7-day NHS a huge pay cut for Trainee Doctors

I have spent most of my clinical years in medical school hanging around the wards and listening to doctors moan. They moan most about the NHS. Some common nuggets include: “Why are you here?” and “Get out whilst you can” and “Be a baker. You’ll be much happier.”

Cutting doctors’ pay would probably drown any remaining morale. Already, so many talk about leaving for Australia or Canada, the private sector or industry, for a wage several times their own. Taking at least one year out to work as a highly-paid locum in an exotic part of the world is already the plan for a good chunk of my graduating colleagues. Many will not return.

Much has been made about its impact on consultants, but the 7-day NHS proposals in England amount to little more than a huge pay cut for junior and trainee doctors. I’m not even working as a doctor yet (I start on “black Wednesday”, 5th August). I’m in Scotland, and therefore I am protected due to devolution. But I feel it is my duty as someone who is mildly in the public eye and entering the medical profession to talk about it.

I’m not opposed to the idea of a 7-day working week and the more efficient use of the resources we have. I do feel, however, that we’d need to implement it very slowly, wisely and, most importantly; train far more doctors and nurses than we have already. Almost all of us have rotas that mean we work at (or over) our 48-hour European Working Time Directive limit, including regular night shifts and weekends. We are spread as thin as we can be, and far thinner than most of us should be. This impacts patient care. This causes the headlines. It is not our fault.

Most people don’t know how doctors get paid, so it’s easy to claim in public that, under the new proposals, we’d get as much as a 19% increase to our basic wage. This is technically true. But very few doctors actually get paid this wage – because we get paid more for unsociable hours. We work a lot of these, as you can see on Twitter if you search #ImInWorkJeremy.

Our wages works like this. Trainee doctors earn a basic wage. In 2015, my very first year as a doctor, my basic wage will be £23,205. If I work only between the hours of 7am and 7pm, Monday to Friday, that’s how much I’ll take home, before deductions. Depending on how much I work outside those times (i.e. nights and weekends), I’ll get more.

For most of us, our pay-banding gives us around 1.5x our basic wage. This means that a newly qualified junior doctor, working both nights and weekends, might expect to earn £34,807. Which is great. I can’t bloody wait. But then again, it’s pretty much comparable to what someone in the tech or engineering industries might hope to earn should they get a place on a graduate programme. Considering the exhausting training, the cruel competition at every stage, the bloody hard work and the unsociable hours, the NHS is getting a pretty good deal from us.

Below is a picture of planned proposals of a 7-day NHS. Many thanks to Chris Smart for highlighting this and doing the maths on Facebook: (ref: https://www.facebook.com/chris.smart.355/posts/10153043919937473:1 )

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Of the scenarios listed under the new proposals, Scenario C+ works out best for most trainee doctors. Yay, we’d receive a 14.9% rise to our basic pay. And for every hour worked outside sociable hours, we’d get 50% on top of this new basic pay, or 33% on a Sunday. Compared to what we’re getting right now, we’d be getting 1.72x banding on nights, and 1.52x banding on Sundays. Which sounds kinda good, right?

Except then you realise that currently, we get the blanket 1.5x banding for every hour we work, irrespective of whether these hours are social or not. Under the new system, to maintain pay at the current levels, a junior doctor would have to work over 4 night shifts for every day shift.

Chris gives an example of a typical, if harsh, rota. Over an average 28-day period, an on-call registrar might expect to work 12 weekday shifts, 2 weekend shifts and 7 night shifts. In this time, working at or below 48 hours per week, they would currently earn 1.5x their basic pay. In the best-case scenario under the new proposals (Option C+), they would earn a mere 1.31x their current basic pay. This amounts to a 12.5% pay cut. Option A, including an increase to our basic wage of 19.1%, would amount to a 16% pay cut.

Many junior doctors working fewer nights than the above still get 1.5x banding. These will be harder hit. This is despite the reality, where many work far beyond the hours their rota states, because they aren’t contracted for enough time to get the job done. There are still a few jobs that are 1.8x banded, a level of pay achievable when there aren’t enough doctors to get even each person’s scheduled hours below the 48-hour European limit. These, the hardest working in the most stressful working environments, will be the very hardest hit under the new proposals.

Whenever doctors complain about their wages, it’s easy to point out how much they earn to begin with, before telling them to shut up and be grateful.

But we should all be grateful. If doctors weren’t publicly funded, wages would be several orders of magnitude higher. Doctors are not just highly trained and skilled, but carry huge responsibility on their shoulders. It is into their hands that we all, at our most vulnerable, place our lives. And that’s exactly why, if left to our own devices, we are prepared to pay so much for their services. That’s why doctors in the USA earn such mind-boggling amounts and why so many consultants are tempted into the private sector.

Which is where the NHS will be, too, if everyone who works in it is screwed out of a fair wage.

33 thoughts on “7-day NHS a huge pay cut for Trainee Doctors

  1. Thank you very much for your very clearly explained article on the 7-day NHS. As I am starting graduate medicine myself in September I have been struggling to understand all the different points of view that have been put across in the media, where personal bias and opinion are the main point of the story rather than the facts.
    Best of luck in the new job.

  2. I’m not a doctor but I work in the NHS – not in a clinical role – and I can tell you that the introduction of this would have far further reaching consequences than just ‘losing a few grads to Australia’. We are already stretched beyond belief on nursing staff let alone if we start to demoralise and demonise our medical teams.

    What I think pretty much everyone in Government is forgetting is *why* people like yourself have decided to train as doctors, and why my colleagues decided to train as nurses or therapists; why you choose working long night shifts and dealing with the often unachievable targets set by people who’ve never walked on NHS ground over a steady 9-5 job. It’s not for the respect from others, or feeling like you owe society something, and it sure as hell isn’t for the money! The NHS was set up on the core values that anyone who needs it can access quality medical care and that is being compromised.

    x

  3. Well written, I just hope someone does something to make the NHS better for everyone (not just patients but the staff too) before it’s too late and it falls into the hands of uncaring private companies.

    1. Really? Then why Have spent nearly every other weekend in hospital at work . There are certain services that don’t run at weekends, but the medical and nursing staff are not amongst them. To be fair most of the working population get Saturday and Sunday off, and get to be with their families, hospital workers frequently don’t. And it is hard to have any meaningful family life. Whilst I am very sorry about your mother, I missed the last Christmas my Mum was alive because I had to go to work on night shifts from Christmas Eve until New Year, and so didn’t get to spend it with her. Instead I was looking after other people’s mothers like yours, in the hope that at least they’d get to spend more years with their family.

    2. I would probably say ‘Don’t bother feeding the troll’ But just for the sake of possible non-medical people reading this:-

      Simple fact: If doctors don’t work weekends, your mother would not even be in a stroke ward because nobody would have diagnosed it. Your mother probably did receive a scan and early treatment as well ie.thrombolysis / aspirin if not contraindicated. Stroke nurses are not able to request scans nor prescribe medications. She would also have been reviewed by a stroke consultant on the same day if not the morning after. This is because all stroke units in the country provide this. If you have nothing useful to contribute, please don’t make yourself look like a fool.

  4. Genuine question (with no hidden agenda – I do think this stinks)… What is the suggestion that £34k is “comparable to what someone in the tech or engineering industries might hope to earn should they get a place on a graduate programme” or is *hope* the key word there?!

    1. A graduate job where you worked 13 hour days, night times, weekends, bank holidays and constantly faced criticism from people with no clue what your job entailed. I think you definitely would expect at least 34k (before tax and thousands of pounds in mandatory courses and memberships that are in no way subsidised by the employer as they would be in the private sector).

      1. Well said. I am a paediatrics trainee currently using my one week annual leave to study for an exam exam which has cost me £600! There is no support for mandatory exams. Not to mention the countless other subscriptions we have to pay for. After this week I’m starting 5 long days that’s 13 hours followed by 4 nights.
        Cutting salaries is offensive and completely unjust.

  5. This is a very well written article. I am a medical student in my penultimate year and have been so discouraged from working in the UK that i have decided to move to the USA when i graduate. I know the healthcare system is screwed up over there but at least doctors are treated better.

  6. To those not already too far gone into postgraduate medical training, I would suggest doing something else or doing medicine abroad.
    Chose two:
    UK
    Medicine
    A happy life

  7. Well written, what is not coming across as well is that the government are about to make it much more difficult to jump ship, the new contracts move the certificate of good standing to an st3 level, which means that when I graduate in a year my colleges and I will have this contract forced on us and without a get out clause for 5 years. The pay cuts are bad but why are the medical schools, the BMA and the media so quite on the subject?
    To David, I am sorry to hear a doctor wasn’t around for your mother but I have had a job in A+E for over three years (and have worked Christmas Day to boot) and I can assure you there isn’t an hour of the day at least one senior consultant isn’t available on the shop floor. There are numerous doctors working at weekends and as the FOI request showed only one consultant in the country has opted out of working weekends.
    What’s needed is a voice in healthcare, someone who speaks for us at a public level, someone that is a face to this!

  8. Am i correct in thinking that any change in contracts will have to go through the Commons and the Lords before it can be implemented? If so is it not essential to petition your local MP to try and block the passing of the bill?

  9. The fact is, having doctors work a 7 day week without a full social work, physiotherapy and community support team and pharmacy will not improve the efficiency of the system. The system currently works as safely and efficiently as it can given the level of multidisciplinary staffing. Sounds like a certain party is trying to destroy the NHS and is doing a good job at it.

  10. Sorry but a Texh/Engineering grad salary won’t ever be £34K base pre-tax- more like £27K. The salary is also often that high (£27K) because engineers are highly daughter after for their specific skills and expertise. Unfortunately there are actually loads of medics graduating each year but not enough money to go around.

    £24k base salary for 48 hour weeks is a great salary. Compare this to a trainee barrister who would get £15k for 80 hour weeks with a fraction of the chance of actually getting a permanent position after completion of training and you should be laughing. And don’t argue you do more valuable work, a barrister is extremely valuable when required as they protect your rights, assets and livelihood! (I’m not a lawyer I work in academic clinical research.)

    I don’t agree with the cuts that are being made in the NHS and I’m sorry that junior doctors are being hit I’ve already signed a number of petitions regarding this. But let’s not forget times are getting tough for everyone in this country! Many of these arguments being put forward just sound like their from privately educated children of upper middle class families who finally realised medicine often doesn’t actually pay that well and that actually working for money is damn hard.

    Maybe try concentrate on doing the extremely exciting and rewarding work you get to do and less on trying to get your starting salary as close as you can to and over the £30k mark.

    1. A junior doctor makes life changing decisions. They also include anyone under consultant level so people who have trained 10 years. Constant criticism, working well over rota hrs and paying around ( this is me) £700 a month for insurance. My last exams were £2000 an exam. Can I add I’m still £10000 in debt following uni, and no I was from a working class family who went to a normal school and worked my ass off ( which at times made me Ill) to do the job because I care about what I do. I’m no longer a junior but they deserve every penny.

  11. I have three sons, one just qualified as a doctor and earned almost the exactly the same in his first year as his younger brother who got a maths degree and went to work for a statistical software company. The Maths graduate is now probably earning £5-10K more per year in his second year.

  12. My daughter and her partner are junior doctors. They were not privately educated, nor do they have wealthy parents. They earn every bit of their income working long and unsocial hours.

  13. Interesting that you are protected by being part of a devolved health care system and yet you exhorted others to vote “no” to independence for Scotland.

    D’you still feel “Better Together” ProudScotBut?

    1. maybe he’ll cross the border to work in the english NHS to show his solidarity, working on a british contract with the british government and not the distasteful nats in edinburgh and their small contract -finally he does OWE it to the people of england who carry you, and to whom your eternally grateful for that, dont you jamie?

  14. Well James you voted No after lying through your teeth about the fabulousness of Better Together and all that bollocks and now you are whinging despite working for NHS SCOTLAND that is not being dismantled like NHS England by your Britnat Tory pals. You really are a total embarrassment to yourself and Scotland. What a tosser.

    1. Did you come here from Wings too Clive? Bit harsh on the wee man there, although I sympathise with your point of view. Hope you’re not too taken aback by all the rabid snarling cybernats your about to see James. Maybe some public repudiation of that Better Together BS would help…

  15. Well the simple solution is NOT to give a pay rise to junior doctors, that way the junior doctors can just start worrking the new shifts and get no change to remuneration. SIMPLES – even for a junior doctor!

  16. Would Drs prefer to works max of 48hrs or not?( the system may not like it) but I’m not seeing Drs pleased to see the max hours reduced? Is this not better for Drs?

  17. When I worked for the waterboard (AWA) I was expected to work 24 hours a day on occasions for 2 days in a row for basic and on call 7 days every three weeks. All this for a basic salary of £19,000 per year. And out in all weathers as well.

  18. I have to disagree. Why shouldnt doctors work weekends? Majority of jobs people work nights and weekends, in both public and private sectors. Why should doctors be exempt and have their weekends free? They should be working weekends as nhs 24 hour care not monday-friday. Ridiculous commenting by some of the doctors here. The ones who swan off to exotic locations r obviously money focused n want the glamorous lifestyles. U knew before doing ur degree how much a doctor earns and how tough the job it is. U should also know the nhs is for the people, not for doctors to fund their private jets. Maybe u should have picked a 9-5 admin job.

    1. Mary your comment is utterly stupid. Nobody is talking about not working weekends. We are talking about not getting a paycut for working weekends. And probably no point making this some kind of class war issue. If you think the government will stop at the doctors ….nurses physios radiographers will be next and will be easy fodder for them. The juniors are doing the fighting for everyone else here. Look at the bigger picture Mary and at least learn how to read (the facts) before you post such uncontrolled drivel.

    2. Mary, go and visit your local hospital, Doctors already work weekends. They are there for all to see on a Saturday and Sunday and every single day in between. You really need to think a bit before posting drivel straight from the Daily Mail. They work weekends Mary, Jeremy Hunt the Health minister wrote a book about how best to dismantle the NHS and he is now the Health Minister. People like you help him, if you believe the rubbish he spouts and do you honestly think that Doctors would earn LESS if the NHS was dismantled, because I don’t they will earn far more. Never be on the side of the Tories, Mary they are out for big business and their own back pocket, look at the nonsense that was spouted that millions of pounds would be diverted to the NHS if we left the EU and now no one wants to take ownership of that comment.

  19. Mary you are afrigging idiot. You clearly believe the daily mail, think Boris would have made a fine PM, think Jeremy Hunt really cares about you and your health as opposed to trying to find his next job and screw the NHS into private hands. Idiots like you allow the Tories to carry on their BS rhetoric all whilst avoiding tax themselves and paying themselves and their banking and corporate chums billions out of the tax payer coffers. No money to pay?! Don’t talk shit, they had billions automatically to plug into the banking system the day after British morons voted Brexit. I would say what do you see at weekends and nights at hospitals and who do you think runs the medical services at night if not doctors, but you’re clearly already brain dead so I won’t bother.

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