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 )
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.