwards, also attending placements in clinical settings. However many schools have now started sending students on placements from the very first term. Graduating will give you the letters MBBS after your name, which stands for Bachelor of Medicine and Surgery, or in Latin, Medicinae Baccalaureus Baccalaureus Chirurgiae.
Some medical schools, as well as a graduation ceremony, also hold a ‘rites of passage’ ceremony. This is a ceremony, where students recite the Declaration of Geneva, the modern-day Hippocratic Oath, or something similar.
Junior Doctor
The next stage is to enter employment and complete two years as a junior doctor, during this time, doctors are paid (a little) but are still considered ‘trainees’, are still supervised, and are taught things not covered in medical school.
In the first year, a junior doctor is referred to as an F1. This stands for foundation1, in the second year, an F2. Occasionally FY1 will be used, i.e. foundation year 1.
During these two years, doctors rotate around all wards and placements. At the end of their F2 year, they should choose one of three pathways. GP training, surgery, or medicine. Choosing one of these three pathways is the first step toward choosing a specialty. These pathways are called ‘core training specialty’.
The non-official F3 Year
The F3 year is not an official part of the pathway, but this term is often used and heard around the hospital, so I thought I should include it. If a doctor introduces themselves as an F3, they have taken a year where they have completed the F1 and F2 years, but have chosen to stay at this level for a year without progressing onto the next stage of the pathway. This allows them a year, to do whatever they choose. Some choose to travel, work abroad, or locum(this is explained below), or they use it to work in a specialty they are interested in to see what it is like before fully committing. For example, if a doctor was undecided between medicine and surgery and hadn’t had much exposure to surgery in the foundation years then they could spend the unofficial F3 year focusing on surgical placements.
Core Speciality Training
From this point onwards doctors are no longer considered juniors and because they have now chosen one of the three pathways, they will, from now on, only rotate around the placements relevant to their chosen pathway. This is the stage that doctors are considered fully qualified. Reaching this stage of training also allows doctors to start taking the three exams that are needed in order to one day become a consultant. Although there is no requirement to take them at any stage.
The terms used at this stage, vary depending on which of the three pathways was chosen as an F2:
- Internal Medicine (IMT 1, 2, 3)
- Surgical training (ST1, ST2)
- GP training (GPST1, GPST2)
Specialty training/ Registrar
This stage of training is referred to most often as ST1- ST6/7 and is when a specialty is chosen. i.e. if at the end of the F2 stage a doctor chooses the medicine pathway, they could now, from their ST1 year onwards, choose to specialise further, e.g. a cardiologist.
This stage generally lasts 6–7 years, except for GP trainees, who after 4 yrs as a registrar, will have completed this section of the training and can become a consultant.
During the ST1–7 years, if a doctor takes a break (I.e. similar to the F3 year mentioned above), they could still work, but without progressing, and so are given the title of ‘clinical fellow’.
Consultant
Becoming a consultant is the final and highest position one can reach as a doctor. This means that they have successfully reached the end of their specialty training/registrar years, and have also passed the three exams. These exams have to be studied for in personal time, and doctors choose to take them at varying points.
Even further study?
Some doctors, after becoming a consultant, or sometimes as a part of that process, Doctors will choose to voluntarily study for a Ph.D. This might be simply out of interest but could also enable them to get a job at a competitive hospital.
What are locum doctors?
Locum’s doctors are doctors who have taken time out of their training program and do bank shifts. Bank shifts work like a 0-hour contract, allowing the individual to pick and choose which shifts they want to do. This gives them flexibility in working the hours that suit them rather than having a set rota. Locum doctors are also paid more per hour (the trust pays more to entice them to cover the shifts no one wants to cover), the catch in taking a locum year, is that they don’t progress in their careers.
Doctors coming from abroad
We are incredibly lucky in the UK to attract some fantastic doctors from around the world, but how does this work?
Doctors coming from abroad are called “Trust Grade” doctors. They are usually doctors who have qualified/worked abroad but never in the UK. Because they haven’t qualified in the UK, they would start their first year working as an F2, regardless of how many years they have been qualified abroad. They start as an F2 because the NHS generally operates very differently from healthcare systems abroad. But crucially they are not in the training program. After a year as an F2, they would have to apply (if they feel ready) for an actual F2 job or the core specialty training and can then progress up the career ladder.
What are Bands?
Bands are how the NHS decides on pay and responsibilities, i.e a newly qualified nurse would start as a band 5. This means that nurses start on band 5 pay and still have to be supervised with certain tasks until they achieve band 6 status, which they would work towards on the job while receiving a salary. Doctors are considered to be in a band in terms of pay, but not in terms of career progression because they follow the above route.
Private work
In my experience, most doctors, once at the consultant level, will do some degree of private work. A lot of NHS consultants take on private patients, so they might work for the NHS 3 days a week and see private clients in their own private clinic 2 days a week. Consultants can of course also work in an entirely private setting.
Hopefully, this is helpful for anyone out there trying to navigate the difficult world of NHS doctors!