Junior Doctors Strike

[Lanchester]

Do the Junior Doctors seriously think that they are still
respected for always putting the interest of their individual patient first?

So once again, missing the point.

Only consultants can do private work.

We have a minimum 10 session contract. A session is four hours. It was brought in to control what we were doing and evidence that we weren't on the golf course or sitting in private practice when we were supposed to do NHS work. What it showed, was that not only were the vast majority at work for the NHS when they should be, but they were working considerably more than managers and the government thought they were. Most of us do more than 10 pa's . With on calls this means that there are normally two session of non NHS time in the week that are the doctors own if on a 10 pa contract. Of you are doing above a basic 10 pa contract, then you work more for the NHS.
Outside of major urban areas, there is not the demand to allow for the costs of private practice to be covered - so market forces dictate that it is not worth it. And prices (fee for service) are controlled by insurance companies.
In areas where it may be more feasible to cover costs, in many cases the time issue (ie working outside the NHS hours, plus staying to make sure patients ok, do paperwork etc, which we don't claim for) this means to do private practice you would have to work outside these hours, and many feel the toll on personal life isn't worth it.
So your argument is ignoring the basic point, which is without the NHS demand would rise, making private work more feasible and therefore of course consultants would do it. This doesn't address the training of new consultants and gp's, (ie junior doctors).

Miss triggs, unfortunately some doctors are pompous asses no matter how much the rest of us would prefer them not to be. He should not have denigrated a colleague in that manner, and if he felt the need to point out the MRI was t necessary, could have written to the gp to help educate, and potentially just said he might not have done it if he still felt the need to comment.
We do find that simple things like space available in clinics can mean that we cannot offer more clinic time for different specialties, (not to excuse, just to explain), and extending these hours would be part of a truly seven day NHS, but you need all the ancillary staff too.

Sheza. Can I ask you, do all hospital doctors become consultants eventually or could someone stay as a 'junior' doctor until retirement?

Thanks Shezadoc.. I tell the story partly to disclose my own emotional baggage, partly to continue the thinking about misunderstandings ( it was a learning curve in many ways but that is for another thread).

To Talk uk lawyers again, we earn between£30000 and£40000 per annum on average. But several thousand of us earn over£100K in the City( generally for ten years if we want to be mothers). and some of us earn£300000 as tax QCs in London. no prize for guesing which groups command higher public awareness!

The" average" Jd compares their salary to that of a City lawyer and feels agrieved-, quite wrongly. The" average" earning lawyer compares her salary to that of the fancy private neurologist, and again that is a misleading comparison.

Thanks for your posts Shezadoc and Miss Triggs. I am going to wade in again now there is some reasonable discussion!

Any JDs feel free to correct me if I am wrong but I would like to reiterate again that for the vast majority of JD s there is no pay rise and this isn't about pay. I think JDs have been feeling the strain and poor working conditions for a while. They are deployed all round the country at short notice, often posted for 6 months at a time 1-2 hrs drive from their family. Hospital accommodation is grotty and not inexpensive so those without family/ partner live in pretty demoralising environments. Shifts are long and antisocial with an hour or two of unpaid work on the end of a 12 hr day. Add in 2 hrs minimum commuting and you can see that sleeping and eating can be all that there is time for in between.

JDs already work a lot of weekends so a couple may work one each a month or more. Add in all the weekend courses and exams they pay vast sums to sit (thousands of pounds!) and the unpaid studying , research and audits you can see that there may be only one weekend a month to see their partner and children.

Add in the hugely stressful understaffed shifts where they can run on adrenaline, tired, not having eaten or drunk or peed and barely able to run from bleep to bleep ( a night shift may involve 5-10miles of walking) and the fear that a mistake will get you sued or worse jmprisoned!

The weekend of downtime to relax and forget is vitally important to a doctor's sanity.

More and more JDs are feeling pressured to stay and locum when the managers tell them they can't fill shifts.

Now imagine JH starts telling you you will be paid less and will be doing More weekends for it. And is removing the safeguards to prevent you being even more overworked. Many doctors felt that this was more than they could cope with- a line was drawn in the sand !! No doctor will be apparently be put on more than every other weekend they say! Well what if your partner was on alternate weekends to you?! And every time you ask a colleague to swap so you can take your weeks hol that is you and them working 3 weekends in a row.

There are so many other issues that have emerged as the contract has gradually been released that JDs are now fighting sex discrimination, unfair non resident on call rates, realisation that there will be paycuts for the specialties with the worst recruitment problems and a fear that the service can't cope with 5 days never mind being stretched over 7!!!
More doctors and support staff and beds is the answer not driving away the few that are left!!!

To

There is relevance of private work - my jam tomorrow argument. You lawyers and doctors tolerate many conditions others would not tolerate because they know there is a good chance in 10 or 15 years' time they might earn a good bit more; whereas your average hospital cleaner has no such hope. It's the deal - you accept the awful time in your 20s+ because you might get something better later.

If it becomes impossible to recruit or train new doctors the NHS/state will then improve conditions. That is how market forces work. That does not mean life can be pretty dire for many young doctors, lawyers (never mind cleaners) of course.

nationalcareersservice.direct.gov.uk/advice/planning/jobprofiles/Pages/psychiatrist.aspx

I dont know how old the following information is and salaries may be even higher now.
I personally know a psychiatrist working on hospital who is only 31 years old
He says that he earns over £70,000 per year

Income
As a junior hospital trainee, the basic starting salary is £22,636. This increases in the second year of foundation training to £28,076. For a doctor in specialist training the basic starting salary is £30,002.
Doctors in training are paid extra if they work more than 40 hours or they work outside the hours of 7am to 7pm, Monday to Friday. This is usually between 20% and 50% of the basic salary
Doctors in the specialty doctor grade (psychiatrist) earn between £37,176 and £69,325.
Consultants can earn a basic salary of between £75,249 and £101,451 per year, dependent on length of service.
Consultants working in private sector hospitals may receive higher fees.

I think that lack of autonomy plays a big part laura. And the monopoly employer situation. They are probably a JD til consultant at 36-37 ish and mid-late 40s if female part time with children. Many also do a PhD or fellowships which can add time. Once they have a place on a run through rotation they have to go where they are sent every 6 months. They can't decide actually that isn't close to where my kids go to school etc. These aren't all young hardworking 20 yr olds. The danger is that people are no longer going to be sticking around to get to the "jam" as you put it. I accept that other people have poor working lives as well but I don't think comparisons are helpful. It shouldn't be a race to the bottom- everyone deserves a family life.

I also disagree with your suggestion laura that people put up with working conditions in order to start earning big money in 10-15 hrs time. Very few doctors are motivated by money. medicine is fascinating and rewarding and on the whole medics are used to being the class goody/ high achiever and teacher pleaser. Complaining is nigh on impossible as they want to impress their consultant and if others can stick it out they should be able to attitudes etc. There is probably also a feeling of oh well this sucks but I am moving in 3 months and I have heard the operating experience is excellent at st else where's next so that will be great ( despite the 2 hr drive!)
Most medics are comfortably off but I think junior doctors with travel/ renting a second room/ exams and spiralling childcare cost/ log book fees/ conference fees as well as £70,000 student debts are sometimes not aswell off as others may think.

Could you cope with a 20% reduction in your salary tomorrow? Or needing to pay a nanny on adhoc days? Or paying one months take home salary this year on exams?

A Public Sector Similar Saga:
Some years ago teachers used to constantly complain about how stressed and burnt out they were, and how impossible their task was because of lack of resources.

They never talked about their generous pension scheme and good conditions of work re sick / maternity / training

They never mentioned their 1/3 of the year off as paid holiday - to travel the world

Yet as soon as the term started the parents would be told that the school was closing for 'inset / 'training' / 'Baker' days - so the parents had to make their own child care arrangements - perhaps take one or two of their own annual holiday days That was exasperating forparents as they often only got about 23 days holiday per year themselves.
The parents wondered WHY the teacher training days could not have occured during the 4 month teachers holidays ?

(The parents of course did not say that to the teachers as they were afraid that that might cause their child to be out of favour with the teachers).
Perhaps that is similar to why some JD supporters posting on this thread say that they 'do not know anyone that does not support the JDs' strikes

All the while ....UK education standards were falling further and further behind other similar European countries.

Therefore the government introduced more testing to give the parents information as to the 'value added' effectiveness of the schools.
The teachers were told that they had to cover a set curriculum.
The teachers complained loudly that their professionalism and autonomy were being undermined - see the similarity to posters on this thread like Shezadoc for example
The government went ahead with the reforms.
Now we hear less complaints from the teachers and the academic standards nationally have improved.
Parents are informed and empowered - more than they used to be when they were expected to accept what the school did and BE GRATEFUL.

By the way there are obviosly many many dedicated and good teachers and there always have been -but they felt that they couldn't speak out against the overall attitude of their profession - because they would have been ostracised by many of their colleagues.

Michael Gove stopped the education system lying to parents and students about the value of their grade A a levels - and he ACTED to stop self serving grade inflation by the education establishment.

Unlike the BMA - Jeremy Hunt and Michael Gove are NOT acting to promote the interests of entrenched elites - they are acting to improve standards for all.
THEY are doing their duty.
I notice that in his latest job Michael Gove is acting for the common good again in trying to reform prisons -once again he has come up against a (this time) prison establishment set in inefficient ways -and he has sought to change that - Again he is acting for the good of the common person and society as a whole.

NHS Doctors and to a certain extent other NHS Staff are acting like a privileged elite who want NO efficiency reforms that might change or even potentially challenge the comfortable status quo - of being cosseted at the expense of mainly poorer taxpayers.

Taxpayers and Patients are in general the same people.

So as Taxpayers they pay almost all the funding for the NHS,
but at the same time as patients arriving at the NHS they are treated as tiresome arrivals, and often told to wait for hours, weeks, or months as a form of lack of caring and/or deliberate rationing.
Some of them will get better before they are treated, others will die, others will be left with long term health problems that could have been avoided if they had been treated diligently and promptly by NHS Staff.

Arrogance and a rapacious sense of entitlement is rampant in the BMA

Three cheers
for Jeremy Hunt's efforts to improve the NHS for the patients /taxpayers !

Hmm, I know three Drs who are definitely not consultants and are definitely working privately.
This is in the UK.

Not a for or against argument, just was surprised to see it stated that only consultants can do private work.

Not meaning to de rail, genuinely interested. BMA says this;

Any doctor fully registered with the General Medical Council (GMC) in accordance with the provisions of the Medical Act 1983, is entitled to set up in private medical practice. Doctors with provisional or limited registration however cannot practise in their own right without supervision. Doctors registered with the GMC do not need to inform them that they will be undertaking private work, but are required to ensure that they fully observe the GMC guidance
on ‘Duties of a doctor’. This guidance clearly set out the responsibilities and constraints of doctors working in private practice.

Jeremy I think it is possible. I believe that my DH's registrar used to "moonlight" in a BMI hospital at the weekend for extra cash. The vast majority of JD's do not do private work - either because they have an unsuitable specialism (A&E for example) or because the demand is not there.

I agree with the PP above who said there is some "deferred gratification" involved here. Today's JD's will be tomorrow's consultants and many (not all) will enjoy job security and pensions beyond the wildest dreams of most. (We usually go on 5 holidays a year using my DH's private income alone and use his NHS income for living expenses.) Incidentally, many of my husband's colleagues talk a lot about ways to minimize their tax liability and which accountants are good at it. Most have a limited company set up for this purpose - lawfully, I might add. It sticks in my craw a little bit to see the JD's demanding more tax money when it seems they minimize their own liability given half a chance.

I also agree that the behaviour at the picket lines was distasteful in the context of cancelled operations and patients suffering. Some may have been doing CPR lessons or whatever but there was a very loud and vocal presence partying outside my local hospital. I found it pretty revolting and any sympathy I had for the JD's pretty much evaporated at that point.

I find that interesting, as one cannot get training within the private sector, and will only be given priveleges normally if they have completed training. Certainly those on a training programme are unlikely to be doing this, and they are the ones affected by the new contract.

They are NHS registrars, one works in a private hospital, the other two in aesthetic clinics. I guess they would come under being 'supervised' loosely if a consultant around.

As in they still work in NHS mostly.

I think the doctor in my example was at staff grade level when she started covering the BMI hospital at weekends, thinking about it.

Oh yes and I know an orthopedic registrar who has a Botox clinic on the side.

There's not much difficult to understand in medical books, but there's not much that isn't difficult to understand in for example Bsc / Msc/ PhD Chemistry literature

Ah yes. Medicine is a simple yet lucrative career, an ideal choice for intellectually-challenged, failed chemists.

misstrigs

Love your post yesterday 13:49. Seems like quite an accurate summary of all the many threads to me.

Private work is technically possible as a junior dr after the 1st year (when you have full registration) but I have never known it because 1) what patient is going to pay to see someone who is not fully trained and 2) how would they have the time? Most junior dr contracts explicitly ban any locum or private work as this would inevitably breech working time regulations.

What junior Drs do sometimes is locum posts for an agency between jobs or you can work as a junior dr in a private hospital but I don't think this would be most folks understanding of 'private practice'

Young girl, as has previously been pointed out, your husband is incredibly lucky, and not typical.

Teachers are currently up in arms re the new changes to the curriculum and academisation, which are again being imposed by the government.

Young girl your DH really is not the majority of NHS Drs. I guess he's a surgeon?

I'm a psychiatrist. None of my immediate colleagues has any private practice let alone makes the money for 5 holidays a year or has any need of a limited company!

The cars in our car park are Fords and Volvos

Plus I guess he might be of an older generation than me. My colleagues just retiring in their 60s are bemused that I can't afford a nanny, a cleaner or private school fees but Drs salary has eroded in real terms. Add in student loans that generation never had.

I'm not actually moaning about that. I think my pay is fair/ generous. I just want to correct the impression that it is a kings ransom and we are all raking it in.

it is perfectly acceptable for doctors to undertake 'private' work at any grade. You do not need legally or from a regulatory point of view to be a 'consultant' to do private work.
the misunderstanding on the thread is what 'private work means'
Basically any doctor can set up and sell services such as botox/sleep therapies etc to th epublic, as long as you are working within your competencies and not making unreasonable claims...i.e. you cannot claim that your newly discovered potion will cure the patient;s cancer !
All you need is to rent premises for this .
If you want to do private work through a private hospital you need to be granted practising privileges at the hospital , I do not know a private provider who would grant this to a non consultant unless it was for something like a botox clinic.
However private hospitals need junior doctors on site 24/7 to do menial stuff for the in-patients, as the responsible consultant is not going to be there all the time. This means all private hospitals employ juniors , who write up pain relief, fluid charts, review patients who maybe having complications etc ...
many of my JD friends ( as did I) do this work to make a bit of money on the side. It is not paid like a private consultant gets paid, it is more like a hourly pay .

the other way juniors do 'private'work is to be assistants to surgical consultants...this is also something i used to do when training, so Mr BIGWIG consultant is operating all day saturday doing 4 hip replacements, for which he is charging the patients £8000, but a hip replacement you cannot do on your own so he asks his nhs junior ( me a long time ago) to work for him for the day as surgical assistant...which i do and he pays me. all legit and above board and allowed.
I have anaesthetic friends who pay their nhs trainees to come and assist in their private work.

I will add my JD days were long ago, and i worked a 2:1 rota , so meant i worked every other weekend from 9 am Saturday to 6 pm monday, as well as normal week, so then did one day a month as private assistant, but i had no children, was not studying for post grad qualifications and was happy to .

oh and it was well before working time directive thingy !