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Renewed Calls to Change 'Demeaning' Junior Doctor Title

A surprise motion at the annual conference of the British Medical Association (BMA) called on the association to cease using the term "junior" to refer to hospital doctors below consultant level.

The topic was not listed on the agenda for last week's meeting in Liverpool, but the conference agreed to discuss a resolution calling on the BMA simply to use the description "doctor" in its communications, after delegates described the junior doctor label as "demeaning" and "misleading". 

Staffordshire foundation year 1 Dr Sai Ram Pillarisetti told the conference, "This title of junior doctor may imply lack of experience or competence, creating a misunderstanding about the work we do and the qualifications we hold."

Nothing Junior About Doctors' Responsibilities 

There was nothing junior about their responsibilities, he said. "Every day these so-called junior doctors act as the first point of contact for sick and unwell patients on the ward, they're in theatre operating on your loved ones, and they're leading teams across various specialties in our health service." 

He also pointed out that the title failed to distinguish between doctors with differing levels of experience.

Countering the suggestion, Dr Ciaran Scott, an anaesthetics trainee from the east of England, said that attempting to educate the public about the capabilities and responsibilities of junior doctors might be a better use of time. 

But Noor Al-Saffar, a medical student from Manchester, pointed to numerous anecdotal reports in which patients had asked for "a senior doctor" because they didn't believe in the competencies of so-called juniors. Abandoning the "junior" title is an important step in redefining the way these doctors are perceived, she said.

The BMA pointed out on Friday that the issue had been "a subject of debate for some time", citing a report by consultant orthopaedic surgeon Scarlett McNally for Health Education England published in April last year after a 3-year investigation. The report said that that "junior" and "trainee" were educational labels imposed in 2007 but "poorly understood". 

In a BMA survey of 1948 doctors, 78% thought "junior doctor" was inappropriate, and 47% thought "trainee" should also be avoided. Many respondents felt strongly about this, and indeed the labels were "felt to be pejorative" and "belittling" when used in reference to "qualified adults with experience, skills, and responsibilities".

"The term 'junior doctor' does not fit with the incredibly hard work that all qualified doctors do," Prof McNally said. Most of every doctor's time is spent working, not training, and indeed many doctors do not even aspire to be a consultant or GP. 

Every doctor should be identified as "doctor" or "surgeon", she said. "Each should be valued for the work they are doing, rather than their future academic potential," which was "not relevant for most interactions in the workplace".

Call to Bring Back Registrars 

The 2022 report suggested re-introducing the term 'registrar' in a 4-tier ranking scheme: 

  1. Foundation year 1
  2. "Central doctors" — a "very broad term" to "exactly replace" the old senior house officer (SHO)
  3. Registrars
  4. Consultants, with "postgraduate doctor" recommended to identify a doctor in a training programme

Many clinical settings still use the terms "SHO" and "registrar" for convenience, similar to the way that imperial measures, such as describing someone's height as 6' 2", were still in common parlance, the report said. While SHO has "its own negative connotations", and acronyms were confusing and disliked by patients, the term "registrar" remains particularly popular.

"This is not a simple re-branding exercise," Prof McNally said. "There are different audiences, including patients. In hospitals, it can be dangerous if other staff don't realise the seniority of the opinion given."

At the time of the report's release last year, the BMA's UK Junior Doctors Committee said that it had "not adopted a position on new terminology" and would continue to use the terms "junior doctor" and "doctor in training".

Health Education England agreed "to cease use of the terms 'junior doctor' and 'trainee' in our formal communications", and to implement the term "postgraduate doctor", but said that it was "a step too far" to take forward the other recommendations.

One Step Closer to Ending "Culture of Disrespect"

At the conference last week, the Doctors' Vote group, which campaigns for pay restoration in the NHS, reportedly claimed credit for getting the debate on the agenda. The motion calling on the BMA to cease using "junior doctor" was passed, though it was not clear how that would affect the BMA's junior doctors' committee and junior members' forum.

There was reportedly wide support for the decision on social media, with West Midlands' junior doctor committee member Dr Shivam Sharma tweeting: "One step closer to ending this culture of disrespect towards doctors".

British Medical Association Annual Representative Meeting. Liverpool. 3-5 July 2023.