The chairman of the British Medical Association has resigned.
By Nick Triggle
Health reporter, BBC News
He says it is over the fall-out from the overhaul of doctor training, but it may well be indicative of a wider problem - how the profession reacts to the changing NHS.
The training row sparked protests by junior doctors around the country
The junior doctors training fiasco has claimed its latest victim.
Junior medics were angry that BMA chairman James Johnson had written a letter to a newspaper defending Chief Medical Officer Sir Liam Donaldson, seen as the chief architect of the system.
But it would be wrong to view his decision to step-down as a victory for the vociferous campaign against the reforms, which mean that about 30,000 junior doctors are chasing about 20,000 jobs.
The four-year stewardship of Mr Johnson was always going to end next month when hundreds of doctors meet for their annual conference.
He has said he would not be seeking re-election and even if he did many within the BMA do not believe he would have the support of members anyway.
There has been growing disquiet for over a year about Mr Johnson's style of leadership. There were even calls for him to go at last year's BMA conference amid accusations that he was too close to government and did not consult with members enough.
Jonathan Fielden, chairman of the BMA's consultants committee, said: "Concerns have been expressed about his attitude... that he is out of touch with the membership and senior officers of the BMA.
"The letter was the final straw, he had to go."
However, this was a far from universal view. Some doctors the BBC spoke to expressed anger over the actions of junior doctors involved with the pressure group Remedy UK with one describing them as a "rabid mob".
But all were too worried about being named because of the momentum the campaign has gathered.
Remedy UK is currently fighting a legal battle to get the online application system matching junior doctors to specialist posts scrapped.
The government has effectively ditched the scheme for all subsequent rounds of interviews, but Remedy UK wants jobs handed out during the first round, which did use the MTAS system, made temporary until applications can be re-assessed, using more traditional measures next year.
The BMA has argued that such a move would simply cause more uncertainty.
Mr Johnson has said his decision to resign was solely over the issue of the letter last week and defended claims he had not stood his ground on NHS reforms.
But perhaps most tellingly, he has also made a point of stressing the current mood of doctors, saying the profession was "on the edge".
"I think there is a huge amount of anger in the medical profession about the direction of the reforms and privatisation agenda.
"It is the worst I have known it for over 30 years since my involvement with the BMA started."
This seems to be the crux of the matter. Simon Eccles, a former chairman of the BMA's junior doctors committee, said it was right for Mr Johnson to go over the issue of the letter which was at odds with the view of the wider membership.
But he also stressed the wider context. "There is a real tension in the medical profession about the best way forward."
James Johnson is resigning over a job selection system
He said there was disappointment that record levels of funding had not led to similar improvements in care and disease survival rates.
"Some people want to keep things as they are and some believe we are the sick man of Europe and an overhaul is needed."
The recent discussion paper put forward by the BMA which effectively proposed a rationing of care to allow the NHS to focus on core treatments has caused much debate among doctors.
Mr Eccles said it was likely that in the future the BMA would be pushing forward this debate and taking a "stronger" line against the so-called market reforms.
But Dr Richard Vautrey, a member of the British Medical Association's GPs committee, said Mr Johnson had faced a tricky task over recent years.
"Sometimes some of our members have great expectations that if the BMA says something it will happen.
"But that has not been the case with a government with such a huge majority. We have to have realistic expectations."
Dr Matt Jameson Evans from Remedy UK said: "We adopt a friendly open door policy to any individual or group that wants to engage in reasoned dialogue about the best road forward.
"We have a weekly meeting open to all. We have tried to avoid any kind of antagonism at all times as it is always counterproductive."