Editor—There is an increase in the number of vacancies advertised for non-training positions for junior doctors variously classified as clinical fellows, trust doctors, etc. Increasing staffing is just one strategy used by NHS trusts to reduce junior doctors' working hours.
My questions are: Who fills these vacancies? What becomes of them?
Higher specialty training distinguishes clearly between training and non-training positions. Requirements for specialty examinations are met only in positions recognised for higher specialty training. Non-trainees are without the respect, training, or recourse to complaint that trainees have. They have to be very productive (and lucky) to have any chance of progressing properly.
However, insufficient training positions exist to accommodate all non-trainees, raising the standard for entry into higher specialty training (another bonus?). Most non-training vacancies are filled by foreign doctors trying to get a foot in the door and take it from there. Few doctors who have received career advice and intend to specialise spend time in these positions—at least not for very long.
Prospective employees should identify their career requirements and ensure that a vacancy will help in meeting their objectives. Unfortunately, the need to remain in continuous employment or avoid getting into trouble with the Home Office may lead to the taking up of unsuitable employment.
I do not claim to have a solution. The national shortage of junior doctors seems likely to produce a class of doctors in non-training positions who will not be able to progress, and I wonder what is expected to become of them.
Competing interests: None declared.