AIBU unreasonable to say everyone should know about the junior doctor's contract the government is trying to impose?

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The government is seeking to impose a new contract on junior doctors. By junior doctors I mean all those in training I.e. Not consultants and GPs. Starting salary for these doctors is £22636 plus a supplement for additional & antisocial hours worked.
The contract seeks to re-classify normal working hours so that 9am on a Tuesday will be the same as 9pm on a Saturday night (so normal hours Include up to 10pm 6 days a week). This will lead to a pay cut of 10-30% for all junior doctors depending on which specialty they work in. They also propose to remove certain safeguards over lack of breaks & working over contracted hours.
They also propose to entirely scrap a pay supplement for junior doctors training to be GPs. This was designed to make pay equivalent to that of a doctor in hospital training who receives the pay banding I mentioned above. There is already a recruitment crisis in general practice. One in ten posts in England are unfilled in a recent survey. Many training posts are unfilled too.
You might think this doesn't matter to you but we are all patients sometimes. I know people who won't be able to afford their mortgage if the contract is imposed and they plan to emigrate. What will happen to the NHS then?

No, the answer to this is not more consultants! The answer is to have a competitive environment, where the inefficiency of the NHS would have to be eliminated.

It is very difficult to watch our money being pissed up the wall in the NHS, and the best answer anyone seems able to come up with is to fling more money at it.

i.e. if the NHS managed its existing resources better, there would be adequate funds to pay consultants (and nurses, porters etc) more money.

Sorry to harp on about him, but when I compare DH's job (constantly looking for areas they can gain even a small competitive advantage over another company; basically eating what you kill) to the great wallowing behemoth that is the NHS I just want to weep. My GP's surgery still closes (both surgery and phonelines) for lunch

What is the case for the proposals? Presumably the government has published information about why they think these changes are needed, and there are some medics that support them? I'm in two minds. The cuts are clearly unfair to the current cohort of junior doctors, but on the whole I don't think the NHS is wonderful and I'm not against attempts to improve things.

*I think this is a large part of the problem with the public sector. I very much doubt your DH actually 'works' 120 hours per week. by work, I mean actually treating patients/doing paperwork etc? That works out as 17 hours a day, 7 days a week. What I think is more likely is that he's on call over a weekend and is counting those hours as 'work'

The thing is, everybody else (on a decent salary) works like this all the time. DH (C level exec in large multinational) is 'on call' 24 hours of the day, 7 days a week, 365 days a year. If there is a serious problem, at his level of seniority, he is expected just to get it fixed, irrespective of the time of day/night. This is a huge pain, but he is well paid for it and on balance, he would rather take this inconvenience and have the nice perks.*

I take it you are not a doctor and you have never lived with one. No, everyone else on a decent salary does not work like this all the time. They think they do but they don't. As your dh is on call 24/7 does that mean he never has an alcoholic drink just in case he is called on to solve a problem? He never strays further than 10 minutes from his workplace in case he has to solve a problem? If he wants to go to a wedding in the next county does he say no because he might be needed to solve a serious problem? Of course not. of course he is not on call the same way a doctor on call is.

My dh is a doctor and I have worked both in law and in major industry at a high level, including working a high pressured, deadline driven part of the industry and there is no comparison to the level of work required from junior doctors and other professions.

He regularly worked from 8-9 (including unrostered and unpaid overtime) 6 days a week including 2 nights of call (and that is a euphamism if ever there was one - being on call might mean you get a few hours of interrupted sleep - or not). Maybe not 120 hours a week but often close to 100. I can't tell you how many of dh's colleagues crashed their cars after a nights on "call". I don't know any other set of people among my friends, whether lawyers, financiers, engineers, business people, teachers, nurses, who had the same working hours.

I have no doubt all those lawyers and executives honestly think they are working just as hard as junior doctors. They don't know any better.

And I find it funny that you think there is hysteria about doctors saving lives. When they make a mistake and someone dies do you take the same attitude? -- "ah well pity he couldn't postpone the inevitable but that's life"

We do know better. My daughter works very long hours as a lawyer longer than all doctors I have ever known and as I've said above we are a family of doctors as well as lawyers. however this is not a competition. i would say sensible daughter - she earns more than doctors and more fool doctors for picking medicine not law. I know people who have swapped - qualified doctors requalifying as lawyers. If you don't like the heat you can leave the kitchen and when too many leave the kitchen then market forces might jack up the pay although I suspect there are at least 100,000 extremely good Syrian doctors who would be more than happy to fill the void.

ManorGreyhound: I take your point that privatisation of the NHS may be the only way to maintain standards and decent pay for its employees. However, you are conflating two issues as this discussion is not about the current government's trying to privatise the NHS (that may well be their long-term goal but that is a different discussion), it's about the new proposed junior doctors' contract.

I'm afraid your comparison with your husband's job is of little relevance to the debate. Here are the differences:

He may be on call 24/7 but how often does he have to physically go into his place of work overnight? When he is on call 24/7 is he able to leave your home town? Is he allowed to have a glass of wine? So when the government says 7am-10pm is a normal working day they mean treating patients.

For example, when I mentioned my husband's working hours of 83 hrs this week (as a random example) I was not referring to him sitting at home and 'if there is a serious problem, at his level of seniority, he is expected just to get it fixed'. For that 83h he is IN THE HOSPITAL FOR THE ENTIRE 83 HOURS ADMINISTERING ANAESTHETICS/ PUTTING IN EPIDURALS AND ATTENDING CARDIAC ARRESTS/ INTUBATING PEOPLE ETC....As for me, I work in cancer medicine so whilst, clearly we have not found the secret of immortality, it is absurd to ignore the fact that the decisions that doctors make minute to minute can have a profound impact on life and death. As for other specialists e.g. GPs, they may not be at the frontline of life and death but the decisions they make can still 'save lives'. Anyway the point of mentioning the whole saving lives thing is not to say we are holier than thou but to make the point that when the stakes are so high and your decisions could kill someone/save their lives or affect them deeply ----

e.g.if you dont get this needle in the right place you could paralyse someone/ if you write up the wrong dose of this drug you could kill someone or give them kidney failure/
if you spot that this young guy with back pain actually has cancer so needs to see a specialist ASAP you could increase the chances they are cured/
if you decide this person with schizophrenia cant go home yet when actually had they gone home they would have commit suicide (to name but a few of the decisions drs make day to day)

-the job you do is intensely stressful/ exhausting (mentally/physically and emotionally) and requires a high level of expertise/ability and commitment so it is essential that doctors/nurses are supported in terms of working hours/pay etc....so that they can perform at the level required to handle this level of pressure and provide high quality service to all those that they treat. Also I'm sure the public want good people to be recruited to this career- to do that you need to paint positive career prospects. Currently the prospects as a dr are that your 20s and 30s are likely to be a constant state of exhaustion/studying and exams/hours of unpaid work/uncertainty/pay cuts constantly being undermined by the government/inability to purchase a house/major disincentives to having children etc... etc....

You also mention re your husband's senior position that 'he would rather take this inconvenience and have the nice perks'. Good point! That's precisely the problem with the way the government undermines our profession: any perks/ financial incentives for what are not just minor inconveniences but major life sacrifices are being eroded. And, again if we were on a great salary that allowed us to buy a house/have a childminder etc... perhaps these impositions wouldn't matter or we would be able to cope with them better that's not the case.

Sorry some of that was meant for canyouforgiveher

Canyouforgiveher: sorry we're saying the same thing!

I'm another junior doctor who is still regularly working 24-hour shifts with barely a break (supposed to be non resident) - it's terrifying when you need to make important decisions about someone's life when you are exhausted.

Most doctors I know are fairly happy with their money and it is the working conditions that they struggle with - particularly not having enough staff to give the care the care they would like to give to their patients

Doctors are not asking for more money - they just don't think they deserve huge pay cuts and a further decrease in their working rights and conditions. The proposed new contract will disproportionately affect women with children - and women who have taken time out to raise families could experience the greatest reduction in their take home pay.

ManorGreyhound - I just don't understand how you can say doctors don't save lives? Some of the stuff is routine and monotonous, but for hospital doctors the majority of their time is making snap decisions about courses of action which may save or end someone's life. These decisions have to be made in a split second, with the on-call bleep going off and people coming and constantly asking questions and relatives getting upset...then the minute there is a bad outcome, even if nobody is at fault, there are investigations and complaints and litigation. I'm pretty sure your DH doesn't have to deal with all of that, day in day out.

Yes - the NHS is inefficient because of the huge strain it is under. Yes - money is poorly managed because some idiot who doesn't know the first thing about medicine or running a hospital decides to spend billions of pounds on a computer system which never works. Why should the doctors, who are the ones keeping the show together (with the nurses, physios, porters etc) be the ones who get punished?

As for the previous poster's comments about lawyers thinking they've got it tough: I work some insane hours, I am made to work through my weekends and cancel holidays, I regularly have phases where I do not leave the office for 3 days straight. I am exhausted. I make mistakes. At worst, these mistakes cause me to get a bollocking and can lose someone money (directly or indirectly). It is incredibly stressful. It does not, however, come remotely close to the stress of wondering whether your action contributed to someone's death or serious injury. The panic when I am out of my depth does not compare to the panic of a junior surgeon (and remember "juniors" in this line of work are not 22 years olds fresh out of uni) who is on call at 3am and has a dying patient infront of them and they are having to guess the best course of action. To suggest that the stress and long hours of other professionals is comparable to this is just unacceptable.

They are just running it down for a takeover of private companies. Changing contracts now means less fuss later when mcDonalds starts running A&E.

Just lol at people comparing junior doctor's hours with teachers hours.

Market forces will never work for a 'market' in which the 'customers' are the sick, the old, the vulnerable and the desperate.
Have a look at health care provision in the States works - or, rather how it does NOT work for vast swathes of the population.

Re 'efficiency': a hospital can never run like a hotel, hoping to get as close to 100% bed occupancy. This is part of the problem - to work well at times of crisis (major incident, flu epidemic, never mind a 'slow crisis' like an ageing population with increasingly complex, expensive and chronic needs) there has to be built in slack in the system. Of which there is not enough.

I find it quite upsetting when people argue 'efficiency' and 'market forces' because the market model just does not apply. Again it's a 'I'm all right, Jack' attitude, usually from people who would be able and happy to pay more for a high quality health care provision because they can.

I am not naive enough to not know that lawyers, actuaries, market traders etc etc don't have very stressful jobs involving long hours, but it just does not compare. Telling a doctor to 'just retrain as a lawyer' is just nonsense. Is not the time to mention the highly qualified doctors who trained as lawyers originally?!

And I guess many of the folk pontificating about working hours have never done a run of night shifts. It is not comparable to having to work a couple of weekends. Not the same thing g at all.

Wishing I had tamal' baking skills quite frankly and could have something to fall back on! On that note, hoping he speaks out in defence of Drs given he has a bug Twitter presence!

NutterButtSquash
As a nurse, I'd like to say that this is a fantastic post (not necessarily for you though). Well said, it's all true .

This thread is redic, I actually can't believe people are happy that junior doctors are facing a large pay cut and deterioration in their working conditions.

And its not exactly the same as someone in the private sector such as an accountant facing a contract change where they can leave and find a new job with a difference accountancy firm. Junior doctors have to work in training posts for the NHS, they can't just skip off to another employer!

I a "Junior Doctor." I am 36. I have 2 children and a mortgage.

I have spent 5 years at medical school and 12 years working for the NHS ( besides mat leave.) I have two sets of postgraduate exams.

Junior means not a GP or consultant.

In any other profession i would not be considered a junior.

I am not junior in terms of skills or experience.

I am at the top of the pay scale, the best it gets, take home after student debt around £3000 a month. Or a total of £36000 a year.

To go to work, from that "take home" I pay £4000 a year GMC insurance college and revalidaton/assessment/course fees. So I take home £32,000 a year.

I am paid well, double the salary of many, but, I also do the equivalent of two full time jobs in terms of hours.

When FT take home is considered £32,000 i am earning a take home of £10-12 per hour for my " at work, at the coal face hospital hours.

When FT I work an average of 48 hours per week which is the max my rota allows. This is calculated over 16 weeks average and will includes my AL of 0 hours. This means I will work normally 60-70 hours a week in the hospital with patients.

What does that mean, that means I work every 2-3 weekend on days or nights. ( these 3x13 hours days on the rota but usually 15 in reality and I then I commute home ) If annual leave is coming then I often work 3 weekends in a month as I have to cover my share of out of hours before I can taken annual leave.

I do other Long Days and Evening shifts and the occasional rare 9-5 shift.

I do a lot more hours for administration, learning, audit, training etc.When not on shift, I complete 1 audit, and write 1 guideline every 12 months.
I read 2-3 hours a week. I write quality improvement programmes, I arrange training days, collate feedback. i mentor other trainees and medical students. I even teach them for free on my day off. I take annual leave & go to work to complete the assessments I need for revalidation as there is no time in hours.

Still sounds good, I don't earn any extra nights or christmas day, if I stay late, and my hourly rate does not include the last paragraph.

Am I worth it?

At any time of day or night or bank holiday when I'm on shift I might be doing things like this for just £10-12 take home pay for the NHS.

I might be the person sent to pick up your baby or child, risking my life in an ambulance. I might be leading the intensive care transport team.

I can act as the "anaesthetist," if needed but I am not one by trade, its just another string to my bow. I can provide a 500g baby life saving tube, or line. I can administer the anaesthetic if required.

I am a good communicator.

I might be the one leading the team should you be unfortunate enough to have to bring your child into resus in A & E.

I could be the one who has to sort out the irregular heart beat of your child with a defibrillator.

Or I could be on shift on the ward. Supervising your child's "dialysis" in intensive care.

I will also be looking after between 6-12 other ventilated children all very sick with different issues for 13 hours, at the same time. I will always make time for you and your child even after my shift has ended.

I will probably be the most senior doctor on site for my speciality for an unexpected acute emergency. I promise I will do my absolute best to ensure you get the best care, sometimes I won't be able to save a life, sometimes there will be limited amounts of things I can do.

I will go home, hug my children tighter and cry, because I care.

Occasionally I will be shouted at, blamed for events through no fault my own, the joys of having to consent a parent for a medical examination for child protection cases, but it has to be done.

During my career, I have had Oxygen cylinders thrown at me by a psychotic patient who was scared, have an attempted strangulation by a withdrawing alcoholic who had cancer, and hadn't confessed to his need for alcohol on admission, we could have prevented that. I have been verbally abused, watched verbal abuse, and seen members of the public try and attack a colleague with scissors. I have had to treat convicted criminals including murderers and paedophiles in the same way as any other and ensure I was treating them equally, sometimes thats hard. I have seen births and deaths.
I have to see the DM headlines.

Make one significant mistake and my career, that I love could be over.

Now you have read above I want you to think. Next August, will I be worth just £7.00-£10.00 and hour? Should I pay childcare fees to look after my children at £10 an hour children whilst I try to help the sickest of yours, or should I stay at home? What would you do?

This is your NHS, ultimately its the weight of public opinion that will decide if we are worthy of a pay cut, as without you, we will get one. Some of us haven't got the luxury of moving to scotland, or wales, Aus or canada my Husbands job is here. But I have got to decide if it is worth me working.

No one is saying it's easy or that junior doctors don't work hard. Young gradutes working in Macdonalds or unable to get jobs don't have it too easy either. We have the biggest debt in history which is getting worse not better.

By the way never put female careers before men. Why if a husband's job is in the UK cannot the family move? My children's father left his job and moved hundreds of miles to follow my career. Men follow women's careers all the time.

The doctors can obviously object to pay cuts and voice their views as they are doing on there and I see today's Times Letters page similarly has a lot of complaints. The only thing that will really talk though will be when and if there are no doctors left to do the work and then the taet will have to act to increase pay. However I still see massive demand from the best A level students around here (London) to go into medicine with huge competition for places and large numbers of foreign doctors keen to work here. Whether that wll continue if pay gets worse remains to be seen of course.

It's already happening. They cannot recruit enough doctors into A&E positions. Young doctors are going to Australia.

2 applicants on 18 GP training places for next year here. Applicants. I have no idea about the quality of the applicants.
GPs are a dying breed.
Unfilled posts in A+E, in psychiatry, CAMHS is unable to see suicidal teens in a timely manner due to lack of medical staff, NHS waiting lists being funded from one pot while no funds are available (apparently) for training or for funding substantive posts.

Pacific what areas are the new doctors going into these days? Which one do they consider to be the "least bad"?

Grazia, the WHO estimates Syria has 1.455 doctors/1000 population (apps.who.int/gho/data/node.main.A1444). The population is roughly 23million (en.wikipedia.org/wiki/Demographics_of_Syria). I make that about 33465 doctors in Syria in TOTAL. That's before we consider how many of them would want to leave, would speak adequate English, would pass the relevant skills exams in the right specialties. So I think you should leave the hyperbole elsewhere.

Grazia grazia i have worked in mcdonalds, boots and next amongst other places. ( Incidentally Boots paid £8.20 on a Sunday in 1999 and i had a discount card .. for me to stack shelves.).... I appreciate every job has its stress; its perks aa shop discount card and disadvantages..... Itsr" for the hours.

We need to be open and honest I'm not overpaid, I earn well there is significant difference.

Its simply a case, that if I am the top paid you can be as a "junior hospital Dr" for the hours. I'm floating the idea that I'm cost efficient for my employer a private company will charge NHS £100-£150 an hour for me, my employers know that as well as me. I haven't worked on a fully staffed rota for ?6 years..... so why the drive to reduce permanent staff pay? I'm not asking for more? But I am asking for politicians to be honest about the policies and incentives which drive their politics....I want to live in a democracy where we can discuss the real politics of our time ... Do we want the NHS? Do we want to pay for it? Do we want to have a two their system? ........what is certain is we can't have sweetish healthcare on us rate of tax. What do we want?

These proposals threaten recruitment, most especially to the most acute specialities. We already, nationally, cannot recruit enough doctors to training schemes for A&E, acute medicine, paediatrics, O&G, anaesthetics and GP, to name but a few. This will make it so much worse. Those of us who are consultants already are already going under, trying to cover gaps where our teams no longer exist. This will make it worse. We won't get the next generation of consultants and GPs (already seeing much bigger problems recruiting these). They will leave medicine, emigrate, or pick the least intense specialities.

If you want there to be anyone left to treat you in years to come, please, please support the "junior" doctors. Many of whom have years of postgraduate experience and training, which will be lost to us. It is a terrible waste.

petition.parliament.uk/petitions/108782

Yes I know doctors work hard. I picked law not because the hours are less but because the pay is on the whole better. (by the way my daughter as a trainee solicitor reckoned she earned under the minimum wage when all the hours working over time - through the night etc were added in - she worked a week every day to 4am no pay beyond 9 - 5 of course, recently but is not complaining - that is the deal; the pay is high and she made the choice).

Anyway we are not in competition to prove who works the longest hours. I suspect over the 30 years I have worked without maternity leaves and without breaks and full time is probably harder than most doctors work over 30 y ears of continuous career and I suspect the NHS gives you more maternity leave and pay rights than I had not that I am complaining. I love my life.

It is instead about what we tax payers need to pay doctors to ensure we have enough of the ones we need.