To resent doctors who leave the profession?

[Prrambulate]

IN PARTICULAR, to take up lucrative management consultancy roles at the likes of McKinsey. I know three doctors among my uni cohort who have left the profession in the early-mid 30s, very close to or having trained at consultancy level for specialisms like ophthalmology, orthopaedics. It seems to be happening more often but that could just be my perception.

It’s frustrating because medical places are significantly capped in the UK, getting a place on a course is difficult, and training these doctors is costly. And then just to lose these qualified doctors at a time of dire need in the NHS is kind of maddening.

Are you bitter about the teachers who are leaving the profession too?

I don't resent anyone who decides that their pay and conditions are dreadful and they are burning out and getting out of the job. Doctors, nurses, teachers.

I resent the government who are doing nothing to resolve the problems.

They don’t leave the NHS. They combine NHS sessions with private practice.

Eh? I get to use the famous phrase “are you on glue?” So a doctors full time hours get paid for those hours. If they work 50% they only get paid 50% and they employ another doctor 59% to fill thopse hours. If a doctor can earn more in one day private practice than their 4 days NHS why shouldn’t they?

Would you tell a cleaner, nope that one day working for a millionaire you shouldn’t do as you are depriving tesco of their one day a week cleaning? You wouldn’t tell anyone to take a lower paid job just because it’s a worthwhile job and they are only doing it out of the goodness of their own heart? Nope hard and harsh jobs get more money. Hence people on oil rigs/truckers get paid quite well with time off in between as it’s hard work. But not everything that is hard, like care work gets the pay it deserves.

Great. Super helpful comment. Idiot

Thats what doctors get told.

A full time nhs contract is 40 hrs, or 10PA (paid activities) per week.

In order to do private work they have to offer an 11th PA to the nhs first, otherwise they forfeit pay progression and several other benefits.

Not at all. It's perfectly reasonable and smart to go for the job that will give you the best quality of life.

You're blaming the wrong people.

“Psychiatrists for example do very little over and above psychiatric nurses but are paid more than three times as much on average”. Sorry what???
I agree that the average band 6 RMN working in for example crisis or liaison psychiatry does a lot of independent initial assessments that historically the on call SHO might have done but are now done by nurses due to the volume of referrals. They should really be paid band 7 not band 6 as they are independent practitioners, which would be a similar salary or even slightly more than junior doctor.
However saying that a psych nurse is the same as a psychiatrist is just not true- they might be able to assess someone who has self harmed and put a safety plan in place but they can’t diagnose or prescribe. Anything complex gets immediately escalated to the doctor, particularly medically complex stuff, anything requiring a diagnostic assessment, medication or anything involving the mental health act as nurses aren’t section 12 approved. Consultants who are “responsible clinicians” for detained patients on wards have a lot of additional legal responsibilities and consultants are expected to be supervising and teaching lots of other professionals (medical students, junior doctors, physicians associates, ANPs/nurse prescribers) as well as often having other leadership/management roles in their job plan. So they are completely different roles.

I greatly appreciate your hard work. I used to be a staff nurse and understand how awful it can be x

I’ve worked in mental health for 30 years. I know what psychiatrists do and there are some brilliant ones and some are about as useful as a chocolate teapot.

Whilst psychiatrists can do some things over and above a Band 6 or 7 nurse, the difference doesn’t warrant three times the pay IMO. That’s why it was so unfair that agenda for change didn’t include medics.

For the record I support the recent medic strikes and think Junior doctors are treated appallingly. That should change and I think doctors deserve to have salaries that reflect the level of training required and the level of responsibility. I don’t begrudge them it at all. I’d like to see it change. The doctors I work with now are put under enormous pressure and we need to treat them better. A shift the day after a difficult over night on call just isn’t on.

But one of our CAMHS consultant psychiatrists would boast about earning a quarter of a million a year and he did not provide value for the tax payer at all. Others I’ve seen have been barely competent.

I believe all NHS staff should have had their pay made fair with agenda for change. The highest paid were protected. Cleaners are employed externally now so didn’t benefit - yet are essential.

Agenda for change sucked. But if medics had been part of it everyones pay would have been better and we wouldn’t be in this mess.

Treat medics better, we need them. But also bring the salaries of the rest of the NHS in line. Including domestic and cleaning staff. The difference shouldn’t be so huge.

No consultant earns 250000 through the NHS. He must have been referring to additional private income, or he was employed through a private locum agency. The starting salary as a consultant is about 93000, which I don’t think is unreasonable to be honest, after 6 years at medical school and at least 8 years of postgraduate training including a lot of postgraduate exams and getting section 12 and AC approval. The legal aspect is very time consUming and is a lot of additional responsibility and risk, as is the prescribing.

The salary goes up to a maximum of 126000 after 19 years as a consultant. https://www.bma.org.uk/pay-and-contracts/pay/consultants-pay-scales/pay-scales-for-consultants-in-england

edited to add - there is no way of incorporating medics into agenda for change, our way of working is too different. For starters despite their responsibility junior doctors are actually trainees with our salaries part paid by health education England rather than the nhs trust. So you couldn’t really class them as “band 5” for example, but equally putting someone who has just finished a 6 year degree probably wouldn’t be happy starting on a band 1 salary! Secondly our out of hours commitment is very varied and eg full shift versus non resident on call which I don’t think would be easily covered by agenda for change. Thirdly we work a 48 hour week as standard full time rather than the 37.5

Maybe we should treat doctors better instead of making people feel guilty for burning out?

We have a consultant currently on £400,000 in our trust in a hard-to-fill post. You’re not accurate. Although many do earn more with private shifts added they can also top up by charging above the rate card for in call shifts.

Yes I accept people can get extra through overtime for extra on call shifts but a basic salary of 400 000 or even 250 000 is not possible through the NHS contract. It’s more than the chief exec! I have just included the link to our pay scales- they are agreed through BMA and the trust will not go beyond that. The most they will do in negotiations for a hard to fill post is a golden hello or bump people up the starting salary (eg start on point 5 at 105K rather than point 1).
That person you speak of must be employed through an agency locum contract. They might have been there for a long time- we have similar where I work because of shortage of consultant and sometimes end up with people working as locum for so many years that they are then entitled to the usual employee rights and none of their colleagues even realise they are locum anymore even though they are still on locum rates. It’s galling, where I work I could quit training now and locum as an “acting consultant” in an unfilled post at ridiculous rates through an agency and still be massively overqualified compared to many of the people we have doing it in our trust some of whom don’t even have mrcpsych! But at the end of the day, it’s market rates so 🤷‍♀️. But those salaries are not representative of nhs consultants.

also, just because you have come across some consultants who you didn’t think were clinically very good, doesn’t mean that all consultants should not be paid for their skills and experience. I’ve met some pretty shocking nurses but would never use that as a reason not to pay nurses well.

They would have to be a locum consultant where a lot of that headline rate is going to an agency to earn that much. It's because no one wants to work in mental health that Trusts are over a barrel and figures like that get paid to people profiteering. It's absolutely wrong and abhorrent and people willing to do that are not usually the most talented Drs.

I have also worked in mental health for 20+ years. I do not earn much over 100,000 full time and I massively resent you suggesting my job can be done by a B7 nurse. I work closely with B7s and B8A nurse consultants and they are excellent but they know their limits and they still cannot do MHA work or prescribe lithium, clozapine or complex meds regimes. They also admit that the intersection with physical health including older adults and neuropsych is not their bag. You need a Dr for that. I also accept more risk and responsibility. The team know that the person ultimately going to be held responsible in the coroners court is me not to mention complaints and other difficult situations are all mine to deal with and that is a heavy responsibility. It's by far the worst thing about the job that if there is a suicide you know you that you, as the consultant, will surely be blamed. I am responsible for the quality and performance of the whole service as well as what I individually do and I do view it as my job to take the responsibility because I get paid more. Whether you like it or not the general public still demand 'I want to see the consultant' when the shit hits the fan.

It would never work to make Drs join AFC. It's totally different hours and working culture eg it's always baffled me how when nurses start a shift one of the first discussions is 'when is my break?' and it all gets written down who is on a break when. It's a very firm boundary 'no sorry I am on my break.' Whereas Drs do not assume they will get any break. They just work through if it's busy and stay late until the works done. Or at least that was the expectation I trained with.

Based on this response, they’ll never close the gap between liability and asset.

Dr is like any other workforce. If liability needs to increase, training positions (and training availability) needs to increase. It works with other workforces - I’m thinking military pilot specifically whereby there’s long and costly training followed by an OJT liability of several years (requiring mentorship and supervision). Experienced military pilots to provide that mentorship take 10 or more years to get there.

the DR training aperture needs to be responsive to workforce needs. I suspect there’s other forces at play.

Then there's all those GPs who are taking part in Masterchef.

Many consultants earn more than the chief exec in my trust. The one on £400,000 is an ophthalmology consultant. Not in the Trust anymore as he moved abroad but he was paid that much because we couldn’t fill the essential position. That was the highest we’d ever paid. The reality is, trusts will pay more for the hard to recruit to roles. We have to declare it in the annual report. If a consultant also has some kind of leadership role, they also earn more on top of their dr pay.

He was the lead for blah blah and had some extra input in terms of government advice. It was all tax payers money.

You don’t start at Band 1 and work your way up. You apply for the job tor which you have the training and skills. I entered at Band 5.

The Junior Doctor role could have been banded. It’s not about the funding it’s about the l bel of training needed and what the job requires. Could have been done.

Oh and as a Trainee I was band 6. so it is possible and was possible. Just wasn’t done.

Re the not expecting breaks. Agenda for change would have helped with that. And the nurses I have worked with would never take a break if it left an emergency situation. Doctors should be able to take breaks. We need more of them so you can.

This, every word of this. NHS GP, for 14 years, and junior doctor for 5 years before that. I’m staying in the NHS, because I believe in it and I still like (not love) my job, but it’s very tough. And yes I work 3 days a week- each day is about 12hrs on average with no break (can’t remember the last time I didn’t eat at my desk), so I usually work 36hours for my ‘part time job’ which as others have suggested is most people’s full time job. I could not do any more- if I did it would mean I left the profession. It’s that simple.

This. 20 years nhs, 8 years consultant
I love my job but the under resource and the stress my colleagues (nursing pharmacy etc) are under makes it really hard to deliver good care which is hugely demoralising.

I sort of get what you are coming from although it is clear the problem lies in those higher up and in government policy.

I am a teacher and am basically the last man standing out of my friends who I worked with early in my career. They all have lovely wfh jobs now and although I love my job, they keep asking me how much longer I'll Hold out for. Others are now ofsted inspectors! It does grate some times, especially when for example, they whinge about their own children being taught by non specialists, or about hearing about someone they didn't rate being promoted to slt. I think to myself, well that's what happens when everyone else leaves the profession!

But then I know when I think about it rationally that it is a systemic problem and not the fault of individuals.

It does feel like a betrayal almost. Like medicine should be a life long career, and working in the NHS is the key part in that in the UK.
But if people aren't happy, their skills are valuable elsewhere, you can't really blame them.
The one I remember that annoyed me was this Irish woman who did the apprentice, she'd only just done the bare minimum in the NHS after training and opened a bloody chain of Botox clinics. I think she'd worked for about a year as a hospital doctor?!

This is what happens when people value their cosmetic surgery, short weekend in tenerife, flat screen tv, or new pcp lease car every 3 years above appropriately funding the national provision of healthcare.