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The work of Doctors in the NHS

Do doctors still have to work some shifts outside of their immediate specialty after completing F2 training? Does a doctor still have to regularly work in A & E if they are training in Urology, for example?

Reply 1

Once they have obtained a training place in a particular speciality, the doctor will be attached to a particular department in a particular hospital for a time, after which they will rotate to another location.

However, this does not mean that a doctor training in urology will remain solely in theatres or on a particular ward. If they are the on call doctor for that specialty on a particular day or night shift, they will often be the on holding the referral bleep and be asked to come and review or consult with patients on other wards, other sites or in surgical/medical assessment units or in the emergency department. Some surgical trainees are expected to run surgical clinics at times- they will be asked to see patients in clinic for whatever reason, either patients who have been referred in by others who are presenting to clinic for review.

The same would broadly apply to doctors training in medical or other surgical specialties. Ear, nose and throat for example, will be asked for advice on patients who have presented to the ED front desk, they may perhaps later come to the department to consult and examine the patient and then formally admit the patient or carry out a procedure within the department. Doctors working in Obs and Gynae would be another common specialty to call to ED, as would paediatrics (although some hospitals now have specialist paediatric emergency departments).

Doctors working in intensive care or anaesthesia would also be attending the ED a lot as and when their skills are required.

I am not familiar with urology as a training pathway but I suspect you would have to complete core surgical training to be able to start in urology which means you will be trained first in other surgical aspects first and so much of the above would still apply to you.

Can I ask why you are asking about the need to work in the emergency department specifically?
(edited 1 month ago)

Reply 2

Original post
by ErasistratusV
Once they have obtained a training place in a particular speciality, the doctor will be attached to a particular department in a particular hospital for a time, after which they will rotate to another location.
However, this does not mean that a doctor training in urology will remain solely in theatres or on a particular ward. If they are the on call doctor for that specialty on a particular day or night shift, they will often be the on holding the referral bleep and be asked to come and review or consult with patients on other wards, other sites or in surgical/medical assessment units or in the emergency department. Some surgical trainees are expected to run surgical clinics at times- they will be asked to
The same would broadly apply to doctors training in medical or other surgical specialties. Ear, nose and throat for example, will be asked for advice on patients who have presented to the ED front desk, they may perhaps later come to the department to consult and examine the patient and then formally admit the patient or carry out a procedure within the department. Doctors working in Obs and Gynae would be another common specialty to call to ED, as would paediatrics (although some hospitals now have specialist paediatric emergency departments).
Doctors working in intensive care or anaesthesia would also be attending the ED a lot as and when their skills are required.
I am not familiar with urology as a training pathway but I suspect you would have to complete core surgical training to be able to start in urology which means you will be trained first in other surgical aspects first and so much of the above would still apply to you.
Can I ask why you are asking about the need to work in the emergency department specifically?

I was just trying to ascertain what a junior doctor actually does whilst training to be a registrar and beyond. It seemed incomplete to expect a doctor to only spend nearly all their time within the training speciality beyond F2.

Reply 3

Original post
by Anonymous
I was just trying to ascertain what a junior doctor actually does whilst training to be a registrar and beyond. It seemed incomplete to expect a doctor to only spend nearly all their time within the training speciality beyond F2.


The term 'junior' doctor is no longer used.

Once you are on a training pathway, you are training in that speciality alone. One simply will not have the time to learn what they need to know in urology if they spend time working in any other area. It is possible to pick up locum shifts in other departments but in all honesty a registrar's life is busy and involves a lot of responsibility, particularly if you happen to be the medical registrar, literally the most senior medical doctor in the place at times and often the same person who other doctors will be ringing for advice when they need advice or help.

Of course, a doctor training in urology will be looking after patients within the urology ward or department, which means they are in some cases likely to have to have a reasonable grasp of any general medicine involved in caring for patients under their care whilst they are an inpatient under the care of urology.

Reply 4

So after FY2, doctors don't get involved much with patients that come in through A & E? They only really see patients referred to hospital via their GP?
Original post
by Anonymous
So after FY2, doctors don't get involved much with patients that come in through A & E? They only really see patients referred to hospital via their GP?

I think these days a lot of patients that go to wards are in fact referred from A&E rather than their GP (I think I read somewhere that actually GPs more often refer patients to A&E now rather than directly to specialists, and so A&E then have to refer to the specialists) and I suspect they may be requested to go to A&E to review a patient before refusing admission in some situations etc.

Reply 6

Original post
by Anonymous
So after FY2, doctors don't get involved much with patients that come in through A & E? They only really see patients referred to hospital via their GP?

I mentioned some of this in my first post.

A doctor on a urology training pathway may be called to consult, examine, review or perform a procedure on any patient in the entire hospital where urology input might be required.

However, this does not mean they will be working in the emergency department seeing absolutely any other patient the department might contain. In the main, the people working in emergency will try to manage what they can in the department themselves but call upon other departments as needed.

I have worked in primary care, secondary care and in particular the emergency department on and off quite some time. By way of example, in any average shift in ED this kind of process might occur:

A doctor in ED bleeps the on-call urology registrar because they have already tried to catheterise a patient in the department who has presented with acute urinary retention. We've already tried with the equipment at our disposal and so it's logical to have an expert try who might elect to do something different such as place a supra-pubic catheter or something only a doctor with specialist knowledge in urology can do or decide upon

An ED registrar contacts the medical registrar via telephone to advise them that we have a very unwell patient in the department who we intend to admit to medicine. The patient is known to have Addison's disease and so is medically quite complicated and the emergency department has provided initial resuscitation and treatment but will be heading to an acute medical ward for onward evaluation

An ED consultant receives an urgent phone call on the red phone from a doctor in general practice who has a patient they think has Cauda Equina syndrome and whom they are sending to the emergency department pronto

A patient with an eye problem presents to the minors end of the emergency department. They are initially evaluated by a doctor in the department using a slit lamp/Ophthalmoscope and they contact the on-call ophthalmology registrar for advice on this patient before discharging them home

A patient comes to the minors section of ED with abdominal pain. Everything in their history and examination plus investigations is strongly suggestive that they have appendicitis. The emergency department might get some initial management started (analgesia, make nil by mouth etc) but they call the on-call surgeons to come and review the patient who then consult with their boss/anaesthetics before deciding when to take the patient to theatres


Lots of doctors, and even consultants; the most senior members of their team, can and will seek advice from other doctors/registrars or consultants as needed when managing their patients. If you're an F2 working on a respiratory ward and a patient develops urinary retention, you might well consult the on-call urology team for advice at some point. Everyone works to their level of competence and knowledge and would be expected to seek advice from others as needed.

Fully trained GPs are considered consultants in of themselves. They can (and do) refer patients directly to acute medical admissions or to surgical or medical assessment clinics. They do not solely send people to the emergency department because if a qualified doctor has already assessed the patient and the GP thinks they need admission to hospital, a medical or surgical ward might be far preferrable than sending people to ED and simply adding to the case load there. The clue is in the name: accident or emergency. If the patient isn't acutely unwell then in reality it's a bit unfair to send people to ED if you know they will need medical or surgical assessment anyway- people coming to general practice are normally ambulatory and well enough to come to the practice but they can be more unwell than you'd think sometimes, say with a condition like asthma in a patient who has a history of nasty exacerbations of their asthma, that would be one scenario where I'd be ringing the red phone and telling the consultant in charge I'm sending someone directly to them.

The role of general practice is vast and by far the most demanding role in medicine and not for the unwary. It involves a great deal of responsibility and the ability to recognise and manage risk and these require a lot of confidence in your examination, consultation and management skills. That being said, it is amongst the most productive part of our healthcare system and by far the most cost effective: general practice does 90% of the work in the NHS and gets less than 10% of the spending. Without a growing number of solid and capable doctors in general practice, the present system would struggle in a big way.

Reply 7

Original post
by ErasistratusV
I mentioned some of this in my first post.
A doctor on a urology training pathway may be called to consult, examine, review or perform a procedure on any patient in the entire hospital where urology input might be required.
However, this does not mean they will be working in the emergency department seeing absolutely any other patient the department might contain. In the main, the people working in emergency will try to manage what they can in the department themselves but call upon other departments as needed.
I have worked in primary care, secondary care and in particular the emergency department on and off quite some time. By way of example, in any average shift in ED this kind of process might occur:

A doctor in ED bleeps the on-call urology registrar because they have already tried to catheterise a patient in the department who has presented with acute urinary retention. We've already tried with the equipment at our disposal and so it's logical to have an expert try who might elect to do something different such as place a supra-pubic catheter or something only a doctor with specialist knowledge in urology can do or decide upon

An ED registrar contacts the medical registrar via telephone to advise them that we have a very unwell patient in the department who we intend to admit to medicine. The patient is known to have Addison's disease and so is medically quite complicated and the emergency department has provided initial resuscitation and treatment but will be heading to an acute medical ward for onward evaluation

An ED consultant receives an urgent phone call on the red phone from a doctor in general practice who has a patient they think has Cauda Equina syndrome and whom they are sending to the emergency department pronto

A patient with an eye problem presents to the minors end of the emergency department. They are initially evaluated by a doctor in the department using a slit lamp/Ophthalmoscope and they contact the on-call ophthalmology registrar for advice on this patient before discharging them home

A patient comes to the minors section of ED with abdominal pain. Everything in their history and examination plus investigations is strongly suggestive that they have appendicitis. The emergency department might get some initial management started (analgesia, make nil by mouth etc) but they call the on-call surgeons to come and review the patient who then consult with their boss/anaesthetics before deciding when to take the patient to theatres


Lots of doctors, and even consultants; the most senior members of their team, can and will seek advice from other doctors/registrars or consultants as needed when managing their patients. If you're an F2 working on a respiratory ward and a patient develops urinary retention, you might well consult the on-call urology team for advice at some point. Everyone works to their level of competence and knowledge and would be expected to seek advice from others as needed.
Fully trained GPs are considered consultants in of themselves. They can (and do) refer patients directly to acute medical admissions or to surgical or medical assessment clinics. They do not solely send people to the emergency department because if a qualified doctor has already assessed the patient and the GP thinks they need admission to hospital, a medical or surgical ward might be far preferrable than sending people to ED and simply adding to the case load there. The clue is in the name: accident or emergency. If the patient isn't acutely unwell then in reality it's a bit unfair to send people to ED if you know they will need medical or surgical assessment anyway- people coming to general practice are normally ambulatory and well enough to come to the practice but they can be more unwell than you'd think sometimes, say with a condition like asthma in a patient who has a history of nasty exacerbations of their asthma, that would be one scenario where I'd be ringing the red phone and telling the consultant in charge I'm sending someone directly to them.
The role of general practice is vast and by far the most demanding role in medicine and not for the unwary. It involves a great deal of responsibility and the ability to recognise and manage risk and these require a lot of confidence in your examination, consultation and management skills. That being said, it is amongst the most productive part of our healthcare system and by far the most cost effective: general practice does 90% of the work in the NHS and gets less than 10% of the spending. Without a growing number of solid and capable doctors in general practice, the present system would struggle in a big way.

I have to say, l expected junior doctors (l don't like their new name, resident doctors) to spend more time working in different areas alongside their main speciality. For example, I thought a doctor that has started their speciality training in Urology would also be expected to regularly diagnose things like a pinched nerve, muscle tearing, measles etc. Essentially all the things they would have come across during their foundation years.

Reply 8

Original post
by Anonymous
I have to say, l expected junior doctors (l don't like their new name, resident doctors) to spend more time working in different areas alongside their main speciality. For example, I thought a doctor that has started their speciality training in Urology would also be expected to regularly diagnose things like a pinched nerve, muscle tearing, measles etc. Essentially all the things they would have come across during their foundation years.

I'm not sure I have adequately explained the speciality training process in my posts.

Speciality training is several years long and involves studying for and passing some pretty serious exams alongside a lot of specific procedural skills (doubly so for surgeons). Whatever the registrar might have encountered in foundation (and this is becoming very variable now) is almost of secondary importance. Sure, a doctor in urology training might well recognise a case of measles in a patient who was admitted for a urological procedure but certainly for surgical specialties their aim is to become proficient in urology, and to do this is going to involve a lot of focused study and clinical practice within this same specialty for a long period of time. It's a bit unrealistic for someone many years into an intensive specialty to also recall the management of cluster headache and a muscle tear despite the fact they might not have seen a case of either in some years.

Whilst I have met some doctors who do seem to have an astounding range of medical knowledge, nobody can know it all: I was once told the realm of human medicine doubles every 8 years because of the pace of scientific progress. Everyone has their preferred area of knowledge or practice and strengths and weaknesses, that's human nature I'm afraid and it's why we have speciality doctors in the first place.

Reply 9

Original post
by Anonymous
I have to say, l expected junior doctors (l don't like their new name, resident doctors) to spend more time working in different areas alongside their main speciality. For example, I thought a doctor that has started their speciality training in Urology would also be expected to regularly diagnose things like a pinched nerve, muscle tearing, measles etc. Essentially all the things they would have come across during their foundation years.

Why though? Do you want your urologist to be an expert in urology or an expert generalist? Because we already have the latter: they're called GPs (or A&E doctors, if you want to view generalism on an acute vs chronic continuum).

Also, as rubbish as the state of the world is, I don't think we're yet at the point where anyone in the UK is "regularly" diagnosing measles.

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