The posts of Registrar, Senior Registrar and the new unified Specialist Registrar grade make up the middle grade hospital medical staff.
Entry to the middle grades of Junior Hospital Doctor is now regulated by a strict quota system. It was recognised in the early 1970s that the medical career ladder had a significant bottle neck developing in it such that, without action, there would soon be large numbers of doctors who had completed their specialist training, but for whom Consultant Posts did not exist. It was felt that this would be detrimental to the morale of the profession and the well being of the public (see the Snow report). As a result, a committee named JPAC sits annually to decide on exactly how many Registrar and Senior Registrars there will be that year nationally in each of the various specialities. Thus, all Registrars and Senior Registrars are assigned a number, and no further middle grade appointments may be made unless a number becomes free (unless the doctor is from overseas, and not intending to settle in the UK).
In theory, this quota system was supposed to control matters while a 2% compound annual increase in Consultant numbers gradually relieved the need for it. It is a matter of considerable debate as to whether this expansion has taken place, and whether JPAC has done its job properly. Cynical Juniors argue that it is not in the Consultants' interest to expand Consultant numbers as this increases competition for their Private Practice Income, nor is it in their interest to decrease the numbers of Juniors, who do all the NHS work on behalf of the Consultants when they are busy in their Private Practice.
Middle Grade posts are usually of three year tenure, although there is commonly rotation between firms and sub-specialities within and between hospitals during this time. Further Royal College Examinations - usually of a more clinical bent than previously - are undertaken during this time. Because of the persistence of the bottle-neck, it is also becoming common (verging again on obligatory) to undertake some form of research work as a Registrar in order to further your chances of succeeding in an application for a Senior Registrar post.
Registrar and Senior Registrar hours of duty are notionally also no more than an average 72 hour week, but since there are relatively fewer of them it is probable that many are still on 83 hours or more. Most, if not all, are shielded from the front line of duty by virtue of having an SHO and/or a JHO working beneath them. Some of them even get to sleep!. Basic remuneration for these posts is £25920 rising annually to a maximum of £ 37775 after 9 years. The pay banding system applies as before, although generally SpR posts are in less lucrative pay bands as they get more sleep. Malpractice Insurance is still covered by the State.