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Doctors' Titles Deciphered (By An Actual Doctor)

Doctors’ Titles Deciphered (By An Actual Doctor)

Updated on: December 3, 2023
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Written By Dr Ollie

Every article is fact-checked by a medical professional. However, inaccuracies may still persist.

In the world of medicine there are a confusingly large number of titles that doctors go by.

From FY1, to SHO, to clinical fellow to registrar. They all relay slightly different meanings about a doctor’s position, their experience and what they do.

In this article, I want to clear up some of the confusion over all the different terms for doctors and exactly what they mean. Having worked in medicine for a couple of years, I think I’ve just about got my head round the main ones!

It’s not going to be dictionary definitions, but hopefully will give you a better understanding of what’s meant next time a consultant tells you the core trainee has to speak to the locum doctor before the FY2 starts treatment.

A generalisation of the training ladder for doctors in the NHS

What Is A Junior Doctor?

I wanted to start with one of the most commonly used, and often misunderstood, terms in medicine.

What actually is a junior doctor?

A junior doctor is any doctor who has not fully completed their clinical training. This encompasses doctors who have just graduated from medical school to those who have been in training for over ten years. Despite the term, a junior doctor can be a very experienced medical professional.

So essentially, a junior doctor is any doctor who isn’t at the very top of the training ladder. I.e., a consultant or GP.

The term is misleading because these ‘junior doctors’ often really aren’t that junior at all.

Because of how long the training pathways are in medicine, a junior doctor can have worked in medicine for over a decade since graduating medical school and be an extremely experienced clinician.

Junior doctors can do operations by themselves, prescribe medication for patients and are essentially the workforce that keeps the NHS running from the ‘doctor’ side of things.

That being said, the term can also be used colloquially in its more literal sense. A doctor, who is in fact, quite junior.

This would often be a foundation year doctor or core trainee. That is, a doctor in the first five years of work following their graduation from medical school.

What Is A Medical Student?

If you’re ever in hospital you may bump into medical students who want to talk to you, examine you, or observe as other doctors treat you.

A medical student is a student who is currently studying medicine at university. Students generally spend four to six years at medical school, before graduating to become a doctor. Medical students spend time in hospitals and working in the community but cannot prescribe nor see patients independently.

A big part of learning how to be a doctor is actually getting stuck in and doing the job. That’s why a significant chunk of medical school is made up of clinical placements.

These are often 6-8 week blocks where medical students embed themselves in a clinical team within a hospital or in the community.

Medical students aren’t yet doctors, so can’t do anything unsupervised, but can help the other doctors and learn along the way.

What Is A Foundation Doctor (FY1/FY2)?

Foundation year doctors are the most junior doctors in the hospital. They’re also who you’re likely to see first if you come to hospital.

A foundation doctor is a doctor generally within the first two years of their training. The foundation program is a two-year training scheme that all doctors must complete after graduating from a UK medical school. Doctors in this scheme are often referred to as FY1s or FY2s. 

You’re an FY1 (foundation year 1) doctor in the first year of the program and an FY2 (foundation year 2) in the second year of the program.

Foundation year 1 doctors are fresh out of medical school and usually need a bit of time to settle into their new job (I can confirm this having been one myself…).

By their second year of work, as an FY2, doctors have normally learnt the ropes and the basics of how things operate in the hospital.

Foundation doctors are generally the people in charge of making sure the consultant’s plan gets implemented.

If a consultant comes round in the morning on a ward round and decides a patient needs a scan or a blood test, it’s then the foundation year doctors who actually do the paperwork to make that scan happen or take the blood for the test.

As part of the foundation program, doctors do six four-month rotations over the two years. This means they’re frequently moving to new specialties- which provides an excellent breadth of medical experience but also means you have to keep learning how your new department works!

What Is An F3 Doctor?

Now you’ve got your head round F1 and F2 doctors, you may be wondering what an F3 doctor is..?

An F3 doctor is a doctor who’s one year post completing the foundation training scheme. The term is generally used to describe doctors who’ve taken a year out from the traditional training ladder to have more control of their working hours, often taking advantage of this freedom to travel.

An F3 doctor isn’t actually an official job role. It’s a colloquial term to describe this common sidestep year that junior doctors choose to take.

The term derives from the foundation training program. You’re an F1 in your first year of work, F2 in the second, so it follows that doctors in their third year of work are F3s.

Because they’re not in an official training scheme, having completed the foundation training program, F3 doctors often have a lot more control of when and where they work. This negates a lot of the downsides of being a junior doctor.

A lot of F3s choose to work the first half of the year to save up some money and then go travelling in the second half.

After the year, doctors can choose to enter into an official training program (to start down the road of becoming a specialist or GP) or they can keep going with this alternative career path.

Doctors who take multiple years out can be called F3s, F4s, or F5s! Each title simply referring to how many years they’ve worked since completing the foundation training program.

What Is A House Officer?

I’ll admit it was before my time, but it wasn’t always FY1s and FY2s. It was house officers (HOs) and senior house officers (SHOs).

A house officer (or HO) is a term traditionally used to describe doctors in their first year of work. As a result of changes in the training pathway for doctors, the term is now outdated. The modern equivalent is a foundation year 1 doctor or FY1.

A house officer taking a patient’s blood pressure

Before the foundation training program was introduced, doctors straight out of medical school used to be called house officers. They worked in the hospital (the ‘house’) and were medical officers of the ward.

The term house officer is now rarely used and has become somewhat obsolete. But that’s not the case for our next title…

What Is A Senior House Officer (SHO)?

Once a doctor has completed their first year of work in the NHS following graduation (as an FY1/house officer), they’re able to move onto the heady heights of senior house officer.

A senior house officer (or SHO) is a junior doctor who’s at least one year post qualification. Traditionally, doctors were ‘house officers’ in their first year of work and ‘senior house officers’ in their second. This system has now been replaced by the foundation training scheme, but the term is still widely used.

Senior house officer is also a term used to describe a junior doctor not currently on a specified training pathway. So a doctor can be a senior house officer from their second year of work up to the point they enter a formal training scheme (which not uncommonly is two to three years).

At this point, their title would more commonly reflect the training scheme they were on. For example, if they’d entered core training, they’d be a CT1 (core training year 1).

What Is A Trust Grade Doctor?

You might not hear the title of ‘trust grade doctor’ as commonly as some of the other titles on the list but it’s an important one to understand nonetheless.

A trust grade doctor is a doctor working on a permanent contract but not as part of a training scheme. Trust grade doctors often have more control over their working hours but aren’t actively progressing towards completion their clinical training.

In medicine, there’s often a relatively linear career ladder doctors take to becoming a fully qualified consultant or GP. As a broad generalisation, you’re a foundation year doctor, then core trainee, then registrar, then finally consultant.

A trust grade doctor is a doctor who’s essentially taken a sidestep away from that linear training ladder. They’re not at the top of the ladder but have chosen to (temporarily) stop moving up it.

The appeal of doing this is you can normally get far more control of your working hours and geographic location. You can choose exactly where in the country you want to work and how long for.

Training posts, on the other hand, jobs that will actively progress you up this linear career ladder, are often a lot more gruelling. Doctors in official training schemes will frequently be asked to work weekends, night shifts and don’t have nearly as much choice as to which hospitals they work at.

There’s nothing to stop doctors from moving between trust grade positions and training schemes, indeed many do as a bit of a breather between intense training periods, but some doctors do also make the conscious decision to only work in a trust grade position for their careers.

What Is A Core Trainee?

Core trainees are one step above foundation year doctors, or SHOs, but aren’t quite registrars yet.

A core trainee is a doctor who’s part of the core training scheme. This is a two-to-three-year training program that doctors can enter into after completion of their foundation training. Core trainees are either on the core ‘medical’ training program or the core ‘surgical’ training program.

Core trainees are middle-grade doctors who have started down the road of specialisation. Prior to entering core training, as a foundation year doctor or SHO, junior doctors can work anywhere in the hospital as they don’t particularly have any specialist skills.

A core trainee has taken that first step towards specialisation. They’re now either a ‘medical’ or ‘surgical’ core trainee.

If you don’t know, fields in medicine are broadly divided into two camps: medical specialties and surgical specialties.

Medical specialties include things like hepatology (livers), rheumatology (joints) and renal medicine (kidneys). Surgical specialties include orthopaedics (bones), ENT (ears, noses & throats) and plastic surgery.

If the area of medicine a doctor wants to specialise in is mostly surgically based then they’ll need to complete core surgical training but otherwise, they’ll need to complete core medical training.

What Is A Registrar?

Registrars are the most common (relatively) senior doctors that you’ll come across in a hospital.

A registrar is a doctor who’s entered into specialty training for one particular area of medicine. Registrars are often quite senior doctors who are just one step below the top level of consultant. Doctors are generally registrars for 4-6 years before completing their clinical training.

As a registrar, a doctor only works in one particular area of medicine. For example, an ophthalmology registrar only looks at and treats eyes.

This is compared to lower down on the training ladder where doctors generally rotate round a few different departments through the course of their training. As a result of only working in one field, registrars have the opportunity to develop a deeper specialist knowledge of their chosen area of medicine.

To become a registrar, a doctor will generally have been working in the NHS for at least five years. This means they’ll have built up enough experience to be able to deal with most situations they’ll encounter on the wards.

A paediatrics registrar transports a young patient between wards

Registrars are often the most senior doctors in the hospital out of normal working hours. For example, at weekends or overnight. A registrar will always be able to reach a consultant over the phone if they need to, but they’ll be able to manage the vast majority of things themselves.

Registrars are still technically ‘junior doctors’ as they haven’t officially completed their clinical training by becoming a consultant yet. Although technically correct, the term doesn’t really do justice to a doctor who might have over a decade of clinical work under their belt and be fully competent to perform operations completely unsupervised.

After finishing their registrar years, which generally takes about four to six years, a doctor will become a consultant or GP. That is, they finish their clinical training and are fully qualified to work with no senior supervision.

What Is A Middle Grade Doctor?

A middle grade doctor is a rather vague term when used to refer to junior doctors. So exactly does it mean?

A middle grade doctor is a broad term used to describe doctors partway through their clinical training. A ‘middle grade’ may refer to a core trainee, junior registrar, or other equivalent grades of doctor. A middle grade doctor will normally have been working in medicine for at least three years.

Because of the vast variety of training pathways that doctors can take from graduating medical school all the way to becoming a consultant, ‘middle grade’ can be a useful catchall to refer to a doctor who’s not exactly senior but isn’t entirely wet behind the ears.

A middle grade doctor will still be working under a more senior doctor, such as a registrar or consultant, but can also have some clinical leadership over the more junior members of the team- such as foundation year doctors.

What Is A Consultant?

If you’re ever unlucky enough to be in hospital, you’ll likely find yourself being reviewed by a consultant each morning on the ward round.

A consultant is a senior doctor who’s completed all of their clinical training. They are specialists in one particular area of medicine or surgery. Consultants are ultimately responsible for the care of their patients and direct more junior doctors who work under them.

Consultants are who call the shots when it comes to the care of their patients with the rest of the team working under their direction. This does however mean the buck ultimately stops with them if anything were to go wrong with a patient’s care.

The shortest possible time to become a consultant in the UK is seven years after university. However, for the majority of specialties doctors will have been working in that field for approximately eight to ten years by the time they complete their clinical training.

At the other end of the spectrum, doctors can have been working as a consultant for over twenty years before retiring- which just goes to show the vast range of clinical experience two doctors with the same job title can have!

Doctors can become consultants in an incredibly wide range of specialties- from microbiology to general surgery to emergency medicine. Consultants generally only work in their one area of medicine and will be frequently asked for advice by doctors from other fields.

What Is A General Practitioner?

There are more general practitioners than any other type of doctor currently working in the UK. So what exactly is one?

A general practitioner (or GP) is a doctor who’s specialised in community general medicine. GPs aren’t experts in one specialist area of medicine but rather retain a broad base of medical knowledge that they use to help patients in the community.

You’ll likely see a GP when you go down to your local medical centre (or GP practice). They’re one of only a few types of doctors that don’t work in a hospital.

GPs are experts in managing incredibly common but non-life-threatening conditions. They’ll send anything that’s too serious to a local accident & emergency department.

Because GPs aren’t specialists in any one particular area of medicine once they’ve detected a problem they will normally refer the patient to a consultant in that field. However, because of their broad base of knowledge, GPs can in fact confidently manage most conditions patients present with by themselves.

What Is A Physician?

‘Physician’ is a bit of a confusing one because Americans use it to refer to anyone that holds a medical degree. Us Brits however assign a slightly different meaning to the term.

In the UK, the term physician refers to a doctor who’s an expert in a medical specialty, such as haematology. This is as opposed to a doctor who’s an expert in a surgical specialty, such as cardiothoracics, where the doctor would be referred to as a consultant surgeon.

Both the expert doctor in haematology and the expert doctor in cardiothoracics would be ‘consultants.’ However, using the term physician or surgeon can just differentiate between what a doctor is an expert in- either a medical specialty or a surgical specialty.

It’s not a term that’s amazingly widely used in the UK, with people more commonly referring to the doctors in question as ‘medical consultants’ or ‘surgeons,’ but still a good one to know the definition for.

What Is A Locum Doctor?

The term ‘locum’ is really only used when referring to either doctors or a member of the clergy. So what one earth does it mean?

A locum doctor is a doctor working in a temporary role, usually to fill a last-minute vacancy. Locum doctors, in a similar manner to temp teachers, are employed when there is a demand for additional manpower that can’t be met by permanent staff.

Locum doctors can either be full-time locums or they might just be doing it for a bit of extra spare cash.

A full-time locum doctor doesn’t have a regular day job, in that they don’t have a contract that mandates them to be in Monday-Friday 9-5. Instead, they regularly pick up spare shifts advertised in the hospital in order to earn a salary.

By working in this manner, locums are able to have far more control over their working hours and are generally paid a higher hourly rate than their regular counterparts. They also get to work in whichever departments need an extra pair of hands and suit their fancy.

A locum doctor putting on PPE before going onto the ward

On the flip side, full-time locum doctors have very little security in their work as they rely on unfilled shifts being advertised. The number of these shifts available often waxes and wanes depending on the time of the year and how busy the hospital is.

A part-time locum might be a doctor who has a regular day job in the hospital but also just picks up a few extra shifts on weekends or evenings.

I actually picked up a number of locum shifts, working on COVID wards, over my time as a foundation year doctor. These shifts were nearly always put out to locums as due to the novel nature of the pandemic there were no doctors who ‘normally’ staffed the (non-existent) COVID wards!

What Is An Academic Doctor?

I can’t say becoming an academic doctor has ever really appealed to me. Too much reading, research and being clever for me.

An academic doctor is a doctor that splits their time between clinical work and academic research. This might be a weekly split, with some days spent on the wards and some researching, or it may be much broader, with eight months working clinically and then four months researching for example. 

Although it’s not for me, I’ll be the first to admit that academic medicine is an incredibly interesting and exciting field to work in.

You can literally be on the cutting edge of medical research. Discovering new diseases, new investigations and new treatments. There’s undoubtedly something uniquely appealing to furthering humankind’s knowledge in the field of medicine.

Why Are Some Doctors Called Mr or Ms?

Have you ever noticed how surgeons often go by Mr or Ms instead of Dr? If you have, then you’ve probably also wondered why that’s the case…

Surgeons are generally referred to as Mr, Ms, Miss or Mrs as opposed to ‘Dr’ because surgery was traditionally performed by barber surgeons, who weren’t qualified doctors. In modern medicine, a doctor can choose to relinquish the title of Dr after passing a professional surgical exam.

That’s right, after a minimum of five years at medical school to gain the title of ‘Dr,’ surgeons choose to ignore it and revert back to Mr or Ms!

Of course I’m only joking, as it’s actually considered somewhat of a prestigious step in a junior surgeon’s career to be able to call themselves Mr or Ms.

They can only officially do this after passing a particularly tough surgical exam. One in which the majority of people fail the first time they sit it!

I do think the history behind this change in address is incredibly interesting too. Surgery never used to be performed by doctors, but rather by barbers (yes the same people who cut your hair…).

Not being doctors themselves, despite performing full-on operations, these barbers weren’t able to go by ‘Dr.’ Which is why your modern surgeon in the NHS will likely also be a Mr or Ms someone.

Final Thoughts

As I’m sure you’ve realised by now, there’s a ridiculously large number of terms and titles used in medicine to describe all the different types of doctor.

Now I won’t claim to have covered anything like all of them, but I hope that by having read this article you’ll have got to grips with the most common ones used in the UK.

The fact that training pathways are constantly changing, along with the way we describe different levels of doctor, really doesn’t help matters. However, at least now you should have the framework from which you can make vague sense of the latest updates to junior and senior doctor titles alike.

About the author
After studying medicine at the University of Leicester, Dr Ollie now works as a junior doctor in London. His interests include medical education and expedition medicine, as well as having a strong belief in the importance of widening access to medicine.