Re: relieved yet annoyed with registrar
Terri, we have a different system here in the UK.
Doctors come out of med school and take jobs for 6 months at a time as house doctors. They're the donkeys of the NHS, on call about 4 nights out of 7 and do all sorts of general stuff like admitting patients, doing general rounds making sure patients are ok and signing up any routine tests and scripts the nurses need.
Then, when they've done about 4 years of house jobs, they get senior house jobs where they can help in theatre and clinics and make some decisions. After another 2 years or so of that, they'll choose their speciality (medicine or surgery) and do the appropriate post-grad training. For orthos, this means doing their FRCS, Fellow of the Royal College of Surgeons. No doctor can do surgery of any kind without that.
Then they'll go on to do some junior registrar jobs there they can be first assistant to the seniors and be in a training, supervisory and advisory role to the house doctors. If the senior registrar is absent for weekends or a week, he can stand in for him. He doesn't operate much unsupervised yet. This period varies depending upon how ambitious or driven the man is. It's usually a minimum of 2 years but can be as long as 6 years.
Then he'll go on to do his speciality training on an Orthopaedic rotation courses when he becomes a Senior Registrar. These last for 5 years and involve them spending 6 or 12 months at a time at different hospitals, working at centres of excellence with very experienced surgeons. One such course is run by the RNOH and involves about 6 other hospitals. Whilst they're doing this course, they will begin taking more and more responsibility over patients' treatment but always under the guidance of the consultant. Towards the end, they will be having their own operating lists and start doing joint replacements and other procedures on their own. They must also undertake research and write several papers for the professional journals, in this case especially the Journal of Bone and Joint Surgery. They also need to offer papers to conferences and symposia and present them. The more they do, the better their credentials and this will stand them in good stead and they will have become known around the very small orthopaedic world and have a ready 'in' when they come to apply for posts. At this point, they are consultants in waiting.
Then they get posts as consultants at hospitals all around the UK. They have their own specialty, their own bed allocation and clinics and take their turn being on call for all the trauma intake for the whole week at their base hospital. Generally, such jobs are for life. We don't often get consultants moving from job to job unless they're really bad!
A consultant in a large hospital like the RNOH may actually be in a team like the Department of Joint Reconstruction at the RNOH. In this case they will have additional positions like lecturers and Clinical consultants. There will be a Professor in over-all charge.
Patients are generally referred to consultants by their GPs and have to wait to get an appointment. Mostly the practice is that new patients are seen by the consultants and follow-ups are seen by the registrars. This seems to be otherwise at the RNOH because when I went there, also expecting to see the Prof, I was seen by the registrar who pronounced that there was nothing wrong with my knee and it was perfectly normal! I saw the xrays he was looking at and that the depression on the medial tibial condyle was gone! I was so delighted (miracle healing, don't y'know!) that I requested a copy of the films only to find - these were not the ones we'd been looking at in the clinic! They weren't even my xrays!
Also, consultants work in the NHS on a 'part-time' basis nominated as 7/10ths of a week, thus getting 7/10ths of the full time salary. The remaining time they can use to have a private practice! If a consultant is employed on a full-time basis, he is not permitted to have a private practice! But IMO, we get the best of both worlds because if they were forced to choose, the best surgeons would opt for private medicine and be lost to the NHS.
Another oddity is that all surgeons in the UK are called Mr! This came from the very old times in 18/19th centuries when surgery was done by barbers. "real" doctors wouldn't lower themselves to do surgery and jealously guarded their doctor title. Surgery was thus considered 'fringe' medicine. It was in the early 20th century that they were finally admitted into the hallowed halls of medicine and as a mark of their difference, retained their appellation of "Mr"! In fact, a UK surgeon would be highly insulted to be called Doctor! This is why I sometimes get confused when you Americans talk about seeing your 'doctors' as to me, that indicates your GP, not your surgeon!