To think that not all doctors are badly paid - junior ones, yes, but not all?

Depends on whether they started pre 2017 or afterwards. Plan A is very different to plan B longer term. The government only managed to get it passed by excluding existing doctors and students. I don’t think they should have agreed something so divisive, on such a self interested basis, and in effect they pulled up the drawbridge, somewhat.

Gosh, that story impresses me! It’s much more straightforward in many ways to follow a conventional path into a professional career like I did. I worked v hard but I knew where I was heading which makes things simpler.

I think one of the big problems with pay satisfaction for Drs is the tax system. Yes, £105-135k sounds like a lot of money, but it is a terrible pinch point in the tax system where they lose their personal allowance, lose free childcare hours and are probably making 9% student loan repayments and contributing 10% to their pension. The net result is that some Drs in this group are paying 90% marginal tax rates!

That would p* off anyone.

As you get higher up the income scale in the £200k+, this high marginal tax rate gets averaged out so it doesn’t seem so bad, but for those stuck there, it’s terrible.

It also means that those that can afford to, keep their earnings below £100k by going part time or adding pension contributions. This is so bad for society as a whole - productive Drs are working fewer hours than they could and if they make pension contributions the tax man loses out on 100% of the tax. It is a mad system.The Times published a graph - which I can’t find now - which showed the huge spike in the number of taxpayers on £99k followed by a huge drop at £100k+ which only began to recover in then £135k+ range. People will do everything possible to avoid going over £100k.

As successive govts freeze the tax bands more and more workers - quite a lot of senior public sector workers - are falling into this £100k tax trap. It needs to be sorted out so that the marginal tax rate increases gradually. It isn’t rocket science and cld be done to raise the overall tax take but the optics would be those in the low £100k paying less tax than they do now and so the govt is too frit to do it.

I would also add that there are a lot of non£ things that annoy Drs about their working conditions that contribute to their dissatisfaction eg no lockers, unisex changing rooms, slow out-dated systems, patients that don’t turn up for appointments (because they don’t get to choose a convenient appt time), car parking fees, student loans, inflexible rotas, unproductive co-workers who are never managed out, lack of availability of healthy food, money wasted on identity politics (see Fife and Darlington)……..

On the other hand, I don’t have any sympathy for the argument, “I cld be earning £millions as an investment banker/city lawyer…..”. Because if that’s what you want to do, then go and do it, and you will discover those careers have their own stresses.

So in our university town there are a few areas of expensivo housing. Once upon a time you'd find these occupied by academics and doctors mostly. I'm 60 and academics stopped being able to afford large detached homes in town about 35 years ago. Doctors (consultants/GPs/surgeons) still could until about 15-20 years ago. Depressingly, they all belong to hedge funders, business types and oligarchery who often remodel distastefully. I don't know why planning allows so many horrible extensions etc.

@CornerTable we all have different reference points. We are a little older and were London centric. All of the medics I met when the DC were at school (other mothers) were part-time and as the wives of accountants, solicitors and bankers seemed to have an excellent work life balance. Here, in our little Surrey road, our neighbours are lawyers, accountants and surgeons. Three of eight houses are surgeons.

I'll be clear. I was not academic at school, I dropped out of university after a term and had no ambition whatsoever beyond becoming a mother. But, I liked work, was good at numbers and had an eye for detail. I found I liked work in a way I never liked school or academic work and work liked me. At 65 and as a director in the quasi public sector I still suffer terribly from imposter syndrome.

I have nothing but respect for those in such difficult jobs. I have a fair bit of stress/long hours working in my job but I would never compare it. The best thing I saw on FB when the junior doctors were first on strike was a nursery worker who worked 9-3 term time only and compared having to plan a session to doctors working more hours than they were paid for 😂

I don’t know. We are in our fifties. The ‘City couples’ we know tend to have a much higher standard of life than the doctor couples. Even if the women go part time, the men retire early etc, the holidays, cars and houses etc are of a much higher spec for the City high-flyers. And none of
my doctor friends took years out to be sahms. That’s just my anecdata though. And money ofc is only one measure of ‘success’ as we all know.

We need good functioning private and public sectors. I found it irritating in the pandemic when people used to complain saying, ‘the government cares more about the economy than saving lives’ etc. We need a healthy private sector and the money it generates. It doesn’t always have to be a competition between them.

Doctors deserve more than the Prime Minister, IMO

I had to laugh at a poster thinking that a doctor is on call for just one ward in a hospital.

I know. The mention of covering one quiet ward ticking over nicely made me smile. Or the poster who wrote about staff having nothing to do in A and E. Never seen that, but maybe it happens!

The responsibility for people’s lives is really what makes the role stressful for me. Esp when there is limited time and resources to do what you really want for patients. I could never be a pilot. One person responsible for hundreds of lives each flight, no thank you!

My friend would not do medicine again had she known what it would be like, its got massively worse also. Its all she ever wanted to do, it was a huge slog for her and she had to do it a long way round. Judging by tights thread people dont actually believe how tough it is, there is no comparison to most other high paid careers, I'm not talking about hours worked, the actual stress of the job and seriousness of what they are doing on a couple of hours sleep or after 21 hours in the hospital!

I had to laugh at a poster thinking that a doctor is on call for just one ward in a hospital.

I don't have the same insight as the pp but I also think that earnings have to be calculated across whole careers. The City whiz kid may earn £400/£500k but they are unlikely to do so for their entire 30 to 40 years in the workplace.

It would be helpful to have data about the career earnings of solicitors, bankers, etc, compared to hospital consultants and GPs over the span of their respective careers. Except for a few, I suspect the doctors would win.

For example, I earnt a relatively large amount of money between 1982 and 1995 in the City, until I was burnt out and had children. I had seven glorious years at home and spent three retraining and then earning about £40k to £50k for ten years. It was only a couple of late career promotions that took me over £100k again and I am close to retirement. Similarly DH earnt a pittance until he was 32/33 which escalated to about 15 years of very high earnings before a sideways move which means he now earns about one third or less of his peak earnings.

I can remember trying to explain the “up or out”/“perform or out” career models to a government department team once and they could not get their heads around it. Its not just redundancies when the economy dips, its the routine pruning out of staff who don’t make promotion points on time or who dip in chargeability/performance. These were senior civil servants and they knew it happened, they simply could not get their heads around the concept.

From your other post:

I just think there are pros and cons to private sector and public sector work and there is probably more understanding needed on both sides.

This is spot on and I’d extend it. I work cross industry and across sectors. Every industry or sector has its own culture, each thinks its slightly special and to some extent this is true.

One of the key differences between public and private IME is that if I visit a large bank, retailer or telco they want to know what the competition is doing here and abroad and how they can get an edge and improve productivty. They want to be bleeding edge if they are telcos or cap market banks, fast followers if they are from more cautious industries.
In the public sector this is rarely a conversation initiated by the client because the culture is often more about “doing stuff” than doing it better, faster or more efficiently. The status quo is safer than change and productivity is not the priority on the whole. There are pockets of innovation, usually where their is someone senior who has seen the benefits but on the whole efficiency is not the priority.

Then there is working with the NHS. Its an outlier even in the pubic sector with the cultural resistance to change, with each of the thousand little fiefdoms not only convinced that they can learn nothing from other industries but that they can learn nothing from the trust in the neighbouring county. There is a staggering lack of accountability resulting in huge amounts of waste and systems which are a generation behind even the public sector. Systems and processes adopted with alacrity in other state backed health systems to improve the lives of both patients and staff are rejected because “we are NHS subdivision 194 and we are yoonique and speshul so it can't work for us”. Systems which could be centralised are fragmented across trusts at great expense and at great loss of benefit to patients and medical staff. None of this is a consequence of a shortage of money - its an utterly intransigent culture which results in huge waste where money is spent.

For my entire life I have believed in state backed healthcare with the better off contributing more and the worse off not having to worry about health care. I simply don’t believe our model delivers this and I’ve worked with and experienced so much better in European state backed provision. Honestly it surprises me that an intelligent and educated cohort such as junior/resident doctors are so wedded to a system which gives them poor T&C to work with when they are able to look across the channel and see better options. When I talk to young doctors they comment more on T&C than base salary but this seems not to figure in the union campaigns.

The rewards are potentially very high, but those rewards come with significant job insecurity.

Yep. The young people I know at Deloitte etc live in fear of losing their jobs.

@CornerTable whilst it seems your nephew is earning an eye watering amount at 24, the stark reality is that many many young people who start out at Magic Circle firms do not stay long after qualification. Fewer make partner. There may be many times between qualification and retirement when their jobs are at risk. The rewards are potentially very high, but those rewards come with significant job insecurity.

My DS, aged 30, is an academic and very lucky to have a substantive role at a good university. However, due to the difficulties HE is facing, he is relocating at the end of the summer to a university on another Continent. He is very very lucky to have got it.

What a heartbreaking and depressing story. It’s awful that your husband was so restricted by his work.

I just wanted to say that many of us do care about letting others down. When I was doing ward rounds, if I was running more than five mins late, I would ask for someone to inform the patient/relative asap and apologise. In practice I was only more than fifteen minutes late a handful of times as I have a thing about timekeeping and reliability. If I have a phone appt and am more than a minute late, I lead with a genuine apology. Often to the bewilderment of patients.

I do respect others’ time and know what it’s like to wait for a call. Whether the patient is a stressed city banker or someone unemployed waiting by the phone. I am sure I am not alone.

I just think there are pros and cons to private sector and public sector work and there is probably more understanding needed on both sides. Mt nephew aged 24 is working in the City on a salary of £107k as a new lawyer. Which is incredible to me at such a young age. But if he had a family crisis, it would be easier for me to take time off as an NHS worker than it would be for him, with the brutal demands from his top law firm.

It's fine. It was decades ago now and whilst you never truly get over it, you do come to terms with it and very gradually, it stops hurting. I say that regularly on the pregnancy/bereavement boards and am glad that nowadays they exist.

I was just making the point that other professionals don't have things as easy as medics think and often have as little or less agency over their time and have no alternative but 100%+ commitment.

Sorry that last message was to @AndSoFinally

So who do you think acts for the rude violent and obnoxious clients? I’ve had to take instructions sitting across a desk from a defendant on a 6- man lockdown. That means he required 6 officers with him/restraining him every time he was out of his cell. He’d murdered multiple people (hence in prison) but the offence I was dealing with was that he had ripped open a prison guards throat with a biro casing. Needless to say I was taking notes with a biro. I thought about using a pencil but figured if he really wanted to go for me a pencil could probably do the job too.
solicitors deal with the rude violent dangerous and mentally ill every single day. This idea that doctors are the only professionals working long hours with difficult people is just ignorant.

I’m so sorry for your loss. That must have been terrible. I’m so sorry.

Your solicitor and your accountant will have a reasonable number of clients that they can accommodate within their set working hours. When your solicitors case load is full, they will not accept anymore. Do you honestly think it’s the same for doctors in a hospital setting? Medicine is incomparable career; so these comparisons are utterly pointless.

Exactly. And if the solicitor's clients are rude, obnoxious or violent, they'll just refuse to take them on as a client. Doctors still have to see them

Absolutely.
Let me give you an example. When I went into labour with DS2 at 27 weeks, many years ago now (Hypoplastic left heart syndrome - he died), DH was in court. His clerk waited outside to bundle him into a cab - he got into it at 4.30pm. He arrived just before DS2 died. The judge adjourned the case the following day but DH had to be back in court on the Monday.

Those who work in the NHS have zero cognizance of the pressures their patients and those in other careers might face. If I am kept waiting 90 minutes for a 10.30 appointment, that takes out my entire morning and that work has to be done still. Other professions are not as linear.

Yes I find this constant claim that doctors alone cannot clock off at 5pm precisely to be one of the silliest repeated claims on these threads. Every professional does long hours, spends years training and qualifying and accepts significant compromises in life to achieve promotions/career progression.

There are legitimate grievances which should be addressed but this insistence that nobody else works as hard simply undermines the legitimate cases.

That is the figure produced by the BMA, who as a union have stretched the figure regularly although I note they seem to have abandoned the previous wild claims of 35-40% pay “cut”. Data was never the BMA leadership strength.

Pretty much every sector has seen stagnant pay (effective pay cuts) since 2008. Most sectors have also faced significant redundancies and indirect cuts such as reduced promotional and career opportunities (in the private sector at least - that wasn’t the case across all of the public sector - some parts used extra promos were used to retain the facade of a pay freeze). They have also had to address major workplace change and restructuring, retraining and relocations.

Doctors have not “lost their final salary pension scheme”. They still have a DBP, its just slightly less platinum plated than it used to be. Have you forgotten the chancellor actually changed tax law on pensions specifically to benefit doctors due to the huge value of their pension pots? Even amongst public sector pension schemes the doctors’ scheme is very generous.

Every professional spends many, many hours over standard at work, takes professional qualifications, is constantly uprating training etc - usually at their own expense. Everyone has seen the impact of the last 17 years on pay.

Doctors should be well rewarded for an important and demanding job. However most of the young juniors/residents in my family/circles talk more about conditions than pay. They talk about managing placements in the early years if they don’t have the connections to stay in preferred locations, nepotism, some of the staffing levels and poor operational management (especially if they have worked abroad in better structured systems).

Lets face it - given a blank sheet nobody would design the mess we have at the moment but in a messy system doctors are far from the worst done by. I would like to see some of the logistical and practical problems early career doctors face being addressed rather than blanket pay rises with no connection to productivity.

“Set working hours…..reasonable number of clients…”

What are they for solicitors and accountants in London at least?

DS works for a medium sized firm. He works seventy hours a week normally and up to one hundred a week, when he’s busy. He worked away in a hotel in a different part of the UK, every week during his training - when he might have had to work 9 am to 2 am, including weekends.

We were at his house for DGS birthday. He had worked until 5 am, then got up again at 9 am. He asked his partner if he could spend 10 minutes watching DGS open his presents and she said no. The firm would send him a birthday present. DS worked until 1 am the next morning. That’s how it is on big jobs with strict deadlines, which can go on for several weeks.

Actually, I don't think they are paid enough relatively. However, to be paid more, and that includes nurses and allied staff, I think the services need to improve dramatically. Interactions with patients need to be more mutually respectful and communication needs to improve tenfold.

I earn as much as a consultant and quite often say when the CEO has a whinge up, "let's get it into perspective, nobody died". However, if I had a track record of being rude to internal or external stakeholders, being late for meetings, causing stakeholders inconvenience, etc., I would lose my job. That's without any negligent practices in the mix.

The world and expectations have moved on since the late 1940s but regrettably the NHS and its machinery has not. It needs to keep up. If it sends me a snotty, rude letter instructing me not to be late and telling me that a missed appointment costs the NHS £65, it doesn't make me think "gosh, how awful". It makes me think gosh, that's a sentiment that works both ways and I trust you aren't going to cancel my appointment at short notice or keep me waiting for 90 minutes without explanation or apology. The optics are just shocking.

There is much emphasis on the general public wasting public money. There needs to be significantly more on the extent to which patient time is wasted with a knock on effect on GDP and employers.