As aspiring medical students, it is important to understand the route of a doctor after graduating so you have an idea of what your potential career pathway could look like. It is also something useful to know for your interview as it's always impressive if you can show off your knowledge of the training pathway where appropriate.
This guide will walk you through how the training pathway works once you finish medical school, and answer common questions students may have.
We will start with the following graphic which is from our partners overs at Medify. This is a great place to start and refer back to as we go through it in more detail throughout this blog:
During your final year of medical school, you'll be applying for your two-year foundation programme anywhere in the UK. You'll be expected to rank and choose which foundation schools you will like to apply to (quite like the UCAS process), and you'll receive offers depending on your medical school ranking and a one-off exam called the Situational Judgement Test. Once you graduate with your medical degree, you'll be ready to start working as a doctor in the foundation programme you've been accepted into.
The two-year foundation programme is a work-based training programme where you'll be working as a doctor whilst simultaneously developing your clinical skills to prepare for specialty training. They are often referred to as Foundation Year 1 (FY1/F1) and Foundation Year 2 (FY2/F2). During these two years, you will rotate through different placements in medical and surgical specialties. As well as the standard foundation programme there is also a slight variation called the academic foundation programme (AFP) which places an emphasis on research and academia whilst you work. You can find more about the programmes here.
Once you've completed your two years in the foundation programme, you will have several options. The next natural step is to enter specialty training which we will discuss below. However, you don't have to go straight into speciality training. In fact, in 2018, more than 60% of F2 doctors opted to delay speciality training and decided to take an 'F3' year. This is where doctors can take a year out of training to do things such as: work abroad, take up locum posts, research, volunteer, postgraduate exams, CV strengthening, career planning, travelling and so on. Following this year (or years) they can pick up where they left off, and re-enter the training pathway by starting specialty training.
Once doctors finish their foundation training, they can apply for speciality training. This is where they decide which particular area of medicine they want to become an expert in. These include areas such as: general practice, paediatrics, obstetrics and gynaecology, rheumatology, cardiology and so on. The application process for this will involve interviews, unlike the foundation programme.
There are around 60 different specialties available so it can be quite complex to understand the training for each one. Therefore, to make it easier, we will split the types of specialty training into three categories: general practice, run-through training and uncoupled training. But remember, the length of medical training is dependent on the specialty chosen and any breaks taken.
General practice: following the foundation programme, doctors can apply for a three-year General Practice training program, after which they become a qualified GP. GP’s can also get further training in a special interest like women’s health which they can then incorporate into their GP work. As a result, they might be known as a GPSI (GP with Special Interest).
Run-through training: this is one full training programme. After F2, you submit one application before you start the programme, and after it's completed, you'll be a qualified consultant. These are usually 5-8 years long (Grade ST1-8) and include specialties like Paediatrics, obstetrics and gynaecology and cardiothoracic surgery.
Uncoupled training – most specialties fall under this uncoupled training bracket. This splits your training into core training and higher specialty training. Therefore, following foundation years you will first apply for core training which is 2-3 years depending on which program is chosen (Grade CT1-3). This is then followed by an application for higher specialty training which will last 3-5 years depending on the specialty (Grade ST3-8), and upon completion you are then a qualified consultant.
You can find details for each specialty here.
Note: There is also the option of working less than full time (LTFT) which can alter the length of your training.
Junior doctor is a term used to describe any doctor who is currently in postgraduate medical training i.e. in a training pathway. Therefore, it's not just for doctors who are in the foundation programme, it is essentially for any doctor who is still training to become a qualified GP or consultant. Consequently, someone is a junior doctor for around 5-10 years depending on which specialty they choose.
To become a consultant, you must have a medical degree which takes 4-6 years, undertake two foundation years, and then undertake 5-8 years of specialty training in hospital. Therefore, the age you become a consultant is dependent on the age you begin medical school, the medical degree length, which specialty you choose as well as any potential breaks in the pathway you take. For a student studying medicine straight after A levels they can expect to become a consultant at roughly 32-36 years of age. However, there is really no rush to consultancy, so many people may opt to take time out for personal reasons, travel, working abroad, teaching, research, and so on.
To enter surgery, you usually need to complete medical school, the foundation programme, core surgical training and then surgical specialty training. This is an example of uncoupled training. The list of surgical specialties include cardiothoracic, general, neurosurgery, oral and maxillofacial, otolaryngology (ENT), paediatric, plastic, trauma and orthopaedic, urology and vascular surgery. Most of these options involve around 6 years of specialty training, therefore if you add the 2 years of foundation programme and 2 core surgical years, surgeons are usually consultants at age 34–38. However, once you are on the specialty pathway you are considered a surgeon so technically you become a surgeon at around age 28-32.
Note: Some surgical specialties also have run-through training after the foundation program which is 8 years long. This requires the same amount of time to become a surgeon, but it does mean only one application process needs to be done.
Becoming a GP involves the shortest training pathway in medicine. After graduation from medicine, doctors have to undertake a 2 year foundation programme followed by a 3 year GP training programme. Upon completing these programmes, you are a qualified GP which is a senior doctor position as you are no longer in medical training. Therefore, GP training can take as little as 5 years after graduating from medical school.
The following salaries are for hospital doctors in the UK at different stages of training, according to the NHS doctors in England published in 2020. These are all pre-tax, NI and NHS pension.
The ‘Basic’ pay (see note below)
Foundation Programme:
In Hospital Specialty Training (dependent on length of program)
Consultancy
£82,096-£110,683 depending on experience of consultancy. For example:
Note: These are the average national 40-hour week ‘basic’ salary which can vary slightly by trust. However, the total salary also includes pay for extra working hours (at normal rate), extra unsociable hours (37% more than normal rate), on-call availability and bonuses for working more than 1 in 8 weekends (extra 3% for 1 in every 7 weekends ranging up to 15% for 1 in every 2 weekends). There are also premiums for priority programs where there might be a greater requirement for clinicians. These include jobs in certain locations around the country (e.g. rural areas) as well as jobs in certain training programs like Emergency medicine and psychiatry where they may be a higher demand.
We've outlined below the salaries of a GP trainee, a qualified GP and a GP partner.
GP Trainees (premium given for posts done at a GP practice and NOT at hospital):
Qualified GP
GP partner (practice owner): around £113,000
In simple terms, the training pathway can be summarised by the graphic above. If you already have an inkling of what you want to specialise in and would like to learn more about the process then click here. When thinking about potential careers, it’s always worth remembering that most medical students and several doctors even are unsure of which career path they would like to take. For aspiring medics, this decision is a long time away so don't worry about it too much now. As you approach your clinical years of medicine, you'll naturally enjoy certain specialties and you'll start ruling out other ones. You won't be expected to know what type of doctor you want to be anytime soon. Just remember to keep your mind open and try to experience as much as you can. You never know what could take your fancy.
Author: Dhillon Hirani
Editor: Latifa Haque
