Junior Doctors Strike

[Tristan]

What are people's views of the BMA's strike by Junior Doctors?

I don't see how it's justified at all, particularly at the moment, and can't see them getting much public support. Their pay rises over the last 3 years have outstripped those of public sector workers by quite some margin.

I saw this placard today and it absolutely reeks of entitlement and snobbery. They're not helping themselves.

bma.jpg (59.29 KiB) Viewed 685 times

[TopBadger]

Well, they have a point in that the pay of doctors has been eroded over time.

It's right for the government to play catch-up, and Streeting has, but I don't think it's right for the doctors to go back so soon for "another 20% please". Realistically, getting back to 2008-09 pay levels will take longer than two pay review cycles.

[Allo V Psycho]

Basically, no, I do not think that the current strike and pay claim are justified by circumstances. I believe that some of the data presented about salaries are misleading, and of course, by choosing a start date for pay erosion claims carefully, very different views can be presented. Of course, the BMA is essentially a trade union, and can act as it thinks best in its members interests, but then cannot also claim to be a force promoting the public good.

[dyqik]

Well, they have a point in that the pay of doctors has been eroded over time.

It's right for the government to play catch-up, and Streeting has, but I don't think it's right for the doctors to go back so soon for "another 20% please". Realistically, getting back to 2008-09 pay levels will take longer than two pay review cycles.

I think they are fully justified.

Everyone else should be striking as well.

[IvanV]

It's right for the government to play catch-up, and Streeting has, but I don't think it's right for the doctors to go back so soon for "another 20% please". Realistically, getting back to 2008-09 pay levels will take longer than two pay review cycles.

Is 2008-9 the right benchmark? I think it is generally understood that Gordon Brown was rather over-generous with a very large pay rise for doctors, though I'm lazy to try and research just when that was. Which is precisely why their salary was subsequently allowed to erode through inflation. But rather than adjust it to something sensible, it was allowed to carry on and on.

I think the right salary is the one that equates demand and supply. Might take a little while to discover what that is, after the roller-coaster ride in doctor's salaries.

[dyqik]

It's right for the government to play catch-up, and Streeting has, but I don't think it's right for the doctors to go back so soon for "another 20% please". Realistically, getting back to 2008-09 pay levels will take longer than two pay review cycles.

Is 2008-9 the right benchmark? I think it is generally understood that Gordon Brown was rather over-generous with a very large pay rise for doctors, though I'm lazy to try and research just when that was. Which is precisely why their salary was subsequently allowed to erode through inflation. But rather than adjust it to something sensible, it was allowed to carry on and on.

I think the right salary is the one that equates demand and supply. Might take a little while to discover what that is, after the roller-coaster ride in doctor's salaries.

Well, we know that there is a massive shortage of doctors, and all healthcare workers, and that that isn't improving...

[IvanV]

Well, we know that there is a massive shortage of doctors, and all healthcare workers, and that that isn't improving...

One of the problems at the moment is that many of the doctors who are qualifying are unable to get jobs, because there isn't funding to employ them. So that particular problem isn't a salary problem. In fact putting up their salaries might make it worse if any salary increase isn't funded.

Another problem is that there is insufficient capacity in training doctors. Even if all the doctors who finished training were able to get a job, there'd still be a shortage of doctors.

Another problem is that doctors are retiring as soon as they can and disinclined to do overtime because the daft pension arrangements mean that they get stuffed financially by working longer. This has been acknowledged for a long time. But the reason it doesn't get fixed is that it would cost money, even though of all the methods of increasing the supply of doctors it would be the cheapest.

So there are several other egregious issues reducing the supply of doctors before we consider whether the salary is sufficient. The first fact I cited suggests that insufficient salary is not, yet, the first problem in terms of getting people to train and apply to work as doctors. Rather it is the refusal of the government to fund the employment of doctors, which they are doing in several ways.

But probably, in other disciplines, such as nursing, low salary is a much more important issue in terms of supply. But again, probably the primary issue is availability of funds to employ people.

[Tristan]

You make good points Ivan. The issue isn't a shortage of doctors at all.

The other thing I'd add is that whilst they're asking for "pay restoration" none of them have actually had their pay cut. They want to be paid as much as people who used to do their job got paid. This is one of the clever things about them rebranding themselves "resident doctors" rather than "junior doctors". It obscures the fact that these are early career roles when they are STILL IN TRAINING with an expectation that they'll go on to earn good money in future. Physician Associate roles (what I assume they mean by "my assistant") are fully qualified roles undertake after post-grad qualification. They are not training roles, the way Resident/Junior Doctor ones are.

That's what pisses me off about that particular placard. The sense of entitlement to say "I should be earning more from day 1 during my training than someone fully qualified, even though within my career I'll earn more than they ever could".

[Lew Dolby]

No, redident doctors are doctors who haven't yet become GPs, consultants or some other specialist role.

Some are still "residents", nearly two decades after qualifying.

[Allo V Psycho]

Well, we know that there is a massive shortage of doctors, and all healthcare workers, and that that isn't improving...

One of the problems at the moment is that many of the doctors who are qualifying are unable to get jobs, because there isn't funding to employ them. So that particular problem isn't a salary problem. In fact putting up their salaries might make it worse if any salary increase isn't funded.

If by 'doctors who are qualifying' you mean doctors graduating from medical school, this is not the case. When UK medical students graduate, they are required to undertake the two year Foundation Programme, with provisional registration with the GMC for the first year (FY1). On successful completion of their first year, they are given full registration. However international medical graduates (IMGs) can also apply for FY1 places, and this has been previously welcomed, as increasing the number of doctors in the UK, which historically has lower numbers of doctors per capita than comparable European countries.
Since gaining an FY1 post is a requirement for full registration, there is a tacit understanding that enough FY1 posts will be provided for all UK medical graduates (and, since the IMGs apply through the same organisation the UK Foundation Programme Office, this means for the IMGs too). However, the number of pre-determined Foundation places planned for the 18 UK Foundation Schools is generally less than the number of applicants, each year some applicants go on a 'reserve list' until jobs are created or shuffled around for them all. But so far, every qualified applicant to the Foundation Programme has been found a job somewhere.

The number of UK medical graduates is gradually increasing, with new medical schools coming on line, and is now close to the number of predetermined Foundation places. There is pressure to prevent IMGs applying for FY1 places, which would mean a reasonable match between UK graduates and available places at the moment, but this requires legislative change. The expectation is that this will happen, but it is not entirely clear when.

Once a doctor has completed the Foundation years, they become a 'Resident' doctor, and can apply for an advanced training post (e.g. Core Medical Training, Core Surgical Training, GP training etc. and then apply for a particular speciality within these general areas. You don't have to specialise in this way - there is the SAS Grade (Specialty, Associate Specialist, and Specialist).

There is competition for Training Numbers, particularly in some fields (we only need so many heart surgeons), and not every graduating medical student is going to become a Consultant. And doctors earn relatively high salaries, so they are expensive.

[bob sterman]

No, redident doctors are doctors who haven't yet become GPs, consultants or some other specialist role.

Some are still "residents", nearly two decades after qualifying.

True - but the placards and headline pay comparisons (e.g. with PAs) are usually based on Year 1 / Year 2 salaries.

[Allo V Psycho]

No, redident doctors are doctors who haven't yet become GPs, consultants or some other specialist role.

Some are still "residents", nearly two decades after qualifying.

True - but the placards and headline pay comparisons (e.g. with PAs) are usually based on Year 1 / Year 2 salaries.

I believe but am not sure that the Year 1 doctor salary is based on basic pay, where by the nature of Foundation, there is also overtime pay.

I do indeed know someone who is a Resident almost 20 years after graduating as a mature student (so 'junior doctor' was particularly inappropriate) but that is by their choice, and they are very highly esteemed ('loved' was the word slightly unusually employed) by their colleagues.

In order to progress to higher training levels, doctors generally have to pass Royal College exams, which may have quite high fail rates, and to succeed in competitive interviews. So by these metrics, some who do not proceed in training have failed one or more of these hurdles.

GP employment is different: after you have your Certificate of Completion of training, you will be applying for a job in the UK's slightly weird public/private model

[science_fox]

It's right for the government to play catch-up, and Streeting has, but I don't think it's right for the doctors to go back so soon for "another 20% please". Realistically, getting back to 2008-09 pay levels will take longer than two pay review cycles.

Is 2008-9 the right benchmark? I think it is generally understood that Gordon Brown was rather over-generous with a very large pay rise for doctors, though I'm lazy to try and research just when that was. Which is precisely why their salary was subsequently allowed to erode through inflation. But rather than adjust it to something sensible, it was allowed to carry on and on.

I think the right salary is the one that equates demand and supply. Might take a little while to discover what that is, after the roller-coaster ride in doctor's salaries.

We have a similar problem in academia, this year offered 1.4% pay "rise" with insufficient strike mandate to complain about it. (and also huge issues with workload, staff retention and job cuts, and weird funding schemes)

Perhaps a different thread is needed, but which year is a suitable year to take as baseline for how much salaries have changed ?

[Grumble]

Just to say that the doctors per capita figure can be misleading and it shouldn’t automatically be assumed that we would want to match say Germany in this. In Germany specifically the microbiology labs for example are run by medical doctors, in the UK they are run by microbiologists. That’s an example I know of (was told of some years ago) and there may be more, but the main point is that a country with more doctors per capita might not be employing them all in what we would see as a doctor’s role.

[IvanV]

Perhaps a different thread is needed, but which year is a suitable year to take as baseline for how much salaries have changed ?

It depends upon what sector you are talking about and what is the history of wages in that sector. But some time during the Brown or Blair administration, but driven by Gordon Brown, doctors were give a very large wage increase. It was generally considered too large, which is why doctors salaries were not increased, or barely increased, for a long time thereafter. So taking as a benchmark the level at or shortly after that increase would probably be more than is required to be paid.

But then we have the broader issue of general increases in wages in the economy to take into account.

In the case of doctors being unable to get jobs, the specific case - but one very prominent to us all - where lack of funding to employ the available newly qualified for that role, is GPs. If I wrongly applied that elsewhere, when it isn't true, then apologies. But if what is actually happening is that such doctors are continuing in employment as other kinds of doctors, then at least the total number of doctors isn't held back by that specific funding issue. And maybe part of the issue in that case is that GPs are more expensive than keeping people in their current, lower posts.

[dyqik]

Perhaps a different thread is needed, but which year is a suitable year to take as baseline for how much salaries have changed ?

It depends upon what sector you are talking about and what is the history of wages in that sector. But some time during the Brown or Blair administration, but driven by Gordon Brown, doctors were give a very large wage increase. It was generally considered too large, which is why doctors salaries were not increased, or barely increased, for a long time thereafter. So taking as a benchmark the level at or shortly after that increase would probably be more than is required to be paid.

Surely that depends on why that large increase was given.

If it was given to make up for the shortfall in previous increases, because the duties of doctors had expanded significantly, or because demand outstripped supply, then there's nothing wrong with taking it as the baseline.

[Allo V Psycho]

Meant to come back to this earlier, but, you know...

It is also a little misleading for that strike poster to suggest that a Physician Associate* (PA) is an assistant of a Foundation Year 1 doctor, with the implication that they are less capable.

There are two routes to being a PA, neither of which is quite the 'two year course' the BMA describe it as. In the first route, those with a relevant degree (pretty much always healthcare related, and in practice including nurses, paramedics, combat military technicians and laboratory scientists) do indeed do a two year conversion course, meaning they have had at least five years in higher education, as well as (usually) practical experience in their previous role. In the second route, school leavers generally join a four year programme, of which the first two years may be shared with medical students in the same classes, and sitting the same exams.

Doctors do 6 four-month rotations over their Foundation years, so they may have only been in their current role a couple of weeks when you see them (stay out of hospital in August if you can). One of the advantages of PAs is that they can offer continuity - a PA may have been doing the same role for some years, and is therefore experienced in that environment. An experienced PA may well be able to offer valuable guidance TO a Foundation doctor new to the rotation, just as experienced nurses can and do.

*The argument about the exact naming of PAs was to my mind a matter of prestige, with doctors feeling threatened by the title 'Physician Associate'. The BMA did produce anecdotes about PAs making mistakes, but to my knowledge there has been no comparative study of error rates for PAs, junior doctors and nurses to substantiate any risks. Revealing, to my mind, was that one of the BMAs demands was that PAs should not be regulated by the GMC but by some other body, which does sound rather like a prestige issue rather than a safety one. The government initiated a review, led by a doctor, which came down on the side of doctors, and recommended that PAs be now referred to as Physician Assistants.

Where doctors might have more justified cause for concern, to my mind, is over placements and training opportunities. This is in part caused by the current expansion of medical and healthcare training. To invent some figures, if an organisation devotes 10% of its resources to training, and it is decided to double the number of training places, then the remaining 90% of its activity comes under stress. This is where we are at the moment, with the expansion in medical student numbers. Both before and after qualification, doctors and PAs may feel as if they are competing for a limited number of training opportunities.

It is also the case that, expensive as it is to do a medical degree, in the UK it is still heavily subsidised by government, and the full economic cost does not fall on the medical graduate. And if we compare doctors to non-doctor medical researchers, after graduation the latter will have spent at least three years on a PhD stipend, followed by the job insecurity of post-doc places, before they (if they are lucky) secure a long term post.

One way that the issue of strikes and salaries could be addressed is to move the point of full registration with the GMC to graduation, so there was no moral requirement to give all graduating medical students a job. Then they would have to compete for the available FY1 posts, which would be available in smaller numbers than the number of graduates. This would bring laws of supply and demand into operation. (The major reason for FY1 being a requirement for full registration was because most EU countries require 6 years of medical training. Theoretically, this could be a Brexit benefit...). This would not be popular with doctors, and is not likely to happen.

[bob sterman]

It is also the case that, expensive as it is to do a medical degree, in the UK it is still heavily subsidised by government, and the full economic cost does not fall on the medical graduate. And if we compare doctors to non-doctor medical researchers, after graduation the latter will have spent at least three years on a PhD stipend, followed by the job insecurity of post-doc places, before they (if they are lucky) secure a long term post.

Also with the non-medical researchers - it will generally take longer to make full Professor (if at all) than it takes a doctor to become a consultant. And even then Professorial salaries can start as low as £75k whereas NHS consultants start on £109k.

[Allo V Psycho]

It is also the case that, expensive as it is to do a medical degree, in the UK it is still heavily subsidised by government, and the full economic cost does not fall on the medical graduate. And if we compare doctors to non-doctor medical researchers, after graduation the latter will have spent at least three years on a PhD stipend, followed by the job insecurity of post-doc places, before they (if they are lucky) secure a long term post.

Also with the non-medical researchers - it will generally take longer to make full Professor (if at all) than it takes a doctor to become a consultant. And even then Professorial salaries can start as low as £75k whereas NHS consultants start on £109k.

Yep, according to Co Pilot about 3-5% of UK PhD students make professor, while 75% of UK medical graduates make consultant and your salary figures are pretty accurate. It took me 23 years to go from new PhD to post doc (two posts) to lecturer to senior lecturer to personal chair, and I thought I was doing pretty well. A medical graduate could be a consultant 8 years after graduating, and the NHS pension scheme is more generous than my University one. A surprising number of my former medical students are retired while I... am not. Yet.