To wonder why we treat our Junior Doctors so badly?

[alfredomuretto]

These people have likely been the very brightest in their school, got very high grades, struggled through 5 years of university (£9k fees). Then they get to enjoy two years of being a junior doctor. They have to work very long hours, in appalling stressful conditions, direly understaffed, with nurses treated just as badly. Then they get a starting salary of £27k.

Why aren't we valuing them better?

ODFOD? I’m guessing that’s rude?

The biggest issue is that being a junior Dr is massively family unfriendly so unless you have family locally you need to fund a nanny or have someone working very part time as your partner, if you have children... having a Dr in the family massively impacts the other parent's earning capacity! A nanny isn't cheap, nor are the registration fees, cpd and exam fees needed to progress!

is so unfair when compared to the loopholes of those with businesses or in private sector.

The vast majority of highly paid private sector people are employees, so do not have loopholes or ways of avoiding tax.

LaurieMarlow, are you Serious? Most people I know have business arrangements such as consultancy company’s or holiday cottages in their gardens that are used to avoid tax. Occasionally happens in private sector but not as much.
Accountant friend had his children as directors so paid university fees as part of the company training programme. He gives his wife loan notes rather than take income. He has his children’s and wife’s car as company cars.
Our neighbours have their country house (lovely nine bedroom weekend retreat) as a conference centre and business satellite. Everything they do or buy is offset against tax. They are multimillionaires with a house in Chelsea and a ski chalet but pay no income tax at all.
No wonder public servants feel cheated.

I am nearly 4 years post ccst. I will earn £110,000 this tax year. I don't work anything like as hard as lawyers or bankers on similar salaries. I do minimal low frequency on call and meet the dcs off the train at 4:45 pm 3 nights a week. I have 6.5 weeks leave a year (not counting bank holidays) and as others have said an excellent pension. This is all NHS btw and I do not consider myself a high flier. So I do think once the junior years (15 in my case) are over we are well rewarded.

On the flip side I worked every other weekend with rotered anual leave from aged 24-36. For most of this time I earnt between £30,000 and 50,000 a year and changed jobs and therefore working patterns every 6 months. When I entered higher training aged 37 working conditions improved and I could choose my holidays for the first time in my working life.

I do feel sorry for the juniors now, their starting salary is the same as mine was 20 years ago and they are coming into it with horrific student debt, which we never had to the same extent. I think the hours hours have improved a bit over this time, but overall I think the package is less good.

Cherry you’re taking about people who have equity in the company. That’s not regular private sector workers with comparable incomes to doctors.

You also seem to be talking about people who are making money out of property they own. That’s not specific to private sector workers. A public sector worker could also build a holiday cottage on their land, rent it out and avoid paying tax.

I agree it sounds really hard and exhausting.

However, it is very difficult to get into medical school, even with loads of A*s . . . while so many people want to do the job there is no incentive for the employer to improve pay or conditions.

Same applies to Firefighters - dangerous, badly paid work, but people are clamouring to apply so why pay more?

I do find it bizarre that the people who have most responsibility - keeping people alive and well - have to work crazy hours. How do they work for days on end on barely any sleep and not make errors in judgement? Why is it acceptable to make doctors work these long shifts

They don’t work like this anymore. They will tell you they work incredibly long shifts with tales of woe because that’s what they genuinely believe. Cue the ‘back in my day stories’. It was nothing for us to work over 72hours straight, often with no food. Of course, you had gone so long over your planned shifts you were now nearly on your next one so you just grabbed 6-8hrs kip in the doss room and started Groundhog Day all over again. Most of the time you just went past tiredness into something else. That’s a loooong time ago. What you can do when you are 22 you can’t do in your 50’s. I do recall driving home one night after working over 72hrs, I missed my turn off so threw an illegal u-turn to go back, right in front of a police car (didn’t even see it). Explained the situation, was they were sympathetic. Missed the turn off a second time, passed them again. Missed it a third time - they politely gave me an escort the rest of the way. I did what any self-respecting person did back then to escape situation, jumped over to the NHS as soon as possible, much better working conditions at the time (talking 30 years ago).

I will admit the medico-legal aspect has changed in this time so they have it a lot harder in this respect now. But to be fair they don’t work nearly as much and conditions are so much better.

I’m really glad things have evolved and changed but by god a lot of the trainees are whingers now.

Dh is a high earner. There aren't "loop holes", as people are so eager to claim. He doesn't magically save thousands and thousands of pounds through these magical non existent loop holes people think exist.

Oh yeah, student debt, we didn’t have any student debt which is another thing I’ll give them.

The hours used to be worse, dangerously worse. The fact doctors used to be paid half time (not time and a half, half normal pay) for overtime is disgraceful. Hours now are better generally but weeks can still add up to 72 hrs and my husband just did a 72 hour shift over the weekend - he did get some sleep but still having to go in at 2am home by 5am and then At 8 am for the days work isnt fun. I do resident shifts so for my weekends I do 3x13 hr shifts with a four hour round trip commute so I leave at six am and get back at 11pm and I’m paid for 24 hours a week as I’m part time. It’s better than it used to be but it is hard and then your expected to come home and put in 2-3hrs Study a night!

It’s the acuity that’s changed though - we are expected to do more than our contemporaries 50 years ago, medicine has moved so fast and patients are sicker as they just wouldn’t have survived back then. So shifts are more intense. Facilities have also declined (true across the whole public sectors) - no where to rest and no where to make a cup of tea at 3am and to top it off they have removed all the sugary drinks from the vending machines!! - serious issue at 3am when you need a pick me up between one trying to die baby and the next! Please don’t say I should buy one before I start! Ever seen a shop open at 5am on a Sunday?

HoppingPavlova theres no way "back in the day" you had the ridiculous targets, processes, bureaucracy, crap systems and lack of staffing junior doctors are faced with these days so I think its really unfair of you to try to compare. Also, I don't think your anecdote is a great example for the point you are trying to make, its really stupid, dangerous, unsustainable and shouldn't be the type of attitude to be encouraged. I think the whingers you speak of would "back in your day" have been inwardly depressed, anxious, exhausted and feeling very alone having to avoid the stigma of discussing their mental health because people like you set this disgraceful president, dismissing valid feelings as whinging. Well done you.

I expect that as all senior doctors had to go through the same route, they will be unwilling to argue for change, on the grounds that they had to do it so why shouldn't new doctors.

I'm glad my trainees are 'wingers' now - why shouldn't they stand up for themselves? It's not a race to the bottom.

My dad was a junior doctor and worked longer shift patterns than I did. But he says his shifts were loads less intense. He was rarely called, spent significant chunks in the on-site bar (!) and the whole 'firm' were regularly taken out for dinner by the consultant. On the other hand, he had to do an antibiotic round as the nurses didn't administer them then and was regularly expected to work above his competence. He says that people died who should have but it was considered part of learning :/ not a system I'd prefer as a patient that's for sure.
Medical careers have changed massively over time. Is it better or worse? Who knows!

But there's nothing wrong with the current cohort pushing back about the shit bits of their work. And don't underestimate the loss of goodwill following the new contract 'negotiations'.

The other thing to consider is that once you've qualified and you're finally truly familiar with the beast, you can't really just look for a different job. You can change specialty but that's not the same thing and it's usually same shit different location. My husband is one of those high flying lawyers mentioned upthread and when he was working more hours than he was happy with he was able to find another job with fewer hours and more money. He can also apply for jobs in other places as often as he want. Doctors have to apply for transfer to change location and they're more often than not they're refused. And there's no negotiation for different hours or pay.

There are worse jobs and better jobs!

@YorkshireGoldFanClub well said.

hopping I have no doubt you faced challenges 'back in the day'. I do not agree though that this detracts from the current, different, challenges, that juniors face. Branding junior doctors as 'whingers' for talking about the difficulties that they face is counter productive, and frankly dangerous too. If we want safe working conditions we need to see all involved as key stakeholders.

@fakefake

*I think a big part of the problem is lack of empathy/help from non doctors.

Many people think £27k as a starting salary! “I’m only on £30k myself and worked 10 years!They’re just greedy”

Well no Sandra, when you were having great teenage years with Donna drinking and getting 7 GCSEs at C, the future junior doctor was studying hard. Then that future doctor studied hard for another 8 years. THEN got that 27k, all the while you were earning from 16/18. So that salary also amount for lack of salary during those years. And that job as a junior doctor will involve twice or even thrice your hours at 5 times the stress level*

You're absolutely spot on!

My lovely cousin is a almost a newly qualified GP, she has 2 children and didn't go to medical school until she was late 20s- had done a degree and had a career before.

In some ways this has helped her as she realises that the grass is not always greener

A couple of her (non-medic) friends/acquaintances have previously joked that her DH can give up work once she qualifies as a GP- the assumption being that she'll be on such a massive salary

It is generally said in jest, but it really used to wind her up

Hopefulhalf May I ask which specialty you are in.

For me I feel it is a survival of the fittest and it does really depend on your soecialty. Many of my contemporaries from med school are now GP’s doing lucrative locums and working part time- they mostly couldn’t hack the stress of specialty training.

I am now at the end of my training but still have a fellowship year to do paid at 50k pre tax- which for a surgeon pretty much with already 6 years med school and 7 years specialty training under my belt I think is ridiculous but something you have to do to progress.

On the flip side my specialty pays well from a locum and private perspective and I have no doubt many consultants are in well in excess of 150k (including their NHS salary). They also rely on juniors who are experienced and run on-calls so rarely get called in if on-call.

@Moreisnnogedag I’d be willing to bet my house your job plan was signed off by your clinical director. I’ve worked directly in around 10 trusts and come into contact with tens more. Job plans are the ultimate responsibility of the Medical Director and were signed off by CDs or clinical leads in all of those organisations. Your divisional operational or business manager might do the grunt work in actually pulling job plans together, which by the way is an utterly thankless task, extremely complicated and a massive PITA, but responsibility and agreement to job plans sits with your senior medical colleagues.

Nearly every Trust works with a divisional structure these days, meaning the CD holds (and is usually given 2+ PAs for) managing the division, with the support of senior nursing and operational people. They have a shared accountability.

What a fucking stupid comment.

Plenty of people work incredibly hard and get great grades and degrees and will still never hope to earn £30k. There will also be lots of people who bombed school but are on 6 figure sums. Working hard studying does not always translate to a high wage.

Saving lives and providing such a specialist service should mean getting paid a lot.

It is always hard to compare old and new. It is true that doctors used to work longer hours (although they were paid - many many many other professionals do not get a single penny of over time - I am writing here from a family of doctors and lawyers by the way). So much shorter are the doctors' hours today that they have less experience at the same stage when comparing older doctors and younger ones which would make them worse at the job of course or take much longer for them to have the hours of practice. Pros and cons of both approaches and it is never easy to compare different times and what was appropriate at one time and what may not be now.

I value them a lot and the service they give

Do I trust them with my life and conditions which aren’t straight forward? Heck no!

IMO, one way to treat juniors doctors better would be if people stopped using A & E for all sorts of things, that are not accidents or emergencies!

DD2's bf is a F2 on his A & E rotation at the moment. We are shocked at what he has told us about why some people went to A & E by ambulance!