Why protecting medical expertise matters for patients
Ever increasing numbers of patients living with frailty and multiple long-term health conditions need doctors who can manage complexity across specialties and care settings. At the same time, they need specialists with the procedural, diagnostic and therapeutic expertise required to provide advanced care. Too often these are presented as competing priorities, but they are not.
Generalism is not the absence of specialisation. It is a specialist skill in its own right that requires doctors to synthesise information, manage risk, coordinate care and make holistic decisions in increasingly complex healthcare environments.
At the same time, specialist expertise remains essential, and as medicine becomes more sophisticated, procedural and specialty training opportunities become more important, not less. That is why Training physicians for the future calls for protected procedural training, including ringfenced training lists, immersive learning opportunities and dedicated training blocks. It argues that educational requirements should be determined by patient need and curriculum objectives, not by workforce shortages.
The new RCP report also highlights the importance of clinical judgement and risk-holding. These are among the most important capabilities physicians develop. They allow doctors to make decisions when there is uncertainty, lead multidisciplinary teams and take responsibility for complex patient pathways. We believe these skills should be recognised explicitly as core educational objectives and developed through supervised practice, graduated responsibility and real-world clinical experience.
Protecting expertise also means supporting the transition to consultant practice. Training should produce doctors who are not simply competent practitioners but confident decision-makers. That requires opportunities to develop leadership, governance and educational skills alongside clinical expertise. It also requires mentorship and protected time to consolidate specialist skills before independent practice.
Ultimately, the question is not whether patients value expertise. The question is whether the NHS is willing to protect the training opportunities needed to create it. If we want future physicians who can manage complexity, hold clinical risk, lead teams and deliver safe specialist care, we must protect and continue to develop the educational experiences that help to realise those capabilities.
Dr Max Thoburn is the RCP RDC deputy chair and representative for the West Midlands and a member of the writing group that developed Training physicians for the future. He works as a registrar in infectious diseases and general internal medicine in the West Midlands.
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