The effects of negative nomenclature: 'Junior Doctors' and 'NCHDs' 'in training'

drkpower

Although not practising any more, what always bugged me (and still does) is the use of these terms to refer to Interns, SHOs & Registrars.

Most docs would agree to an extent but most dont seem to appreciate what I feel is the actual significance of it. The constant references to 'junior', 'in training' or even NCHD (defining doctors by what they are not, rather than what they are) gives across the impression that the doctors (many of whom are qualified professionals for many years) are somehow not fully fledged doctors. Which is patently ridiculous, particularly when it comes to docs who have completed all of their professional exams and are simply 'waiting' for a consultant post to open up.

Comparing it to another profession illustrates the absurdity; would a solicitor who is 5,6,7,8 years qualified, but who is not yet a partner in a major firm, be considered or called a 'junior lawyer'? Of course not; in fact they are more likely to be introduced as 'one of our senior lawyers' - their position and worth is more likely to be 'talked up' rather than downplayed. In fact, I am aware of no other profession/job where fully qualified professionals, who exercise extraordinary responsibility every day are referred to in such (what I would consider) derogatory and negative terms.

And for those who think, 'so what, its only a name, what does it really matter...'? It matters a lot; perception means a lot. First the perception of the public, many of whom dont think they have met the doctor until they have met the consultant. Second, the employer - I am convinced that one of the reasons why NCHDs (oops, I did it too...;)) have been so shoddily treated for years is because thay are viewed merely as a lower training grade, not deserving of proper condsideration, conditions and respect. And third, themselves. Hospital doctors have taken more sh!t than any other body of professionals would ever consider taking, with almost no real resistance offered for decades (with a possible exception of 1999/2000); I cant help but thinking that they have some kind of inferiority complex caused partly by accepting this subservient role. Would any other profession define themselves in these terms?

It always amazes me that hospital doctors accept the use of these terms with little attempt to create an alternative that would not be framed disparagingly or negatively; 'Hospital Doctor' is one - but perhaps there are suggestions for others.

sam34

you're right, it is very derogatory and demeaning

it doesnt exactly inspire trust or confidence for the patients when theyre told by the nurses "the junior doctor will see you"

if i was handing my car into a garage and i was told "the junior mechanic will sort it" i'd be inclined to say "actually could someone senior have a look at it please"

the way ward rounds are conducted doesnt help either - have a look at the LTI forum and you'll often see derogatory references to "minions trailing after the consultant"

0lddog

sam34 wrote: »

you're right, it is very derogatory and demeaning

it doesnt exactly inspire trust or confidence for the patients when theyre told by the nurses "the junior doctor will see you"

if i was handing my car into a garage and i was told "the junior mechanic will sort it" .......................

'Apprentice' is the word we are all trying to avoid ?

sam34 wrote: »

.........
the way ward rounds are conducted doesnt help either - have a look at the LTI forum and you'll often see derogatory references to "minions trailing after the consultant"

Cheer Up, most Consultants treat their customers just as poorly. Its just a Consultant thing ( bet most of them cant multitask too )

Traumadoc

drkpower wrote: »

Although not practising any more, what always bugged me (and still does) is the use of these terms to refer to Interns, SHOs & Registrars.

Most docs would agree to an extent but most dont seem to appreciate what I feel is the actual significance of it. The constant references to 'junior', 'in training' or even NCHD (defining doctors by what they are not, rather than what they are) gives across the impression that the doctors (many of whom are qualified professionals for many years) are somehow not fully fledged doctors. Which is patently ridiculous, particularly when it comes to docs who have completed all of their professional exams and are simply 'waiting' for a consultant post to open up.

Comparing it to another profession illustrates the absurdity; would a solicitor who is 5,6,7,8 years qualified, but who is not yet a partner in a major firm, be considered or called a 'junior lawyer'? Of course not; in fact they are more likely to be introduced as 'one of our senior lawyers' - their position and worth is more likely to be 'talked up' rather than downplayed. In fact, I am aware of no other profession/job where fully qualified professionals, who exercise extraordinary responsibility every day are referred to in such (what I would consider) derogatory and negative terms.

And for those who think, 'so what, its only a name, what does it really matter...'? It matters a lot; perception means a lot. First the perception of the public, many of whom dont think they have met the doctor until they have met the consultant. Second, the employer - I am convinced that one of the reasons why NCHDs (oops, I did it too...;)) have been so shoddily treated for years is because thay are viewed merely as a lower training grade, not deserving of proper condsideration, conditions and respect. And third, themselves. Hospital doctors have taken more sh!t than any other body of professionals would ever consider taking, with almost no real resistance offered for decades (with a possible exception of 1999/2000); I cant help but thinking that they have some kind of inferiority complex caused partly by accepting this subservient role. Would any other profession define themselves in these terms?

It always amazes me that hospital doctors accept the use of these terms with little attempt to create an alternative that would not be framed disparagingly or negatively; 'Hospital Doctor' is one - but perhaps there are suggestions for others.

Never heard of devils, apprentices or junior council?

drkpower

Traumadoc wrote: »

Never heard of devils or junior council?

'Devil' is just a weird concept tbh; not sure if the name necessarily describes a lack of experience in the way 'junior' does. But at least it is only the name applied to someone in their first year of employment as a barrister (although its more and more becoming the norm for two years). Its akin to intern year.

Fair point on 'junior counsel':p; some of those guys are in their 50s....! I think that the 'title' junior counsel is actually a statutory title so a little more difficult to change that. Also, junior counsel is a 'type' of barrister; it might be a little different if they were called 'junior barristers'. But in any case, it doesnt really change the desirability/appropriateness of fully qualified doctors, perhaps in practice for years, being called 'junior doctors'.

Apprentices are not qualified solicitors (or mechanics, or anything else); they would be the equivalent of someone in the last two years of medical training/college (albeit earning a few quid) .

sam34

0lddog wrote: »

'Apprentice' is the word we are all trying to avoid ?

no, that wasnt a word i was thinking of at all

0lddog wrote: »

Cheer Up, most Consultants treat their customers just as poorly. Its just a Consultant thing ( bet most of them cant multitask too )

i disagree actually. while i have seen some consultants who treat patients in a rude or condescending manner, the number is far outweighed by those who treat their patients with dignity and respect.

RobFowl

It's an emotive subject but with the new medical council guidelines is technically correct.
Unless you have completed specialist training and are on the specialist register you are not allowed "independent practice" unless you are on the "general register" and this route is becoming more limited as "GP's" who are not vocationally trained and now being denied coverage by the MPS (new entrants).
Personally never found the label of junior doctor to be an issue or a problem.

Narkius Maximus

I prefer Lackey, general dogs body, clinic monkey. Any offensive term that whittles away at my self esteem while the HSE are busy doing something else.

Vorsprung

Narkius Maximus wrote: »

I prefer Lackey, general dogs body, clinic monkey. Any offensive term that whittles away at my self esteem while the HSE are busy doing something else.

It may be one of the few things the HSE have any responsibility for!

The junior doctor thing doesn't really annoy me. I've been called the baby of the team before by patients, despite being the tallest on the round by a country mile. The upshot of the whole thing is that the Irish public health system (well, the hospital end of it) is largely managed by NCHDs. Consultants don't want you to know that though!

docbroc

There are worse things than being a junior doctor. On the 30th of June after eleven long hard years - I graduate from being a JUNIOR doctor to being an UNEMPLOYED doctor.

Traumadoc

I was in that position 7 years after graduation, awful feeling at the same time it was a great thing.

just-joe

Traumadoc wrote: »

I was in that position 7 years after graduation, awful feeling at the same time it was a great thing.

Why so?

Traumadoc

Forced me to reappraise my career then emigrate, best thing I did.
Was horrible time all the same.

imported_guy

last time i checked in america a resident is called a resident or a resident-doctor, some times senior resident (if they are in the final years of residency), not a doctor, only attendings (like consultants here) have that previlage, fellows are called fellows even if they have been attending physicians before. so its not just in ireland where this practice is occuring, they still have junior engineers in engineering (engineers who dont have the right to call themselves chartered engineers).

drkpower

RobFowl wrote: »

It's an emotive subject but with the new medical council guidelines is technically correct.

How so?
The fact that you cannot practice in certain areas does not make you a 'junior doctor'.

Traumadoc

Even in government they have junior ministers. ( now called ministers of state)

drkpower

Vorsprung wrote: »

The junior doctor thing doesn't really annoy me.

Robfowl wrote:

Personally never found the label of junior doctor to be an issue or a problem

This attitude is somewhat puzzling, yet not surprising. Whatever about NCHD, the term 'junior doctor' is, at best, an incorrect description (in most cases) and, at worst, is a demeaning title that has real effects on the perception of this subset of the profession, amongst the public, in particular, and, I would argue, amongst the employer. The tagline 'in training' only compounds the damage. It is one of the (many) factors that has contributed to the DoH/HSE treating hospital doctors like sh!t for years. You may not 'feel like' its a problem, but Im afraid you would be wrong.

I dont mean to be mean,(and I include myself in this criticism as I was once there - although I did try....!), but 'NCHDs' have always been the greatest bunch of moaners (not that the grievances arent worth moaning about, btw) I have ever come across, yet when it comes to doing anything practical about it, they run or point at the other guy......and then they moan some more about the HSE & Mary Harney....:P

Im not saying that a 'name-change' will suddenly bring about revolutionary change, but it would be soooo soooo simple to insist that the HSE/Government stop using the term and it would, over time, have a positive effect.

drkpower

Traumadoc wrote: »

Even in government they have junior ministers. ( now called ministers of state)

Yep; and in the US Senate, you have 'the Junior representative for New York' etc.... I am not saying that it is absolutely unique (perhaps I need to amend the OP....) but it is highly unusual to have an entire subset of a profession labelled in this way.

And on the specifics of a junior minister, it is a little different. A minister is a highly elveated position, the reference to a junior minister (or the junior senator from NY) is less likely to suggest to the unitiated that the individual is inexperienced or not a fully qualified politician. The analogy, if there is one, would be politicians who had been a member of a party for less than 10 years being called 'junior politicians'.

Traumadoc

I feel that the "junior" refers to a doctor who is a subordinate to a more senior rank.
It may also reflect experience etc.

Vorsprung

Practically speaking, and others may have different views on this, I've always associated the term "junior doctor" with anyone below registrar level. Then you have your registrars, SpRs and senior registrars as appropriate. That's just my own feeling on it. And yea, people below registrar level typically aren't that experienced.

drkpower

Vorsprung wrote: »

Practically speaking, and others may have different views on this, I've always associated the term "junior doctor" with anyone below registrar level. Then you have your registrars, SpRs and senior registrars as appropriate. That's just my own feeling on it. And yea, people below registrar level typically aren't that experienced.

If that actually was the case, I could see why it would be less bothersome but it isnt. But that is not the case. As you know junior doctors refers to (and is used by the HSE/Gov./media to refer to) any hospital doctor not of consultant status.

Narkius Maximus

It's a really interesting concept, being a 'junior doctor', especially if you have lazy ass consultants who don't give a crap and are happy just to take the money and who do 2 ward rounds a week, max time seeing patients~30mins per round and two clinics-1 hour each and for the rest of the time is Christ knows where. So as reg, one is then in charge of patients and making decisons-what tdoes the consultant actually get paid for? It's a joke. At least with the EWTD, 25% of NCHD posts being cut, inability to fill vacancies, there might be a screwballs hope of getting some work out of these lazy sh*&tes.

Traumadoc

I suppose they should get rid of the consultant grade and just have registrars. :rolleyes:

I wouldnt worry as a consultant in the future you will not have a team , secretary etc and you will probably be paid the same as a registrar, especially in your first few years post appointment.

sam34

Narkius Maximus wrote: »

It's a really interesting concept, being a 'junior doctor', especially if you have lazy ass consultants who don't give a crap and are happy just to take the money and who do 2 ward rounds a week, max time seeing patients~30mins per round and two clinics-1 hour each and for the rest of the time is Christ knows where. So as reg, one is then in charge of patients and making decisons-what tdoes the consultant actually get paid for? It's a joke. At least with the EWTD, 25% of NCHD posts being cut, inability to fill vacancies, there might be a screwballs hope of getting some work out of these lazy sh*&tes.

in the interests of fairness, lets not tar all consultants with teh same brush

DrIndy

Narkius Maximus wrote: »

It's a really interesting concept, being a 'junior doctor', especially if you have lazy ass consultants who don't give a crap and are happy just to take the money and who do 2 ward rounds a week, max time seeing patients~30mins per round and two clinics-1 hour each and for the rest of the time is Christ knows where. So as reg, one is then in charge of patients and making decisons-what tdoes the consultant actually get paid for? It's a joke. At least with the EWTD, 25% of NCHD posts being cut, inability to fill vacancies, there might be a screwballs hope of getting some work out of these lazy sh*&tes.

I too would be cautious about tarring everyone equally. Some consultants just get burnt out as they get older because they fight the same constant fight for resources from people who have no appreciation for their role. They have to politically wheel and deal when 5 other people are sitting and trying to grab off the same empty plate.

They are trained to very high standards as clinicians - yet at the same time, their job becomes subsumed in administration when working in small units and yet can do little clinical work - which in the end of 10-15 years of hard training to become the best clinicians - all they do is medical reports and recruit junior staff and simply have no time to see a single patient.

Some are of course lazy - but many work above and beyond the hours they are paid for (remember consultants in the old contract got no overtime) and balance research, clinical load and a ****load of admin together.

The other argument is about private patients - in fairness 80-90% of consultants would do maximum one private half to full day session per week and not any more and this is simply due to demand for this.

This is a direct result of policy which limits consultant posts - get more consultants and you share out the admin more evenly and as a result have much more time for clinical shifts which in the end is what consultants want to do.