Related to the previous trend: My impression is that the British-style physician system (I know first hand the systems in UK and Ireland, and I've read about the US) is too hierarchical. Too many ranks, too much work and responsability burden in lower ranks (and pointless work*), and too much fear of bothering the immediately-above rank. For what I've read the US system is, if anything, LESS guilty of all of this than thé Isles, as it seems to be more straightforward regarding the endgame, and attendings/consultants have more direct oversight over junior doctors, which is a critical point. Even then for what I hear of people's experiences many of the hierarchical problems remain. The ladder dillutes responsability, reduces oversight, and all too often results in people not doing something because someone else in the ladder (higher OR lower) will take care of it
My personal opinion is that the system would be served better if, instead of relying so much on juniors/NCHDs, those functions were more evenly shared with more CNSs and possibly more CNS roles and a hospitalist/internist/"hospital GP" class which would have direct oversight over the patients and would liason with specialists, but wouldn't really be lower on the power ladder , and hopefully they'd work shorter shifts. These things already exist to an extent so it shouldn't be hard to just boost them .
*with pointless work I mean: I've noticed that juniors tend to waste loads of time doing stuff that really should be being done by the nursing staff. I find it particularily egregious that trainees are spending a significant amount of time doing phlebotomies, and I feel this is bad for junior docs, nurses, and patients.