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Hospital Doctor All doctors in the UK follow the same initial education and training. A degree in medicine is followed by a structured one-year pre-registration training programme. After this, doctors choose one of a number of possible routes. All the options require many years of further postgraduate training overseen by the relevant professional body. Most doctors work either in one of the many specialties in hospital medicine or as a general practitioner. There are also opportunities to work in public health medicine, and small numbers work in occupational medicine, pharmaceutical medicine, research or for the armed forces. There are about 50 specialist fields within hospital medicine, and a hospital doctor specialises in one of these fields. Within a specialty, doctors work in teams or 'firms', that range in experience from pre-registration house officer to consultant. A doctor's role in this team depends on their experience. Hospital doctors work in a team of health professionals. Patients come into hospital either as emergencies or by referral from other doctors. Most doctors examine and talk to patients and their families to diagnose their medical condition and recommend or carry out the necessary treatment. They make notes, both as a record of treatment and for referral back to GPs in the community. Some doctors are based in the pathology laboratories and have limited contact with patients. The General Medical Council (GMC) oversees the training of doctors. In recent years there has been an improvement in training provided for both pre-registration house officers and junior doctors, resulting in better educational supervision and feedback on performance. All doctors must complete the one-year pre-registration training before they can be fully registered with the GMC. Career progression is then through training grade posts as house officer, senior house officer, specialist registrar and finally, when fully trained, consultant. Study, continuous assessment and exams are an important part of the lives of all training grade doctors. As house officers and senior house officers, doctors are given increasing responsibility for patient care. Initially their work is closely supervised and monitored by more senior doctors, and they take on more responsibility as they gain experience. They develop their medical knowledge and professional skills through education and training programmes. Specialist registrar is the grade at which doctors begin to work in their chosen specialist area. They take higher specialist training as well as being responsible for supervising the work of more junior doctors. Consultant is the career grade to which hospital doctors aspire to. They are fully trained although they will still undergo continuing professional development. They are responsible for their own work and for supervising the work and training of all the doctors in their team. Associate specialists and staff grade doctors can also work at a senior level in hospitals. They may not become consultants for personal reasons or because of the competition for jobs in their specialty. The specialisms in hospital work can be grouped under four main headings: Medicine: This includes doctors who deal with general medical conditions and emergencies, examine patients, diagnose their condition and decide on a suitable treatment. Surgery: A surgeon is responsible for patients before, during and after operations. Pathology: Pathologists work in laboratories investigating the causes and effects of disease. Psychiatry: Psychiatrists work with patients with mental illness or disabilities. Prescribing drugs and managing drug regimes is an important part of their work. Working Hours, Pay and Conditions Hospital doctors work in a variety of hospital settings depending on their specialty. These could include special units such as accident and emergency or x-ray departments, wards, consulting rooms and operating theatres. Pathologists work in laboratories. Surgeons and other specialists carrying out surgical procedures may have to stand for long periods of time. Salaries for hospital doctors within the NHS are: house officer - B#17,260 to B#19,480 senior house officer - B#21,535 to B#28,760 registrar - B#24,070 to B#29,200 specialist registrar - B#24,070 to B#35,080 senior registrar - B#27,730 to B#35,080 consultant -- B#48,905 to B#63,640. Additional payments are made for extra hours for doctors in training. Consultants may get additional merit payments, and in London, staff get a London weighting allowance. Hospital doctors work very long and irregular hours, especially more junior staff. They can work shifts or an on-call rota system. Junior doctors should not work more than 56 hours a week - but they can be on duty for up to 72 hours. There is considerable pressure within the profession to reduce these hours, as they are a real cause of stress for junior doctors. A national model contract is offered to all doctors on training grades. Contracts for consultants can vary between the NHS trust hospitals. Entry Requirements In the UK a medical degree awarded by a university recognised by the General Medical Council (GMC) is essential for anyone wanting to practice medicine. The degree course lasts five years for candidates who have taken science subjects at A level. Eight out of 24 medical schools offer an extra premedical year for candidates with non-science subjects. This provides a preliminary course in chemistry, physics and biology, and lasts 30 weeks. Two medical schools (St George's in London and Leicester University in collaboration with Warwick University) have developed four-year postgraduate programmes for people who already have a good relevant first degree. Another school has introduced a four-year programme for graduates with a degree in any subject, and other courses will come on stream in the next few years. The minimum qualifications to get on a degree in medicine are three A levels grades and five GCSEs grades (A-C), including English and maths. Scottish candidates may need Advanced Highers. Biology and physics (or dual sciences) are also needed if not held at A level. For the five-year course, candidates should normally have A level chemistry or physical science, and at least one of physics, biology and maths. Most medical schools prefer A level biology, seen as helpful in understanding the course. Most medical schools now accept an arts subject as a third A level, and some medical schools only ask for two science AS levels. A small number of schools may consider applicants with a distinction in a relevant vocational A level, such as science, and an A level in a science subject. Medical schools also accept the International Baccalaureate. Competition for these courses is fierce, and most entrants have A level grades between AAA and ABB. High grades at A level are normally demanded because the course is long and intellectually demanding. Many universities accept two AS levels in place of one A level. Applicants should check with admissions tutors about acceptable It is difficult to get into medical school after the age of 30, but applicants should check the policy of each school. Graduate entrants must have a first or upper second class degree, usually in a relevant subject. The development of postgraduate programmes will allow candidates with a first degree to take a course lasting four years. Two of these courses were offered in 1999. Hospital doctors need to be able to absorb large amounts of scientific and technical information. They need practical ability and manual dexterity for examining patients and performing procedures. In addition to medical skills and knowledge, hospital doctors need a wide range of skills to enable them to do their work effectively. They need well-developed communication and interpersonal skills, especially listening skills, to assess and diagnose a patient's problem. And they must have a real interest in medical matters as well as a genuine desire to help people. Hospital doctors must work to high professional standards, being both responsible and trustworthy, and be able to remain calm in a crisis. They need good written skills for writing letters and reports, and computer literacy for record keeping. Surgeons and other specialists who carry out complex surgical procedures need a high level of manual dexterity and practical ability. There are courses in Northwest Workplace related to this profession: MEDICAL SCIENCES (1 course) Opportunities There are 60,000 hospital doctors in the NHS. The number of hospitals is likely to decrease in the future, with a corresponding rise in treatment in the community. The creation of centres of excellence could mean that specialist posts would not be as widespread as at present. Relocation for more senior positions is common. Competition for promotion varies from one specialty to another. Progression within the field of geriatrics, for example, is less competitive than surgery, general medicine or paediatrics. There are opportunities for private work for NHS doctors. These may increase in the future as government policy on the health service attempts to address the rising costs of caring for an ageing population and paying for expensive new treatments. There are limited opportunities within the armed forces with some possibility of working overseas. Voluntary and charitable organisations employ small numbers of doctors to work in developing countries. Hospital doctors must take exams in their chosen specialty in order to progress through the various grades. Competition for promotion is keen, but the levels of competition vary widely between specialties. General surgery and cardiology are examples of highly competitive specialties. Further Information British Medical Association (BMA), BMA House, Tavistock Square, London WCIH 9JP (please send an A5 sae) 020 7387 4499 Web sites: www.bma.org.uk and www.bmj.com British Medical Association, 61 Malone Road, Belfast BT9 6SA 028 9066 3272 Council of Heads of Medical Schools, Woburn House, 20 Tavistock Square, London, WC1H 9HD 020 7419 5494 Web site: www.chms.ac.uk General Medical Council, 178 Great Portland Street, London W1W 5JE 020 7580 7642 Web site: www.gmc-uk.org Royal College of General Practitioners, PR Dept, 14 Princes Gate, London SW7 1PU 020 7581 3232 Web site: www.rcgp.org.uk Relevant Labour Market Information NMW and age discrimination ? Caution urged on NMW increase ! Fat cat salaries and the baverage wageb Tough time for SMEs Nursing trends Flexibility

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