Last week I attempted (but think I failed) to explain to a non-medic friend how junior doctors are allocated to their next job. Perhaps this is unsurprising as many of us doctors are also confused about this!

For any readers who are unfamiliar with how Core Trainees (aka Senior House Officers and Registrars) apply for and obtain jobs, I will explain briefly how it works. During their second Foundation Year, doctors must decide what they want to specialise in and apply for the training scheme (core training) for their chosen specialty in their chosen area of the country (deanery).  This is the route to become a consultant in the specialty. Each specialty runs their own selection process and allocation to jobs slightly differently, but in general the process seems quite fair with a series of interviews and often an exam to enter into CT1 (core training 1) in your chosen specialty, and once on a CT programme doctors move jobs within this specialty and this deanery every 6 months, until they finish the programme and apply for a consultant job.

A particular deanery should have the correct number of CT1 jobs available for the doctors selected, so if a particular specialty accepted 20 CT1 doctors to their deanery, they should have 20 CT1 jobs to fill. Of course, some of these jobs are likely to be more desirable in terms of the work involved and the geographical location than others, and it is the allocation to the CT jobs that seems to pose particular problems. Many specialties then use a reasonably fair method for allocating doctors to specific CT1 jobs in that each accepted doctor was allowed to rank all the available jobs, from say 1 to 20, and then the doctor with the top selection score had their first choice, and so on until the jobs were filled.

However, for allocation to jobs in CT2 and upwards the system was rather murky in some specialties and deaneries. In some, everyone was sent the list of 20 jobs again and ranked their choices in order from first to last. Instead of the person with the highest selection score getting first choice the deanery said that they would allocate out the jobs trying to give as many people as possible their high choices. In practice, this meant that although a small majority got jobs they had ranked highly, many doctors were left with jobs they did not want to do, which they had ranked low down their list of preferences.

Even more surprising was the realisation that some of the most sought-after jobs from the list had not in fact been allocated out at all. By CT2 some doctors have left the training programme for various reasons. The jobs still all need to be filled and it is understood that locum doctors or doctors doing one-year only posts would need to be recruited to fill these. However, it emerged in some places that the most highly regarded jobs that many doctors had ranked as their first preference were being saved for temporary doctors as they will be more likely to come to work in  that area if they are being offered a desirable job. The Core Trainees are unlikely to leave a training programme they have spent several years in for the sake of one year of an undesirable job, so this strategy benefits the hospital as it means all the jobs are more likely to be filled and there will be fewer rota gaps. However it is understandably disappointing for doctors already employed on the training programme to find out that their needs are being prioritised lower than the wishes of someone who has not yet even been interviewed for a job.

Of course managers are under pressure to ensure jobs are filled and rota gaps negatively impact on everyone working in the hospital. However, I think the concerns doctors express about the allocation of CT jobs are often brushed aside as trivial and the doctors who complain are often dismissed as simply not wanting to undertake a greater commute, or a job with more on-call commitments. In reality, in many specialties, the specific jobs a doctor does in CT years affect what type of consultant they can be. A specialty such as psychiatry, for example, is made up of many different subspecialties (general adult psychiatry, old age psychiatry, forensic psychiatry, child psychiatry, addiction psychiatry etc) and when it comes to interviews for consultant posts someone who has done a job in their chosen subspecialty is likely to have a more relevant portfolio than someone who has not, as they will have been exposed to far more opportunities to achieve the relevant competencies.

This is not to say that things like extended commutes are trivial – I have met doctors who simply cannot take up a particular CT post as the commuting means they cannot continue with their family commitments, and for everyone, this additional burden means it is harder to study for exams and harder to make time to relax away from work. Looking at the longer term, bigger picture, however, it is not an exaggeration to say that the jobs a doctor does in their training years affect the rest of their career. I think that this is something which needs to be taken more seriously by the people allocating out the CT jobs – most doctors understand that they are under pressure to fill jobs, so therefore a balance of everyone’s needs has to be reached, but in many areas more understanding is needed of how the wrong job can adversely affect not just that year, but the rest of a doctor’s career.

Do any readers have suggestions of how job allocations could be made fairer? Should all doctors be interviewed each time they move jobs? What should be justifiable grounds for a doctor being given the job they want? Should one person’s career plans take priority over another’s commuting distance, for example? How does it work in your specialty and are you happy with this arrangement?