To think the BMA have misjudged with another doctor's strike? Thread 2

[Locutus2000]

Rolling this over as people still seem to have something to say but no new poll.

Original post

AIBU to think the BMA have misjudged with another doctor's strike?

Last year they got more than anyone else in the NHS along with an improved deal. Nurses and other AHPs received lower rises.

BMA have just announced another 'resident' doctor strike continuing to chase pay restoration to 2008 levels.

Having just had the major win with changes to IMG prioritisation and the clamp-down on PAs it feels a bit tone-deaf and I can't see Streeting going for it.

Following on. I just expect graduates to pay their graduate “tax”. The Doctors have received far better value for money than others. In fact others pay more in fees than courses cost so unis divert their money into stem. I know all grads should continue paying off if abroad and that’s fair. I don’t see why we keep thinking one set of grads is a special case. Everyone who has taken a loan is equal. However not all grads have had £££ spent by the state funding their very expensive training only for the doctors to walk away or strike.

Billionaires are few and far between even in this day and age ! Others who rich and do pay taxes - we need them! They don’t rely on the state. We need as many higher tax payers as we can muster.

I was exaggerating in saying ‘billionaires’. Whenever tax policy is discussed financial advisers are quoted saying that their HNW clients are thinking about leaving. It is tiresome.

IMO one reason for the disastrous NI rise in employer contributions is that Labour did not want to hit their new buddies in the City where it might really hurt - their own pocketbooks. CGT could be raised further. Other countries which maintain higher growth than the UK do similar. (Although is low in America). Dividends could be taxed as ordinary income.

I should think people keen on growing businesses would be incentivised to plough profits back in to their companies and hire under such policies. But they wouldn’t take home as much money in the short term.

@poetryandwine
You asked on the earlier thread (I think) if people agree that UK graduates should have priority for training posts. In my opinion they should not. The NHS does not exist to provide medical graduates with employment. It was often pleaded on the first thread that medical graduates are a special case, in having only one potential employer, and it is certainly a tactic used by the BMA. But this is rubbish, a medical degree can be, and often is by choice, used like any other. Before even finishing medical school 3% of entrants decide to go into other lines of work, principally consulting, technology, financial services and law.

Medical school entry is progressively less competitive (equal, diverse and inclusive) and that trend will continue, it is currently open to about 20% of A level pupils. Medical graduates are therefore academically heterogeneous. If postgraduate examination is a suitable test of fitness to proceed in the profession, graduates of post-2000 medical schools, for example, are on average less fit.

It is in the interest of everyone using the NHS that competition exists and at every step in the process the best people are appointed. Instead of giving UK graduates "priority", I would raise the pass mark for PLAB and make UK graduates compete fairly with high ability foreign graduates. If UK graduates are displaced by foreign graduates it should be cost neutral - foreign graduate training is free.

@poetryandwine A lot of your ideas are anti savings though. I’ve paid lots of CGT and it’s quite a whack and hits savings for old age. We are now of that age.

I would ensure the self employed paid income tax and not dividend tax at a lower rate although they got their comeuppance when they didn’t get furlough money. They had dodged income tax and that’s wrong. However you need companies to invest. DH invested in people. The more taxes people and companies pay, the more we stagnate. Investment is a cost and no profit equals no investment and no growth.

Labour doesn’t really have buddies in the city. Labour just doesn’t want to do a Truss and be seen as incompetent. They need the tax revenue from the city and post Brexit, that’s not necessarily growing. Being anti the City would be foolish. We need big salaries to pay income tax.

Many SMEs don’t make much money. They are not fat cats. Yet from small companies bigger companies can grow but higher taxation just puts everyone off taking on more risk and scaling up is fraught with fiscal danger. Plenty of companies barely make a profit let alone expand. These are also the companies who employ the most people in the uk, 60%, but you would never know it. They are largely not unionized and many are just keeping heads above water. Risk takers need a decent return. Or why bother? Taxing pensions (with no employer contribution), taxing employees, taxing profits, taxing capital gains soon adds up to no one bothering and no growth.

Labour and Truss were right about growth. They just didn’t know how to get it.

I can’t quarrel with this in theory, @TizerorFizz . But various Tory governments since I have moved here gave tax breaks meant to encourage ‘investment in people’ - a phrase I also like very much.

What happened? Their buddies ploughed the money into dividends and stupid acquisitions, and we sank to the bottom of the league tables in terms of private R&D. We developed borderline abusive zero hours contracts. We agree we need growth, but my question is - how do we get it when Tory pals consistently abuse tools meant to be used to achieve it? On a very large scale.

I know from previous threads that isn’t how your DH ran his firm. He sounds at a guess like an old fashioned Tory of the best kind and a bit like my DF. I don’t object to Tories on principle and as you can see I am not happy with Labour right now.

DH and I are also caught by IHT and the various remedies I’ve proposed, by the way. I hope living in a better society, with a stronger economy and a better health system would make it all worthwhile.

The talks went well then.

I actually agree with what Wes Streeting is saying.

@poetryandwine Well not all employers are the same but nearly everyone relies on their staff. So treating them well matters. Business relies on staff being fit enough to work and the health of the nation is important. It’s not old fashioned to believe that being a decent employer gives you an edge and DHs staff had a choice didn’t they? He wasn’t the only employer that wanted their skills. NHs doctors have no other employer until they become consultants and run their own private clinics. That’s part of the frustration I think. No competition for their skills.

I’m really in the Mandelson camp of being relaxed about wealth and the City of London. Its spin off is immense and we have all prospered because it’s done well. I think we are all cross about large salaries and poor performance though - Thames Water springs to mind.

I think the private sector is more efficient in many ways though and strikes less. Zero hours contracts are not everywhere and don’t need to be. However we don’t stop using the firms who have them. Some employees actually like flexibility, like supply teachers. In effect the self employed are the ultimate zero hours contract. No contract - no money.

As you know I’m very much wanting people to have better jobs and better prospects. I just don’t think forcing employers into paying more tax and having more legislation that makes them swerve employing people is the way to go. We shall see what happens. The Cons didn’t help SME business either. My main concern is that business is always seen as uber wealthy, but it’s not. Some pockets of it are but most Governments think it’s everyone. SMEs are the backbone of employment but aren’t getting much help to thrive or grow.

We need growth more than anything. We cannot compete with Ireland (as an example)as a place to do business at the moment. When the public sector employees demand more, the cost is extremely high when you add in pensions and it’s a massive burden for everyone else, which Labour has recognised. So far Labour has not created a climate for business success and neither did the Tories with Brexit wrangling and its aftermath. So where is the money for the nhs coming from? It’s not clear to me other than huge borrowing or higher taxation. I shudder at both and definitely have no political home.

Seconded.

This is incredibly duff leadership at the BMA. They're absolutely not acting in the interests of their members.

Thirded.

We can split the details but I agree completely about having no political home, and I deeply appreciate the stimulating and civilised debate. :)

I agree with Wes too

Deeply depressing that this is going ahead this weekend. I am so sorry for all the patients whose ops and appts will be cancelled. They will be harmed.

I have been guilt tripped into cover shifts after all. It’s been hard to find cover this time. Lots of consultants had pre booked holidays at the start of the school
hols. The timing could not be worse.

I am hoping that the turn out will be poor and they won’t do it again.

Thank you for this very thoughtful post. I am new to some of the terms so in no way can I assess it as an expert.

My (mis?)understanding from earlier posts is that IMGs may have an economic advantage when applying in that overall costs to employ them are less - typically they are more senior and there is no training component. Is that correct or incorrect?

I see merit to employing top performers and cannot offer an opinion on that vs taxpayer investment as an outsider. Certainly a worthy debate. But employing IMGs because they cost less is something else altogether and makes no sense to me.

You’ve also written about the quality of Home MGs in rather vague terms. Can you say in what ways performance is declining?

In my ‘hard’ STEM field - I think that correlates with the amount of Maths - WP students are a heterogenous lot. My experience of Mit Circs panels suggests that, based on the narratives I’ve read, students from a likely WP background are somewhat more likely to experience adverse events. But they are pretty good at coping, in that WP students are, at minimum, not over-represented amongst repeat petitioners. That’s the red flag. We also have lots of evidence that their average marks are virtually indistinguishable from the overall cohort although the SD in both directions is bigger. (This is a very competitive School with a standard offer above AAA and not much of a WP concession, BTW)

Students overall are in no way coping as young adults anymore. That is a different issue.

@poetryandwine

That is a lot to address, and I'm probably not the best person to ask. My experience is lengthy, clinical rather than managerial, and anecdotal; although for what it's worth, it is consistent with the data.

I think you are broadly right about costs, seniority, and training because new IMGs are predominantly locally employed (LE). However, I would say that "training" is a misleading term because there is not much difference in learning between these and training posts, if any. The difference is in credentialing and career progression. Costs can be lower because they are not nationally negotiated posts but that is not a reflection of the doctors who fill them or a reason for creating them - IMGs are not employed because they cost less. The posts are set up with specific service requirements in mind and it is helpful to have experienced people filling them.

I think about a third of LE posts are taken by UKGs.

A couple of things may help to put "non-training" posts into perspective. For insight into the job titles:

https://www.kingsfund.org.uk/insight-and-analysis/long-reads/specialty-specialist-locally-employed-doctors-nhs

and for LE numbers, trends, and where they come from:

https://www.gmc-uk.org/about/what-we-do-and-why/data-and-research/the-state-of-medical-education-and-practice-in-the-uk/workforce-report

Performance is measurably declining, for additive reasons, probably starting with the reduction of content in A level sciences, and culminating in reduced clinical exposure in the early years of medical careers. For the effects of reduced science teaching in medical schools, and the lower prior attainment of medical students, see "Exploring UK medical school differences: the MedDifs study of selection, teaching, student and F1 perceptions, postgraduate outcomes and fitness to practise":

https://doi.org/10.1186/s12916-020-01572-3

Thank you again, @Marchesman , and for the references.

It is accepted that Maths A Levels, required in my field, got easier for about 30 years and levelled off in the late 90s. (Loughborough did good research on this.) It is plausible something similar happened in other fields and I can imagine the consequences for the study of Medicine.

I am interested in your last link, which I have only skimmed just now, and the statement that a PBL curriculum correlates to worse exam outcomes than a traditional curriculum. This seems obvious, because presumably exams were designed to assess mastery of the traditional curriculum.

But patients surely have an annoying way of refusing to fit nicely into pigeonholes. Does a PBL approach - which I am well aware offers ample opportunity for abuse, to say nothing of genuine mistakes and misunderstandings - have any advantages in Medical education that cannot be captured by the standard exams? Or do you see PBL as essentially worthless even when practised optimally?

Indeed. The BMA leaders seem to be refuting the idea that this was about anything but pay

Yes. Those in support keep saying about Drs terms and conditions, hours worked, lack of training opportunities etc. Then the bma come out and say actually the strike action is, at its core, about pay.

The people leading the negotiating for the doctors seem to lack basic negotiating skills. That's likely to be a problem for them.

And the soundbites in my newspaper this morning were about being ‘paid less than our assistants’. (Sound familiar?) I am not sure most adults think it is a good look for F1-F2s aged 25-26 to be unhappy that people with different competencies (and, mostly, much more experience) outearn them.

This is separate to whatever genuine medical questions exist around the use of PAs.

Yes quite, arrogant. No doubt the same sort of overly-pleased-with-themselves young doctors who talk down to nurses (who will often be much smarter than them and working at least equally as hard). That's also a terrible look.

Are PA's actually F1 and F2's ' assistants ' anyway ? My experience is they are not. The PA's that I know are supervised by consultants and registrar level. That's who they are 'assisting' , if it has to be called that.

@Marchesman I’m interested in the significance of academic standards in making good doctors.

Back in the dark ages when I did “A” levels places for medicine, like Oxbridge, all required an interview before any offer. In practice this meant a good interview could result in a lower grade offer if the candidate was particularly liked. The downside of course was the favouring of “types” or those with connections who received the lower offers.

Then there was a shift toward removing interviews and going solely on grades/school reference. This resulted in higher grade offers as there was no interview elimination round (and of course grades started to inflate). An acquaintance who spent most of her career working in and then running admissions at one of the big London medical schools stated at the time that this resulted in students who were very successful academically but often had shockingly bad communication skills (and a good few horrified to realise anatomy classes involved touching bodies!). At this point most of their pupils still came from private schools or elite grammars but were slightly less white and male.

Wind forward through the 2000s and the private sector has largely priced itself out of its traditional market of doctors, solicitors, bank managers and small business owners. Those pupils now came from the state sector as their parents spent school fee money on tutoring and house moves but they were fundamentally the same cohort, coming with a list of A* but no guarantee of comms skills or interest in actual people. She would have students demanding info in the first weeks of term about networking opportunities with private sector practitioners and often very clear about where the money was speciality wise. I don’t know if its similar at less famous schools. Her view overall was that the overall calibre is less than when she started even though at that time nepotism was rife.

Its always seemed to me that medicine is one of those careers where you need strong academics but also some decent comms skills. The latter may be more significant in, say psychiatry or general practice than from Mr Knob who you meet for 30 seconds before going under anaesthetic to the sound of highland bagpipes, but even in surgery a specialist needs to be able to communicate options and understand the patient’s needs often in limited time.

Something I’ve observed over the last ten years in my own and other industries is what I would loosely describe as a “lack of maturity” in this age group compared to previous cohorts. They need a lot more direction and instruction and seem less able to work independently early on and are less keen on putting the hours in. We have had to completely revamp graduate training to actively teach skills which used to come with the package and even lay on staff to deal with questions from parents not happy about their highly paid graduate child’s “experience"! There are plenty of bright, motivated graduates still and obviously they will be the candidates who succeed long term, but overall the “average” is not what it was. I imagine this effect is felt in medicine as well. I’d love to be able to diagnose the reasons but I can only speculate (but note this is the first generation to experience childhood drowning in SM).

This is also my understanding. It seems to be confirmed on this thread

Love the idea that parents get in touch to complain about the grad scheme experience 😂

Fascinating post, @C8H10N4O2

I also genuinely wonder about the relationship between academic knowledge and medical skills.

It seems most UK medical schools now use Problem Based Learning. In my own discipline I see this as more valuable in the later years, when you have a good mental map of core knowledge. Acquiring core knowledge through PBL can obscure fundamental principles and, I think, make things seem unnecessarily complicated.

I think there is some merit in @Marchesman ’s idea that the best candidate via exam gets the job - to be weighed against British economic investment, which is a different discussion - but the exam needs to be curriculum neutral and to assess various qualities, not only book learning. That is a tall order.