I was surprised that Fung et al (Psychiatric Bulletin, February 2007, 31, ) did not find non-availability of a National Training Number (NTN) to be a primary reason for entering staff grade and associate specialist grade (SAS) posts. I passed the MRCPsych part II in June 2006 following which there were no NTNs available locally. I was aware that a few candidates were applying before results came out and in retrospect I wish this is something I had pursued more actively. However, at that time I could not have known the intensity of competition for NTNs that would be precipitated by the approach of run-through training.

It was apparent that I would not secure a higher training post before the senior house officer rotation ended and therefore I applied for a staff grade post locally. Fung et al cite pay protection and additional clinical experience as the primary reasons for entering SAS posts. Although these are without doubt benefits of holding the post I did not see them as reason enough for postponement of higher training. I entered staff grade because I had no alternative.

My feeling from discussion with senior colleagues is that times have changed. Previously doctors would work as staff grades to accumulate additional clinical experience or for other reasons, and enter higher training when they felt ready to do so. With the introduction of Modernising Medical Careers (MMC) competition has become more intense and there is a general feeling that in future it will be much more difficult if not impossible to re-enter training from career grade posts.

Although I have been lucky enough to secure one of the last NTNs it required numerous applications, more than would have been allowed under MMC. I have certainly benefited from pay protection and additional clinical experience, however I could not cite these as reasons for entering the grade in the first place.