Thursday, 14 January 2016

I'm not Really Buying This

From the Daily Telegraph

Patrick is a junior doctor, but he’s not some pimple-faced new medical school graduate. At 33, he is a neurosurgery registrar at a leading hospital with eight and a half years’ experience and more than 1,200 brain operations under his belt.

For his expertise and his many years of medical training, he is paid the whopping great sum of… £39,000 a year. That is his basic wage, but on top of that he can earn another £13,000 or so for working unsociable hours at night and at weekends. Not that this is a choice, mind; it is required under his contract.

The medical world loves to use fancy words where a simpler one would suffice. I suspect to create some mystique and this is no different. "Registrar" is a fancy word for "trainee". When he gets through being a trainee, he'll be on something closer to £100K a year salary. That's for life, guaranteed job, nice pension. In some parts of the country, that makes you super rich.

So, on the first weekend of this year, while the rest of the country was sleeping off its New Year’s Eve hangover, Patrick started work at 8am on the Saturday and he finished his shift at midday on the Monday, 52 hours later.

During that time he was able to grab a luxuriously indulgent four hours of broken sleep but otherwise survived on copious amount of coffee.

OK, I'm calling bullshit on this. When I was younger than this guy, I used to pull the occasional all-nighter. A critical system failure had occurred and it was all hands to the pump. So, I went from 9am right through to the next 9am and beyond. I even tried to do a full day the next day. At about 3pm, I fell asleep at my desk. And yes, I was well caffeinated, but that just stops working after a while. You can only hit a certain level of caffeine before your body starts reacting to it, plus, you're pissing it out during the day. You can even try seriously loading up on caffeine, like drinking triple espressos, but then you start shaking and feeling ill (tried it).

I learnt that you pull the all-nighter, you get it fixed and then you get a cab to drop you home.

I can believe that someone had a couple of short nights... 4 or 5 hours sleep a night, but 2 nights of 2 hours a night? You'd be dysfunctional after the second one.

“We feel like we are being treated as the problem,” he says. “The assumption from Jeremy Hunt is that we don’t already work those hours, when we do. I already work regular weekends and nights; I worked over Christmas and over New Year. All Jeremy Hunt is offering is more unsociable hours for less pay.”

Well, yes. He is.

Patrick, like many doctors, is also sceptical of the Government’s claims that it is a lack of medical staff on duty on Saturdays and Sundays which is behind the higher death rate for patients admitted to hospital at weekends than on weekdays.

“We admit all the sickest people at the weekends – that’s why the mortality rate is so much higher,” he explains. “No one goes into hospital at the weekend who isn’t already very ill.”

That's a report that was co-authored by a far more experienced surgeon than him, Sir Bruce Keogh, so he might want to look into that.

Patrick says he personally could never consider leaving medicine – “I couldn’t imagine doing anything more worthwhile with my day” – but not everyone feels the same. Indeed, the NHS is haemorrhaging highly trained professionals every day.

Many of Patrick’s medical student friends and colleagues have either left Britain to work abroad or joined pharmaceutical companies on double the pay for family-friendly nine-to-five hours. Their skills and expertise, funded at great cost by British taxpayers, are now lost to the NHS forever.

Bullshit. First of all, almost no-one is leaving the country. The Daily Mail's scare story about this quoted figures of 3000 a year, up 1/5th on figures from 2008. So, 600 doctors, compared to 2008. Out of 174,000. Not exactly "haemorrhaging ". As for "pharmaceutical companies", that's probably a good thing. It's much cheaper to treat patients with drugs than surgery and so moving doctors from one to the other is good. I don't really care if they're "lost to the NHS". All that matters is if their training isn't being used for us.

The problem in this story, to me, is that it's basically an upper middle class strike, and this is just a rallying cry by another member of the upper middle class. I suspect that Jeremy Hunt knows what he's doing. Medicine is massively oversubscribed, gets nothing less than people with 4 As at A level (and I really doubt we need the elite students for the mundane shit that most GPs do). So he figures maybe they're overpaid and can cut pay, especially at the junior level.


Rich Tee said...

Much of GP's expertise is just remembering all the facts and figures, it is a job that is frequently cited as one that will be seriously impacted by IT as computers can store and recall data much better than a human can. I say this being a medical programmer (and I've heard a rumour that Jeremy Hunt has visited our offices recently so Hunt may be aware of the IT angle).

Anonymous said...

How many Doctors hours are on smoking related illnesses.

Its a crime selfish smokers are clogging up the health service.


Anonymous said...

For the sake of some balance I think it worth pointing out that junior doctors pay for several years after qualifying [they can be juniors for up to 15 years] is rather shitty. There are few jobs as nerve racking or with as much responsibility as that of being a doctor in a general hospital, often in conditions where staff shortages are more the norm than the exception.

When you consider their pay and work conditions compared to an engineer or an accountant for an example, it's quite a disincentive, little surprise the NHS have to recruit so actively from abroad.

Yes they are required to have excellent A level qualifications and then they have to study 5 or 6 years to get their medical degree before even starting out as juniors.
Compare that to my younger sprog who got herself two B's and a C at A level. Then four years at Uni to get her construction management degree [included one years paid work experience]. She got a first but a 2.1 would have sufficed. After 2 years in work having started at more than a junior doctor she's just had a raise to £45k and does only the occasional weekend or bit of early evening work. And there's plenty of upward scope in salary to look forward to down the line. She has pressure but nothing like the sorts of pressures faced by doctors.

I think that whilst this government is apparently frantically trying to increase the recruitment of doctors from within the UK this strike will probably [and certainly should] dissuade a large number from entering the profession.

As for soem of GP's work being replaced by computers I think most GP's would welcome that seeing as at present they are widely criticised for spending too little time with their patients and increasing numbers of surgeries are refusing to take on additional patients due to current workloads. So yes that might be a good thing. General practice is one area of medicine that is widely acknowledged [including by Hunt] to need an increase in recruitment. So I really doubt minister Hunt thinks anything along the lines of 'we wont need so many GP's in future because IT companies who fuck up more often than most are going to make their life so much easier...[kind of bollox]'

As for doctors going to join pharma' in increasing numbers being a good thing. That might be plausible in an alternative universe where big pharma wasn't routinely enveloped in one major scandal and fraud after another and hardly added a worthwhile alternative to anti-biotics in years. ie; they'd rather give people drugs they have to take for the rest of their lives than just a few days...shock!

Tim Almond said...


The reason we have to recruit from abroad is that we don't qualify enough people, and that we now create a lot of women doctors who work part time, take long maternity leave and retire early. There is no shortage of people who want to do medicine, and pretty much no-one leaving medicine.

As for IT, it's not the IT companies fucking up. It's the people writing the specifications: the politicians and bureaucrats. I'm not a huge fan of the likes of Accenture and Cap Gemini. I think there are better value companies out there, but I can name plenty of private sector companies that use them that get a reasonable job done.

Dr Evil said...

You don't do 09.00 - 17.00 in the medical department of a pharmaceutical company. But an all nighter is very rare.

Anonymous said...

TS. OK so we can qualify more people by lowering the entry standards?
What could possibly go wrong...

As for pretty much no one leaving medicine. UK's most senior casualty doctor demurs.
More than 1600 UK doctors registered to work overseas in just three days last week – twenty times as many as normal.
“We are in an existential crisis,” Dr Mann told a King’s Fund conference in London.“We now train about 250 trainees a year and we lose 50 per cent of them when we get to year four. If this carries on like this, within 10 years we will have trained more doctors in Emergency Medicine that work overseas than work in the UK.”"

Mark Wadsworth said...

Yes, agreed to just about all of that. If it were up to me I would pay junior doctors a bit more for shorter hours and senior doctors a lot less and give them longer hours, but hey.

Mark Wadsworth said...

TS, I just have one question - is Patrick the junior doctor reporting that weekend death report correctly? It seems perfectly plausible to me that his summary is correct, i.e. "only really ill people go to hospital at the weekend".

So who is the "he" who should look into it? Patrick or Jeremy Hunt?

Tim Almond said...


"More than 1600 UK doctors registered to work overseas in just three days last week – twenty times as many as normal."

Funny that. Just before a strike based on the fear of doctors going overseas if not paid enough, suddenly a whole load of doctors register to work overseas. Is there any cost to registering to work overseas? How many registered the week before? Are you really that naive about how PR stunts are done?

That just tells me it's all a huge bluff.

Tim Almond said...


I'm saying that the report that said there was a problem of expertise at weekends was co-written by a far more senior and experienced surgeon. So, maybe he should talk to him.

Mark Wadsworth said...

TS,who is "he"? Patrick or Jeremy hunt?

Mark Wadsworth said...

TS, don't forget that the "senior surgeon" has skin in the game as well.

The old doctors have rigged it so that they do half the work of the younger ones and don't have to come in on evenings or weekends, but get paid three times as much anyway.

So when the "senior surgeon" bemoans "lack of expertise" at weekends, what he is probably saying "give us old guys a thirty per cent pay rise and we'll do what people expect of us".

DBC Reed said...

Granted senior doctors are absolute shits and want junior doctors to suffer as much as they did in their training years , (this is part of the ancien regime this country loves so much, calling it tradition), it is still not good policy to have doctors working in hospitals while exhausted.End of.

Mark Wadsworth said...

DBC, that is my general impression.

Why do the young ones do 100 hours a week for £40k and the old ones do 20 hours a week for £100k?

Why not just pay them all a flat £60k for a sensible 40 hour week or something?

Derek said...

I remember being told (in the late 1990s) that a part of the problem was that junior doctors were paid overtime at 2/3 of their normal-hours rate. This led to them being given long hours because it made more sense for the budget holders of their departments to work them as long as possible than it did to employ more doctors. Any idea if this is still the case?

Tim Almond said...


To be honest, I don't really trust any doctors about value, because I'm very skeptical about whether many of them that good cop. I don't particularly trust industries with long qualifying periods and limited places. I'm the same with solicitors. I remember coming away from my last house move with a legal bill that I thought frankly took the piss considering what I know was involved (mostly, tapping in the details of the property into the Land Registry computer and printing off some standard contracts).