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?

It's fine. It was decades ago now and whilst you never truly get over it, you do come to terms with it and very gradually, it stops hurting. I say that regularly on the pregnancy/bereavement boards and am glad that nowadays they exist.

I was just making the point that other professionals don't have things as easy as medics think and often have as little or less agency over their time and have no alternative but 100%+ commitment.

What a heartbreaking and depressing story. It’s awful that your husband was so restricted by his work.

I just wanted to say that many of us do care about letting others down. When I was doing ward rounds, if I was running more than five mins late, I would ask for someone to inform the patient/relative asap and apologise. In practice I was only more than fifteen minutes late a handful of times as I have a thing about timekeeping and reliability. If I have a phone appt and am more than a minute late, I lead with a genuine apology. Often to the bewilderment of patients.

I do respect others’ time and know what it’s like to wait for a call. Whether the patient is a stressed city banker or someone unemployed waiting by the phone. I am sure I am not alone.

I just think there are pros and cons to private sector and public sector work and there is probably more understanding needed on both sides. Mt nephew aged 24 is working in the City on a salary of £107k as a new lawyer. Which is incredible to me at such a young age. But if he had a family crisis, it would be easier for me to take time off as an NHS worker than it would be for him, with the brutal demands from his top law firm.

@CornerTable whilst it seems your nephew is earning an eye watering amount at 24, the stark reality is that many many young people who start out at Magic Circle firms do not stay long after qualification. Fewer make partner. There may be many times between qualification and retirement when their jobs are at risk. The rewards are potentially very high, but those rewards come with significant job insecurity.

My DS, aged 30, is an academic and very lucky to have a substantive role at a good university. However, due to the difficulties HE is facing, he is relocating at the end of the summer to a university on another Continent. He is very very lucky to have got it.

The rewards are potentially very high, but those rewards come with significant job insecurity.

Yep. The young people I know at Deloitte etc live in fear of losing their jobs.

I can remember trying to explain the “up or out”/“perform or out” career models to a government department team once and they could not get their heads around it. Its not just redundancies when the economy dips, its the routine pruning out of staff who don’t make promotion points on time or who dip in chargeability/performance. These were senior civil servants and they knew it happened, they simply could not get their heads around the concept.

From your other post:

I just think there are pros and cons to private sector and public sector work and there is probably more understanding needed on both sides.

This is spot on and I’d extend it. I work cross industry and across sectors. Every industry or sector has its own culture, each thinks its slightly special and to some extent this is true.

One of the key differences between public and private IME is that if I visit a large bank, retailer or telco they want to know what the competition is doing here and abroad and how they can get an edge and improve productivty. They want to be bleeding edge if they are telcos or cap market banks, fast followers if they are from more cautious industries.
In the public sector this is rarely a conversation initiated by the client because the culture is often more about “doing stuff” than doing it better, faster or more efficiently. The status quo is safer than change and productivity is not the priority on the whole. There are pockets of innovation, usually where their is someone senior who has seen the benefits but on the whole efficiency is not the priority.

Then there is working with the NHS. Its an outlier even in the pubic sector with the cultural resistance to change, with each of the thousand little fiefdoms not only convinced that they can learn nothing from other industries but that they can learn nothing from the trust in the neighbouring county. There is a staggering lack of accountability resulting in huge amounts of waste and systems which are a generation behind even the public sector. Systems and processes adopted with alacrity in other state backed health systems to improve the lives of both patients and staff are rejected because “we are NHS subdivision 194 and we are yoonique and speshul so it can't work for us”. Systems which could be centralised are fragmented across trusts at great expense and at great loss of benefit to patients and medical staff. None of this is a consequence of a shortage of money - its an utterly intransigent culture which results in huge waste where money is spent.

For my entire life I have believed in state backed healthcare with the better off contributing more and the worse off not having to worry about health care. I simply don’t believe our model delivers this and I’ve worked with and experienced so much better in European state backed provision. Honestly it surprises me that an intelligent and educated cohort such as junior/resident doctors are so wedded to a system which gives them poor T&C to work with when they are able to look across the channel and see better options. When I talk to young doctors they comment more on T&C than base salary but this seems not to figure in the union campaigns.

I don't have the same insight as the pp but I also think that earnings have to be calculated across whole careers. The City whiz kid may earn £400/£500k but they are unlikely to do so for their entire 30 to 40 years in the workplace.

It would be helpful to have data about the career earnings of solicitors, bankers, etc, compared to hospital consultants and GPs over the span of their respective careers. Except for a few, I suspect the doctors would win.

For example, I earnt a relatively large amount of money between 1982 and 1995 in the City, until I was burnt out and had children. I had seven glorious years at home and spent three retraining and then earning about £40k to £50k for ten years. It was only a couple of late career promotions that took me over £100k again and I am close to retirement. Similarly DH earnt a pittance until he was 32/33 which escalated to about 15 years of very high earnings before a sideways move which means he now earns about one third or less of his peak earnings.

My friend would not do medicine again had she known what it would be like, its got massively worse also. Its all she ever wanted to do, it was a huge slog for her and she had to do it a long way round. Judging by tights thread people dont actually believe how tough it is, there is no comparison to most other high paid careers, I'm not talking about hours worked, the actual stress of the job and seriousness of what they are doing on a couple of hours sleep or after 21 hours in the hospital!

I had to laugh at a poster thinking that a doctor is on call for just one ward in a hospital.

I had to laugh at a poster thinking that a doctor is on call for just one ward in a hospital.

I know. The mention of covering one quiet ward ticking over nicely made me smile. Or the poster who wrote about staff having nothing to do in A and E. Never seen that, but maybe it happens!

The responsibility for people’s lives is really what makes the role stressful for me. Esp when there is limited time and resources to do what you really want for patients. I could never be a pilot. One person responsible for hundreds of lives each flight, no thank you!

Doctors deserve more than the Prime Minister, IMO

I don’t know. We are in our fifties. The ‘City couples’ we know tend to have a much higher standard of life than the doctor couples. Even if the women go part time, the men retire early etc, the holidays, cars and houses etc are of a much higher spec for the City high-flyers. And none of
my doctor friends took years out to be sahms. That’s just my anecdata though. And money ofc is only one measure of ‘success’ as we all know.

We need good functioning private and public sectors. I found it irritating in the pandemic when people used to complain saying, ‘the government cares more about the economy than saving lives’ etc. We need a healthy private sector and the money it generates. It doesn’t always have to be a competition between them.

I have nothing but respect for those in such difficult jobs. I have a fair bit of stress/long hours working in my job but I would never compare it. The best thing I saw on FB when the junior doctors were first on strike was a nursery worker who worked 9-3 term time only and compared having to plan a session to doctors working more hours than they were paid for 😂

@CornerTable we all have different reference points. We are a little older and were London centric. All of the medics I met when the DC were at school (other mothers) were part-time and as the wives of accountants, solicitors and bankers seemed to have an excellent work life balance. Here, in our little Surrey road, our neighbours are lawyers, accountants and surgeons. Three of eight houses are surgeons.

I'll be clear. I was not academic at school, I dropped out of university after a term and had no ambition whatsoever beyond becoming a mother. But, I liked work, was good at numbers and had an eye for detail. I found I liked work in a way I never liked school or academic work and work liked me. At 65 and as a director in the quasi public sector I still suffer terribly from imposter syndrome.

So in our university town there are a few areas of expensivo housing. Once upon a time you'd find these occupied by academics and doctors mostly. I'm 60 and academics stopped being able to afford large detached homes in town about 35 years ago. Doctors (consultants/GPs/surgeons) still could until about 15-20 years ago. Depressingly, they all belong to hedge funders, business types and oligarchery who often remodel distastefully. I don't know why planning allows so many horrible extensions etc.

I think one of the big problems with pay satisfaction for Drs is the tax system. Yes, £105-135k sounds like a lot of money, but it is a terrible pinch point in the tax system where they lose their personal allowance, lose free childcare hours and are probably making 9% student loan repayments and contributing 10% to their pension. The net result is that some Drs in this group are paying 90% marginal tax rates!

That would p* off anyone.

As you get higher up the income scale in the £200k+, this high marginal tax rate gets averaged out so it doesn’t seem so bad, but for those stuck there, it’s terrible.

It also means that those that can afford to, keep their earnings below £100k by going part time or adding pension contributions. This is so bad for society as a whole - productive Drs are working fewer hours than they could and if they make pension contributions the tax man loses out on 100% of the tax. It is a mad system.The Times published a graph - which I can’t find now - which showed the huge spike in the number of taxpayers on £99k followed by a huge drop at £100k+ which only began to recover in then £135k+ range. People will do everything possible to avoid going over £100k.

As successive govts freeze the tax bands more and more workers - quite a lot of senior public sector workers - are falling into this £100k tax trap. It needs to be sorted out so that the marginal tax rate increases gradually. It isn’t rocket science and cld be done to raise the overall tax take but the optics would be those in the low £100k paying less tax than they do now and so the govt is too frit to do it.

I would also add that there are a lot of non£ things that annoy Drs about their working conditions that contribute to their dissatisfaction eg no lockers, unisex changing rooms, slow out-dated systems, patients that don’t turn up for appointments (because they don’t get to choose a convenient appt time), car parking fees, student loans, inflexible rotas, unproductive co-workers who are never managed out, lack of availability of healthy food, money wasted on identity politics (see Fife and Darlington)……..

On the other hand, I don’t have any sympathy for the argument, “I cld be earning £millions as an investment banker/city lawyer…..”. Because if that’s what you want to do, then go and do it, and you will discover those careers have their own stresses.

Gosh, that story impresses me! It’s much more straightforward in many ways to follow a conventional path into a professional career like I did. I worked v hard but I knew where I was heading which makes things simpler.

Depends on whether they started pre 2017 or afterwards. Plan A is very different to plan B longer term. The government only managed to get it passed by excluding existing doctors and students. I don’t think they should have agreed something so divisive, on such a self interested basis, and in effect they pulled up the drawbridge, somewhat.