When you visit a hospital with your child, you are likely to be introduced to a doctor. Then another…and maybe another. Perhaps you’re in a room with your child and a cluster of five  people in white coats come in and you’re thinking, ‘Who are they, and who is in charge?!’

It may be that you understand who’s who in the pecking order, or it may be that – like many of us – you’re left baffled and wondering who you’re actually speaking to and what their responsibilities are.

Here is a list of UK doctors’ ranking, listed from the lowest down the ladder up to the highest. The aim is to give you an idea of how experienced the doctor you are dealing with actually is.


You are likely to come across plenty of these – doctors who have done their five years at medical school and are now embarking on their two year foundation doctor training or its subsequent specialty registrar training. They are always answerable to a consultant.

Foundation doctor

This is the lowest level of doctor in the hierarchy. A foundation doctor is a a newly-qualified medical practitioner in the UK who is undertaking the Foundation Programme. This is a two-year general postgraduate medical training programme which is the link between medical school and specialist or general practice training which comes next. The General Medical Council (GMC) describes them as ‘provisionally registered doctors with a licence to practise’. The foundation doctor grade replaces the traditional grades of ‘house officer’ and ‘senior house officer’. This happened from 2005 onwards so you won’t hear these terms being used any more. As this is a two-year programme, foundation doctors are either known as FY1s (foundation year 1) or FY2s (foundation year 2). FY2s sometimes refer to themselves as SHOs or senior house officers.

If you meet an FY1 or FY2 they are likely to be on one of their four-month placements, with the FY2 having more responsibility for patient care.

What are they called?

The title of an FY1 and and FY2 is ‘doctor’.

Specialty Registrar

Immediately after FY1 and FY2, doctors start a minimum of six years of training as a specialty registrar (formerly known as specialist registrar). Only when they have completed this training and been placed on the GMC’s Specialist Register can they go on to the next stage and be appointed a consultant in the NHS. As well as speciality registrars in a hospital specialty (StR), there are also specialty registrars in general practice (GPST) – a minimum three-year position.

What are they called?

The title of a specialty registrar (either in hospital or in general practice) is ‘doctor’.

Middle-grade doctors

There are a number of different ‘middle-grade’ doctors working in the NHS with a range of confusing titles. Many of these titles were conferred, or given, before 2008 when changes were made to NHS structure. The important thing to know is that they are all qualified to make medical decisions but are ultimately answerable to consultants.

Staff grade doctor

A staff grade doctor is one who has a permanent position as a middle-grade doctor. They work under the consultant and must have had at least six years experience in a specialty. This grade was closed to entrants in 2008 although some staff grade doctor positions still exist (in other words, you may still come across doctors with this title in hospitals). Although they are able to carry out a number of duties including doing ward rounds for inpatients, reviewing emergency referrals and even carrying out emergency operations when on call, all their work is done in the name of a consultant in whom they are answerable and they are duty-bound to ask for help or advice if they feel it is needed.

Although some staff grade doctor positions still exist (in other words, you may still come across them in hospitals), the grade itself hasn’t had any new entrants since 2008. Many who were in this grade moved to the ‘Specialty Doctor’ grade instead.

What are they called?

The title of a staff grade doctor is ‘doctor’.

Specialty doctors

This grade of doctor was introduced in 2008 and is the name given to doctors who used to be called trust grade, clinical medical officer, hospital practitioner, clinical fellow and clinical assistant. These are all middle ranking doctor positions which are post-training but not as high as consultant. Not to be confused with specialty registrar.

What are they called?

The title of these various types of specialty doctors is ‘doctor’.

Associate specialist doctor

This is a doctor who is appointed to a permanent position in the middle ranks of the doctor hierarchy. This grade was closed to new entrants from 2008 so any associate specialist doctors you meet will have been given the rank and title before then.The rank is the highest that a doctor not seeking to become a consultant could achieve and will probably have been conferred upon them after spending several years as a staff grade doctor. Doctors with this title are highest in rank after consultants – the rank is the highest a doctor not seeking to be made a consultant may achieve.

What are they called?

The title of an associate specialist doctor is ‘doctor’


A consultant is a senior physician/doctor who has completed all of their specialist training and has been placed on the Specialist Register in their chosen speciality. Consultants are in a position of great responsibility, typically leading a ‘firm’ (a team) of doctors comprising speciality registrars and foundation doctors, all of whom are training to work in the consultant’s specialty.

They may also have other ‘career grade’ or middle-grade doctors on their team, such as clinical assistants, clinical fellows, specialty doctors (including clinical assistants and clinical fellows), associate specialists and staff grade doctors, all of whom are lower down the hierarchy than consultants. Consultants also have various other key roles in the hospitals and in the wider NHS. Virtually all consultants in the UK are employed by the NHS.

What are they called?

If they are a surgeon, the title of a consultant is Mr, Mrs, Ms or Professor.

If they are a physician (i.e. non-surgeon) then their title is doctor/Dr.