Junior doctors

[IamSuperTired]

Before people suggest it, I'm not intending to bash junior doctors. They work incredibly hard in a massively under funded NHS. I was also surprised recently to hear they earn less than I thought.

I am posting to ask if anyone knows how long it takes to go from junior doctor to a more senior level where the pay is better? And what's the career path from medical degree to the grade above junior doc?

I ask because other professions, even in healthcare, also get paid pretty poorly at the lower grades but tolerate it because they will eventually reach v large salaries. Eg. Psychologists do their degree, then usually MSc, then often have to work in band 4 jobs for 3 or 4 years to gain the pre-requisite experience, before moving onto another 3 years doctorate level training (is this equivalent to junior doc?) paid at band 6. So in total it takes them (on average) about 8 years before they reach band 7 NHS wage. Other professions are similar.

I'm asking because I'm trying to work out whether the pay is a little unfair or a lot unfair! Given potential future earnings and when they might be reaped! Just trying to educate myself really. Not sure what the AIBU is :) sorry!

@lookluv as someone who is about to become a registrar your comments make me despair. Yes you worked longer hours but patients were not as elderly/complex and resources were more plentiful (although still scarce).

Doris aged 92 with 7 serious comorbidities didn’t exist 20-30 years ago, we’re much better at keeping complex patients alive now (I say this as someone applying for gerries as my HST and a current IMT) than 20 years ago.

According to my consultant colleagues they would often clear the board overnight in ED. Now at 4am as a medical SHO I am taking referrals for patients who should be in resus but are stuck in an ambulance as there is no space. I’m trying to find somewhere to do an LP on the ?meningitis but it’s delayed by 8 hours as there’s no where to even get them to lie down. People with MIs sit in the waiting room. I have seen someone who had an arrest in triage. I have seen an acute disabling stroke sit in a waiting room and miss the thrombolysis window.

The attitude of not wanting to hand things over disappoints me. Consultants with attitudes like yours contribute to burn out and low morale of their colleagues. Yes a small minority of people are lazy but for most people there is just too much work to do safely on a short staffed rota to not need to handover jobs. Criticising colleagues who’ve gone above and beyond but cannot win in a broken system must stop! When did we stop having compassion for each other?

Your generation never faced the extra unpaid work my peers now do just to get into the equivalent of core medical training (now IMT) as it is so so much more competitive than it has ever been (although granted we don’t face nepotism and favouritism previous generations suffered from). When I graduated I was guaranteed an F1 job, not any more! I feel so sorry for the medical students of today, they will have a worse time already than I did in 2018.

Are you in a surgical specialty? As this attitude does not fly in medicine…..

Please read and take on board what I’ve said! Have empathy for your juniors, don’t internally berate them in your head for handing things over. Because I can tell you they sure will be picking up on your attitude.

To be fair, for a lot of health staff, the potential of that image is a daily reality. I go to work every day knowing that today might be the day I make a mistake and a child ends up in a body bag as a result of my actions. And no, I don't work in PICU.

@lookluv I meant to say even medical training is now competitive. The things people do to get into surgical specialties and radiology and anaesthetics are massive commitments of time and money. Just to stand a shot at it.

@lookluv maybe think about why so many are disagreeing with you on this thread. You have the attitude that I dread. Such a lack of compassion for juniors, the kind of clinical supervisor that people dread. That might sound harsh but the “it was worse in my day” is not helping anybody.

You had no student debt and in many cases free hospital accommodation. The average UK house is now ten times the average income. The lifestyle current consultants lead will not be emulated by their junior colleagues. Often we don’t even have a doctors mess to sit in anymore.

@DenimSkirtLove thank your for your compassion and empathy.

My current consultants are lovely and really fought for us to have rest facilities and have been nothing but supportive during the strikes. They are what I hope to be one day.

@lookluv - my experience is same as yours.

I would hate to work as a junior doctor now. Remember we worked as a team and no one was left behind. I remember finishing work on the wards and going down to medical assessment unit to help out. I don't think it is just the generational shift in the juniors attitude. My consultant and his team was on call one in 6 / 7/8. The first two days after the on call were tough, then you knew your patients and had time to sort things out before they were discharged. You had time to speak to family, had physio support, OT support and even had a social worker allocated to each ward. You did have reasonably quiet day or two before your team was on call again.
Now, the team do not do on calls together - they are all cogs in a system. Just numbers.. that's all. It is very rare to have same member of junior team for a whole week on the ward. They are off doing twilight shifts, night shifts, covering front door for the day etc..

Training is not adequate - not because of just decrease in hours in a week, but you never look after patients from the moment they get admitted till discharged, there is no way to give feed back to the juniors who saw the patients when they arrive. It is an apprenticeship and you learn by following patients, being responsible for them.

I still remember my last day of my on call as registrar - I was becoming a consultant, my SHO was becoming a cardiology registrar and my PRHO was becoming an anaesthetic SHO.
We did a busy night on call, worked our socks off that night and went to local Mc Donald to celebrate our progress after hand over in the morning !

The working hours may be better but the current junior doctors working conditions are much worse compared to my time.

I don't think I could have managed to bring up two children with the current junior doctors work pattern. How do you sort out childcare from 12:00 pm to 9:00 pm, three days a week?
Unless you have family willing to help or hire a nanny

medstudent12 -your ignorance of what has gone before is breathtaking -
"Your generation never faced the extra unpaid work my peers now do just to get into the equivalent of core medical training"

Really - I got paid for 72 hours per week and worked 100+ - what part of unpaid do i not get!

There are 3 people disagreeing with me and one mother. I have not criticised anyone who has gone above and beyond but I do criticise those who complain about their working life but do not make changes that they can own and implement. No manager does not understand it is not their working life -rather than blaming the manager work with them to change it into something better.

I admire my juniors for striking - but I do not think their argument is being well put and dissing other peoples skills and knowledge as has happened here is just plain rude and loses support.

As to my juniors - i have been voted trainer of the year 8 times, campaigned for an actual on call room not a fold out chair and got it, got back pay and enhanced rates and much much more, but I will not tolerate arrogance and disrespect of our allied colleagues which some on this forum have done.

Stanley aged 102 with co morbidiities did exist 20 yrs ago, as far as I am aware average life expectancy has gone up 4 yrs since I qualified. Resources were not plentiful nor were staffing levels.

I will have in 14 hours time - done 7 nights in support of my junior colleagues, cancelled a week of leave and abandoned my children during their Easter holidays to support my junior colleagues and ensure our patients safety - so please dont insult the effort I and my colleagues have made to show our support. My pay has gone to the JD fund and I did not take TOIL. The least I expect is that my junior colleagues are not as rude and disrespectful of allied professionals as they have been on this forum - you have diminished your position.

I get long hours piss poor pay, I get leaving the country and working overseas, I get the sacrifices that I had to make to get to where I am now and recognise that some of these have changed and made easier - run through training and some are harder. - I get this in a way I hope you never have to because things have improved but not enough there is still some way to go.

medstudent12 - I paid overseas student fees - I also get debt. I worked thoughout my medical school training to contribute to my then single parents income was focussed on my siblings.

Not every consultant had no debt at the end of med school. Tuition fees have been around since 1998 - so most consultants appointed in the last 8-10 yrs get fees.

www.euronews.com/next/2023/04/12/doctors-salaries-which-countries-pay-the-most-and-least-in-europe

@lookluv - what year did you qualify?

I qualified in 2000. Towards the end of my 19hrs shift on call as a house officer I remember begging the nurses to help me with some tasks. They said they don't have time. Fair enough. But I had no choice but to make time. There were very sick patients. Seniors were often not available. Who is holding the can at this point?

As a SHO I collapsed during my 24hr on call whilst assisting with a c/s due to sheer exhaustion

The docs before me had it worse. You may think since the EWTD came in it is better as the shifts are shorter. However the training is worse because as a pp said it is difficult to follow a case from start to finish and follow up on patients . I can completely see why it would take longer to meet competencies and fill the log books now.

I have already explained the different realities of GPs then and now

I didn't even think about the money aspect until the last few years. Now I no longer work for free and put my foot down if the workload is too much. I can do this as a senior doctor who works as an independent contractor and I pick and choose my shifts for the NHS. However I am pleased the juniors are saying enough is enough which perhaps my generation should have done

Total disingenuous post. So many threads on this at the moment and Google exists for a reason.

chopc - we are on the same page.

However, as some people on here have done, is denigrate other peoples skill sets and responsibilities and say no one has it as bad. The poor physicians associate who dared to raise an opinion was roundly patronised and their skills denigrated.
This is not a race to the bottom and is exactly why previous generations of doctors worked to reduce hours. This generation is going to go after pay but do it in a manner which is respectful of your colleagues and not arrogant - that loses support.

My departments juniors came to us and said they wanted to change rota as current one did not suit 40% with children. They had worked it, come up with a solution which everyone was happy with and was easy for the managers to run. No the manager did not get that the shift times were causing issues because they did not have those issues or understanding. Too often people moan about rotas but do not own their working lives - control what you can control and make it work for you, empowering yourself in a system that is creaking and shit feels better than being a passive victim all the time.

When as has happened on this thread you start bashing your colleagues and making out that no one is aswell trained, intelligent, has it as bad and you are the only true victim you lose your argument. What was going on was unprofessional and would in my department be reported on your Form R at ARCP.
Life is shit at all levels in the NHS but to say this is the worst generation is wrong and no one gets it is again arrogant. It is different with different pressures than other professions and generations - we are not arguing over who has the shittiest end of the stick. Refusing to recognise other peoples experiences and say mine is worse in the way it has been here is very sad and reflects on those individuals not those they are shouting and putting down.

I am heading home now after my night shift and will support my nursing colleagues in 2 weeks time.

I’m sorry for your experience @Forgooodnesssakenow but it is also not the job of strangers on the internet to predict who they may trigger or offend when making a comment that is, in fact, relevant and not, in itself, disrespectful to anyone.

I have worked in PICU/NICU and have seen my own baby hooked up to so many wires and tubes and went through the awful silence as he took ages to breathe after he was born. So, I’m not ignorant to this reality and pain from either ends.

@LameBorzoi and as you deal with that potential, you shouldn’t have to also worry about how will you pay your rent.

Consultants also don't earn 100k. Starting on 79k and only get to 100k after 20+ more years work

I think what the public need to do is wake up and see the NHS shouldn't exist any more. Throwing money at it won't make it any better. There are too many patients, it is horrendously inefficient, and it is not fit for purpose any more. We need a new system.

If we had a new system, perhaps it wouldn't be the massive money drain it is and we could actually pay the staff the wages they deserve.

And what do you think should replace it?

Absolutely no idea. Obviously we don't want to give up free healthcare but maybe some form of tiered system? We should look at what other countries do and go from there. As long as it isn't private like the US and is open to everyone it doesn't matter.

The thing is the tories want US style privatisation. Pretty sure they’re enjoying sitting back and watching the nhs burn

All this about what the tories want. So what does labour want? And how do they plan to find it?

@lookluv whilst I appreciate the skill and training of the allied healthcare professionals, I don't think they carry the same responsibility as the doctors they work with. In general practice for example the allied healthcare professionals will follow protocols and write in notes discussed with Dr ...... and feel they have absolved themselves of the responsibilities. A lot of allied healthcare professionals don't think outside the box (either unable to or don't have the confidence to do so) and the buck usually stops with the doctor

chopc - you and I, of the same generation were on the same page until your last paragraph.
Responsibility means different things to different people and different roles -does not mean within that role it is anyless stressful.

I suppose the F1 is the equivalent of the First Officer on a flight deck - is there job less stressful? Starting salary as an FO is around £32k, most have £100K+ of debt as their professional training and exams is usually funded by themselves. FO salaries can then progress over the years to closer to£100k but these senior first officers have generally been in post for 20+ yrs.
Progression to a Captain and hence better salary can take 20+ yrs - not based on merit simply on date of joining the company.
I think the level of responsibility is equivalent but different?

It may have been this way once but it's not anymore because there aren't enough doctors for allieds to sit back. They are often trying to keep a patient stable, a difficult task without resources and an extreme responsibility, holding on until a doctor can sign off on a treatment or diagnostic that they already know is necessary. If the patient dies in the interim they know they will be in a difficult position explaining their decisions, just as doctors do. Everyone is in a surprisingly similar boat.

Mumsnet, the website where people complain about how awful everyone else is whilst 50% support declining living standards of one of the most important professionals in society.

No wonder Tories keep winning. Just keep licking that boot.