Could someone please explain doctors grades to me please

[Rapidmama]

Like I’m 5?!

I’m in a new job and really struggling to get a grip on all the different grades of doctors. They use so many names for the same type of doctor and I’m really confused!

So far I understand that an FY1 is in their first year, FY2 is in their second.

But sometimes the FY1s go on the rota as SHOs.

So we have SHOs, JR and SR then consultants. But sometimes they are referred to as ST1-6 . And then we have ST3+ and dream doctors!!

I’m so bloody confused and googling isn’t helping at all!

House officers, SHOs and registrars officially don’t exist any more... FY1 is in their first year, they used to be known as house officers but some rotations don’t have the ‘house officer’ role so they may be on the SHO rota (but likely to be ‘babysat’ a little bit more by the senior doctors and probably won’t do nights). FY2 is second year and will be on the SHO rota. After foundation years you start to specialise so will be an ST (speciality trainee) or a CT (core trainee) - so ST1-2 or CT 1-2 will be the equivalent of an SHO. ST3 may be an SHO or a registrar depending on the job (I was both during my ST3 year). ST 4 and above will be registrar level, the higher the number the more senior. Clear as mud?!?

And beyond registrar level you have speciality doctor and associate specialist and then consultant. My job involves dealing with senior grades of doctors and I know it's a bit tricky to understand the nuances between them. I

On top of what SallySparrow said there are also lots of non-training, non-consultant posts, including LAS (Locum appointment for service... could be SHO or reg equivalent); staff grades, associate specialists (sometimes grouped together as SAS or NCCG doctors). Clinical fellow could also refer to an SHO or reg. Have probably forgotten some others!

I started trying to explain but realised it's too complicated...you'll soon figure it out!

Yeah the problem is that there is a new system in place, but people use the old titles because they were actually useful in kind of grouping the doctors together for appropriate positions on rotas etc.

Basically pre (about 2004?) you had....

PRHO year straight out of uni -now replaced by FY1 and FY2, that is the made the pre-registration year into 2 years

SHOs who were doctors doing jobs for training experience, either as standalone 6 months posts or part of a junior (1st 3 or 4 years) training scheme, included GP trainees passing through collecting hospital experience -now CT1, 2, 3 i.e. core (junior trainees) and GPSTs (GP trainees).

SpRs were doctors who had completed those first 3 years, passed exams and were now on the remaining 3/4 year path to being a hospital consultant of some kind -now ST1,2,3s, that is Specialist Trainees.

Then Consultants and some “almost” consultants like Staff Grades and Associate Specialists who’d travelled an experiential route. Now still Consultants and those extra roles don’t exist, essentially because the new system streamlined things and you can’t take your time being a jobbing SHO doing experiential stuff any more.

Notes:
Junior Doctor means anyone who isn’t a Consultant, then and now.

There are a few other names around like Speciality Doctor, LAT, LAS, Trust Doctor....these are all usually SHO level and just indicate that the Doctor isn’t on a training program or is a locum etc. They kind of proliferated with the powers that be got things so wrong (the idea that they could streamline the SHO grade and force people through to Consultant rapidly by limiting and restricting choice).

Our speciality doctors are definitely working at registrar level, not SHO level. Several of them have been doctors longer than the consultants...

nocoolnamesleft it’s a bit of a grey area as these titles were invented after the redesign to solve various problems, sometimes it is used instead of Staff Grade, who were indeed often extremely experienced and used to fill the SpR part of the rota. But the title doesn’t really guarantee anything and there’s a lot of variation. Indeed there used to be a lot of variation in Staff Grades too, whereas Associate Specialist used to be a bit clearer (had the experience to be a Consultant but didn’t have the formal exams).

The other problem with Specialty Doctors is that the term is easily mixed up with Specialist Trainee. It’s all clear as mud for patients I’m sure.

Remembered specialty doctor as soon as I’d posted (the second ‘s’ in SAS) - staff grades, associate specialists & specialty doctors should all be operating at a higher level than an SHO equivalent (you certainly have to have more experience than an SHO in terms of years to be appointed to an SAS post). They could also include people who’ve completed training but for various reasons decided not to become consultants (being a consultant isn’t necessarily all that!).

There’s an article by the BMA called Doctors Tittles Explained (2017) that explains all of this.

Also forgot that while the SAS posts are not training posts, doctors in them can use them to get the experience needed to CESR (get a certificate of Eligibility for the Specialist Register) and become consultant’s thereafter.

Yeah, the NCCGs (non consultant career grades) do add to the confusion. But we'd be screwed without them!

I’m no more clearer than when I posted

I might make a flow chart!

Greybeardy doctors tittles? Sounds like an interesting article!

Eeeeek! That is absolutely not what I meant! It sounds a bit more Mills & Boon than the standard BMA document!

Speciality doctors can run departments in A&E etc far better than Consultants and are definitely not SHOs!