A small mercy of the coronavirus lockdown is that there are so many great classic films on television. One of my favourites is “Indiana Jones and the Last Crusade.” In this movie Indiana Jones and his father are trying to find the Holy Grail before the bad guys get hold of it for sinister purposes. The almost 40-year-old Indiana Jones (Harrison Ford), a famous college professor of archaeology, is constantly irritated by his father (Sean Connery) who keeps calling him “Junior” and he repetitively exclaims: “Don’t call me Junior!”.
Since coming to the United Kingdom more than three years ago what has really impressed me while doing clinical work as a consultant in acute medicine is the fantastic team of non-consultant grade doctors I work with. They are more often than not very experienced, with long years of training under their belt, and many are more than 30 years old; yet we keep calling them junior doctors.
Apart from this incongruity, there is a more serious issue. We have a large and well-trained medical workforce, many of whom have completed or almost completed years of training towards their chosen specialisation, have met their predefined competencies, and have passed demanding exams and obtained their certificate of completion of specialist training. Yet this skilled, competent, and impressive workforce cannot work as independent medical consultants as this requires an official appointment in a hospital. As these posts are scarce, these doctors have to wait a long time before they become a consultant, trapped in “junior” training grade roles despite being able to take on full specialist ones.
Going forward the NHS will have to continue to treat critically ill coronavirus-infected patients and at the same time restore routine healthcare and reduce the backlog and waiting lists for elective work. We will need doctors to be able to address this Herculean task. The paradox is that we have an excellent, skilled, and able medical workforce to help, yet we cannot use them effectively as consultants and independent decision-makers due to the outdated system in our hospitals. The United Kingdom is the only country in the Western world utilising this archaic system of consultant appointments. In all other countries’ completion of the specialist training and fulfilling all competencies leads to a position as autonomous senior specialist clinician.
In my own hospital, and across all others in the NHS, over the past difficult weeks, when our healthcare services were almost overwhelmed by very sick patients with severe viral pneumonia, we had to utilise every doctor in the hospital to staff our wards. We have given great responsibility to our postgraduate trainees and they have responded splendidly, demonstrating their fantastic medical skills and ability to be independent decision makers and responsible clinicians. It is time we consolidate this situation and consider those who have completed their specialisation trajectory successfully can be designated as entirely competent consultants and independent practitioners. Having sufficient high-quality medical specialists to address the need of our patients is probably one of the true Holy Grails in medicine.
Marcel Levi, Chief executive, Professor of Medicine, and Consultant in Acute Medicine and Haematology, University College London Hospitals, London, UK
Competing interests: None declared