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?

Oh, and divide and conquer is also at play when trying to get Primary and Secondary Care to start squabbling against each other, over funding, staffing, transfer of care, prescribing, unfunded activities etc etc.
When we should ALL recognise that we are all in this together. By which I mean all HCP and all patients - which also includes me: I happen to be a doctor, but I am also a patient. I am likely to be a patient much longer than I will be a doctor, so the short-sightedness of the whole debate really boils my piss!

Pacific I do completely agree we are all in it together.

To explain a little more what I meant by sealing your fate. It was made very clear to my profession that if we pushed too hard about the changes they enforced they'd simply get rid of us and hire from elsewhere. To an extent they have, we've got practitioners from outside the UK, some of whom are severely lacking but the government doesn't seem to care. They get cheaper and more malleable staff that way.

I think we are all being shafted here

You can't compare being a a teacher to being a doctor. The intelligence & amount of training you need to be a doctor is phenomenal.

Yes, I fear we are witnessing the beginning of the end of the NHS.
And most people won't know what hit them until it's too late.

Oh, I beg to differ, angelos: perfectly normal intelligence and hard work is what's needed to train and work as a doctor. It really is a very vocational profession and I do things every day that no training course will ever teach.
Don't be alarmed, I am very good at what I do, but want makes a 'good doctor' is far less tangible than IQ points and exam results IMO and IME.

You need at the minimum an A and a couple of Bs at A level to get onto a medicine degree.

You need at the minimum 2 Es to get onto a BEd.

I haven't read the whole thread but I am getting pretty tired of all the bleating on my FB page. (DH is a consultant.)

Nobody in a profession should get overtime: they should work until the job is done (like lawyers, accountants, actuaries, most other professional jobs...) I have never had a contract that did not require this. It's the price one pays for earning significantly more than most.

And yes, pay restraint in the public sector is essential if we are to live within our means Asa country.

Nothing about the NHS pension in all the bleating - it is astonishingly generous. (It would cost DH more than his net salary to purchase an annuity which would pay out the same amount on his retirement).

Finding it hard to get too excited either way, but then again I wouldn't mourn the loss of the NHS, IF it was replaced with a European social insurance scheme.

Nobody in a profession should get overtime: they should work until the job is done (like lawyers, accountants, actuaries, most other professional jobs...) I have never had a contract that did not require this. It's the price one pays for earning significantly more than most.

I am old enough to remember the 'good/bad old days', working 120 hrs/week, at work for 56 hours straight with no protected rest times etc etc. I know I was not as safe doing practical procedure in A+E at 3am on my 2nd night on without sleep as I was at the start of a weekend stint on.
That is why the European Working Time Directive came in to play. To ensure safe working. It has other down sides that maybe go beyond the scope of this thread.

The whole 'professionalism' being used to say 'put up and shut up' is really not a very well thought through argument.
Apart from that, junior doctors DO stay behind, finish the work that needs doing and are then put under considerable pressure by management to falsify their hours worked on working time audit sheets.

The government and the general public cannot have it both ways: otoh 'professionals' who are trusted to do what needs doing, otoh tightly controlled hours and pay conditions.

The NHS has been run on good will and people going going the extra mile for years.

I came from a country with a very good health service with a state run social security system (Germany), it works, is provides a very good service, over investigation and over prescribing is rife, and some people do fall through the net.

Is your consultant husband happy with his conditions? Mine is about to quit

pacificdog I don't believe for a second that someone that is of 'normal' intelligence can ever become a doctor no matter how hard they work. It takes an exceptional mind & memory to be a doctor.

It takes exceptional mind and memory to pass the exams to qualify as a doctor, maybe.

My DH is happy and certainly not quitting - he lives for his patients and research. I do think he sees the other side of the argument now that he spends time with a lot of commercial and transactional lawyers (my colleagues) who often work 100 plus hour weeks throughout their careers, not just at the beginning. And they are often paid far less than he is. (It's worth remembering that private income can dwarf NHS salary which itself is not un-generous, so I don't think an element of deferred gratification for junior docs is too unjust). Also, DH's chosen specialism is not the most demanding in terms of hours although it is emotionally grueling.

FWIW I have also waived my rights under the EWTD in every job I have had, even before my postgrad. It's not ideal, but I don't mind - I am very privileged to work in the area I do. I have sympathy for the junior docs but I think their world view is rather blinkered - you don't just get handed a six figure salary on a plate because you got good A levels.

I also think there is a fairly unanimous view at the senior end of the profession that the new "softer" training is not turning out such great doctors. I have heard this discussed a lot amongst surgeons. There has to be a happy medium between the 9 to 5 that the DM says that junior docs work now (wrongly, of course) and the crazy hours from 10 years ago.

*Nobody in a profession should get overtime: they should work until the job is done (like lawyers, accountants, actuaries, most other professional jobs...) I have never had a contract that did not require this. It's the price one pays for earning significantly more than most.

And yes, pay restraint in the public sector is essential if we are to live within our means Asa country.*

YoungGirl, this baffles me. You first compare being a doctor (working in the public sector) to lawyers/accountants (private sector) then go on to say pay has to restrained in the public sector.
There not any like for like there is there?

Why is it that everybody assumes that if you work for the public sector you have to be treated like a second rate employee?
Having worked in both it's astounding how different peoples perceptions are.

The same people who moan that their works Christmas hamper budget has been cut to a meer £100 would be up in arms (for the opposite reasons) if they heard all the staff at the local hospital were getting the same.

As for pensions, mine was considerably better when I worked in the private sector.

This is not primarily about pay, though - it always ends up as a discussion about money alone when it's not.

Read NutterButtSquash's post from Fri 18-Sep-15 22:44:51

Well, like I said, it's just not possible to have it both ways: professional AND highly regulated at the very same time.

Right, I'm off to work. Not to see patients or because I will be paid for it, but because there work to be done and I'm a professional and the working week does not have enough hours in the day. All part of my part-time job….

Deferred gratification is all very well, but if junior doctors from less privileged backgrounds are unable to stay the course (because they cannot afford to raise a family on their salaries especially when you factor in the costs of insurance and continuing education) then they will never reap them. Medicine will return to its roots as a profession drawn mainly or only from the ranks of the privileged.

I also take exception to the idea that just because lawyers work long hours, so should doctors. There is a difference (lawyers don't wield scalpels or make life-and-death decisions on living people at 3am).

Nor does the "you work the hours needed to get the job done" cut much ice in my view. What happens when this becomes impossible, because there are only 24 hours in a day, or is only possible at the cost of burn-out and the loss of doctors from the profession? There is absolutely no need to engage in a race for the bottom.

Nor are social insurance schemes as in Europe a panacea. Most of the decent ones cost 20-30% more, and there is a far greater incentive than in the UK to over-medicalise and over-prescribe. The french system from which I benefit is excellent - but so too could the NHS be if the same amount of money was spent on it.

cheeky that post is a bit of a non-sequitur. Those two things are not mutually exclusive, surely?

Pay restraint and pensions reform in the public sector is essential for national debt reduction. The NHS is a massive employer by any standards.

Most "professionals" I know have a clause in their contract stating "no overtime - hours are as necessary to fulfil your obligations" (paraphrasing, but words to that effect). It's standard for roles over a particular level so I find this insistence on being paid "overtime" on a salary that is already pretty generous for what is essentially a training role rather baffling.

Misti I was once advised by a partner in my previous firm to "take a spoonful of cement and harden the fuck up" when I was bleating about being burnt out after working on a deal for 60 hours straight without sleep.

I thought - and still think - that partner was an asshat, but unfortunately he also had a point. Jobs that pay as handsomely as medicine (and law) require hard graft throughout the training period and not just a decent number of UCAS points! It's not a "race to the bottom" to point that out.

YoungGirl it's plain from the posts in this thread by doctors that the issue is about far more than just pay.

Professions in which tiredness may lead to poor judgements with fatal consequences typically have restrictions placed on their working hours. Pilots and even lorry drivers are not allowed to exceed strict working time limits.

While it's true that many of today's consultants will have worked very long hours as junior doctors in the past, there is a good argument that the job has changed since then - fewer medical professionals are being expected to do more with less, treating an ageing population increasingly suffering from more complex and chronic illnesses. All this at a time when they are under unprecedented scrutiny from regulators, professional bodies and the public and where mistakes can end a career.

It is true that the NHS budget is exceptionally large, but it is also true that the UK spends far less on healthcare than comparable European nations with social insurance schemes.

I suppose eventually the market will decide, as doctors vote with their feet. (And it may even be that this is one of the unspoken objectives.)

Yes, I agree with your last point. I think the ideal would be for the government to stop acting as a healthcare provider and let the private sector step in. That would mean an individual doctor's pay was a private matter between that individual and the provider and (in theory at least) deliver greater efficiency. But as I said, I prefer the social insurance option anyway. I don't think situations such as Stafford would have occurred under (say) the French system. I just don't have your confidence in our politicians' ability to plan that far ahead!

Your point about the European average healthcare spend is also interesting. I can never tell whether the comparisons include the co-pay element made by those with the ability to pay? In other words, are the additional funds all from government or do they also reflect the individuals' contribution?

It's always a difficult issue but plenty of the bright teenagers out there will be choosing between medicine and law so eventually if doctors' pay gets too bad then we will have to let in lots of good Syrian doctors or pay more to doctors in the UK. There are large numbers of teenagers with As and A*s very very keen to be doctors at the moment though so I do not see the supply drying up very quickly.

I agree with Pacific that this discussion always seems to boil down to money. Which is a shame, as the problem with it coming down to money is that it's where you're least likely to get sympathy.

For example, on this thread there has been someone complaining that they "only" have >1k left after childcare... Often, (for women, and well qualified women too) they just about break even after childcare. FT CC is a temporary situation, and for a doctor it's even more temporary as their earnings increase so much quicker than other professions.

There have been many posts about how junior doctors won't be able to start a family or buy a home on their meagre wages. Again, a FY1 currently earns 27-30k depending on rotations. That is over the average salary. And that's only their first year. Then it's a 20% (ish) baseline pay rise in year 2, rising again each year following. Complaining that you'll never be able to survive for a year or two on a salary that most people will never earn in their lives will not get you much sympathy.

Having said that, doctors should expect to be above the "average" salary, given the effort it takes to become one. But they already are.

I think the focus should be on the hours. We need more doctors to cover the whole week's shifts. So doctors can do say 4 long days and have proper time off. No more than 50hours per week.

Those comparisons usually reflect all financial input (government/individual/insurance) added together. The NHS is good value on the international stage despite what our government may like us to believe.
My DH is a consultant and is angry about these 'proposals' (changes) mainly because of what they represent when you look at the government and its attitude to the whole of the NHS. It's not about individual drs, it's about the destructive changes that are being brought about that will not tackle real issues (PFI debts, lack of joined up social care/healthcare, greater demand) but will cause real problems (unsafe working hours, staffing problems, demoralised staff)
Comments about private work earnings aren't really relevant even for consultants as unless you live in London/SE at the moment private work isn't that prevalent, however I'm sure this will change as the NHS starts to disintegrate under the current push to break it.

Commonwealth Fund comparison of health care services 2014
Really, junior drs' salary is a total red herring in the discussion, but makes a convenient scapegoat to mask other issues.

there are plenty of bright young people queuing to go to medical school.It would be quite easy to put a clause in their training contract that they have to pay £xxx of their training costs if they work outsidethe NHS for x years
Lets not forget they are only 23 no 'real' work experience and still training.I can't see any suggestion that working hours will increase, just the definition of unsociable hours, and hence pay, that will change.

Younggirlgrowingold-could you provide some indication of when I get to declare the job 'finished'. Shall we pick an hour to shut a&e? Or shall i just go in one day and keep working until I get so exhausted I make a mistake and someone dies? slow hand clap

I've left my job as a pretty senior doctor because to return part time, I was going to have return 30 hours a week. And those would just have been the hours I was paid for, so I would have easily worked 35-40 hours a week "part time".

Medical schools are still busy but so many people are moving abroad once they are qualified.

Brioche, while junior doctors are still "training" until they become a consultant, who do you think is actually doing the work? The consultants are the last part of the chain and not even necessarily in the hospital.

Junior doctors have a massive amount of responsibility. I was 22 when I graduated, and in the hospital where I did my first job, so I was brand shiny and new, at the weekends, it was me and an SHO, who had graduated the year before me running the show for the medical admissions and wards.