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.

Not disagreeing with you about doctor quality, which I simply cannot assess. But based on positive WP outcomes in my own ‘difficult’ field I would like to see the issues at Foundation level assessed more carefully.

The thoughtful @Marchesman makes a case that a Problem Based Learning approach results in less effective learning, for clinical purposes, at medical school. Could that be a key issue? Probably there are others.

Thank you. Much more interesting thread than the first one - hopefully we stay away from the antagonistic tone of the first.

I find it very irritating how the figures for resident doctor pay continually quoted are the base level. In my day the majority got additional 40% or 50% for being in job with on call rotation. Has this changed?

And even back then I was irritated by people seeing the job as strictly 9-5. Most other junior professionals have to work more hours to gain experience and get the work done. That’s just how it is. Why have the mentality of being a factory worker doing a shift, but expecting the wages of a professional. Of course lots worked beyond. But lots did not or thought an extra hour was scandalous. And it sounds like it’s got worse.

I did support the residents in the first rounds of strikes, but this one does seem more tone deaf considering the other options. Maybe it’s a generational thing. Lots of friends who manage the 20 somethings in various industries comment on their attitude to work. Maybe it’s a more healthy balance, others will say it’s entitled. But those people can’t strike, it’s just the public sector.

re PBL. I think it depends how it is done. As a student sometimes we had non-clinicians as facilitators. Quite ridiculous. But when guided by clincians I thought it was good and quite a pragmatic way to learn. I think whatever model is used to teach, a huge amount of real world medicine is clearly going to be learnt in the foundation years and beyond. Though even that takes hours and effort.

Thank you, @BudgieHammockBananaSmuggler . Very interesting indeed

Yes the 40-50% ‘banding’ went out 8 years ago after Hunt and the BMA destroyed our careers in the 2015 contract dispute. Base pay went up but banding disappeared overnight. Now there is a tiny uplift if you do nights/weekends (like <2k a year or something ridiculous) but it’s not like before where if you worked a demanding OOH specialty you got paid more than those on a 9-5 for your trouble.

Thank you for explaining. I know that’s what the 2016 junior doctors strike was essentially about but I didn’t know the outcome. How about the consultants contract? Do they get much more for unsociable hours?

I don’t know the ins and outs of consultant pay tbh but the most recent contract on their pay circular is 2003 😵‍💫 . Looking at pay circular the max uplift to basic salary is 8% for unsociable hours (for those doing 1 in 1 - 1in 4 on call where you are resident/frequently expected to return to hospital).

A consultant in the hospital at night/weekends was a pretty rare sight when I graduated (esp in medicine). There’s multiple in every weekend now. Changes needed here. Hopefully the BMA cons committee is very separate to the RDC.

The BMA seems to have been taken over by not very bright activists who aren’t in touch with the public at all though. See the way they denounced the Cass report. They act like petulant teens. It’s embarrassing.

Why do we need to reduce the number of medical school places?

Can resident doctors who did not vote for this join one of the other unions instead and distance themselves from the BMA? That is what I would do.

Classic politically motivated thread. Hiding it now.

I’m a consultant not a resident Dr but that’s exactly what I did. Now I can easily shut down any pressure to strike or vote to strike.

There are no other Unions that are specifically for Drs but you can join Unite or Unison or one of the other healthcare unions. We are also required to have insurance from a defence organisation so I think my employment rights are covered and I would still have someone in my corner if I have a complaint or GMC issue or something.

For teachers there are several unions some more militant than others. People choose the ones that suit their level of militancy. Sounds like there needs to be at least one other resident doctor union.

So its gone from £12 to £15 to £18 in two years and its STILL not a fair wage. They must think we are stupid, or have bad memories. And let's not forget this is just the basic wage for a starter F1 straight out of uni, and with no overtime, extra out of hours, or increases in pay from F2 onwards.

The BMA are pretty much the monopoly Drs Union. I have heard good things about the HCSA but they don’t cover GPs. I joined Unite which is more general but has a Drs section. They are a lot cheaper than the BMA too!

Coming back to this late but:

@poetryandwine The Thog problem is elegant. I think most undergraduates in my School could explain the reasoning clearly to a random high school graduate but I wouldn’t bet vast sums on this

Honestly? Its fairly basic logic and probability - my (youngest end) millennial DC did this level of logic and probability well before GCSE level. I would agree that basic grasp of stats is woefully bad amongst the general population but the high level failing this test is depressing. OTOH its consistent with the level of credulity shown to just about anything in the era of mass social media.

@Marchesman The communication thing is not grounded in evidence; educational attainment is heritable and correlates positively with emotional intelligence

So I would agree that someone intelligent and well educated should be able to learn good communication skills but that doesn’t mean they will or that they will recognise them as an important skill. We have all met doctors with terrible communication skills including amongst those qualified under more academically rigorous training eras. So maybe the problem is that it isn’t recognised as important in medical training or by the students themselves. Maybe this correlates with a culture of “be grateful, its free”.
In my industry this wouldn’t be tenable, however clever and well trained the junior, if they cannot communicate effectively and understand a client’s needs, problems and concerns then they cannot do the job well and we lose money and clients.

How does UK PBS style training compare with more traditional education systems common in South and East Asia and parts of Africa? Are they still more academically focused? If so does this explain the success of such candidates competing for UK jobs?

Would agree with this.

I'm currently having a very similar discussion on TwiX at the moment.

An apparently retired Consultant has told me I don't understand FY1s roles or rotas. I'm currently a top band 6, Clinical Nurse Specialist, triple trained, NMP, work mainly nurse led clinics with 35yrs experience, majority of it in acute care.

I've apparently never worked in a DGH or I'd know FY1s are always the sole medic on duty with no senior support and manage all deteriorating patients by themselves. Don't I know FY1s are expected to manage undifferentiated and acute pathology autonomously?

No shit Sherlock, it's the bare minimum I'd expect. I do it too on a daily basis.

Apparently no one other than FY1s are "diagnosing and managing electrolyte disturbances, renal failure, sepsis, weird and wonderful complications etc etc?"

How is there any Probability or Statistics is the Thog problem? It is strictly a question of logic. I suppose it could be framed as a question in Elementary Probability; there is a certain amount of basic logic in that field.

My statement was more about being able to give a cogent explanation to a stranger, who may not have been able to solve the problem and is unfamiliar with your communication style. That is much more difficult than merely solving the problem. I am fairly certain all of our students could do this pretty easily.

Peter Wason published the Thog Problem in 1977. In a pilot study, 0 out of 10 law students students solved it correctly - one argued for more than an hour against the correctness of Wason’s solution. 7 of 14 medical students solved it, taking an average of 6.3 minutes. One medical student solved it in his head in a minute and said, “I would not let any doctor near me who couldn’t solve that problem."

In front of you are 4 designs: black diamond, white diamond, black circle and white circle (I don't think my screenshot will reproduce but a pencil and paper will also work)

You are to assume that I have written down one of the colours (black or white) and one of the shapes (diamond or circle.) Now read the following rule carefully: “If, and only if, any of the designs includes either the colour I have written down, or the shape I have written down, but not both, then it is called a THOG”. I will tell you that the black diamond is a THOG. Classify each of the designs into one of the following categories: a) definitely is a THOG, b) insufficient information to decide, c) definitely is not a THOG.

The psychology behind it is not basic, as attested by the research on it, and there is no element of probability. Any GCSE pupil who can solve it with no help should have a bright future.

Practice based learning has been a part of the clinical years of traditionally taught medicine for fifty years, but PBL courses substitute it for basic science teaching. This seems to happen all over the world now, including Asia and America, mostly because students prefer it. However, as I think tends to happen in other subjects, students are happiest when they are not acquiring skills and knowledge.

My point about academic attainment and "soft skills" is that there is a correlation between them:

"An important link exists between adaptability and stress management skills, as well as interpersonal abilities, and academic success. Adaptability involves being able to cope with environmental demands in a flexible and realistic manner; it involves being able to find appropriate ways to deal with everyday problems (Bar-On, 1997, 2000, 2002). Stress management skills involve being able to withstand stress by being calm and work ing well under pressure (Bar-On, 1997, 2000, 2002). Interpersonal abilities involve having good social skills and being able to interact effectively with other people (Bar-On, 1997, 2000, 2002)."

"Academically successful students had higher levels of interpersonal, adaptability, and stress management abilities, as well as overall emotional intelligence."

See Parker 2005 Academic Achievement and Emotional Intelligence: Predicting the Successful Transition from High School to University https://eric.ed.gov/?id=EJ795801 (The findings are consistent from primary through tertiary education and beyond.)

2nd attempt at image

Why don't you try it on your students. You might be surprised.

There are also many similar tests that grew out of it.

FY1
Starts on £36,616 for 48 hours contract

Seems to be based on a 40-hour contract, not 48 hours;

https://fullfact.org/health/resident-doctors-pay-how-much-do-they-earn-and-what-does-the-bma-want/

(New basic rate will be £38,831 based on 40-hour contract backdated to April this year)

mumsneedwine
Watch this and understand why this is happening. Facts. How an F1 today earns £98 more than F1 in 2005 - in actual money.

The 2005 payslip clearly says Senior House Officer at the top - so more experienced than an F1. Indeed, the doctor from 2005 appears to have qualified overseas in 1999.

Except he did.

Some of the main conditions of calling off the last round of strikes were:

The 2023-2025 pay rise
A road to pay progression
Publishing the ddrb decision on schedule
Reform of rotational training
Reform of exception reporting

The goveenment welched on every single one of those promises apart from the first one, and refused to engage with the BMA in dialogue on progeess.

Likewise the cuerent talks. The government offered literally nothing concrete to take to the membership, just vague waffle about 'looking at professional fees' (and ive seen the original copy communications to back this up).

It was clear that the government was never going to budge through any action short of strikes.

Funnily enough, not one word about it on the official documentation / communications with the areas for negotiation outlined.

Infact.... Not much of anything that would constitute an offer the JDC could take to their membership.