Physician titles in medical hierarchies around the world?
March 24, 2013 7:35 AM Subscribe
In the USA, doctors in academic centers are interns (first year trainee), residents (subsequent year trainee), attendings (completed training), fellows (attendings who are further subspecializing and revert to trainee status). Also, leaders of primary teams and consulting services are both called attendings.
What's the terminology in other countries? I'm most curious about English speaking countries (registrars? consultants? LMO?) but would also enjoy hearing about others also!
Response by poster: Roofus -- the leader of a team with primary responsibility for the patient is also referred to as a Consultant in the UK?
posted by raspberry jam and clothes iron at 8:11 AM on March 24, 2013
posted by raspberry jam and clothes iron at 8:11 AM on March 24, 2013
Point of clarification: In the USA the title of "Attending" is actually specific to a doctor who has finished his/her training and is now the head physician on a team of physicians-in-training ("house officers" or interns and residents) who are taking care of a particular group of patients.
Not all doctors who have finished residency are "attendings" - some are just plain doctors. Its a term that is most used by the subordinate docs and medical students on the team, and in my experience is not widely used outside of the medical field.
posted by i less than three nsima at 10:12 AM on March 24, 2013 [1 favorite]
Not all doctors who have finished residency are "attendings" - some are just plain doctors. Its a term that is most used by the subordinate docs and medical students on the team, and in my experience is not widely used outside of the medical field.
posted by i less than three nsima at 10:12 AM on March 24, 2013 [1 favorite]
Best answer: Yes, the consultant is legally liable and carries primary responsibility for a patient and can even be the lead for a regional service.
but the more junior titles have all changed now and Roofus is a bit out of date I'm afraid, although it will take a few more years before the new titles are adopted by everyone. They are hated TBH.
As someone who recruits to CT1 in Surgery and sits on the progress panels (ARCP- Annual Review of Competency Progression)
Intern/. House Officer is now Foundation Year 1 & 2 or FY1 FY2 in new money. The idea is 2 years to make someone Hospital safe.
SHO is now Core Trainee 1 or 2 or CT1 & CT2 (some like GP have just been approved to do CT3 but a CT 3 year is exceptional), the idea is to be safe in the generics of your chosen speciality.
Registrar is ST3-ST6,7, or 8 depending on the specialty. General Practice goes to ST5 but others are longer.
clinical fellow posts exist at both the CT-ST interface (quite junior, while you wait for an ST3 National Training Number) and the post CCT Fellows which are what is understood in USA as a Fellow.
and then you have the unique to the UK (I think?) Staff Grade (Hospital doctors who generally have not finished training and carry a huge amount of the service in the NHS and who are massively female and ethnic minorities) and more senior (but similar) Associate Specialists. The last title can no longer now be recruited to so the remaining ones are the last of the group.
We now have an informal, unrecognised and in many senses unregulated training spine in the UK where a tiny number of people put together a portfolio of competencies largley outwith the formal training process and qualify under what used to be called Article 14.
It's a mess.
posted by Wilder at 10:15 AM on March 24, 2013
but the more junior titles have all changed now and Roofus is a bit out of date I'm afraid, although it will take a few more years before the new titles are adopted by everyone. They are hated TBH.
As someone who recruits to CT1 in Surgery and sits on the progress panels (ARCP- Annual Review of Competency Progression)
Intern/. House Officer is now Foundation Year 1 & 2 or FY1 FY2 in new money. The idea is 2 years to make someone Hospital safe.
SHO is now Core Trainee 1 or 2 or CT1 & CT2 (some like GP have just been approved to do CT3 but a CT 3 year is exceptional), the idea is to be safe in the generics of your chosen speciality.
Registrar is ST3-ST6,7, or 8 depending on the specialty. General Practice goes to ST5 but others are longer.
clinical fellow posts exist at both the CT-ST interface (quite junior, while you wait for an ST3 National Training Number) and the post CCT Fellows which are what is understood in USA as a Fellow.
and then you have the unique to the UK (I think?) Staff Grade (Hospital doctors who generally have not finished training and carry a huge amount of the service in the NHS and who are massively female and ethnic minorities) and more senior (but similar) Associate Specialists. The last title can no longer now be recruited to so the remaining ones are the last of the group.
We now have an informal, unrecognised and in many senses unregulated training spine in the UK where a tiny number of people put together a portfolio of competencies largley outwith the formal training process and qualify under what used to be called Article 14.
It's a mess.
posted by Wilder at 10:15 AM on March 24, 2013
also another difference in the UK is the majority of hospitals have training grade doctors, at least the acute hospitals (or hot sites -24 hours Emergency services), its not just the academic centres. Training in the smaller specailties like Neurosurgery tend to be concentrated in the larger academic centres but we still have historic services like the Burns/Plastics unit at East Grinstead where Plastic surgery was practically invented (for the UK that is) and which owes much to the horrors of War. The Guinea Pig club is fascinating.
posted by Wilder at 10:29 AM on March 24, 2013
posted by Wilder at 10:29 AM on March 24, 2013
I am less than three nsima: it's acceptable to use Attending for any doctor who is taking direct care of a patient in a community hospital, even if they aren't heading a team. It can be synonymous with Admitting physician.
posted by cameradv at 11:08 AM on March 24, 2013
posted by cameradv at 11:08 AM on March 24, 2013
Response by poster: Excellent! Any Canadian, Australian, South African, German, French, Russian etc. medical peoples want to weigh in with how everyone is referred to?
posted by raspberry jam and clothes iron at 12:02 PM on March 24, 2013
posted by raspberry jam and clothes iron at 12:02 PM on March 24, 2013
I'd add to this. In the US, "attending" is not really in the same category as "intern," "resident," and "fellow". Whereas the last three terms refer to specific phases in physician training, the last of which is optional, saying that a physician is an "attending" is basically like saying that a naval officer is "on duty". That is, the term refers to the physician who, for a specified period of time, is ultimately responsible for specific patients admitted to a specific hospital in a specific ward/department. The physicians who support him, if any, are called "house staff," and they're usually residents and fellows.
If a physician never deals with in-patients, he will never be an "attending." GP's basically never are, and it's the rare surgeon, radiologist, dermatologist, etc. who will be, as most of their patients either don't spend much time in the hospital or are cared for by other physicians while admitted. For instance, if physician A admits a patient to the hospital, the patient will be admitted to the appropriate ward, and physician B will more than likely be his attending until he is relieved by physician C, etc. Physician A may even become the attending if it's his turn while the patient is admitted. Physician A may direct the large-scale care of the patient, particularly if he is a specialist, and will likely drop in from time to time, but the attendings on duty will be responsible for ensuring that the patient doesn't die while he's in the hospital and for ordering any drugs or procedures needed on an emergency basis. But a physician in a position to admit patients to the hospital is generally not going to be spending his time caring for patients in the hospital, simply because it's impossible to do both things at once. Most alternate between the two.
Pretty much the only physicians that do in-patient care full time are called "hospitalists," practicing "hospital medicine," which is becoming a specialty in its own right. Some hospitals are moving in a direction where traditional specialists don't serve as attendings at all. They admit patients, and the hospitalists take over from there. But again, "hospitalist" is the name of a speciality, not a phase in a physician's career.
In short, the stages of informal professional titles are: student -> intern/resident -> fellow (optional) -> [practice name]. Once you finish your training, you don't become an "attending," you become a radiologist, or a cardiologist, or a neurosurgeon, or whatever. You may serve as an attending from time to time, but you'd only be called that while you were actively caring for patients in the hospital.
posted by valkyryn at 3:21 PM on March 24, 2013
If a physician never deals with in-patients, he will never be an "attending." GP's basically never are, and it's the rare surgeon, radiologist, dermatologist, etc. who will be, as most of their patients either don't spend much time in the hospital or are cared for by other physicians while admitted. For instance, if physician A admits a patient to the hospital, the patient will be admitted to the appropriate ward, and physician B will more than likely be his attending until he is relieved by physician C, etc. Physician A may even become the attending if it's his turn while the patient is admitted. Physician A may direct the large-scale care of the patient, particularly if he is a specialist, and will likely drop in from time to time, but the attendings on duty will be responsible for ensuring that the patient doesn't die while he's in the hospital and for ordering any drugs or procedures needed on an emergency basis. But a physician in a position to admit patients to the hospital is generally not going to be spending his time caring for patients in the hospital, simply because it's impossible to do both things at once. Most alternate between the two.
Pretty much the only physicians that do in-patient care full time are called "hospitalists," practicing "hospital medicine," which is becoming a specialty in its own right. Some hospitals are moving in a direction where traditional specialists don't serve as attendings at all. They admit patients, and the hospitalists take over from there. But again, "hospitalist" is the name of a speciality, not a phase in a physician's career.
In short, the stages of informal professional titles are: student -> intern/resident -> fellow (optional) -> [practice name]. Once you finish your training, you don't become an "attending," you become a radiologist, or a cardiologist, or a neurosurgeon, or whatever. You may serve as an attending from time to time, but you'd only be called that while you were actively caring for patients in the hospital.
posted by valkyryn at 3:21 PM on March 24, 2013
Response by poster: Valkyryn, that's not quite accurate. In practice, heads of consulting teams, or heads of procedural services, in the USA are referred to as attendings in academic centers. You don't have to have primary care for the patient at all.
For example, if the board-certified neurologist who leads a consult team cosigns a note offering an opinion on a neurological question, he or she consigns it with [name], Attending Neurologist. Similarly if he decides to write a note him or herself.
Similarly, an interventional radiologist who cosigns a fellow's note will end with [name], Attending Radiologist.
posted by raspberry jam and clothes iron at 6:41 AM on March 25, 2013
For example, if the board-certified neurologist who leads a consult team cosigns a note offering an opinion on a neurological question, he or she consigns it with [name], Attending Neurologist. Similarly if he decides to write a note him or herself.
Similarly, an interventional radiologist who cosigns a fellow's note will end with [name], Attending Radiologist.
posted by raspberry jam and clothes iron at 6:41 AM on March 25, 2013
Here's a listing for Spanish, especialista is what I generally hear for consultant in English.
Specialist or consultant is FachArtz in German, HausArtz being the hospitalist and ChefArtz being the Head of a Department. In French the head is known as the Chef de Service. I have a feeling there's a European Union doc with all these but my Google fu is failing me!
posted by Wilder at 6:51 AM on March 25, 2013 [1 favorite]
Specialist or consultant is FachArtz in German, HausArtz being the hospitalist and ChefArtz being the Head of a Department. In French the head is known as the Chef de Service. I have a feeling there's a European Union doc with all these but my Google fu is failing me!
posted by Wilder at 6:51 AM on March 25, 2013 [1 favorite]
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House officer = Intern
Senior house officer / registrar = Resident
Senior registrar = Chief Resident
Consultant = Attending
Clinical fellow / sub specialty trainee = Fellow
posted by roofus at 8:05 AM on March 24, 2013