Dr Kate Pateman was not one of those who walked through the streets of London a couple of weeks ago shouting for jobs for junior doctors.

But thousands of young doctors - and many older ones - did. They had joined the march in protest at medical reforms, claiming careers were being held back by a "badly-organised" online application system and too few specialist jobs.

There is no doubt there have been problems with applications, and there probably are too few specialist jobs, but the reason for the protest isn't that simple.

Whether they realised it or not, the doctors were marching to protect a way of doing things which pre-dates the NHS. They were marching to protect their own comfort zones and a job selection process which, according to Dr Tony Elston, associate medical director with Essex Rivers Healthcare Trust, is not exactly fair.

Dr Pateman has yet to see if the new way to recruit is more impartial. She qualified in August 2005, and became one of the first medical students to begin her training as a junior doctor under the current career structure, the rather grand sounding NHS Modernising Medical Careers (MMC).

At first glance, it looks as though no one could object to the reforms.

The two-year foundation schools will, for the first time, ensure doctors demonstrate their abilities and competence against set standards ,rather than relying on sit-down examinations. MMC also promises better training in more fields, and with a big emphasis on patient-doctor communication.

Dr Pateman - aged 26 and currently undergoing her second foundation year training at the "excellent" Colchester General Hospital - called this new take on training a "breath of fresh air".

But she acknowledged some of her colleagues feel there are problems - and those problems kick in when doctors want specialist jobs at the end of the new two-year foundation programmes.

It has nothing to do with the number of vacancies (22,000) or the number of doctors (30,000) applying for those vacancies; that has been more or less static for some time.

As any doctor will tell you, there have - for the past ten years at least - been too many doctors chasing not enough posts, thanks, mainly, to overseas doctors choosing to complete their training in the UK, and a recent increase in the number of medical students.

The problem now lies with those doctors coming to the end of their two-year foundation training who haven't made up their minds where their careers are going.

"Before the reforms, doctors who had reached the end of a year's senior house officer training would not necessarily choose in which area to specialise," explained Dr Elston.

"Under the old system, they had two or three years drifting' in various medical jobs before they had to decide whether to be a hospital specialist - and which area they intended to specialise in - or a GP.

"Now they have to choose after the two-year foundation programme which, in effect, is two years earlier than under the previous system - and many junior doctors don't like it."

Many doctors don't like the new job selection process either.

Now, hospital vacancies are no longer filled by the hospital, but by the strategic health authority's "deanery", with the emphasis definitely on a candidate's MMC personal logbook, a detailed record of their achievements and capabilities.

"The old system - when hospitals made the appointments - were very susceptible to patronage," declared Dr Elston.

"Now it is all down to competence and ability. That, I believe, will make the system fairer for everyone and ensure we get the best people for the job."

Dr Pateman's logbook must be eight inches thick. Inside is her life as a medical student (five years - MBBS and BSc in molecular biology) and junior doctor foundation training (she is about to finish paediatrics and move on to public health).

Crucially, her logbook contains the sort of assessments deaneries are looking for.

"To be perfectly honest, I haven't really had a life since I went to medical school," she revealed.

"Everything I do is geared towards a job in obstetrics and gynaecology - including getting myself noticed by the prizes and awards I have won, from the Royal College of Obstetricians and Gynaecologists."

Dr Pateman isn't one of the drifters. She decided at five she wanted to be a doctor, after a tonsillectomy put her in hospital and she had a love affair with a Fisher Price doctor's set.

Twenty years on and she is still in love, and has known for a long time which specialist path to take.

"If I were offered a job in obstetrics and gynaecology at Colchester General Hospital, I would not say no," she smiled.

Now for that she probably would march through the streets of London.



THE NEW SYSTEM - HOW IT WORKS

  • 2005: junior doctors go from medical school to two-year foundation schools before applying for specialist training. There are three years of specialist training after which the doctor becomes the equivalent of a registrar (that term is now defunct) and can go on to be a consultant
  • Pre-2005: junior doctors became house officers (one year) and senior house officers (up to three years) then registrars.