to wish doctors weren't going on strike

[MissTriggs]

After 5 months of misdiagnoses, being sent to the wrong person, explaining why suggestions weren't helpful, holding my GP's hand and fighting to get to the right person I'm now booked in to have the test I need on 2nd December, the day after the strike.

If my test was on 1st December I'd be pretty upset

I then read a post on here from a junior doctor claiming s/he could make more money "as a manager at Greggs" and that tipped me over the edge.

I saw lots of posts from doctors saying they already work weekends but it turns out they get paid extra for this at present.

I think doctors have no idea what it is to work in a job where you can be sacked easily, where you don't know whether work is coming in from day to day, where your employers have no interest in getting you back to work after a career break and where you either have no pension or the value of your pension can fall from year to year and be worth nothing.
I also think they don't realise that, whilst a generation ago doctors might have been unusual in working antisocial hours, nowadays all professionals are expected to be available all the time.

I might be wrong, but I don't think I'm being unreasonable here.

I think we do have a graduate shortage - not enough med school places to fill requirements. (I feel like I should know this, I teach in a med school).

Why not list the professions that worse off. You've goaded your way through so far

Such bitterness throughout your posts Miss Triggs.
I wonder exactly what it is in life you value in life most?

I think the lesson everyone needs to learn Maid is that comparisons are odious.

I know some lawyers and accountants have long hours and long commutes to see clients, but anything approaching junior doctor hours wouldn't be the norm unless you were rising through the ranks of a very competitive and well paid part of the industry. If people drop out does it really matter? Also, high flying accountants and lawyers are aiming to be partners and take home a share of profits not just salary.

On the other hand, we need doctors to work where they are needed, however unglamorous the area, otherwise we are all stuffed.

(Or alternatively we are happy for them to work for those who can pay and stuff the NHS).

Divide and conquer.
It's a race to the bottom and we have to stop it.

We need a 7 day a week fully staffed NHS but this is not the way to go about it.

Merry, we all know more about our own profession than other people's I guess......for me that's the take home lesson of this. The grass is always greener...

Mrs Triggs explaining things to you is painful and slow - have you really not read anything on this from a reputable source? My 12 year old knows more

Also horrifying to read that you are a management consultant - this is the level of knowledge and intelligence that comes into play when management consultants are called in to tell the NHS how to run their services - they work 9-5 and the best you can hope for is their stating the obvious.

I suspect like Jeremy C you are being deliberately disingenuous with another agenda completely.

I have been in hospital medicine a long time and I fully support the junior Drs. The rest of us will just have to work longer to cover the gaps and try to keep a safe service - but that's nothing new

Sorry you are suspicious. You're so wrong....

Mind you I remember many years ago whilst working in recruitment that people wanted to work the weekends because it was at least time and a half if not double time.
Over the years the weekend has become part of the working week so no extra money is paid for working weekends whether you are in a factory or a doctor.

The working world has changed and not for the better.

8 years is the fastest you could possibly become a consultant I think. Starting consultant salary is 75,000. Out of hours pay is then much, much less as you are often then 'on call' from home rather than in the hospital on a shift. You get maybe a 1% supplement for the on call.

10-12 years is maybe more average to become a consultant.
If you have maternity leave and part time work it will be longer. Increasingly a period of full time research is required in some competitive specialties for 1-3 years so you can add that on too. If you change your mind about your specialism you will have to redo at least 3 years. So for some folk it could be a very long time being a junior Dr.

Probably the reason people are disillusioned by the time they are a senior registrar (8 years post qualification) is that a job is more than money. People have got married, started a family and want to settle down by then and they realise it is no life.

For that money you will be required to:
Move hospital every 6 months to a year (a rotation) Starting over completely new systems, new colleagues etc every time you get settled you move again. I hated that so much.
Because you will not want to move house every 6months for some of that time you will inevitably commute long distances or live away from home.
You will be issued a new rota with very short notice every 6 months and you will scrabble desperately to make your childcare and personal life fit around that. You will never be able to plan more than a few months ahead. All bets are off 'until I get my rota'. You can't plan where to spend Christmas or sign up for a nursery place or book a family holiday. You can't join a sports team or a choir or any regular commitment as you can't promise to turn up.
You will get a bit sick of missing your friends weddings, partners and children's birthdays as you are never able to swop your on call shift. You will start to wonder if it is really worth it.
You will by now be pretty good at your job but you will be powerless to effect any change as you are 'just the reg'. You will do what your boss (the consultant) says whether you agree or not because you need a good reference and sign off or you can't progress. Anyhow it's pointless to try to change anything as you are out of there in 6 months.
You will also be studying hard for postgraduate exams whenever you are not actually at the hospital. These cost hundreds of pounds just to enter and are essential to get to the next grade so you had better pass. You will also shell out hundreds more and give up yet more weekends to go on courses to make sure you pass said exams.

If you add into the mix that lots of Drs are married to other Drs and both of you are trying to work crazy shifts, study for exams and move every 6 months you can see how something has to give and often the wife quits.

I didn't ever make more than about 40,000 during my registrar years even with out of hours because of working part time and my specialty not being acute so banding only 20%. I shelled out thousands and thousands on exams, courses, GMC, BMA, defence Union, Royal college not to mention petrol commuting and extra expense of childcare at antisocial hours.

Mrs Triggs explaining things to you is painful and slow and the OP's responses are conderscending and goady.

There are other respects in which it is a profession with better conditions than other professions - I don't want to start another argument though so won't list them.

But that is completely irrelevant when you need to see a doctor.

We need a 7 day a week fully staffed NHS but this is not the way to go about it.

Really? Why? I don't think we do.

Why not ? Do people only get ill between 9 and 5 Monday to Friday?

Merry, we all know more about our own profession than other people's I guess......for me that's the take home lesson of this. The grass is always greener..

You are missing the point. I want the grass to be greener for doctors, because (speaking as an accountant) I'm happy for the market to dictate how many people work in tax, but I need there to be enough consultants working in geriatrics.

thanks Mamadoc. That takes you to what age - 32?
sounds genuinely tough.

I appreciate your replies (am studiously ignoring the abuse as I'm sure you do when at work!)

Do people only get ill between 9 and 5 Monday to Friday?

Last time I checked A&E is open 24 hours a day and hospitals do not close at weekends or at night.

Oh I see Merry.

Truthfully, whilst the abusive people tell me it's all simple, I think it's actually very complex! Once you've worked out the individual doctors' experience, you then have to figure out how to alter the system to avoid a lack of doctors.

I haven't grasped how the two interrelate which will no doubt lead to more abuse.

I am a "junior" doctor, although not in England and so not balloted for strike. I am not surprised at the outcome of the ballot. There is a complete break-down of trust between doctors and Jeremy Hunt.

The health secretary is highly economical with the truth. The basis of his "15000 extra deaths at weekend" was a paper in the BMJ- but the authors of that paper and the editor of the BMJ have written to Jeremy Hunt to highlight this and their anger at the misrepresentation of their work.

When it comes to this contract, there is a lot of misinformation. The junior doctors are not asking for more money. They just don't want what amounts to an effective pay-cut for more hours (despite the 11% rise in basic pay).

The removal of punitive sanctions for hospitals who run rota's require doctors to work excessive hours and replacement with nothing of substance means that any promises made about "reduced hours" is absolute rubbish. These rules will be ignored because there is no real disincentive not to and financially attractive to have fewer doctors working longer hours, especially in areas with staff shortages. The only thing that makes management of any hospital I have ever worked in take notice of rota's breaching the agreed hours is when it reaches the point that the sanctions kick in. We can bring up the problem, raise concerns and it will be ignored. Financial penalties come into place and suddenly things are changed (for a while at least). That is part of the reason this contract is unsafe- there will be nothing with teeth that will prevent excessive working hours which are unsafe for doctors and unsafe for patients.

Added to that the disincentives to recruit to general practice at a time when recruitment in to GP training is at an all time low. Ditto the situation into A&E, Acute Medicine and to a lesser extent core medical training (although the latter two are not in as bad a situation as GP and A&E recruitment). This is a recipe for disaster.

I think many are missing a lot of the problems with the "7 day a week" NHS. There are not going to be more Dr's overall, so if there are going to be more doctors working at the weekend and overnight then it stands to reason that this means there will be fewer doctors during the week and during the standard day. Therefore service therefore more stretched during the week. Improved staffing at weekends will mean reduced staffing during the day unless extra staff are recruited.

And it will require more than just extra doctors- all the other staff from physio/OT and radiographers to lab staff and clerical/admin staff will be needed to. Where are these going to come from?

The government want more work done- but with the same number of staff. And then try to tell us that this can be done by working fewer hours. It just doesn't add up.

What we have to ask is do we actually need routine appointments and treatment at the weekend. In our area some of the GP practices trialled weekend appointments. There was some demand for Saturday morning appointments, but very little for anything after 1pm or on Sundays and so it was abandoned as it was unviable to keep the surgery open with all the costs associated for low take up (and higher than average number of "did not attends").

Sorry, long rant. I wouldn't want to strike, but if I was in the same position as the English junior doctors I would. I hope this can go to ACAS and be resolved properly.

Why not ? Do people only get ill between 9 and 5 Monday to Friday?

Hospitals don't shut out of hours .

Really?

You think our NHS works out of hours?

People are going to A&E because they can't get in at their GP surgery
More people die at the weekend in the NHS because whilst the junior doctors are working their bollocks off the support system isn't.

There are no days in healthcare. People get sick regardless.

not a rant (and polite, yeah!)

very interesting - fewer weekday appointments surely a worse thing....

I speak as an auditor for big4 here in NYC. My salary is terrible and in Jan & Feb I have only just managed after 6 years of experience in this field (I have transitioned into this career) my hourly rate is more than minimum wage during these months. I am on a PT schedule and the hours are still tough at about 40-45 hours a week for an 80% schedule. My team who are all FT work 60-80 hours a week. During busy season my hours increase to about 60-70 while my team work about 90-120.

The difference is that we don't have to deal with the general public. My clients are well run organizations who want to do things properly. We go in and audit because it's an SEC requirement. My client who is a broker dealer is heavily regulated and our audit work is extensive.

The big difference between the NHS and my employer is three fold, namely that they know they are getting a bloody good deal and give their employees what they ask for as long as it isn't money coming out of their pockets. If we work past 10pm we get a car service home. My client which is in the middle of nowhere NJ pays for us to stay at a hotel around the corner for the last two week of our year end audit so when we do work until 3am and are back at our desks at 9am we don't have to drive an hour each way to our homes. We also have meals and snacks provided that the client pays for. I asked for a sabbatical this last summer so I could spend time with DS who has a development delay. I am now pregnant and can take 6 months off no problem. I also have a small teeny tiny pension (NHS provision is much better IMO).

The second big difference is that I am serving a client who is professional and qualified. Doctors and nurses are dealing predominantly with people who don't listen to advice, diagnosis or follow treatment plans. Being in a professional capacity I understand how important it is to do as I am told, show up on time for my appointments and respect the doctors who treat me. Very few patients do this and what happens is that when it is your turn you find the doctor doesn't treat you with the respect you are giving them, they are disillusioned and because they are exhausted from treating this sub group they end up not delivering the best quality of care.

The third big difference is that as an auditor I have the authority to determine what testing is performed. Whenever I have determined a gap in procedures no one ever tells me that its not in budget to do the work. Instead we scope it out and bill the client. The work is done and if the client complains we just say 'Enron'. Doctors and nurses have management breathing down their neck and setting up barriers that prevent them from delivering the care they deem necessary. That would drive me absolutely barmy.

Ok. I'll bite.

Juniors basic salary is for 40 hours/week.

They get banding to cover their rostered additional hours and the antisocial component. Most post EWTD are on 48 hours/ week. The banding varies according to the antisocial ness. I'm an anaesthetist. I worked about 1in 3 weekends thoughtout my training (and in fact still do as a consultant). I also did a lot of nights... So I usually had a naming supplement of 50%.

Most lawyers (my brother is one) especially out if London don't do a lot more than 40hrs/week. My DBro has 8yrs PQE and is on about 43K he also gets departmental performance related pay bonuses of about 3K and a firm performance bonus if the same - so assuming everyone is performing nicely he takes home about 49k.

A junior doctor at the same level of PQE will be on a basic salary of about 39k with banding so in anaesthetics (50% banding) they will get just under 58.5k so 9K more but for that the are working an extra day per week and loads of weekends/nights

Junior doctors also fund a lot of their own training costs - study leave is typically funded at 750per annum, just one life support course is around 600quid and most doctors need to be certified in adult, paediatric and trauma life support.

They also do post graduate qualifications by sitting exams which range from 400->1000quid an attempt. Most people sit at least one of these exams more than once and each postgraduate qualification consists of several sets of exams. Exam fees are paid exclusively by juniors. The NHS never Pays for them.

The junior doctors also buy all their own text books for the exams and any revision courses they attend.

In my experience most professionals in the private sector get their CPD needs funded.

There are also other professional expenses paid for out of earnings which are not reimbursed- again in the private sector most of these would be- mine averaged 1500quid /year as a trainee.

GMC fee (£400)
indemnity insurance (and contrary to the poster above I think this is essential about £400).
College membership (to enable you to be registered for training about 200)
other specialist societies eg. Association of anaesthetists as it gives you transfer insurance so that if an ambulance crashes when you are moving a patient between hospitals your family will be looked after -there is an issue with NHS workplace insurance for this as you are "off site" in an ambulance...£.200
BMA fee £ 200

I have never heard of a payrise in the past that came with pay protection, the very fact that it does should indicate that this proposal is anything but a payrise.

Argh that post got ipadded.

I am actually literate. I just hope the typos and random autocorrect don't detract too much from the meaning.