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.

Mamadoc no I haven't read the full thread, sorry, just the first few posts! Will do when I have a mo. But just to answer a few things you say:

1. "When you have to do extra hours yes, it is 'expected' for no extra pay but I bet you get to choose to work from home, when to have a break and when you've had enough for the night."

Are you kidding?! I have lost count of the number of times I have been told "no one leaves the building until the deal signs". My record so far is 58 hours on the trot without leaving the office, no sleep. I have come close to that on many occasions. On the same deals, the corporate guys (I was on one of the comparably "easy" teams) have literally - I mean literally - not left the office for a whole week. No sleep other than the odd hour with their head on the desk. This is not at all unusual. If you work at a big City/US firm, this is what you do.

1. "I bet you don't do those extra hours at 3am in the morning or in preference to attending a friend's wedding."

See above. Genuinely, 3am is not considered particularly late. Allnighters happen all the time. Go into a big City firm and I would say that in the corporate teams, on any given night at least half the team will be there after midnight, day after day after day. As for missing weddings - all the time; that's not even considered a big thing. We are expected to cancel holidays abroad that have been booked months in advance if you have a big deal on and are needed in the office.

1. "You do choose to do the extra hours. You are not rostered on to attend your place of work all night and all weekend. If you don't like it you can walk away and choose a lower pressure, less well paid job. The NHS is the monopoly employer of Drs there is no choice in any of this at a junior level apart from to quit medicine."

I only "choose" to do the extra hours to the extent that if I didn't I would get fired! We often, often work all weekend and all night. On top of having worked all day, all week. And we don't get paid for it. The hours that are worked in the City by most bankers, lawyers, etc are much longer than those worked by doctors in the NHS. And you too could walk away and leave and get a lower pressure, less paid job! Not sure I understand your point there! Fact is that I need the money and it's what I've invested a lot of years training in - same as you. Jobs and pay/conditions are about supply and demand - if you've accepted the job, you do the job; if you don't like what you're being given, you walk away and you choose something else - you don't go on strike and hold people over a barrel.

1. "I bet you also get a bonus for your hard work and your courses, study and professional indemnity paid for."

We sometimes get a bonus - there's no guarantee. It's not very big generally (I'm not a partner - very few lawyers make it to partnership level these days, especially women). It doesn't even come close to making up for the hours we work for free. For many years over the credit crunch there was no bonus and also pay freezes. True though that we do get courses, study and professional indemnity paid for. But we don't have the job security you have, the benefits (maternity pay, etc) you have, the pension you have - all of that adds up to an awful lot more.

I think what I am trying to get at is that many doctors (and others in the public sector) are completely out of touch with what the expected work ethos is in the City (or elsewhere - like in the Army (which I have also been in)) - I really don't think that junior doctors have it that tough compared to other graduates going into many private sector jobs.

And for those who say "well a doctor is more important than a lawyer because doctors save lives" - the City and the taxes paid by the City and its employers are what pays for the bulk of the NHS!

Well MissTriggs and Stopping, if you feel we have it so rosy you could always retrain as a doctor and come and join us - we have a number of vacancies available!

Nurses aren't supporting the JDs strike because we think we will be next, we were first!! We have been shafted for years and there was, from what I saw, very little public support for our 'strike' a few years ago. It was pathetic, only 1 'union' allowed their members to 'strike' and it had no effect whatsoever.

As nurses we care about the NHS. We understand what it is to get treated the way JDs are being treated, by the very people that should be protecting us. We see the job they do every day, the pressures they face, the dedication they show and understand how ridiculously unfair these proposals are. You will be hard pushed to find a nurse that isn't supporting the strike not because we are afraid, because we are proud of them doing what we didn't

ps - if I was very ill I would pay to be treated in an NHS hospital any day over a private one spent many hours in my NHS ITU fixing absolute balls ups from private hospitals with poor facilities and no senior staff on site but nice fluffy pillows and free tv

The day we have a healthcare system like the parasitic American one will be the day I leave my job

Healthcare costs a certain amount. Unless you don't bother to have any as in Africa all healthcare systems are expensive.

I can't see how paying via an insurance system as in some other European countries will reduce the overall cost vs paying out of general taxation as in the UK.

Nearly all other places spend a higher proportion of GDP on healthcare than we do.

People will still be paying just in a different way. It won't make the system cheaper to run in fact it would probably be more expensive.

You might have lower taxes but then you'd be paying out for insurance. Swings and roundabouts.

Anytime you have insurance and co-payment surely there will be people who can't afford it and get a worse service. The precious, unique thing about the NHS is that it is free and fair. It is on the basis of need not ability to pay.

"The City and the taxes paid by the City and its employers are what pays for the bulk of the NHS!"

Unspeakably arrogant! Especially when 'the city' is largely responsible for the recession and does all they can to avoid paying tax!!!!

And for those who say "well a doctor is more important than a lawyer because doctors save lives" - the City and the taxes paid by the City and its employers are what pays for the bulk of the NHS!

Hilarious

Exactly.... More needs to spent so raise the funds via an increase in general taxation or via copays for doctor visits, removing free prescriptions for over 65s, making it income based or charge a monthly fee to receive treatment which is a % of your income over a certain amount. How you raise that extra money is what is open. My PiL pay a monthly contribution (call it insurance if you want) to receive care via the national Danish system. The payment is based on income. My SIL has no income so doesn't pay anything for her treatment. I understand germany has a similiar system.

Previous politicians entered into expensive PfI contracts which everyone knew would suck the NHS budgets dry starting around now.

Baconyum I'm sorry but the money available to the government for expenditure on public services is heavily dependent on the City's financial services sector. I'm not being arrogant - it's just a fact!

With regards to hours worked by those in the city, I can attest to them being brutal. J worked on deals and my goodness it was brutal. I was in Houston for 3 months and never left the hotel we were working from. As soon as we hit the road it was non stop. You slept at best 2-3 hours a night until the deal was executed.

It's why I decided to walk away. The money wasn't good enough to make it worth my while.

Only a lawyer could turn a thread about the plight of NHS staff, into one where we feel we should be thanking the 'city's financial service sector' for all they do

Class, I love it

Ok so lawyers work very hard.
I don't understand your job but equally you don't understand mine.

Your point is that you are not paid extra for long hours. Neither are we.

There is an overall salary same as yours. This includes a 'banding payment' which is a supplement to reflect the number and antisocial nature of hours worked.

It is not a case of getting paid extra per extra hour worked. It does not work like that.

If your job is eg A&E or paeds where you need to be up all night regularly you get paid a bigger 'banding ' than if you work an easier job eg dermatology with little out of hours.

I would imagine this is like the 'corporate guys' you mention getting a bigger bonus to recognise their all nighters.

The government wants to slightly increase basic pay for junior Drs but reduce the antisocial hours payment that is about a third of their pay resulting in an overall pay cut for doing the same job. Would you be OK with taking a big pay cut for the same work?

This will reduce the incentive to take the tough jobs and just make the A&E recruitment crisis worse. This is bad news for anyone who is acutely ill.

Furthermore there is a safety issue in relation to Drs that isn't there for lawyers. If I am tired and make a bad decision literally someone may die as a result. The government proposes to take away the penalty for exceeding hours limits giving a green light to work Drs into the ground. This is also bad news for patients.

The reason that the general public should support the strike is that if the changes go ahead the health service will be less safe. There will be less Drs in frontline services and they will be more overworked. (I do not expect you to care about the inequity)

I am behind the 'junior' doctors 100% .I cannot believe the ill -informed comments above regarding their 'free' training and the massive sums they earn.I have unfortunately had occasion to use the NHS quite a lot over the last two years and have nothing but respect for them, and dread the day when decent health care depends on one's ability to pay . I have friends in the US (middle class, well- paid professionals) who really worry about older age because of this . Insurance doesn't cover everything .
My DD is a fairly recenty qualified midwife .She knows lots of junior doctors and says they will leave the NHS/UK in droves if these cuts-and they are cuts ,however Mr Hunt presents it- in pay go through. UK- trained medical professionals are much sought after in New Zealand and Australia(and possibly elsewhere). Nurses/midwives and other HCPs know that they will be next in line . DD loves her job, though not its stresses.Before shift pay, she earns about £22,000 pa . Not a lot for the level of responsibility she bears. I'm not sure how much a new Dr earns but I doubt its more than about £30,000.
She regularly works 3x 14 hour night shifts in a row (and frequently stays on to complete paperwork, for which she is not paid) . It is not unusual for her to work far too long without a break/eating. It is well known that working shifts has a detrimental effect on your long- term health. The (large regional hospital) unit she works on should have 14 midwives on duty .They frequently operate on 9 or 10 ,which is not safe and puts huge pressure on staff. I assume this is to 'spread' the available staff over 24 hours, as babies do not confine being born to between 9am -5pm.
She and the doctors who work alongside her do their best not to let this affect their patients , but I suspect the NHS would collapse without goodwill .

My point about walking away is that there are various different law firms with various different terms and conditions. If your employer exploits you or you could get a better deal elsewhere you can leave.

The NHS is a monopoly employer. There is only one national junior Dr contract by which all are paid. You can be an NHS Dr or not be a Dr at all. You might have a choice to go private at consultant level but not before. You are obliged to work for 10-15 years on the junior Dr contract.

That is why the contract is negotiated by our union with the government at a national level and why industrial action may be necessary because we cannot change our terms and conditions individually.

NHS mat leave is 6 weeks full pay and whatever makes up to 6months half. Are private law firms really not more generous than that?

Sick pay. No idea. Never been sick more than a few days in 12 years.

I really don't think that junior doctors have it that tough compared to other graduates going into many private sector jobs.

I rarely swear but bollocks dimplehands The awareness that someone might die if you make a mistake isnt 'tough' ?

I think the thing is this is just a small part of the bigger picture - which is that we simply cannot afford the NHS as it stands.

That point I made above that, even if we were to close the NHS now, it would cost over £1 trillion to pay for the NHS workers' pensions scheme. Most public sector pension schemes are unfunded - they are paid out of present government revenues rather than from income generated by pension pots.

To put £1 trillion into context, if I were to give you £1 million per day since the day Christ was born until today, you wouldn't have nearly enough to cover that amount. That's completely mind-blowing isn't it?! I think everyone in politics knows the NHS is unsustainable but no one is brave enough to say it.

well said mamadoc
Explained in simple tems for those who just dont 'get' it

Had to leave the thread unexpectedly - ironically, to go into hospital as an emergency, have surgery and thankfully come back home again!

I don't think you can argue that the state has funded training and therefore we as doctors "owe" the state. Most medical students graduate several thousand pounds in debt, having had to pay tuition fees, 5-6 years worth of accommodation etc, without having the long usual uni breaks during which they can work to fund their next year. I was allowed to work part time during my medical degree (on the wards as a phlebotomist and HCA) to help fund my studies, but I think this is now being discouraged as it's hard enough to get through a medical degree without worrying about working too.

I also think that we pay the state back by working as junior doctors, antisocial hours for not nearly as much money as people think. My first job I took home somewhere between 1100-1200 per month - which covered a 40h week, 32h paid overtime at a third of my hourly rate and 10-20 extra hours a week unpaid just because they needed to be done.

I've already described upthread how much fun it is to move every 6 months, with very little notice, having to choose between uprooting a young family each time or living apart from them and seeing them every other weekend. Not a career conducive to family life!

As for being selfish to emigrate - yup. I care about the NHS and I care about what happens to it - my family are still in the UK. But the working conditions, commute, lack of family life, lack of jobs (rolling 6 month contract - no job security at all if you may find your contract not renewed because the trust has run out of money!) - all factors in my decision to emigrate. I earn less in NZ, work far fewer hours per week (40h public, 10h private plus overnight call for public - 40h / week is the max they will employ anyone for) - but I see my children and the lifestyle is outstanding. So yes, selfishly I put my children and family first.

We could afford a decent NHS if we were all prepared to pay more tax . Or indeed if we taxed big corporations more.Norway has one of the best healthcare systems in the world (ditto free further education) But I believe they pay about 40% tax .

Well we can't win. According to Dimple we should walk away if we don't like our terms and conditions rather than strike but to leave after our expensive education is also selfish according to others. Some think part time working should be banned and we should retrieve retired GPs somehow. Presumably for less pay too. Its also a national contract Dimble so to leave a job without entirely leaving medicine is not possible for juniors who can't do private work. What if the government said all lawyers should take a paycut for the first 10 years of their career? Would you walk away to another job or would you consider striking? What if you also thought it would be the end of an important public good? Didn't lawyers strike over legal aid recently for those sort of reasons?

It is absolutely not about supply and demand in the NHS.

Lots of people try and fail to get into medical school but the government artificially limits the number of places to keep wage bills down.

Supply is deliberately limited but it does not cause wages to rise because it is not a free market.

Because it is a national contract the wages for every Dr of a particular grade are the same in every specialty, in every part of the country (apart from a London weighting). You cannot demand more money for being particularly good or even for being willing to work in a shortage specialty in a far flung place.

You cannot demand anything. This is why we need our union to negotiate a reasonable deal.

Junior Drs are not asking for a pay rise. They are just asking not to have a pay cut. And in particular not to have a pay cut and at the same time also be made to work longer and more antisocial hours.

Is that so unreasonable??

Oh and the person who said that prescribing drugs doesn't look stressful? It isn't, it's easy.

Stressful is undergoing the training to know what to prescribe for which condition, to know which drugs interact with which others, to know whether a particular drug will help or harm or whether anything needs prescribing at all, to keep up to date with current scientific evidence about what to prescribe as first, second and third line for any of the thousands of conditions that people walk in with, to know how this new prescription will interact with any of their pre-existing conditions or current medications, and to maintain all of this in an easily accessible mental database.

Not that the work of a GP is really relevant to a debate about the junior doctors contract.

But the majority of people aren't prepared to pay much more tax! That is the thing! If you are a higher rate taxpayer, the actual percentage you pay in tax on total income (when you take into account ALL taxes, such as income tax, council tax, SDLT, VAT, etc) is about 83%. Where does it stop? How much more do you want people to pay? There is already a massive black hole in public spending. Sure we'd all love absolutely free tip-top healthcare, absolutely tip-top state schools, everyone to own their own houses, all pensioners to get paid a decent pension, the police force to be larger, the Army to be stronger, and so on and so on, but the money simply is not there.

The Drs pension scheme is in surplus. It is completely funded by us.

If you abolish the NHS we will still have to pay for healthcare somehow. Healthcare workers will still need to be paid and will still have pensions!

The NHS is not expensive it is damn cheap actually. Healthcare systems generally are expensive not the NHS.

If the NHS were abolished no money at all would be saved overall it's just that people would pay differently through either private or public insurance which will actually drive up costs.

The NHS pension scheme is funded entirely by current members contributions. These are £2bn more than is being paid out to the retired members.

OK, how about soldiers? Privates start on about £16k I believe. They won't get that much more than that in their careers. Don't tell me working conditions are easier for them. Don't tell me they are under less stress - they can very easily kill someone/many people accidentally because they are tired, they can also BE killed very easily. Or lose one or all of their limbs like several of my friends from my Army days have done. And how much more of a monopoly is there for them in the Army?! What are they going to do if they don't like it - join a private Army?!

No option (and in my experience, no will) for them to strike though.