I recall Michael Moore interviewing a UK physician in his "documentary" Sicko, and using the UK physician as a representative example that doctors do quite well under (in Moore's words) a "state control[led]" health care system - i.e. the UK's National Health Service (NHS):
Similarly, Danny Boyle included in the 2012 London Olympics a tremendous tribute to the UK's NHS:
But what do UK physicians who have worked or work in the NHS think about the NHS today? How fares the much lauded "state control[led]" NHS?
A report commissioned by the Department of Health found the number of young doctors set to qualify as top-level consultants could increase by as much as 60 per cent.
This, it predicted, would take number of consultants to more than 60,000 by 2020, without guaranteed suitable jobs for all of them to move into.
The study, by the Centre for Workforce Intelligence, revealed NHS England’s salary bill would rise by £2.2bn before inflation if the future doctors were paid at the same rate as those currently.
The service is already attempting to meet a £40bn savings target, prompting suggestions new consultants could be asked take roles with lower salaries.
Specialist recruitment agencies and GPs’ leaders say doctors, many of whom have just finished their training, are becoming disillusioned with the state of their profession and seeking fresh starts in countries such as Australia, where they can earn double what they are paid in Britain. Figures given to the Observer by the General Medical Council show that an average of 2,852 certificates enabling British doctors to work abroad were issued annually between 2008 and 2014 – a total of 19,522.
...He added that a number of factors were prompting British doctors to consider moving abroad. One was anger at the overly bureaucratic revalidation process, in which all doctors regularly undergo a series of checks so that they can retain their licence to practise.
Another was the issue of medical indemnity insurance, which Hazel said costs between six and 12 times more in the UK for a GP than in Australia. “While this cost is ‘covered’ by the NHS for salaried GPs, freelance GPs would need to cover this themselves,” Hazel explained. “A full-time GP can expect to pay between £5,000 to £12,000 for insurance, whereas in Australia they would pay under A$2,000 (£1,000). And the Australian insurance policy covers much more in terms of procedures than a UK policy.”
...Changes to the way in which British GPs will be expected to work is another push factor. “I have 40 positions in all the major capital cities in Australia for GPs, all earning around £160,000 with no out-of-hours work,” Hazel said. “The NHS offers a salaried GP around £80,000.”
...“GPs face increasingly challenging and stressful work environments, due to a combination of increasing demand and falling resources,” said Dr Richard Vautrey, deputy chair of the British Medical Association’s GP committee. “The result has been fewer junior doctors choosing general practice as a career, more senior GPs choosing to retire early and more doctors choosing to work abroad.” This has contributed to a workforce crisis and means existing doctors are struggling to meet the needs of the rising number of patients walking through their surgery doors. To stem this problem we urgently need to address issues around workload pressures, resourcing and work-life balance.”
...“In my practice we feel we are stuck in a hamster wheel. I see around 50 or 60 people a day on my on-call day. It’s very difficult to do that in a sustained fashion without getting really fatigued. I don’t want to be a tired and grumpy doctor. I want to be the kind of doctor who enjoys what they are doing, but sometimes you can’t do that because you’re too tired.
...“The workload is going up at a rate of knots. We have 8,000 patients at our practice. We used to do 24,000 consultancies a year; now it’s 50,000. Once, if you had a cold, a family member would give you advice. Now people don’t know who to ask, don’t seem to be resilient enough to cope themselves.
Junior doctors’ pay has fallen in real terms by 25 per cent since 2009...
Of course it’s about money. Are you telling me my services as a doctor are worth 40 per cent less than I’m being paid, and that I should be working significantly more hours? It’s all good and well to claim that doctors should work for the principle of doing good, but are you suggesting we shouldn’t be remunerated for our compassion and hard work? For having to make impossible decisions any time of day or night, and still bring a smile and fresh mind to our next patient?
You speak as if working 90 hours a week is something every person in the country does. When divided by the actual hours a week I work, my salary barely come above the minimum wage.
The fact is, if you pay peanuts you’ll get monkeys. And when you treat highly trained, professional people as monkeys, they have a right to stand up and remind you just how far from the zoo they really are.
@Doctor A S
Yes, Mary Dejevsky, it is sometimes about the money. As doctors we are not expecting bankers’ salaries or anything similar to those in the private sector. What I do expect after eight years in the NHS at 32 years old is to be earning more than a manager of a fast-food chain.
Why should doctors not just work for the job satisfaction, you say? Because we are human beings too, who have lives, mortgages, families. I invite you, Mary, to come and join me on a 13-hour labour ward shift where there is often no time to eat, drink or pass urine. Where your actions can have implications on the outcome of a birth for a mother and a baby. Once you have done that you can tell me if I am worth my £47,000. By the way, that is the whole pay with the extra hours.
A junior doctor is a term that’s poorly understood among the public. A junior doctor is anyone who has completed his or her medical degree but is not yet a consultant. The Centre for Workforce Intelligence says it takes a median 15 years from finishing medical school to become a consultant.
Among the issues exercising junior doctors are the change of hours and the way they are remunerated. Currently, “plain time” is 7am to 7pm, Monday and Friday. Any hours a junior doctor is rostered to work beyond 7pm on a weekday, and any hours on a weekend, are paid at a small premium. This is anything from 20 per cent to 50 per cent of the plain time rate depending on the intensity of the workload. The new contract stipulates that plain time will now extend to Saturday and from 7am to 10pm. This means an extra 30 hours a week will be considered plain time, rather than unsocial hours. I do not agree that working beyond 7pm on Monday to Friday and also on a Saturday (all day) is plain time.
These are unsocial hours and should be remunerated as such. No doctor is unwilling to work these hours – but we often have to sacrifice much of our personal lives for our job and there should be some level of recognition for this. Junior doctors often have to work 12 days in a row, and some will be 12-hour shifts.
In 2003, the Government sought to accelerate junior doctor training by creating a more structured programme; it also agreed to the EWTD [European Working Time Directive] to reduce working hours to a maximum of 48 hours by 2009. To ensure this would happen, NHS Trusts faced financial penalties for introducing unsafe working rotas and were required to pay doctors overtime.
The new contract removes many of the contractual safeguards protecting junior doctors from working excessive hours. For instance, junior doctors are entitled to one 30-minute break for every four hours they work, but the new contract stipulates that doctors will only be entitled to one 20-minute break in a shift of up to 11 hours. Jeremy Hunt is right to say he wants to ensure there are fewer deaths in hospital, but a tired, hungry and demoralised doctor is hardly the correct prescription.
Changes to the pay progression rules will penalise doctors who are taking time out of their regular training to contribute to research in medicine, carry out humanitarian work or have a family. Creating disincentives for taking time out of training risks undermining the potential to create the clinical leaders of tomorrow.
We are keen to return to negotiations. However, junior doctors agree with the BMA that we need concrete assurances before this can happen. These include the following:
* Proper recognition of unsocial hours as premium time;
* No disadvantage for those working antisocial hours compared with today’s system;
* No disadvantage for those working less than full-time and taking parental leave/research time compared with the current system;
* Pay for all work done
* Proper hours safeguards to protect patients and their doctors.
There is also a risk that these changes could drive younger doctors to seek more favourable working conditions in countries such as Australia and Canada. About one in four of my junior trainees have made such a decision.
This dispute is not solely about remuneration. This proposed contract has real potential to create an unsafe working environment for doctors, the wider healthcare team and patients.