I read with sadness Dr Claire de Mortimer's letter (2 March) on the question: 'Does Maynard think that anyone can maintain quality of service after working solidly for 30 hours?' Ten years ago I left medicine feeling similar sentiments about a system that so abused its staff. It is truly a sadness that we continue to see junior doctors emerge so embittered by their experiences.

I went to work as an NHS manager and witnessed first-hand the priority given to junior doctors' working conditions by politicians and managers. I have seen serious investment in initiatives such as phlebotomists, nurse practitioners, electro-cardiogram technicians and mess facilities designed to make the doctor's life easier. I have also witnessed a reduction in hours, which at 72 a week are considerably better than the 92 hours I worked 11 years ago.

But what managers and politicians have been unable to change are the fundamental structures of medical careers themselves. These are set by the profession.

Junior doctors are still faced with limited career options, almost all requiring long working hours to meet training requirements.

There is limited scope for 'parttime' working or for extended contracts in the same grade. Junior doctors therefore still face the same dilemma - work the hours or leave the job.

Dr de Mortimer is absolutely right - junior doctors are critically important frontline staff. They are also the future of the health service and therefore a critical group to involve in new initiatives such as clinical governance.

But she is wrong to blame managers for the problems that junior doctors continue to face.

Managers and politicians can only work within the safe boundaries defined by the profession itself.

Perhaps it is those boundaries that need to be challenged.

Dr Lisa Rees Buxton