Letters

Insecurity about progression is an added stress for senior house officers

BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7182.534a (Published 20 February 1999) Cite this as: BMJ 1999;318:534
  1. Charles S B Galasko, Chairman, training board,
  2. Barry Jackson, President
  1. Royal College of Surgeons of England, London WC2A 3PN

    EDITOR—In their editorial Firth-Cozens and Moss covered some of the factors causing stress among junior doctors.1 However, they did not include what is probably the most important cause of stress among many senior house officers in some of the more popular disciplines—that is, insecurity about progression. Unfortunately, the government did not increase the number of consultant posts and specialist registrar posts when the new deal was introduced. The net effect was that the task forces created hundreds of additional senior house officer posts to cope with the reduction in hours. The effects of this failure to match the greatly enlarged number of senior house officers with future career prospects were worsened when the new specialist registrar programme was introduced.

    At the same time the duration of basic professional training was reduced from three to two years, creating an explosion in the number of senior house officers seeking specialist registrar jobs each year. Once again, the number of consultant posts and specialist registrar posts was not increased simultaneously.

    The increase in numbers of senior house officers in surgery has meant that, even if surgical registrars who satisfactorily complete basic surgical training and obtain their FRCS/MRCS/AFRCS spend 4 years as senior house officers, a proportion will still not obtain specialist registrar posts in surgery, such is the current mismatch in numbers.

    A straw poll of surgical senior house officers found that this mismatch is the main cause of stress. Unless this mismatch is reduced by an increase in the number of consultant and specialist registrar posts, stress is likely to increase with all the adverse factors described by Firth-Cozens and Moss in their editorial.

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