To think that not all doctors are badly paid - junior ones, yes, but not all?

[MyAmusedOpalCrab]

It’s often said that doctors in the NHS are underpaid but is that really true across the board? Junior doctors, yes, absolutely. But consultants, GPs and some specialists earn six figures. AIBU to think that while the pay structure may be flawed, it’s not accurate to say all doctors are struggling financially?

Because if you’re working 12 hour days working 3 days is full time….. if they were doing stressful GP work 62 hours a week they’d be burned out / suicidal / addicted to drugs pretty sharpish….

Please tell me where I can find these shifts where there’s no work to do???

Consultant 1old style swans in for morning clinic at 11am most weeks (with overcoat on in winter so obviously hasn't even been on wards) other consultant and registrars in clinic have been going since 9
Consultant 2 old style arrives at 3pm for afternoon ward round from morning clinic at local private hospital (have friends who work there)
Consultant 3 new style works four days - gets paid four days, emails say not in on one day per week no clinics scheduled that day.
These are not the only ones

I honestly think most people dont have a clue about the hours many doctors work, including consultants. A close friend of mine has to work (well get paid for) 4 days per week because they have work so many hours by Thurs night they are exhausted Fri, then have to work all day Sat and Sun just to get the rest of their work done ready for Monday. A supposed 4 day case load takes 6 days, they are now having to reduce to 3 days so they can work 5 and have a weekend off.

They get 6 figures but it is not amazing for the hours, stress and responsibility. Hopefully they've saved enough to retire early along with a good pension as no one can sustain that sort of work life balance into their 60s!

I think many professionals work very long hours.

The children's friends in Financial Services/law/accountancy, etc (late 20s/early 30s) are all working 60 hour weeks or more.

I usually do about 45 to 50 and I'm approaching retirement. When DH was practicing he regularly did 70+ hours.

It's mythical that medics work longer and harder than other professuonals. They do, however have greater job security. DH was self employed - no paid annual leave, no sick pay, no employer pension contributions, and huge indemnity insurance premiums.

DS, an academic, works a 60 hour week at assignment/marking pinchpoints and regularly burns the midnight oil to produce conference papers or get a book to the publishers. If he makes Professor, he might brush against £100k. At least, however, he earnt the title of Dr by virtue of his PhD, rather than it being granted on an honorary basis. Needless to say, he doesn't expect other staff or students to address him with his title. He uses his first name.

They are all underpaid...... FOR the work they do.

The latter half of that sentence is the important part. '6 figures' is not 6 figures after tax, NI, medical indemnity, GMC fees, etc. After all of that, it works out to be around 50-60k net income for a fresh consultant (who has about 10+ years as a doctor already).

Again, FOR the work, 50-60k net isn't good enough, no matter how much the public tries to make it seem that UK doctors are rolling in cash. US/AU doctors make up to 2-3x more depending on specialty - we are behind the rest of the world because we have a system that means everyone is underpaid and burnt out and then have the audacity to complain that our doctors 'don't care enough.'

The UK public needs to understand that just because xyz career makes more than what they earn, it does not mean that xyz career is paid fairly. As a nation, we are blind to what occurs behind closed doors and it is only ever to our own detriment. 'Do what you've always done, and get what you've always got' as the adage goes. The NHS will not improve until the people who use it fix their attitude towards it.

They may get paid for 4 days but they are working significantly longer hours. On my 50-60th hour in a week working as an accountant I am not making important diagnosis that could have life or death consequences.

I think it really depends on where you are in the UK. I genuinely didn’t used to understand how these wonderful clever educated women put up with the crap they took as GPs in one of the UK’s most expensive cities - the lifestyle they would be able to afford wouldn’t make up for the demands put upon them.

But now I live in a much cheaper part of the U.K. where people still really revere doctors… and the 3-day GPS definitely aren’t working 36 hours as I see them at drop off and pick up and activities after that. So they get high status, good pay relative to where we live, and - crucially - high status, extremely secure work in a region where there actually aren’t that many brilliant high earning stable jobs. I earn a third of what I used to in the big city and that’s not accounting for inflation!

I think a pp had it right - it’s not the big-house-private-school-ski-hols job it once was - but what profession is?

I just looked up my husbands and my graduate degree - mine now costs £120k!!!!’ Husbands is £150k! If I did the same study (undergrad, postgraduate then MBA), it would cost £160k in fees alone - but everyone on our C-suite had similar, and I didn’t even crack that as the hours were too insane. I think maybe doctors don’t realise how insane high earning private sector jobs have become, and how costly thw route can be to getting there!

It’s clear from your multiple posts that you just don’t like doctors.

Are you sure that's actually correct?

Based on how much student loan?

Pension is an investment, not a cost.

I don't like rude doctors and I don't like the fact that they are rarely accountable to the patient.

I took my mother to a hospital appointment yesterday. The young, woman Dr was informative, kind and had looked after mother well. I shall drop a note of thanks. Regrettably that is not always the case. In my experience, for every lovely one, there is one who is less than lovely - usually rude and dismissive. If other professionals were as rude, they would be dismissed.

In my view doctors are professional people like other professional people. In no other sector would employees get away with complaining so much about their employer and to their customers, the patients, complaining about their reward package.

Sadly, I'm not prepared to pay.more for something that isn't fit for purpose. Throwing money at it isn't the answer. My young, Antipodean colleagues, are horrified at NHS standards.

Wes Streeting announced another maternity review yesterday. Have the reviews that have taken place already not already identified the problems.

I don’t think thats it. DH and I have both worked in both the private and public sector. Lifelong public sector employees really have no idea what it takes to accrue a public sector pension or leave entitlements. Most of us leave the public sector due to frustration and the sclerotic nature of public sector organisations tbh. My experience of the public sector was that they really didn’t have a clue what the private sector was like. They were genuinely convinced they were hard done by.

Add in the pension and the work out how much you would have to save over a lifetime of work for a similar annuity and then tell me people are underpaid.

Same here and I couldn't agree more.

Consultants on the golf course therefore late for clinic is ridiculous and so demeaning to consultants. Not a single consultant I work with would be on the golf course before clinic. They might be late because they also have a number of fellows doing PhDs that need help/funding/other supervision, have to check in with their junior team, have a board meeting because they've been told they have to sit on x number of hospital boards, have (often unpaid) research commitments, have been to see a patient on a ward urgently, have been doing their copious amounts of admin because the hiring freeze means they now don't have a med sec, have been grappling with logging into the 12 different ancient IT systems they need to see just one patient, etc etc.

But actually sod all in comparison to many with a much lower level of responsibility, lesser intelligence and shorter training in other walks of life.

@aveenobambino put it perfectly.

You and your friends won’t actually know what these consultants’ job plans are- they could be doing research/ private / management roles but fulfilling their NHS obligations that they are paid for.

Consultant 3 - would you expect them to work for free on the 5th day? They will have cover for their patients for emergencies and may cross cover their colleagues when at work.

I think it great young doctors are showing you can work in the NHS and expect to be treated fairly and paid appropriately. They seem to be teaching the older ones about work life balance.

One of the things for doctors is that they face a severe financial penalty early in their careers. Medical school is demanding and takes 5 years during which time it's very difficult to make any significant income and the debt is accruing fast. The early years as a doctor are low paid and locum work is not as available or well renumerated below registrar level. This means, for example, that if you live in an expensive area like London or the South East, as I do, that you will be late to the property ladder by some 5+ years as compared with other similarly capable (and a great deal of less capable or at least more directionless) school leavers in your cohort. That's not even factoring in all the moving around. You will enter your mid 30s in all likelihood still earning an average-poor salary relative to your qualifications, asset poor, and still paying large sums monthly of student loans. Then it all slows down because it is very difficult to establish yourself as a consultant before you need to be getting on with having a family if you want one. I won't be a consultant or get that salary until I'm about 40. It seems like a delicious salary to me but in the meantime acquaintances who didn't make the same sacrifices relentlessly pursuing one goal from the age of 16/17, who pissed about at uni, who don't do shift work, who haven't dealt with what is at times a crushing weight of responsibility and so forth - but who were able to buy a house just 5 years earlier are enjoying a substantially better lifestyle and will do for many years / perhaps indefinitely. I don't know any doctors, I literally don't know any doctors who haven't at some point been driven to poor mental health by the demands of the career. The majority of doctors I'm close enough with to be aware of such things, have at some point felt suicidal. It's not like other careers. There are times it crushes you.

I don't think the consultant salary in and of itself is poor (though I resent the commonly held notion that consultants are all incredibly wealthy - I don't think I will ever be able to afford private school for my children for example), because it is a vocation and also a wonderful privilege - but that salary has to be taken into the context of the 20 years or so leading up to that point.

Edit: Important disclaimer - nurses in my opinion, do have it much worse.

Consultant 3 is being honest about not being there. Everyone who works with consultants 1 and 2 knows exactly where they are when not in the NHS clinics/wards - plus it is advertised on the website of private hospitals. And the waiting list for 3 is much shorter than the other 2.

I doubt this will get much sympathy but there is also a financial penalty from having to work less than full time to avoid burnout in the current stressful conditions of the NHS.

It's basically compressed hours without the pay preservation. As demands relentlessly increase - due to an aging sick population but also healthcare advancement and increased governance / medicolegal expectations - all healthcare staff (not only doctors) are having to deliver more care to more patients, and do more work overall, without more renumeration.

The added stressful, demanding nature of the shifts/work, and the resulting push of professional development, professional admin, clinical paperwork and even safety functions like checking labs get pushed outside of working hours - can mean that it's just not possible to cope in the role "full time". You do the same amount of actual patient care /work as previous counterparts, but over a compressed less than full time schedule (and much of it in your own "free time"), for less than full time pay.

I think this is particularly the case for GPs.

Hmmm.. the years of training and experience gained over those years counts for nothing?

Eg in times gone by Old Timey Doctor doesn't need to do Safety Training A. When Patient A arrives dying of problem A (if they even present to Doctor at all), Doctor doesn't do much because there isn't much to do. When Patient A dies, family don't ask questions and Doctor doesn't need to engage in any reflective or investigative process. Doctor does not have to see Patient A in clinic. Doctor doesn't have to attend Safety / Improvement / Governance meetings related to problem A. Doctor doesn't have to engage in CPD / appraisal process. Doctor doesn't have to interpret and report investigations which aren't in use or haven't been invented yet. Doctor is also a man with a wife at home looking after the kids so he gets to the top of his career fast and earns well fast. He also gets to do it in one place, very often under the mentorship of a select few who teach him their ways consistently (the firm).

Compare this to Modern Doctor. Firstly Modern Doctor is a woman and her partner/spouse also has to work for a roof over their heads because house prices are so high now so she will usually be stuck in relatively low paid training (cough service provision) for decades if she has kids. As well as all of Old Timey Doctor's medicine she also has to learn and deliver all the new medicine that exists now, to a cohort of patients who are way more complicated and sick. And there are far more of them per Doctor, than there used to be. Advanced and complex treatment now exists for problem A so patients A, B, C and D do not die. They all need to be cared for acutely, with a longer inpatient stay, developing more complications, and all need to later be seen in clinic. Due to surviving they all have the opportunity to develop problem B/C/etc as well. Modern Doctor does have to do lots of safety training and lots of professional development. There is no firm /mentorship model in place so she moves from place to place constantly, never settling and noone takes her under their wing or has a consistent way of doing things. If she wants to practice the best medicine she must constantly research and memorise the latest evidence / guidelines about diagnosis and treatment herself. And she will be scrutinised if things go wrong. She does very much have to attend and present at (therefore prepare for) safety / improvement / governance meetings. And do an appraisal with all the prerequisite paperwork at least every year. And earns much less in real terms than Old Timey Doctor.

Clearly Modern Medicine is better for patients, or at least the whole staying alive part (not universally a good thing). Doctors should be accountable and should learn and develop so that they are doing good medicine. Nevertheless, working life has gotten worse and much busier for Doctors as a result, and at the same time their pay has been considerably eroded.

Let's think about the implications of what you've just told us all.

'I don't want to pay more for something that isn't fit for purpose'
Have you considered perhaps that it is not fit for purpose because there isn't enough investment in the correct places? Let's be very clear about one thing: the government has money already - they do not need to take more from the taxpayer.

Instead, the government is investing in roles such as physician associates to do doctor work but cheaper - which ultimately means it takes a PA and a doctor to review what would be a simple treatment plan, so in fact not cheaper at all.

Our biggest problem, perhaps, is that our healthcare system is run by those who don't actually have any experience working in healthcare. There is no other organisation that would hire people without a background in the industry to run it. So why is the NHS run by politicians who have zero knowledge of what it takes to run a successful healthcare system? This is why the standards are poor, because the people allocating the money do not know where money needs to be and where it shouldn't be.

Countless, pointless reviews because there is a deep lack of understanding of what to do - 'let's do a review so it looks like we're doing something' is all it is. And before you know it, a government's time is up before they've even achieved anything. It's pathetic, it really is, that one of the richest countries in the world cannot meet the basic needs of its population. It's disgraceful.