Intended for healthcare professionals


Shifting boundaries

BMJ 2014; 349 doi: (Published 11 September 2014) Cite this as: BMJ 2014;349:g5502
  1. Tom Moberly, editor, BMJ Careers
  1. tmoberly{at}

Changes that are likely to affect the way that large swathes of the profession train, work, and interact with others across the health workforce are considered in three articles in BMJ Careers this week.

Sarah Liptrot considers how medical training might need to change to resolve the problems caused by the introduction of restrictions on working hours ( She argues that the government’s suggestion that doctors should opt out from working time restrictions on an individual basis would not solve the current problems and would create new ones. She suggests that aligning training along modular subspecialty lines—giving trainees greater mobility and more access to training consultants—could be a much more effective way forward.

Daniel Furmedge argues that, because input from physicians is becoming increasingly routine in the care of patients undergoing surgery, a surgical medicine subspecialty needs to be developed ( “The future must embrace dedicated surgical units led by physicians where surgeons provide advice and shared care and operate,” he says.

Abi Rimmer looks at what the government’s plan to expand the number of physician associates will mean for how doctors work ( The Royal College of Physicians is among the organisations pushing for statutory regulation of those taking on physician associate roles. The BMA emphasises that doctors must be clear about the limits of the care that physician associates provide.

The issues these articles discuss are not simply curious developments of passing interest to small groups of doctors. Changes to working hours will affect all employed doctors, and the shifting boundaries between specialties will have an impact on all parts of the profession. Given that Health Education England has already said that money currently spent on training doctors might be used to train other groups of healthcare workers, shifting the boundaries between professional groups could substantially change the role of doctors in the care of patients.