doctors on strike

From next year we’re going to be paying MPs £74,000 a year (currently £67k), plus expenses for food, travel and second homes, whilst they also have enough spare time for second jobs such as regular column writing and consultancy work. The argument for this is that it’s a very important job that wants to attract the best, an argument which strangely doesn’t apply to other areas of public service, such as the NHS or the education system.

I’d argue that looking after the health of other human beings is not just important, but vital, whether that’s nurses, doctors or surgeons. Cock up as an MP and you get lambasted by the papers, have the mickey taken on Have I Hot News for You, and maybe, just maybe, you’ll lose your job. Cock up as a doctor, and you’re risking other people’s health and possibly their lives.

A doctor requires years of study and training, and will continue to have to learn and adapt throughout their career. An MP has to basically win a couple of popularity contests. An overworked, tired doctor can make mistakes that costs lives. An overworked, tired MP nods off on the cushioned benches of parliament.

I’m thinking that if there are savings that need to be made, we’re looking in the wrong place.

Decent summary here:

I think you need to get your basic definitions sorted,tbh..

OVERTIME – as a junior doctor, this would be time over and above your scheduled hours. I.e.your shift finished at 8am, but you take part in the ward round/continue looking after a sick patient. You WOULDN’T get paid a penny for this. Frequently doctors try claiming for the overtime by managers manage to get out of it.

UNSOCIAL HOURS – This is what the deal refers to. Your Rota will include day work, night work, evening work, weekend work. It’s the nights and evenings (you know, un social times, that attract extra pay above and beyond the basic pay. Often 40% more.
This is what’s going…

DrP

And the other definition that confuses people:

JUNIOR DOCTOR – isn’t just a spotty-faced new graduate or a “petulant teenager”. It’s all doctors until they reach Consultant level. My wife is a 40 year old mother of two. She is a Junior Doctor and has been for fifteen years.

How many hours do junior doctors work? Is it the 48 that is in the headlines or is it way more than that?

Are GPs junior doctors? Given that they’ve completed their training.

Standard full time posts are 48 hours a week – which in reality usually means 50-60.

Are GPs junior doctors? Given that they’ve completed their training.

No, they are General Practitioner that means no longer a Junior.

Wanmakylung – full time is 48 hours but that’s an average over six month rota. Currently it’s up to 91 hours a week officially but often 100 for week of nights, days off elsewhere then bring average down,

Many jobs are over 48 hours on average but the only way to reduce that is more time off in daytime hours which no one wants as impacts on training.

One of key issues is nights/weekends etc need minimal levels of cover and cannot be cut.

We probably need to change the way we deliver some stuff – lots of stuff that is done by a doctor does not need a doctor to do it of that makes sense,

GPs are not juniors. Shortest route to being a GP is five years post med school. Some specialties nearer fifteen years post medschool hence you can be a junior doctor for a lot time depending on career route.

Junior just means not consultant or GP.

Sorry yes, I should probably have said “all hospital doctors until they reach Consultant level”.
GPs have a different path.

Some specialties nearer fifteen years post medschool hence you can be a junior doctor for a lot time depending on career route.

And longer when you factor in maternity/paternity leave and/or less-than-full-time working.

See if I was asked to do 90 or 100hrs in a week i would cease to function. i cannot see how it can be in the best interests of patients for them to be looked after by people in that state. You could not pay me enough to put myself in a position where I knew that my mistakes could cost someone their life and that I had to make those decisions while exhausted.

The other definition that people should know is what we get our ‘banding’ for. This is the “extra” 40% over the basic rate. It is not just because our hours are antisocial.

So when you’re fresh out of medical school, you’re paid £22,636/yr* (gross, of course) for working a 37.5hr week. I think we can all agree this is a pretty low wage for someone who’s spent such a long time in education. Some jobs will just have basic rate and no out-of-hours commitments (on calls). I.e. they’re unbanded so that wage is what you get. Most new doctors will do three four-month rotations in their first year, and usually not more than one of these rotations will be unbanded. Many doctors doing these jobs will of course stay later to help out and not get paid a jot for this – much like in any other 9-5 career. Of course, there is all of the other career progression / continuing professional development stuff which is quite burdensome and done outside of these hours, plus most people I know will spend yet more time reading / learning.

For rotations involving weekends, evenings, nights you get paid more. Your hours are increased to 48hrs/wk (a 28% increase over a standard 37.5 hr working week) and you get paid (a bit) more because these hours are antisocial, so your pay packet increases by 40%. As you can see, most of that extra comes from just working more salaried hours.

Regarding antisocial hours: My wife and I are both doctors, and we will each work on average 1 weekend in 4 or 5, though these weekends are rarely ‘in sync’. Organising any social event at the weekend involves lots of planning because weekend where we’re both free are a luxury. Worse still is when she’s on “long days” (09.00-21.30 or similar) and I’m on nights (21.00 – 09.00). In those situations we don’t see each other for a week. Don’t tell me that’s not antisocial. If I could drop all my on calls, have a basic salary and keep my evenings / weekends free, I’d do that in a heartbeat. Contrary to what Ceremy says, this is never an option. I’ve never met a doctor who could opt out in that way.

I haven’t really written about the effect that the new contracts are likely to have on patient care…

Anyway, I don’t mean to rant. I love my job and I get great satisfaction out of doing something tangibly worthwhile. But new contracts imposed from the top that amount to a complete lack of respect for one of the most educated, hardworking and selfless groups of people is a disgrace.

*NHS Doctors’ payscales are published and easily found online. This is the starting figure for 2015/16.

So new grad drs are paid the same as a physio/nurse/OT/SALT etc who has been in post for 6 months or so. That surprises me.

Like!

Correct. Nurse practitioner posts often better paid too than many more ‘senior’ junior docs of you look at pay for mon to fri hours

That surprises me

And then you get nurse specialist who are the flavour of the month. They replace middle tear doctors, earn about £45-50k. They are great at specific tasks, but do not have the rounded understand that docs do, just hope you don’t have a complication, or a history that doesn’t fit the norm

Doctors cost more for a reason

That’s slightly patronising FunkyDunc. The Nurse Specialists I’ve met certainly don’t struggle with such things, they tend to have a vast amount of experience before getting to that level.

If you’re after a hate figure then look at some of the advertisements for “physicians’ assistants” – a non-doctor role with similar responsibilities to junior docs, except they get paid £48k after a couple of years of subsidised training.

But these people, and nurse practitioners mentioned above, are not the enemy here. Don’t get caught up in squabbles that detract from the bigger picture.

To avoid misunderstanding I would agree nurse practitioners are excellent,

They earn equal and in some cases more than the ‘junior’ docs who may often have to give advice in some roles – just trying to make the point that juniors (I.e. All non consultant docs) are fantastic value for money when you compare pay for mon-fri for other groups.

That said there is no doubt that cutting pay of all other NHS staff will be the next target.

Unfortunately I feel this situation will just be the first of many to come. The NHS is struggling for many reasons:
– A population living longer than ever before.
– People living longer with chronic conditions than they ever have
– The availability of more complex, and hence expensive, treatments.
– Increased demands on social care – and when they fail to meet the needs, the NHS tends to pick up the slack
– A more demanding patient population than ever before.

While this may have impacted the ability of the NHS to carry out certain functions, such as elective surgeries/clinics/GP care etc – it’s ability to treat the acutely unwell patient remains unrivalled – possibly anywhere in the world, and certainly anywhere that has a free at the point of care health system. However, how long this can continue remains to be seen.

I’m not entirely convinced the NHS can continue to exist in it’s current form, as it simply cannot without massive increases in financial investment. However, this government do not seem to be in the slightest bit interested in preserving it in any form. The government claim their current actions are about allowing trusts to maintain a 7-day a week service and removing financial penalties for rostering doctors out-of-hours – but if they roster more doctors to work out of hours – who does the jobs they were doing during routine hours?!?!

Sadly I can’t see any other explanation other than the government attempting to set up the NHS to fail, and fail spectacularly. Private health-care systems are set up to make a profit – not provide the patient with the best care. Elective work, clinics etc are far more profitable than acute services – so I wonder which will become the priority?

I’m not going to get into the “are they paid enough” debate, as although that’s what the current argument surrounds I think there are far bigger issues at play. All I’ll say is that if we end up in a private system – I can assure you the pay will only go one way!!

I’m a junior doctor. I love my job. I think the NHS is one of the gems this country has, and I’m not willing to let this government run it to the ground without a fight!

E

That said there is no doubt that cutting pay of all other NHS staff will be the next target.

They’re coming after the unsocial hours pay.

Jeremy Hunt was co-author of a book called Direct Democracy: An Agenda for a New Model Party.

If you were in any doubt of his intentions then these extracts may help:

“We should fund patients, either through the tax system or by way of universal insurance, to purchase health care from the provider of their choice. The poor and unemployed would have their contributions supplemented or paid for by the state.”
…
“Our ambition should be to break down the barriers between private and public provision, in effect denationalising the provision of health care in Britain.”
…
“Instead of tinkering with a fundamentally broken machine, it (the Conservative Party) should offer to update the model.”

Nice link. Didn’t know that. U.S. Style healthcare would be a disaster.

Equally current NHS format either needs more money or less services as it is not sustainable.

Guess the question is is any politician prepared to stand up and have that difficult conversation….

Like this you mean?

http://www.theguardian.com/commentisfree/2015/oct/17/junior-doctor-nhs-jeremy-hunt

But new contracts imposed from the top that amount to a complete lack of respect for one of the most educated, hardworking and selfless groups of people is a disgrace.

your pay for someone fresh out of uni is pretty standard – it goes up a lot quicker and higher afterwards.

p.s you forgot to add god complex and arrogant to the end of your sentance above 😉

Our starting graduate average salary is £23,285, higher than a doctor’s starting salary. This despite being a 3/4 year undergrad base rather than the longer doctoral qualification.

Yes but the average “salary” for the junior doctos is only part of a remuneration package that typically includes an additional 30-50% of supplements and allowances on top of the salary, and a pension scheme that would equate to an employer contribution of around 25%. So the average junior doctor actually earns twice what the average graduate makes in salary. That’s not to say this is wrong, more that a sensible discussion should at least include relevant facts.

The BMA have consistently made their comparisons on base salary alone which says a lot about the level of integrity and ethics behind the current “campaign” which is precisely why they’ve refused to even discuss it with the dept of health since June.

I mention it just because people keep pointing at starting grad salaries; but

just5minutes – Member

So the average junior doctor actually earns twice what the average graduate makes in salary.

But the average junior doctor is working longer and more unsociable hours than the average graduate, and has spent longer in higher education, making them both more qualified and more in debt and with a shorter overall career earning period. (a fairer comparison is with postgrads tbh but even then it’s uneven)

just5minutes – correct but the allowance is only if working 48 hours, and weekends/nights/evenings but yes fair comment

So the average junior doctor actually earns twice what the average graduate makes in salary. That’s not to say this is wrong, more that a sensible discussion should at least include relevant facts.

Indeed. Where are your facts though? Where do you get this from?

Average uk graduate starting salary is £28k according to this (http://www.bbc.co.uk/news/education-34186954). A fully banded FY1 doctor will earn slightly more than this (c£29k) after banding for all the antisocial hours etc. Bear in mind that the average doesn’t take into account whether you’re a straight A at A level student doing 5-6years at a decent Russell group university or whether you did some non-subject at the University of Nowheresville.

If you’re going to spout the need to check facts, please check your own.

Don’t misinterpret me, though. I’m not saying we deserve to be better-paid. I’m just saying that the perceptions of our pay are (mostly) overestimated and a further cut (over the 25% cut we’ve seen since 2008) is insulting.

The BMA have consistently made their comparisons on base salary alone which says a lot about the level of integrity and ethics behind the current “campaign” which is precisely why they’ve refused to even discuss it with the dept of health since June.

Your posts read like press releases from the govts PR department

Your posts are not impartial statements of facts either they are highly selective to further your agenda and then you have the nerve to criticise them for the same thing

you are an irony and self awareness free zone

just5minutes
The BMA have consistently made their comparisons on base salary alone which says a lot about the level of integrity and ethics behind the current “campaign” which is precisely why they’ve refused to even discuss it with the dept of health since June.

10 reasons why the BMA are not entering re-negotiations

The Government has told us that they want to introduce the new contract for the August 2016 intake, and that they are prepared to impose it if no agreement can be found. The BMA cannot be held to ransom with threats of imposition – if we go back to a pseudo-negotiation we are being defeated. A return to talks under these terms is not compatible with upholding the integrity of the profession or the BMA.

want to introduce the new contract for the August 2016 intake,

Hang on, so it only applies to NEW entrants?

These arguments are going round and round in circles! We have been very clear what a first year Doctor earns before and after banding throughout this thread. The reason that the before banding salary is relevant is because its the only directly applicable thing to what other graduates earn. Do you think if other graduates regularly worked the weekend and nights they would be content with putting it down as overtime and doing it for the basic salary?

ninfan – government said they would impose on all. Not just new starters.

Yes but the average “salary” for the junior doctos is only part of a remuneration package that typically includes an additional 30-50% of supplements and allowances on top of the salary
…
The BMA have consistently made their comparisons on base salary alone which says a lot about the level of integrity and ethics behind the current “campaign”…

I don’t think that’s true at all.

The BMA’s main objection regards the changes to those “30-50% of supplements and allowances” which come from the unsociable hours bandings.

They’ve been pretty clear about that.

May be the Doctors/BMA should pose this question to Mr Jeremy Hunt, to use the words of Robin Day.

“But why should the public, on this issue, as regards the future of the NHS, believe you, a transient, here-today and, if I may say so, gone-tomorrow politician”

Painful as it is for me to say it.

I agree with Junkyard. You’re a real parody of the government propaganda just5minutes spouting bullet points you have no idea about.

We should stand with them – and against the liar Hunt (who denied suppressing the news on most Health Trusts being in the red until after the Tory conference, although it is clear that this is what happened.)

All in the interests of fragmenting the NHS and letting his nasty corporate friends in to really screw things up (as they undoubtedly will.)

But FunkyDunc – I agree with Drac, you underestimate nurse specialists and practitioners, who in my area (neuro) are much needed and in some cases better and certainly more accessible than consultants. But also, if we fight and blame each other, we are allowing Hunt a way in. Together we are stronger.

Re nurse specialist, sorry I wasn’t trying to belittle them. It is however an odd government agenda to reduce doctor numbers, but increase these type of nursing post, which cost slightly less than a doctor, but further reduce the pool of more ‘middle’ doctors.

Once a doctors post gets taken away, you don’t get it back. ( This is direct experience of an ED department )