While the debate rages on the original post, allow me to throw in my tuppence worth.
It strikes me that junior doctors are not particularly underpaid, they are just crassly overworked (starting salary £30,000 for 100 hours a week, or whatever). The reverse applies to more senior doctors.
According to the BMA, senior doctors (under whatever fancy title) are paid up to £180,000, probably for working about 20 hours a week.
My policy would be to flatten the pay scale and flatten the working hours as well, so that junior doctors start on £40,000 for 60 hours a week and the senior ones are paid £120,000 for 30 hours a week, for example. Or they all get £80,000 for 45 hours, or whatever, in line with what GPs currently get.
So instead of this being BMA vs NHS/taxpayer, the NHS can just set a total budget for doctors' and GPs' pay and let them fight it out among themselves.
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15 comments:
Nice idea. Won't work. It's more bureaucratic rationing. The only way to sort all this mess is to move to the MGW (and me) voucher system and de-nationalise the whole bloody thing.
From my understanding that 100 hours is not all hours in work a large proportion of it is being on call. The new contract I believe would not have on call hours attached to it so another beef of the doctors they would no longer get paid for doing nothing. No this strike is all about pay, rights and privileges.
The doctors have ruled the roost for far too long time they earned their money just like French doctors. Those I found them a very dedicated bunch the wife of one GP was telling me that because of house calls her husband often did not get home till midnight.
If there was time and space here and I explained exactly how the French system worked most would be astonished. Their work ethic, competence and the way they do their work with usually no more than the part time help of a wife or receptionist is amazing(GP's that is).
Valid points made by MW re consultants. I doubt the consultants will go for that of course and even the juniors might balk at it especially those just about to transition to consultant status.
Agree totally with Mark: the problem is the privileged position of consultants.
The govt should threaten the BMA with breaking their medical monopoly and legislate for other bodies to certify doctors. The BMA would soon back down, they know what a nice little closed shop they've got going on at the expense of the public, they don't want any competition.
Well get on to them, Mark and arbitrate!
L, we did this recently. Doctors have a lot of bargaining power but the NHS has much more, being a monopsony. Doctors' salaries are whatever the NHS (taxpayer) wants them to be.
Anti, yes the European mixed systems have a lot of advantages, that is not the topic here. And - as zero hours workers know - being on call is still 'work' in that you can't bugger off somewhere and forget about everything.
PC, DBC, agreed and thanks.
S, that whole topic is very murky, There's an overlap between who actually decides who is a doctor and who isn't. The BMA, the GMC, the NHS and equivalent bodies in other developed countries. It comes down to the NHS flexing its muscle - as it does most successfully with drugs companies - and telling the junior and senior doctors to sort it pay grades among themselves.
JH, I'll wait for them to ring me.
MW. Totally agree monopoly/monopsony. However neither side has any real idea what the right, as in market clearing, price for any grade of doctor 'should' be. IMHO they are probably wildly overpaying at some levels and underpaying/over demanding on juniors. (Which to an extent endorses your analysis). I 'think' the evidence for that is the number of overseas doctors in the system and the reduced number of indigenous trainee doctors entering training in the UK.
Without competition (especially IMHO in GP services) we are never going to know.
Ditto teachers. (Who I think are wildly underpaid - mostly their own fault as they provide what they want - or the educationalists think we aught to have -, not what the customer wants).
L, we will never know, because the number of entrants is also controlled by the government i.e. paying for university training.
The only way to find out would be to train many more doctors than we need, which might be more expensive than overpaying the ones we do need.
That said, "get 'em while they are young". If people are attracted to doctoring by the higher early salaries, then once trained up etc, they will remain in doctoring. It's not like they are going to retrain as car mechanics when they are fifty.
MW. Indeed. Assuming that the NHS can't actually forcibly enslave doctors. They'll just emigrate. There is some evidence that that is already the case.
I find the whole thing rather peculiar. There is clearly a shortage of doctors - lots of open posts, lots of very highly paid locums, lots of imported doctors. Surely the solution is to offer more generous contracts? Doctors are very important to the Tory core constituency - pensioners - they're going to get in trouble eventually with their voters. And they are a particularly tricky group to privatise - no private insurer would touch them with a bargepole. Even the US has to socialise old age medicine via Medicare.
M. IMHO this is the classic endgame of all nationalised industries. They fail on every level - bad product, endemic producer capture, shortages of productive employees, surfeit of bureaucrats, over-charging and in general chaos. IMHO(ii) the NHS (and the nationalised education system) both exploit the 'caring' nature of their productive employees.
L, no they won't emigrate.
M, good points.
L, the NHS is pretty good in terms of value for money compared to other countries. It could be better but hey. Which raises the question, how bad are the others...
Apologies for this very late contribution, but there is an aspect of the situation that is little known.
Most organizations are "up or stuck", that is if one fails to be promoted at a certain point promotion will never happen, and some professional organizations are "up or out"; both of them are shaped like pyramids, with many more people at the lower levels than upper levels.
That does not apply to doctors: there are essentially as many senior doctors as junior doctors, that is every junior doctor ("indian") will eventually be promoted to be a senior doctor ("chief").
This is achieved in two ways:
* By restricting ferociously the number of junior doctors, because obviously if there were 3-4 junior doctors per senior doctor, 2-3 would remain junior doctors forever.
* Consequently every junior doctor has to do the work of 3-4 people, because the number of senior doctor ("chief") places must be necessarily limited, because not everybody can be head of an hospital's group.
In addition to this there is a gigantic scarcity of senior doctors too; my surgery says that there should be at least 10,000 more GPs, to start with.
I guess that the government limits the number of senior doctors because they are very expensive, and thus also limits the number of junior doctors to give them all a near-100% chance of becoming senior doctor, and also because training a junior doctor is also very expensive.
BTW the armed forces have the same issue, as their plan is that every academy cadet should become a senior (not necessarily general) officer; since they cannot get lieutenants to command large units, their solution is to hire "short commission" officers who make up the bulk of the junior office levels, and who then have to leave around "captain" rank.
B, that is a great way of looking at things. I have always wondered about the army.
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