Expectations on consultants vs residents - what has happened?
I would genuinely like someone cleverer than me to explain what has happened over the last decade to the balance of work, responsibility and risk between residents and consultants. It feels as though the system has quietly lowered what it expects of residents, while raising what it expects consultants to absorb. Gaps in knowledge, clinical judgement and practical competence that once felt exceptional now feel increasingly routine. Consultants are then left to carry the risk, usually without recognition, acknowledgment or remuneration.
Every year seems to bring a further erosion of professional standards in medical school and postgraduate training. We are now reaching a point where this is not merely frustrating, but utterly unsafe for patients, and for the consultants expected to hold the whole thing together.
There is a fantasy among non-clinicians and consultants who do very little clinical work that consultants can simply make the “big decisions” and everything else will fall into place. This is patently nonsense-on-stilts. It misunderstand, wilfully or otherwise, both the capacity of consultants and the way doctors actually learn to become independent practitioners. You cannot train people by removing responsibility from them, nor can you run a safe service by pretending consultants have infinite bandwidth.
I do not understand why this is not a national conversation.
Postgraduate medical training is becoming unfit for purpose. Consultants cannot keep absorbing the consequences indefinitely.