How much do you think junior doctors should be paid per hour

[Jill688]

you are being unreasonable - they should be paid £14/hr

you are not being unreasonable - they should be paid more

Yep, they’ll go where they’re valued rather than being paid the pittance that some on here seem to think is sufficient

@Onstrikein2016

Doctors are leaving for higher salaries and better working conditions and that is the free market. The issue is we do not have a market driven NHS in that we are aiming to supply a range of care free at the point of delivery. I suspect that sustainability of this model will ultimately be to give wages less than the equivalent in the private sector. You could argue if you value social medicine this may be a given.

Possibly medics being intelligent with highly desirable skills can migrate relatively elsewhere to other lucrative roles but is this ultimately a problem with our system or as a result of the ambition of our medics? If the high achievers move on do we take the slightly less high achieving and hope there is more durability (and value for the tax payer)?

the junior doctors on strike and the are the ones who feel some loyalty to the country and the nhs and have a vocation. Those that don’t have already gone aboard/quit medical field entirely/quit clinical work for working in research or pharma or aesthetics.

we have a healthcare crisis or perhaps a healthcare death spiral . As older people on average need more healthcare than young people and with the shape of the uk population as it is we’re at a place where we need lots of healthcare for our elderly population but from a smaller pool of working age people. Anyone with half a brain could have foreseen that this was coming and 10-20 years ago increased training numbers of medical students and nurses and pharmacists etc. But governments haven’t - they limit the number of pre reg posts and so limit the number of medical students and they in their great wisdom had that little fiasco about charging student nurses for the privilege of taking people to the toilet etc.

since we don’t train enough medical students we rely on imported doctors usually from less economically developed countries (we did also used to have a decent number of EU docs but brexit did for that).m but however isn’t enough to recruit the numbers we need (and there’s a massive culture shock for international doctors coming from countries where doctors are respected to come to the uk where the working conditions are awful and they face so much racism) so we don’t have enough doctors

there was junior doctor strike in 2016 if you remember. A lot of it was about hours and conditons. Promises were made such as giving you eight weeks notice of having to move to another area, six weeks notice of the times of the shifts you have to work and promising to pay for overtime and limiting maximum hours worked in a row. None of this has come to pass.

on paper now I can’t do more than 13hrs at work but if I’m at work for a 13 hour shift (0900-2200) and there is a gap on the rota for the night shift (2130-0930) and so no one turns up to replace me at 10pm the GMC says I can’t leave with no replacement in place so I have to stay. I can then try and claim overtime at least but that has to be approved by a manager who isn’t usually available to approve it at 10pm. Got notification last week that I am working the Easter bank holiday (so four weeks notice to find childcare)

so now there aren’t enough doctors or nurses so there more gaps meaning longer hours and less breaks and less training and so more people leave and on and on. The only way to improve conditons in the short term is to pay enough to attract some international graduates (and actually be nice to them so they stay) and then use that breathing gap to train enough homegrown doctors (and then treat them half decently so they also stay)

£35K sounds like a realistic starting point with rapid increases for experience. A 10 year post-qualification doctor should be on a high salary - whether or not they are a consultant is a bit of a red herring, as they are still incredibly well qualified and experienced professionals.

And we need to stop calling them junior doctors after about the first two years!

Pret workers have paid £250k for each doctor to qualify though do you mean the taxpayer has? Surely it is in the interests of the country to pay for people to learn the skills the jobs we need? Although that goes to the heart of the tuition fee debate and is for another thread.

Botw1 - It is in fact very important to have public support for a strike. If people don't support the strikers the government will get a boost from standing their ground. Terse communication is not going to help. The good news is that a pension change has just been announced, with doctors specifically in mind, meaning that they can save more (1million plus) in pension without extra taxes and up to 60k per year into their pension (up from 40k) without extra cost. I'm sure average joe on 30k will breathe a sign of relief :) ( - Yes I know it's to stop doctors retiring early --)

OK compared with Australia £35K isn't enough even for the first year. And you'd need to pay more in London and the south-east.

Although I'd take issue with the fact that house prices in Perth are low! They certainly didn't use to be.

Although £35K and no repayment of student loans might be a way forward.

@mids2019
You make an excellent point and one that is central to the whole debate.

People are trying to benchmark the 'worth' of a doctor by suggesting that because they are paid more elsewhere then the UK is undervaluing them. This completely ignores the fact that other healthcare models are funded completely differently and if we as a country want to 'compete' on doctors' wages then we would need to charge people for health care in much the same way as these other countries do. Australia has 'gap' payments where patients have to fund their care over and above what is covered by Medicare and over half of Australians have private healthcare. To put it frankly, there is more money in the system to pay the doctors and therefore pay is higher. Of course we could do a similar thing here but is that really what people want?

And of course it's worth pointing out that other countries are desperate to poach our doctors as the British taxpayer has effectively subsidised many years of training. We should be putting clauses into training contracts to stop this practice as otherwise it simply isn't a great deal for the tax payer and the UK as a whole. There is a huge demand for places at medical schools so we should only be offering these to people that are prepared to work a number of decades in the NHS. If people don't want to do that then perhaps they should look into alternative career or fund their place completely using their own money without relying on government subsidies.

I don't think it's relevant what other countries pay doctors (outside it being a reason why they leave)

I think we sshould pay them more because they are worth more

If people don't want a well staffed and funded NHS that's fine.

We can introduce a private model

Still going to cost ya though

@lieselotte
do you mean the taxpayer has? Surely it is in the interests of the country to pay for people to learn the skills the jobs we need? Although that goes to the heart of the tuition fee debate and is for another thread
It is only in the interests of the country if that person uses those skills for a reasonable period of time for the overall good of society. Subsidising fees for doctors to bugger off to Australia isn't exactly a great investment for the country is it?

There is a wider skills crisis and shortages issue that the UK is suffering from and this undoubtedly is causing issues not just in terms of health care and other vital services, but also hampering economic growth and prosperity. Doctors really are just the tip of the iceberg and the squeaky wheel shouldn't always get the all the oil without properly assessing the state of the other wheels too. Once again it comes down to finite resources and utilising what we have as sensibly and efficiently as possible.

Seems to be a lot of misconceptions about what a junior doctor actually does. A lot of people seem to think we trail after my consultant and are just there to learn. In case you were confused, the people who are there to do that are the med students and not us.

I'm an FY1 - first year after uni. I did six years (5 of MBChB, one intercalated) of uni. I work on a ward that has been newly converted out of what was the outpatients department because my hospital was desperate for space to put inpatients. Because of a quirk with how the building was designed, I'm about 8 minutes fast walk from AMU and the 'main' medical wards.

Mornings are spent doing ward round. This isn't learning - I'm there to support the consultants in seeing thirty patients in four hours. My consultants then leave at 12:30. They've got clinics to run, or ward rounds to do elsewhere. Me and the other FY1 are left on the ward to do the 'jobs' from ward round and sort out anything that goes wrong.

Of course, when I say 'things going wrong', I mean acutely unwell medical patients deteriorating. Last week (in five days) that included several deaths (including two patients were for - and subsequently got - resuscitation), a patient having recurrent seizures, two falls, four people becoming septic, and countless other emergencies. Remember, help is eight minutes away so it falls to two FY1s to manage this until the med reg can get to us.

Why can we do this? Because we spent at least five years at medical school. Yeah, the first two years were essentially a write-off as most evenings were spent going out. But the last three were a full time working week with studying in the evening.

You've got doctors like me managing the first 10 minutes of life or death emergencies. You've got doctors like me ringing relatives to tell them to come in now. You've got doctors like me (alongside a nurse) telling people that we're so sorry but their mum has died. And then when we've done all that, we've still got our ward jobs to do. I left over an hour late every day last week. I won't stop to eat all day (the ward manager has banned us from eating lunch in the office), and I won't have time to go the loo till I finish and hand my bleep over.

Does that £14 per hour still sound like a great deal? I pay tax like everyone who doesn't make their money speculating on the stock market and the like. I pay 10% in pension contributions for a pension that everyone states is 'gold-plated' but has been raided twice in a decade and will no doubt look very different by the time I can retire in (what is looking like) my early 70s. I've got a £80k student loan that until recently accrued interest at RPI + I think 4% which I'll start paying back next month. On a non on-call week, I probably work an extra six hours over the week unpaid to get the jobs done, so it's looking closer to £12/hour pre-tax, pre-pension, and pre-loan.

We're meant to have SHOs to support us with things like this. Our department had two long-term locum SHOs but they both left at the start of March for Australia for better pay and better conditions. They can't find anyone to replace them because everyone is leaving and the trust won't pay any more than they already were.

Frankly the only thing tying me to the UK any more is my grandparents. I see my parents infrequently enough as it is. Unless things change, I'll finish FY2 and leave. Health systems in Australia and New Zealand spend a fortune targeting adverts to me on social media encouraging me to. The only way we stem the exodus is by trying to compete with Australia and New Zealand is by improving pay and conditions. If you consider RPI (remember, student loans accrue interest at RPI + a percentage) the pay for doctors has fallen 35% in real terms since 2008. That's why we're demanding 35%.

@Bumpitybumper

I agree. Foreign countries offer higher salaries because they are much more reliant on private healthcare We have made a political decision to have a free NHS and with that decision come choices. We could increase junior doctor salaries significantly by adopting a hybrid healthcare model but we as people I don't think are in that space

I wonder to what extent the medical profession is absolutely commited to the principle of the NHS? Having an NHS may be partially responsible for the 'problems' in health care in that it benefits the poor and elderly disproportionately and if we rationed health care to the financially sound we could reduce workload in the system: question is do we want that?

We have some medics happy with deregulated healthcare with high salaries and the capability view point that entails yet the same doctors are happy to strike with collective industrial action similar to the heavy industries of the past The two don't sit well together

The taxpayer wish to see a healthcare system that meets their needs; they do not particularly wish to subsidise the earnings of junior doctors before becoming a top 5% earner.

Foreign countries offer higher salaries because they are much more reliant on private healthcare

Every healthcare system is on a continuum between single-payer and free-market lunacy. Our comparators are probably the Nordic countries, which manage to pay their HCPs competitive packages and have better outcomes than we do. You can also look at Canada, which has a structure not dissimilar to the NHS and offer far better packages to their staff.

We could increase junior doctor salaries significantly by adopting a hybrid healthcare model

This has been tried in the UK and doesn't work. Even this government has tacitly acknowledged that.

I wonder to what extent the medical profession is absolutely commited to the principle of the NHS

This is a rather bizarre and frankly offensive statement. The NHS relies on the good-will of its staff time and again to avoid collapse. I've stayed late time and again doing jobs that don't benefit my patients but will benefit the system. Desiring fairness does not equal desiring the end of the NHS. Almost all of my friends are junior doctors and "abolish the NHS" is an absolute minority opinion only espoused by people who like being edgy.

There's a reason people are leaving for those countries that have some form of single-payer. You could earn more as an NHS-trained consultant in Qatar than you would in Australia or New Zealand. If one so wished, UK medical graduates could undertake the steps required to apply for jobs in the US. They (broadly speaking) don't.

The taxpayer wish to see a healthcare system that meets their needs; they do not particularly wish to subsidise the earnings of junior doctors before becoming a top 5% earner.

The taxpayer wants a system in which they can get the care they need when they need it. Since 2008 - for a variety of reasons - delays have been getting longer and longer, and care has been getting worse and worse. One of these factors is an exodus of doctors. We are striking for our pay to be restored in no small part to stop this exodus.

Not true. Nordic countries pay slightly less than uk on the whole. Both compared to uk doctors and compared to their compatriots.

I'm not sure you're correct. A dual-national friend moved to Sweden and works there, and the last time we discussed it her salary was higher for an equivalent stage in her career. Furthermore, taking Sweden for an example, you work fewer hours and have strictly mandated breaks. Free tuition (although admittedly she is paying off an English student loan having studied England).

If you would like to provide a reference that isn't one of those click-bait salary comparison websites, I'll be happy to be corrected.

If you would like a more direct comparison within the British Isles, the new Irish Consultants contract is a good place to look compared to the English (or indeed, any of the UK nations) contract.

Yes Irish salaries are higher. One of the only places in the EU where salaries are higher in fact.

And yes I'd be a nordic doctor any day despite the comparatively lower salaries. I totally agree the working conditions are like chalk and cheese. I was talking specifically about the salaries. Seeing a Danish GP has to be see to be believed. And the wait for a new hip/knee is something like 46 days. A and E waits aren't even a 'thing'. You just go in.

The salary itself might be higher but it's purchasing power I was referring to. So Swedish doctor might earn more pounds and pence but after tax and the higher cost of goods they'll have the same or less. But comparative to a swedish national average wage it'll likely be lower (depends on job specific factors obviously).

It's all on the OECD website.

In fairness, while the headline graph on their website is labelled as inclusive of "physicians in training", the section for the UK in their methodology document states they exclude "physicians in training", and as such presumably the UK figure is based solely on permanent locum/SAS grades/consultant grades. As such, they won't be an apples-to-apples comparison.

Agree with you on purchasing power per $ being lower, and the fact Nordic countries are probably a nicer place to be a HCP/patient!

The average pay rise is a joke though. It’s a pay cut effectively after years of pay cuts. We won’t change anything with the whataboutism attitude.

@Jedsnewstar

Working in the charity sector where the average pay rise is 0% - I'd love a 6.4% pay rise.

35% is just bonkers. You must know that.

@Jedsnewstar
The average pay rise is a joke though. It’s a pay cut effectively after years of pay cuts. We won’t change anything with the whataboutism attitude
It's not a very funny joke to the people getting that amount and half the population that will actually be getting less. It's all very well complaining about 'whataboutery' but you do realise that wage increases are a driver of inflation and therefore can drive up the cost of goods.

Put simply, if you're someone getting an average or below average pay rise and loads of people then go on to get higher pay rises, this will likely push up prices of good/services and therefore make your pay rise worth even less as your purchasing power is reduced. This has a very real impact on people's lives who don't necessarily have the means to strike for better pay.

Sub-inflation pay rises have led to junior doctors being 28% worse off in real terms than we would have been in 2008.

The demand of 35% is to restore pay to parity with 2008 levels.

Unfortunately the government messed around and managed to manufacture a retention crisis in the NHS. They're now finding out, but still trying to obfuscate and spin this.

Claims that pay restoration will fuel inflation are one thing (and debatable), but the public sector workforce cannot subsidise poor fiscal and monetary policy forever while the private sector ticks along with inflation-matching pay rises. We've been doing it for 15 years and we have a genuine threat to the survival of not just the NHS but every public service due to people leaving rather than being undervalued.

I think starting 25£ per hour and up to 55£ in 10 years.

100% this. Why should doctors take the brunt? They shouldn’t. And they are not going to stick around

the nhs and the uk public can’t get all morally offended about uk trained grads wanting to leave for Australia/Canada/new zeland when the nhs is desperately trying to recruit doctors from countries where there a massive health issues like India or Pakistan.

BTW the 250k training figure is rubbish. a 5yr undergrad degree at uni of Buckinghamshire (private) costs 175k and they also make a profit so why state funded unis think it costs 250k I’m not sure. So the average uk grad has paid (via loans) for over 50% of their course already. Since they essentially have to do two years in the uk before they can go abroad they have also paid back at least some of the rest of the money.

Thanks, as you've mentioned this figure is really annoying for several reasons.

I've never once seen a good reference for now it's been calculated, it seems to have sprung from thin air and just gets repeated ad nauseum.

It also hasn't changed since I was applying for university, when inflation (granted public sector inflation is less than whole-economy inflation I'm led to believe) most certainly has.

Furthermore, whatever the true sum is, it's not like it disappears into the ether.

If we think where the money to fund undergraduate medicine comes from, it's pretty simple - in England, it's from NHS England (formerly Health Education England).

It goes to universities. They use it (and the standard £9k/year for the first four years) broadly for three things - the costs of running the academic aspects of undergraduate medicine, paying trusts/GPs to have us on placement, and 10% I understand goes into widening participation initiatives.

I'm not convinced my course was that expensive to run in the first two years. We had ~25 academic staff deliver the first two years of our course. So, not dissimilar to my friends who did science degrees. We had course-specific teaching facilities and resources. Again, so did friends on other courses. Indeed, many of them had labs and used very expensive consumables. But the university could pay for that without extra funding (or likely by fleecing those on courses cheaper to run).

Now, money to trusts/GPs for placement. Remember, this is effectively money from one part of the NHS to another. I don't know how much it cost to have us, but I can't imagine it's £225k over three years. So this is a funding stream for trusts (and one of the reasons teaching hospitals were traditionally more 'prestigious' and why every trust is rebranding itself as 'University Hospital of St. Elsewhere's'. In terms of teaching in the latter three years, this was delivered by consultants. Each week we had two hours split between 5 of us with a consultant for a tutorial, and half a day of tutorials delivered by consultants. My uni bragged about how intensive the teaching we had with consultants was so I imagine that's fairly typical of everywhere.

So where does the rest of this money go? If you have a "proper" professor as a consultant, their full job title will be "Professor of X and Honorary Consultant in Y". They split their time between research and clinical practice. They are employed by the university and my understanding is the majority of them also have their clinical time paid for by the university. Their research is also funded in part by the university (and otherwise from grants/legacies).

In fairness, there are also clinical teaching fellows who are doctors who spend a proportion of their time teaching medical students, and the rest working as normal junior doctors. Where I trained, they were employed (and paid) by the university for both their clinical and teaching time in a similar manner to above, but where I work now they are jointly employed (and paid for) by the university and the trust.

So essentially the £250k is made up. And whatever the true figure is, a small proportion is actually spent training doctors - the rest is just another funding stream for trusts from NHS England.