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Last Updated: Saturday, 5 January 2008, 11:27 GMT
Q&A: Junior doctor job controversy
Junior doctors
Many junior doctors are unhappy
Reforms of the process for selecting junior doctors for specialist training posts have been dogged by controversy. Now, the doctors have been warned that competition for jobs this year will be tougher than ever.

How has doctors' training been changed?

Training was revamped in 2005, with the aim of speeding up progress so juniors could reach consultant level in an average of 11 years, rather than the current 14.

It meant doctors who had been through their initial stage of training under both the old and the new systems were all competing for a limited number of specialist training posts.

This is the point at which a doctor would select to focus on an area of expertise, such as cancer medicine or paediatrics.

As a result, the number of training posts available was hugely outnumbered by the number of doctors applying for them.

The exact figures were disputed, but it was estimated that more than 30,000 doctors were applying for around 20,000 posts in 2007.

How did the system work?

It operated through a website run by the Medical Training and Application Service (MTAS).

However, last year the website crashed under the pressure of large numbers of junior doctors trying to apply online simultaneously, and the application period had to be extended.

Not only could the system not cope with demand, doctors argued that it was badly organised and failed to draw out applicants' relevant expertise.

There was evidence that able doctors had not been offered any interviews.

It was also claimed that non-medically qualified staff were involved in the recruitment process, while consultants had insufficient time to shortlist applicants fairly.

It also emerged that the MTAS system had been the subject of two security breaches, with experts unable to rule out the possibility of criminal behaviour.

What happened?

Amid threats from consultants to boycott the process and to refuse to appoint any doctors to specialist posts, the government ordered a review.

Following that review, every applicant for postgraduate medical training was guaranteed at least one interview for their first preference post.

It was agreed MTAS would not be used for subsequent recruitment rounds in 2007.

Instead, applications were CV-based and managed by medical deaneries at local level.

MTAS was ditched by ministers for the year, with the then Health Secretary Patricia Hewitt saying the system would have only a monitoring role after the first round of recruitment.

What did the doctors do?

A campaign group called Remedy UK launched a legal challenge seeking to get the first round of recruitment scrapped.

It argued that the system was a completely inappropriate way of assessing doctors, and effectively unlawful.

It said that posts allocated via MTAS should be made temporary, so that they could be re-assessed under a CV-based system in 2008.

However that was not supported by the British Medical Association, which argued forcing people to re-apply for jobs through yet another new and untested system would be unfair.

BMA chairman James Johnson was forced to resign over the issue, amid accusations that he had failed to reflect the anger among the profession.

Remedy UK lost its battle in the High Court, although the judge said medics were justified to feel angry.

What is the situation this year?

The process has been changed. Applications will be handled by local medical deaneries, and without a limit on the number of applications a doctor can make.

Recruitment body NHS Employers said there may be an average of three applicants per post.

There will be around 9,000 places on speciality training programmes in England, attracting as many as 23,000 applications - a situation expected to be reflected across the UK.

It is expected that half the applications may come from doctors who qualified outside the EU.

The government tried to give UK medical graduates priority, but that was overturned after a legal challenge. Ministers will appeal but that will not be in time to affect the situation for 2008.

NHS Employers said competition means patients will get the best doctors, but Remedy UK insisted the system was still unfair.

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