Are junior docs really only on £14.09 per hour?

[yawningmorning]

That is so low.

I've seen the headline that you can earn more per hour working in pret.

No wonder they are striking.

But you said that our doctors are fleeing to Australia so am assuming that's correct but that Australia hasn't got a campaign to recruit NHS doctors.

Either way, if NHS doctors are fleeing to Australia (as you're suggesting) what are they going to do if you're already working regular hours?

They are coming because the pay and conditions are better, there’s no need for a campaign. There are junior doctor social media groups who share information about which countries are good to work in and how to get there, that may be a big reason why there’s more movements than previously. presumably there’s selection bias at play - those who are happy staying aren’t part of those groups discussing which visas they need.

“Regular” working hours in Australia are genuinely a standard working week - but it’s a big place, there are loads of hospitals and therefore loads of jobs. Unlike in the UK you don’t get sent to different parts of the country randomly as well.

The problem for overseas doctors is getting onto the more desirable training jobs, but it can be done, of course.

I know a senior consultant paediatrician who moved to Oz. Doubled salary and reduced hours, no idea about level but they were definitely still a consultant. This was a few years ago.

@Bloopsie ”what do they expect 50k salary for a junior doctor who cant even issue a l loo prescription without having to talk to a consultant first?”

um what?

f1s can indeed issue an inpatient prescription of pretty much anything in the BNF such as iv morphine , and then draw it up and give it all on their own without any oversight or input in the moment. That’s why they are qualified doctors and not randoms off the street. Yes ideally there should be a second check from someone like a nurse - but that goes for all IV medications whoever prescribed them. F1s can’t issue community prescriptions but that’s a hang over in legislation from when Dr Foster type GPs went round doing solo home visits and giving strong injectable meds in the community and the lack of access to a second checker was felt to be too much of a risk for first year doctors, nowadays most community prescriptions probably have more checks than hospital ones as very few are dispensed straight from the surgery.

I’m

a hospital doctor. I’m in theory training to be a GP so I’m point three on the pay scale but my exact same job is also done by f2s on point two of the scale. I spend my days admitting elderly patients to the wards in a big hospital. I see elderly people that A and E think need to be admitted and decide if they do or if they can be managed at home but currently are not in a ward bed becuase there aren’t any but are sadly stuck in a trolley in a corridor outside A and E E for (and this is shit) about 48 hours. If they can be managed at home I sort out their community care such as prescribing medications and arranging follow up appointments and care packages. If I feel they need admitting I order any X-rays and scans they need, take any blood tests and prescribe medications to treat them. I haven’t spoken to a consultant in about three weeks. I do always have someone I can call if I need to but I don’t usually. The patients will then be seen by a consultant at some point in the 24 hrs after they make it to a ward bed.

my job before this was in gynaecology. Again my colleagues were points 2 and 3 on the pay scale. We saw all the women who presented to their midwife or an and E with bleeding from the vagina (pregnant or not). I would examine them (with a chaperone) and undertake any removal of products that was needed (and could be done without an operation) I would explain ultrasound results and options for management of miscarriage to these poor ladies and then prescribe treatment if wanted or plans for further investigation which I would arrange. I would again decide if they could be discharged home or needed to be admitted. I did this as the only doctor in the gynaecology unit (with a wonderful team of nurses and sonographers) If I thought a patient needed an operation that night or weekend I would call a more senior junior doctor (one who specialises in o and G) who would come and review them and if needed would operate that night/weekend.
Patients I felt needed admitting would if they stayed in that long be seen by a consultant on the next working day and some of those o discharged I arranged to see a consultant as an outpatient but many went their entire hospital stay only seeing me. The consultant had no idea these patients ever existed.

Yes, but if you came as a specialist registrar in paeds you still have to sit the FRACP (both parts) even if you’ve done the UK equivalent. Similar for other medical and surgical specialty exams.

From what I can work out the best options are either complete training in the UK and apply as a consultant or come over as an F2 or F3 and then try to get on a training scheme here. Quite a few of my friends did the latter. The issue with coming as a consultant is that by then you’re quite old and often have a family and actually want to stay in one place.

I’m not sure about the rules for GPs - I have the impression that you do have to work in an area of need for a while but then there are soooo many GPs in my area with British accents and it’s not a rural/remote area.

Based on this do I have it right your base salary is 40k ish without premia?

www.nhsemployers.org/system/files/2022-03/Pay%20and%20Conditions%20Circular%20%28MD%29%201-2022.pdf

Doesn't seem to make much sense. I appreciate it's a big place as my brother lives there and I've been. But if there are lots of jobs and everyone works regular hours, then there can't be much need.

But I appreciate I work in the private sector where you employ more people because the workload increases and there's a requirement for more staff. If workload drops redundancy occurs. No private business employs people when the workload is fine and everyone is working a nominal 40 hour week. Unless you're looking for specialist skills.

I think calling highly qualified professionals Junior Doctors is the first mistake and needs changing ASAP.

Hi, "junior doctor" here.

Long time lurker but couldnt read and run, theres just so many misconceptions on this thread. Day off today having officially worked in the past week 4x12hr shifts and 3x8hr shifts so that's 72hrs. In reality, the 12 hr shifts all have 2x half an hour of handover either side as a minimum and the 8hr shift were about 9.5hrs worked plus 1 x half an hour handover at the start. I'm exhausted so cant be bothered to do the maths but clearly worked quite a lot for free. Why? Because I couldn't just clock at 9pm when I finish. It's a desperate state of affairs, the vast majority of us stay extra hours 1)so that the mega sick patients are attended to, doesnt matter if the patient with a heart attack or stroke was brought to my attention at 8.59 or infact even at 9.40pm when I've handed over got changed, bag on ready to go (that could have been you/your relative/my loved one or a stranger. The job will still be done thoroughly to the best of my ability despite probably starving now and letting down my own loved ones at home. , and 2)to try to make a dent in the workload for the doctor I'm handing over to who probably also hasnt had enough of a rest/sleep post nights.

I can see posts about "doctors signed up to this" - not really, it wasn't like this when we made the decision years ago. Certainly, our children didn't sign up to this. Promising your child you'll be home at 7pm (when really you should finish by 5 and home by 5.30, but say 7 to avoid disappointment and STILL frequently let them down) is exhausting and feels cruel.

What I should be doing now on my day off is studying. Studying for an exam I have paid several hundreds for (I cant remember exactly how much, I think around £580). I have already done several postgraduate exams. For the first time in my life, I failed an exam recently. Why, because there were several shifts over the winter that had NO cover. Consultants don't step down because often its been decades since they've done that kind of work. Same reason they will openly admit they are struggling now during the strikes. Why me? Because the doctor on nights needs to go home to sleep, the one starting the subsequent night needs to rest before coming in to relieve me, the one thats just worked the entire weekend before or the one coming is also out. That left about 2-3 of us. Between us we did what we could to pick up shifts. This included Christmas and New Years. Many more children of doctors again left disappointed. Also missed a Christmas period wedding, for which my husband was in the wedding party. Yet we felt grateful that he managed the day off.

We have long-distanced for years. We are both hospital doctors "training" in different specialities. We both get moved around the country. We both still do exams - there are a lot. We both have vast amounts of debt. We both pay rent and bills for our respective work flats as well as parking and commuting. This isnt sustainable and we are looking to finally buy our first home, in the hope that one of us can start living in it and one day if and when we complete training and become consultants -will aim to work in the same region so we can live together.

We have friends from university who did other degrees earning far more, own their home, started a family at a much younger age and are happy. I wouldnt say I'm not happy but I am exhausted. I am unhappy to have failed that most recent postgraduate exam which is putting that end goal even further. It shouldnt be about the end goal, it should be about the here and now given that I have been working in this for years now. Some of my colleagues will never become a consultant. All of my colleagues got a minimum of AAA when I applied to university (I got all As/A*s in GCSEs and Alevels, not a brag but trying to illustrate how rigorous post graduate medical training is). Nobody is training or teaching me in tangible way. We study after our long hours, when the kids are put to bed for whatever time we get.

I haven't even gone into what each of us do for work, just conscious of time and would like to get some studying in. In a nutshell, we both do very different specialties, but both make acute "senior" decisions. By senior, I mean that nobody is being consulted before making these decisions. The consultants are not on sight. Our more junior juniors are also flying solo doing their own thing, but when they need advice they call me and generally I have an answer for them. I think the last time I reached out to my senior - the consultant was at the end of January (I still remember the case like it was yesterday, it was complex and all the consultant could do was provide verbal support on the phone, which is enough). It is not unusual for the F1 doctor, the most junior junior dr to be first at the scene and initiate immediate management before escalating for senior support. We are all "junior doctors".

I have friends who long left the system, some straight after university and some at various points after. Many of whom are in Australia, earning more than double what I do and work less than half the hours, I think this works out doing about a quarter of the work for the same pay. I cannot blame them for leaving. I don't want to leave the UK but I do fantasise about it sometimes and wouldn't be surprised if one day we did leave. I have more roots now than single UK-based friends who are actively taking steps - one recently started working on a cruise ship. I don't think she'll come back.

Apologies if this has all been a great big ramble.

I cannot for the life of me understand the posters who firmly believe they understand the ins and outs of another woman’s job. The posters who have patiently typed out the nature of their work have been totally ignored or been told they’re wrong.

I know women who have been doctors for over 20 years and have never complained about their job until recent years. Same with my teacher and nursing friends.

These women have spent their lives patiently listening to members of the public moaning on at them and now people can’t tolerate them speaking up. Teaching/nursing/doctors - mostly a female workforce hence the acceptable gaslighting and being told to shut up

I think this description is so much more helpful to your cause than the obvious question raised by the Pret comparison (you make more, right)?

I don't think your job sounds pleasant or easy by any stretch and it sounds as if you are junior only insofar as you are not as consultant. It's clear that many of the issues you mention would not be helped by a bigger pay packet but they urgently need to be addressed. I think we all knew this though.

It's disappointing that you don't think any training of junior doctors as such is going on. I'm not a doctor myself but come from a huge family of medics and that just didn't ring true. It would be shocking if you weren't being actively mentored and trained to progress and if you're being accurate, that is a huge problem in itself.

@Cloudhoppingdancer it’s aA death spiral. Near to no training anymore. I’ve been a junior >10 years (maternity leaves have dragged things out a bit). We used to get so much more training (supervsion has always been patchy -see below)

Supervision of the very junior juniors (fy1s) is a joke. f1s have to be “supervised” by another doctor physically in the hospital. To be very clear this dosent mean that a consultant is standing next to the f1 helping them. This means that there must be an f2/sho” grade junior (so the ones on 16-19/hr >1years post qualification) somewhere in the building they can call for help, there is no obligation or set up to review everything the f1 does they may not even speak to the person supervising them or know their name for the duration of the shift. This is clearly rubbish “training” but does provide some protection for the f1.

This supervision requirement also leads to less training in smaller hospitals (particularly psych hospitals) So you can roster an f1 and an f2/Sho on for a weekend and provide at least some support to the f1 s and have better clinic cover or you could just roster an f2/sho and save money and use the f1 in daytime hours to do menial tasks that require a doctors signature such as discharge paperwork but no supervision requirements and then magically when they become an f2 they can do all of the stuff they were never trained to do unsupervised. Clearly many small hospitals choose option two. (Not advocating for less supervsion for f1s here but that they should actually get some training in)

I remember when I first . I have two named supervisors- one is a GP and is supposed to be in charge of my overall training. I have been supervised by them for two years but have never met them in person. I speak to them on the phone twice a year when they sign off my appraisal (ARCP) paperwork. I also have a named supervisor for each hospital job I work in who is supposed to supervise my day to day clinic work. But I have met my current supervisor twice in the last 8 months I have worked here. She dosent work in the same physical location as me so I don’t see her day to day (we don’t have consultants where I work - it’s a junior run service). When we met last she was very nice and bought me a coffee but we couldn’t talk about clinical cases as we had to meet in the cafeteria as she doesn’t have an office here as she dosent work here and I wasn’t allowed the “time off” to go to her place of work. Yup I have to apply for “time off” from my work to go meet with my supervisor at work. So I feel very very supervised and trained as you can imagine

when it comes to actually becoming a GP I have to pass two exams. We are given five days combined off work to study for them and can have the day of the exam off. That’s it. We’re not taught about how to pass the written exam at work and as I’m not even working in a GP practice I’m not picking up useful knowlage by being “on the job”. There are multiple commercial courses on how to pass the exam that I took some of which are run by thr people that set the exam (hmm- bias there me thinks) Next year I hope to be able to be being trained to be a GP in an actual GP practice to prepare for my practical exam but this has not yet been confirmed. The practical exam involves sending in recordings of you consulting with patients - generally you are expected to make these recordings in your own time not the practices as they haven’t got the capacity for you to be faffing about recording not getting on with seeing the next patient scheduled so you have to come in on your off days or annual leave days to do this.

all of this means that people fail exams and get kicked out of training. If you fail you get 6months extra to try and pass that’s all. You get kicked out and then there are less doctors and then there are more shortages and then the training gets worse and more people fail and so on

The base salary for these roles is 34-40k The same job is done by those on 34k as those on 40k. So the hourly wage is between £16-19/hour for this work.

I’m on ~24k as I work at 60% of a nodal point three as a GP trainee (that’s supposedly 24 hrs a week base.)(not complaining that I earn 60% of the wage for 60% of the hours - that’s very reasonable to me).

I also think f2s should earn as much as any other sho(as in there shouldn’t be the pay discrepancy between nodal points 2 and 3. People at these grades do the same job and should be paid the same.

my current job - the A and E admissions one is just base salary (all hours worked in the daytime on weekdays) but still lots of responsibility

the Gynae one had supplements for nights and weekends, very roughly with supplements for nights and weekends worked out it raises the hourly to about 17.5hr for point two and 20.5 hr for point three

the figures of annual salary’s with all those supplements added are rubbish because no junior gets the same wage for a whole year - the wage changes with each 4 month rotation depending on how much out of hours is done . And rotations don’t line up with pay dates or P60s so the wage goes up and down throughout the year and you often move employer mid year anyway so you never see it clearly laid out as an annual salary. You also don’t get asked if you want your next job to be one with lots of supplements or one with none nor is there any guarantee you keep supplements for the course of the four months - if the hospital manages to recruit an extra doctor (yay) meaning you only work 4 weekends in a four month rotation rather than 6 your pay will most definitely be reduced asap- makes planning your future financial life very difficult and mortgage companies and landlords for example will not allow you to rent/borrow based on the potential “extras” you might earn.

pre clinical 1-2/5 (and often an extra intercalated year to gain a ibsc) most other science degrees -lectures, labs, the bar, daytime tv followed up by panicked essay writing at 2 am. Lots of chemistry, biology anatomy etc

years 3-4 things get serious. Blocks of clincal placements interspersed with lectures and exams. Expected to be in the hospital all day, prompt and on time dressed like a professional and act like one. held to rigorous professional standards. Expected to have professional indemnity. Get hands on with patient care - examining, taking blood, drawing up meds, catheters, recording ecgs. You get 6 weeks holiday from uni for the year- no more long summers to earn money and relax

year 5. Shadowing. I was expected to be on shift when the f1 I was shadowing was on shift - nights weekends etx. I did everything they did except actually sign the prescriptions and death certificates. Then finials (scary) the nhs recognises this year as hard work and a positive benefit and pays your tuition fees for the year.

so by the time you hit the wards in f1 you have spent three years day in night out in hospitals. You’ve held peoples hands as they die and done CPR on those who hopefully haven’t. You’ve cared for hundreds of patients. You’re not green without life experience.

this is especially true of our current f1 and f2 becuase they spend their final med student years selflessly volunteering in hospital during covid. Todays foundation doctors were the very people who stood up at risk to their own lives when mere students for free (or a pittance after protest) to work in itu helping turn patients with covid, helping with donning and doffing of PPE, working as HCAs doing personal care and filling junior doctor rota gaps. These amazing youngsters are not in any way “green”

Sorry too half of that post disappeared

i think there is a fundamental non understanding as well of what undergraduate medical training involves. F1s aren’t appearing in hospital having never done any nhs work in their lives before. They have done five years of training for the role. It’s a vocational degree.

med school is five years;

pre clinical 1-2/5 (and often an extra intercalated year to gain a ibsc) most other science degrees -lectures, labs, the bar, daytime tv followed up by panicked essay writing at 2 am. Lots of chemistry, biology anatomy etc

years 3-4 things get serious. Blocks of clincal placements interspersed with lectures and exams. Expected to be in the hospital all day, prompt and on time dressed like a professional and act like one. held to rigorous professional standards. Expected to have professional indemnity. Get hands on with patient care - examining, taking blood, drawing up meds, catheters, recording ecgs. You get 6 weeks holiday from uni for the year- no more long summers to earn money and relax

year 5. Shadowing. I was expected to be on shift when the f1 I was shadowing was on shift - nights weekends etx. I did everything they did except actually sign the prescriptions and death certificates. Then finials (scary) the nhs recognises this year as hard work and a positive benefit and pays your tuition fees for the year.

so by the time you hit the wards in f1 you have spent three years day in night out in hospitals. You’ve held peoples hands as they die and done CPR on those who hopefully haven’t. You’ve cared for hundreds of patients. You’re not green without life experience.

this is especially true of our current f1 and f2 becuase they spend their final med student years selflessly volunteering in hospital during covid. Todays foundation doctors were the very people who stood up at risk to their own lives when mere students for free (or a pittance after protest) to work in itu helping turn patients with covid, helping with donning and doffing of PPE, working as HCAs doing personal care and filling junior doctor rota gaps. These amazing youngsters are not in any way “green”

The pay of an F2 today. And in 2007. It's called pay erosion. Less money, even before you take inflation into account.

@Qazwsxefv thank you for saying that. Those F1/2 doctors on the picket line were likely the ones holding the iPad so people could remotely say goodbye to their loved ones. They have v likely already acted up as students to be the doctor on the ward, as there wasn't anyone else. People don't realise how bad it is.
If only the support and conditions the consultants are getting during the strike could continue.

@SamanthaCaine why is it hard to understand that there are doctor vacancies in Australia?

I think your argument is that the current staff are not working really hard to do their work and that of the vacant post means that there isn’t really a vacancy? Nah it just means that nhs doctors are idiots (I am one btw) who care too much and work overtime for free to fill gaps when in other countries you finish your scheduled shift and leave even if there is still work to be done. The nhs has a culture problem where it’s not considered acceptable by management for you to take a break if there is still work to be done or to go home at shift end time if there are still outstanding jobs. Doctors that try to stand up for themselves by not working more than there contracted hours find themselves picked on by management who won’t tolerate such behaviour as leaving on time or expecting to be allowed to take ones booked leave.

The shifts for a start which is 13 hours PLUS it runs over! Or they have to stay....

The junior doctor vacancies in Australia aren’t indicative of a massive shortage and a need for NHS doctors though. A lot of doctors are needed to keep the hospital running. Doctors move jobs - in junior years it’ll be different types of medical specialty, in senior years it’s specific roles within their chosen training field.

An NHS doctor can work in Australia easily in one of the more junior roles, they just apply at the usual application time, along with the loads of others.

Their experience is hospital and location dependent - a big teaching hospital in Melbourne will very different to working in a small hospital in Hervey Bay (nice area of QLD). A big teaching hospital is prob better if someone is yearning to get on s training program quickly, a peripheral hospital is better for experiences and often lifestyle out of work.

if the post isn’t filled by an NHS trained doctor it won’t be empty though, it’ll be filled by someone else. Apparently a lot of jobs are quickly filled after recruitment has closed, after life events happen to some doctors and there are now gaps.

The early years, for many, are often a time of travelling to other countries and trying a few things out.

Where there isn’t a shortage is with training posts. If someone wants to be an ophthalmologist, for example, and to get on than training program they’ll be competing with loads of others for the same, ditto the surgical specialties.

So no, Australia isn’t crying out for NHS junior doctors. Many have to take a career back step to start with, if they have a training program in mind. Yet they still come and want to work here.

*in senior years should emphasise that these doctors are still “junior” though

@Cloudhoppingdancer No, I didn't make more than the Pret advert. I just looked it up (having used my payslip to get my rented place), I was on <£11 an hour. Still, I don't think comparing to Pret etc helps. It is not a race to the bottom. I also earnt less than the nurses who would bleep me, meanwhile I've been bleeped by about 10 nurses and prioritise patients in order of whos sickest/needs me the most and when I get to those lower on my list see in the notes "Dr informed at x time". As if they passed the buck. I used to find this frustrating as the F1 junior doctor. Now I understand they do that to protect themselves. Anyway comparison is not helpful. For what its worth, I support the nurses strikes too. As I say, its not a race to the bottom.

Of course a bigger pay packet would help! How would it not? It wouldnt solve all the problems and there are many to be addressed, but it would certainly help in so many ways:

1. DH and I wouldnt have to houseshare (yes we are both 30something and to keep costs as low as possible, share with others in a flat/house close to each of our hospitals). Neither of us imagined this to happen at this age. Our quality of life would be better if we didnt have to do this, even if just 1 of us).
2. there wouldnt be so many staff shortages. less people would leave for Australia etc if there was a reason to stay. My day to day life may be a bit better at work.
3. I wouldnt have to last minute be guilt tripped into covering shifts I do not want to work. Maybe having a bit of time off, annual leave to study would have meant I passed my exam. I was only off by less than 2%.
4. I wouldnt be toying with the idea of leaving.
5. I enjoy my speciality. I have trained a long time to be where I am. I actually enjoy studying, working hard and making a difference. I don't enjoy it more than not working though. If I could afford both the time off actually being able to book leave (we are supposed to get rotas 6 weeks in advance but often dont until the day) and financially to do nice things outside of work I would definitely be happier. I have had to say to a friend that I cant guarantee I can be her bridesmaid, I just don't know what I will be doing in summer 2024. I have no rota, no idea where in the country I will be after August 2023. I wouldnt even have been able to commit to a September 2023 event. Maintaining friendships/relationships/being the kind of parent you'd hoped is hard when your life is so chaotic.

Not sure what your final paragraph is insinuating. Its not that "I think" this is the case, we are the ones living it. "Training" is so very variable across specialities and healthboards. It is very often peer teaching, we each take it in turns to prepare something and present it to eachother. Nobody is paying us. During these sessions if we are called away, we leave. We usually do this over lunch. That sandwich is left uneaten. "Training" is also taken to mean maintaining a portfolio at home in your spare time (again not paid for this time) and used in an ARCP panel at the end of the year to decide if you've achieved competencies for that grade. Non-training doctors dont do this. Possibly why some step out of training, others because its hard to secure a training post. These doctors may never leabe the "junior doctor" stage. I also imagine some do it for stability for their children and schooling. "Training" also equates to exams. We prepare for this outside of work in our own time. I suppose training is often just gaining experience. I am not necessarily criticising this, sure more training opportunities would be wonderful but I don't think it is as needed as it may seem to you as an outsider, "junior doctors" are not really that junior. We have done 5 years of medical school as a minimum, every single one of us. The majority have also done foundation years. Gained experience a range of specialities. Passed postgraduate exams. Gained further clinical experience in our chosen specialty. Perhaps even more so during the years working as a "junior doctor" before getting a training number. We are all so varied. Some colleagues were actually very senior in their country but come here recruited as a "junior".

Teachers do earn less, starting on about 25 grand as opposed to the 29 grand of a junior doctor.