I agree that a lie is given to the term “calling” when even the consultants are on strike. As with most public sector jobs the starting salary is not reflective of the average salary and when you are on a path to anywhere near 100K a year it isn’t reasonable to be going on strike. Overtime is not only freely available but logged with military efficiency – unlike patient data.
To say that the risk of death “loomed over” doctors when such a tiny number actually died from (not with) Covid is hyperbolic. Before you look the figure up it would be best to bear in mind what you think it is. That they worked “impossible hours” is flat out wrong – no one could make them work an hour over their time if they didn’t want to – a far cry from the days of the family doctor.
There are things that I sympathise with the doctors on, hyperchondriacs taking up an inordinate amount of time, rude patients and poor equipment but if they don’t want these things then don’t work in the NHS. Plenty are moving away as the article states and I would encourage more to do so if that is what they want. Just don’t go on about how you want to serve the public when really what you want is a higher wage.
The statement of a “crisis of wellbeing amongst NHS staff” is an outrage. 1/10 having suicidal thoughts is excellent compared to the general population and when you take into account children as a sub-group this number is over half. A classic statistical manipulation on the part of the author.
Early on when we knew much less about the virus, and had limited PPE, many doctors and nurses were pretty heroic. As staff went ‘down like flies’ either with Covid or just frightened, a core kept the show on the road and the ‘espirit de corps’ behind that should not be under-estimated.
I do agree some of the hagiography is unwarranted though. Doctors and nurses divide between knights and knaves much as rest of population does. The dilemma for public policy is how one designs recognition systems that cater for both psychologies.
Agreed. As the partner of a GP I am constantly reminding him that he is a business owner, and can charge a fair price for his time. While he acts like a state employee bound to help everyone and not charge more than the low government rebate for treating complex patients. Doctors wages are high because the population is overweight and old, and the number of doctors is throttled by both the government and the colleges who wish to retain higher earnings for their members. They earning multiples of the average wage working for the state, and as you point out, if this isn’t enough do what other employees do and leave for greener pastures.
The only thing which happens when you raise their income, is you get less doctor-hours, as they drop down to part time.
Early on when we knew much less about the virus, and had limited PPE, many doctors and nurses were pretty heroic. As staff went ‘down like flies’ either with Covid or just frightened, a core kept the show on the road and the ‘espirit de corps’ behind that should not be under-estimated.
I do agree some of the hagiography is unwarranted though. Doctors and nurses divide between knights and knaves much as rest of population does. The dilemma for public policy is how one designs recognition systems that cater for both psychologies.
Agreed. As the partner of a GP I am constantly reminding him that he is a business owner, and can charge a fair price for his time. While he acts like a state employee bound to help everyone and not charge more than the low government rebate for treating complex patients. Doctors wages are high because the population is overweight and old, and the number of doctors is throttled by both the government and the colleges who wish to retain higher earnings for their members. They earning multiples of the average wage working for the state, and as you point out, if this isn’t enough do what other employees do and leave for greener pastures.
The only thing which happens when you raise their income, is you get less doctor-hours, as they drop down to part time.
Milton Gibbon
10 months ago
I agree that a lie is given to the term “calling” when even the consultants are on strike. As with most public sector jobs the starting salary is not reflective of the average salary and when you are on a path to anywhere near 100K a year it isn’t reasonable to be going on strike. Overtime is not only freely available but logged with military efficiency – unlike patient data.
To say that the risk of death “loomed over” doctors when such a tiny number actually died from (not with) Covid is hyperbolic. Before you look the figure up it would be best to bear in mind what you think it is. That they worked “impossible hours” is flat out wrong – no one could make them work an hour over their time if they didn’t want to – a far cry from the days of the family doctor.
There are things that I sympathise with the doctors on, hyperchondriacs taking up an inordinate amount of time, rude patients and poor equipment but if they don’t want these things then don’t work in the NHS. Plenty are moving away as the article states and I would encourage more to do so if that is what they want. Just don’t go on about how you want to serve the public when really what you want is a higher wage.
The statement of a “crisis of wellbeing amongst NHS staff” is an outrage. 1/10 having suicidal thoughts is excellent compared to the general population and when you take into account children as a sub-group this number is over half. A classic statistical manipulation on the part of the author.
Stephen Walsh
10 months ago
These days, only doctors think doctors are saints. And throughout Covid, there can hardly have been a more hackneyed and inaccurate line than “the public was unable to provide the NHS staff with the protective equipment they so desperately needed”.
Why is it untrue? Change “public” to “the government” and I think it’s pretty spot on, many healthcare workers didn’t have anywhere near enough PPE.
I fully support the doctors striking. If the money isn’t enough to retain skilled staff then it has to increase, same as any other profession
What is the money? Genuine question. Despite the acres of print I don’t actually know what the starting salary is for a newly qualified doctor. What he could expect to earn after 5 years. What an average salary is.
If journalists just provided a paragraph of basic facts instead of rhetoric I’d be in better position to make a judgement.
Whether it’s £10k or £100k is largely irrelevant, if it’s not enough to retain the staff then either that needs to go up or working conditions need to improve
It’s c£30k for a newly qualified junior doctor and c£90k for a Consultant. Obviously some get London Weighting (peanuts but something), and can do additional shifts as overtime. Pension and other terms and conditions are pretty good if one stays the course.
We need to recognise though the debt they start with and how medical students are often some of the most intelligent and highest performing students we have. Were they to go into other fields of work they likely excel and be paid more. Yet we need doctors.
They aren’t paid as well as US and Aus doctors and we are losing some to both, but a bit better than some euro countries. We did well from euro recruitment until Brexit made it more difficult.
Geez. Two-click “research” shows that a starting average for doctors here is about 168,000 pounds ($213K). They should come to the US where they can write opioid scripts for extra cash on the sly too. They’d have to live among Americans like me though.
Yep. One of the reasons why our NHS such good value for money. Furthermore much less ‘fee for service’ so less danger of over treatment to generate higher bills. Debate no doubt for another day.
Yep. One of the reasons why our NHS such good value for money. Furthermore much less ‘fee for service’ so less danger of over treatment to generate higher bills. Debate no doubt for another day.
Speaking as an NHS consultant, my concern about pay is not the absolute amount, but downward trajectory. In most walks of life, there is a correlation between pay and calibre. The only doctors we can attract to the NHS are those from poorer, worse healthcare systems than our own or those UK doctors who haven’t left yet. I can tell you, standards are dropping and when no top notch doctors are left in the NHS, this decline will be irreversible. Because reimbursement in the private sector has been dropping since the 1990s, this will become true for the private sector too. When the proverbial hits the fan at 3am, it makes all the difference if the doctor
you see has a high IQ, is well trained and has put the hours(years) in. These are exactly the people who are/will leave the NHS.
Geez. Two-click “research” shows that a starting average for doctors here is about 168,000 pounds ($213K). They should come to the US where they can write opioid scripts for extra cash on the sly too. They’d have to live among Americans like me though.
Speaking as an NHS consultant, my concern about pay is not the absolute amount, but downward trajectory. In most walks of life, there is a correlation between pay and calibre. The only doctors we can attract to the NHS are those from poorer, worse healthcare systems than our own or those UK doctors who haven’t left yet. I can tell you, standards are dropping and when no top notch doctors are left in the NHS, this decline will be irreversible. Because reimbursement in the private sector has been dropping since the 1990s, this will become true for the private sector too. When the proverbial hits the fan at 3am, it makes all the difference if the doctor
you see has a high IQ, is well trained and has put the hours(years) in. These are exactly the people who are/will leave the NHS.
It’s c£30k for a newly qualified junior doctor and c£90k for a Consultant. Obviously some get London Weighting (peanuts but something), and can do additional shifts as overtime. Pension and other terms and conditions are pretty good if one stays the course.
We need to recognise though the debt they start with and how medical students are often some of the most intelligent and highest performing students we have. Were they to go into other fields of work they likely excel and be paid more. Yet we need doctors.
They aren’t paid as well as US and Aus doctors and we are losing some to both, but a bit better than some euro countries. We did well from euro recruitment until Brexit made it more difficult.
Whether it’s £10k or £100k is largely irrelevant, if it’s not enough to retain the staff then either that needs to go up or working conditions need to improve
“The Department for Health & Social Care (DHSC) lost 75% of the £12 billion it spent on personal protective equipment (PPE) in the first year of the pandemic to inflated prices and kit that did not meet requirements – including fully £4 billion of PPE that will not be used in the NHS and needs to be disposed of.”*
The whole world was chasing PPE at the start of the pandemic, do you expect the prices to have remained the same in a time of such high demand? That’s not how capitalism works I’m afraid
From the moment I heard our wretched PM say “protect the NHS” I knew we were about to enter a period of public panic not seen since 1940. And so it has proved to be.
Thus, and through no fault of my own, I was offered the chance to make a modest investment in this PPE nonsense. As a result it has turned out to be the investment opportunity of a lifetime.
From the moment I heard our wretched PM say “protect the NHS” I knew we were about to enter a period of public panic not seen since 1940. And so it has proved to be.
Thus, and through no fault of my own, I was offered the chance to make a modest investment in this PPE nonsense. As a result it has turned out to be the investment opportunity of a lifetime.
DHSC isn’t the NHS CS. I think you recognise this but to some the distinction will be lost.
DHSC, and lots of Tory cronies, ran the procurement. Like ‘Test & Trace’ the Govt too easily then let them use the NHS brand despite serious concerns being voiced that they never fell under proper NHS governance.
The whole world was chasing PPE at the start of the pandemic, do you expect the prices to have remained the same in a time of such high demand? That’s not how capitalism works I’m afraid
DHSC isn’t the NHS CS. I think you recognise this but to some the distinction will be lost.
DHSC, and lots of Tory cronies, ran the procurement. Like ‘Test & Trace’ the Govt too easily then let them use the NHS brand despite serious concerns being voiced that they never fell under proper NHS governance.
I don’t think I do, I just don’t think I’m as tied to any particular ideology as most on here. To ensure the UK doesn’t have a shortage of medical professionals they need to do 3 things.
1. Train more doctors
2. Retain the ones they have
3. Import from abroad where necessary.
You can’t do the last two if the wages aren’t high enough for the working conditions
I don’t think I do, I just don’t think I’m as tied to any particular ideology as most on here. To ensure the UK doesn’t have a shortage of medical professionals they need to do 3 things.
1. Train more doctors
2. Retain the ones they have
3. Import from abroad where necessary.
You can’t do the last two if the wages aren’t high enough for the working conditions
What is the money? Genuine question. Despite the acres of print I don’t actually know what the starting salary is for a newly qualified doctor. What he could expect to earn after 5 years. What an average salary is.
If journalists just provided a paragraph of basic facts instead of rhetoric I’d be in better position to make a judgement.
“The Department for Health & Social Care (DHSC) lost 75% of the £12 billion it spent on personal protective equipment (PPE) in the first year of the pandemic to inflated prices and kit that did not meet requirements – including fully £4 billion of PPE that will not be used in the NHS and needs to be disposed of.”*
Why is it untrue? Change “public” to “the government” and I think it’s pretty spot on, many healthcare workers didn’t have anywhere near enough PPE.
I fully support the doctors striking. If the money isn’t enough to retain skilled staff then it has to increase, same as any other profession
Stephen Walsh
10 months ago
These days, only doctors think doctors are saints. And throughout Covid, there can hardly have been a more hackneyed and inaccurate line than “the public was unable to provide the NHS staff with the protective equipment they so desperately needed”.
Edward De Beukelaer
10 months ago
The biggest problem is that doctors and many other medical staff are not trained for the reality of the job: their training is making them ready to prescribe the drugs they are taught (indirectly) by the pharma industry, putting patients in diagnostic boxes which really work for only 30-40% of patients. Even though they want to care they are not taught how to do this effectively. The NHS is not a health service, it is an illness service responding principally to the needs of the health industry. https://www.bmj.com/company/newsroom/many-nhs-partnerships-with-drug-companies-are-out-of-public-sight/. https://publications.parliament.uk/pa/cm200405/cmselect/cmhealth/42/42.pdf
….. last year during the personalised medicine congress in London in June, Rangan Shatterjee said that there were 2 big problems with medicine: 50% of what doctors are taught is either untrue or not helpful (and that we do not know which 50% this is) and that there are too many egos in medicine. This was received with a big applause by the 800 strong audience and the ex health ministers and ex NHS bosses sitting on the podium…
The best way to be able to work in the illness industry that is our health service, is to ignore patients unless they (or their illnesses) comply with the rules: it a survival technique. If one of my children would have chosen to go into medicine I would have seriously argued with them; unless you want to work in the technical aspect of medicine where patient contact is minimum.
Unless we make the principal job of medicine to make people healthy (fostering health), that treating an illness is not sufficient unless the outcome is an improved health state, that we start researching how to make the whole person better rather than juts treat the boxed in diagnosis, (treat patients in stead of illness) nothing will change..
Edward De Beukelaer
10 months ago
The biggest problem is that doctors and many other medical staff are not trained for the reality of the job: their training is making them ready to prescribe the drugs they are taught (indirectly) by the pharma industry, putting patients in diagnostic boxes which really work for only 30-40% of patients. Even though they want to care they are not taught how to do this effectively. The NHS is not a health service, it is an illness service responding principally to the needs of the health industry. https://www.bmj.com/company/newsroom/many-nhs-partnerships-with-drug-companies-are-out-of-public-sight/. https://publications.parliament.uk/pa/cm200405/cmselect/cmhealth/42/42.pdf
….. last year during the personalised medicine congress in London in June, Rangan Shatterjee said that there were 2 big problems with medicine: 50% of what doctors are taught is either untrue or not helpful (and that we do not know which 50% this is) and that there are too many egos in medicine. This was received with a big applause by the 800 strong audience and the ex health ministers and ex NHS bosses sitting on the podium…
The best way to be able to work in the illness industry that is our health service, is to ignore patients unless they (or their illnesses) comply with the rules: it a survival technique. If one of my children would have chosen to go into medicine I would have seriously argued with them; unless you want to work in the technical aspect of medicine where patient contact is minimum.
Unless we make the principal job of medicine to make people healthy (fostering health), that treating an illness is not sufficient unless the outcome is an improved health state, that we start researching how to make the whole person better rather than juts treat the boxed in diagnosis, (treat patients in stead of illness) nothing will change..
Walter Marvell
10 months ago
No one trusts the NHS anymore. It is hurting so many. The Excess Death bodycount from it converting into a Panicked National Covid Service cannot be masked and is a national scandal. Pity this death toll is not recorded daily on the BBC which so manipulated and warped popular hysteria out of its longstanding NHS-philia. The ‘heroic’ and ‘national religion’ myths are now a tired base lie. We were water boarded as a nation through lockdown to protect the REPUTATION of an unprepared chaotic NHS. We were imprisoned to protect IT. Yet It could not function in an epidemic for more than a few weeks because it had (doh!) got rid of hospital beds to meet some barmy efficiency targets. The Hard Left & NHS workers cling to this monolithic 1940s relic, but only ignorant dupes would put up rainbow posters now while the BMA, its super rich consultants and the equally gold-plate pensioned cold eyed (food bank my arse) young doctors happily cancel yet more grannys surgeries as they pant for more money. As with the nurses They have forever debased their professional status by inflicting this cruel second dose of misery on us…the inflation caused by the 2 year lockdown ‘protection’. Its serious now. We should be bashing pans in protest at them. We need to be free of the ‘NHS First’ opiate.
Walter Marvell
10 months ago
No one trusts the NHS anymore. It is hurting so many. The Excess Death bodycount from it converting into a Panicked National Covid Service cannot be masked and is a national scandal. Pity this death toll is not recorded daily on the BBC which so manipulated and warped popular hysteria out of its longstanding NHS-philia. The ‘heroic’ and ‘national religion’ myths are now a tired base lie. We were water boarded as a nation through lockdown to protect the REPUTATION of an unprepared chaotic NHS. We were imprisoned to protect IT. Yet It could not function in an epidemic for more than a few weeks because it had (doh!) got rid of hospital beds to meet some barmy efficiency targets. The Hard Left & NHS workers cling to this monolithic 1940s relic, but only ignorant dupes would put up rainbow posters now while the BMA, its super rich consultants and the equally gold-plate pensioned cold eyed (food bank my arse) young doctors happily cancel yet more grannys surgeries as they pant for more money. As with the nurses They have forever debased their professional status by inflicting this cruel second dose of misery on us…the inflation caused by the 2 year lockdown ‘protection’. Its serious now. We should be bashing pans in protest at them. We need to be free of the ‘NHS First’ opiate.
Bruce Metzger
10 months ago
Since the Covid pandemic I have accepted it as fact that medical people, despite their intelligence and knowledge to heal, are the most gullible and senseless people on the planet. Those medical professionals that excel in their skill and craft frequently employ common sense in dealing with patients. Medical people are too quick to trust the medical system because they have their own job to do. I speak as a former patient who has needed their help.
Bruce Metzger
10 months ago
Since the Covid pandemic I have accepted it as fact that medical people, despite their intelligence and knowledge to heal, are the most gullible and senseless people on the planet. Those medical professionals that excel in their skill and craft frequently employ common sense in dealing with patients. Medical people are too quick to trust the medical system because they have their own job to do. I speak as a former patient who has needed their help.
Jeremy Eves
10 months ago
Someone I know well has just returned from 9 months as an A&E doctor in New Zealand. 4 years after graduation pay would be £50k for a 37 hour week compared to £35k for a 48 hours week. Commitment to family and friends means long term emigration is not an option. But the NHS treats its medical staff very poorly. Inflexible rotas and shift working is a dehumanising constraint. Amazing that few senior managers work nights and weekends but are paid more than senior doctors.
Do lawyers, bankers, accountants carry the risk and responsibility that doctors do? Your life in their hands! The pay differentials say what we think of doctors. Most will not be consultants until late 30’s having earned modestly and even paid for advanced training out of after tax salary. They have the most student debt.
I do not support strikes, but I fully sympathise with their discontent. The governments latest idea to shorten training won’t support quality! If mangers in the private sector produced such awful results with disaster outs staff retention they would be sacked. Not so the NHS and public sector manager!
I’m a doctor, and these figures can’t possibly be correct. A doctor 4 years post qualification working in A&E in the UK for 48 hours per week is either earning in the region of around £60k per year (if in training) or £90k+ per year (if all done as a locum and taking 10 weeks off per year). That’s to say nothing of the extraordinary pension scheme in the UK, which in early career is equivalent to around 50% more pay.
I’m a doctor, and these figures can’t possibly be correct. A doctor 4 years post qualification working in A&E in the UK for 48 hours per week is either earning in the region of around £60k per year (if in training) or £90k+ per year (if all done as a locum and taking 10 weeks off per year). That’s to say nothing of the extraordinary pension scheme in the UK, which in early career is equivalent to around 50% more pay.
Jeremy Eves
10 months ago
Someone I know well has just returned from 9 months as an A&E doctor in New Zealand. 4 years after graduation pay would be £50k for a 37 hour week compared to £35k for a 48 hours week. Commitment to family and friends means long term emigration is not an option. But the NHS treats its medical staff very poorly. Inflexible rotas and shift working is a dehumanising constraint. Amazing that few senior managers work nights and weekends but are paid more than senior doctors.
Do lawyers, bankers, accountants carry the risk and responsibility that doctors do? Your life in their hands! The pay differentials say what we think of doctors. Most will not be consultants until late 30’s having earned modestly and even paid for advanced training out of after tax salary. They have the most student debt.
I do not support strikes, but I fully sympathise with their discontent. The governments latest idea to shorten training won’t support quality! If mangers in the private sector produced such awful results with disaster outs staff retention they would be sacked. Not so the NHS and public sector manager!
Chris Milburn
10 months ago
A Canadian doc chiming in. We have all of the same problems as you Brits, without the meagre safety net of a private system to back it up (that is illegal under the Canada Healthcare Act).
Our system is broken. Through generations of being public employees, docs have been reduced to whining about needing more and more funding every year as the only “solution” to our failures. We are no longer agents, we are cogs in the healthcare machine – one that only “experts” and politicians are qualified to tinker with.
And at the same time we act like cogs, we want to be paid like gods. At 53, I’m in the “bridge” generation. Not a complete dinosaur, but not a millennial either. Unlike my teachers’ generation, I didn’t spend every 2nd weekend on call, get called in to deliver babies at 2AM a few times per week, or miss out on 95% of social opportunities. But I was paid pretty much the same as them. New grads take extended parental leaves, don’t work any weekends or nights, or take every 2nd week off of salaried jobs like hospitalist or palliative care. And they get paid the same as I did for busting my ass 6 days per week. The same amount of pay is going out for physician services, and the public is getting less physician services for their tax dollar. Monopolies do not provide good service, and healthcare in numerous western countries is a monopoly (or, as in the case of the USA, so disfigured by government control that it is moribund and dysfunctional).
Doctors proved once-and-for-all that we are far from “healthcare heroes” when COVID-19 hit. We did as little work as possible for as much money as possible. We pretended to work, but unlike in communist systems the government actually did pay us – handsomely. https://pairodocs.substack.com/p/are-doctors-selfless-healthcare-heroes
I am a collapsatarian when it comes to government-run healthcare. In Canada at least, we have been on a downhill trajectory for 50 years. I don’t think that doing the same things, only more forcefully, will make things any better.
Thank you for the Canadian perspective. As a doc in the USA, I have heard for years the advocates for a more centralized (government-run) healthcare system tout the NHS and Canadian systems as models to be emulated.
I have NO illusions that the system I work in here in the States is a bed of roses; far from it. Among the problems in the American system are the undue influence of Big Pharma and the amounts of money that get siphoned up by the health insurance company bureaucracies, to say nothing of hospital administrations (example: no one at the hospital I work at can tell me what a “VP for Environments of Care” is responsible for, or what they contribute to patient care). As you point out, the US system is NOT a free market, fee-for-service system, except around the edges (cosmetic surgery as an example). Government mandates, regulations, and government payers have a huge distorting influence. My medical group’s payer mix has gone from ~40% government to ~65+% government payers in 14 years, largely goosed by Obamacare.
As for the “Doctors and nurses are saints” trope: I’m old enough (60s) to believe that it’s good medical practice to not abandon your patients, and that when one works every day with sick people, there is a risk that you may get sick. I worked through COVID as an anesthesiologist, and my group tried to help our ER and ICU colleagues with airway management early on (Lord knows we weren’t doing any elective cases!). But the “Healthcare Heroes” mantra wears very thin, and becomes hypocritical when I see it thrown around by the hospital administrators and bureaucrats who use it as emotional blackmail to get us to continually work more for less, pleading “financial crisis” after they pocketed $ incentives to care for COVID patients and now are deluged with pent-up demand for care and much sicker patients after the pandemic. When I’m told that “management thinks you can open more ORs by just working into the night, and on more weekends,” I’m very inclined to tell management to come down and sub for all the staff they cut during the pandemic and have not replaced.
Like my Canadian colleague, I don’t think that insisting on doing the same thing with more vigor will make things better. “First, do no harm.”
Thank you for the Canadian perspective. As a doc in the USA, I have heard for years the advocates for a more centralized (government-run) healthcare system tout the NHS and Canadian systems as models to be emulated.
I have NO illusions that the system I work in here in the States is a bed of roses; far from it. Among the problems in the American system are the undue influence of Big Pharma and the amounts of money that get siphoned up by the health insurance company bureaucracies, to say nothing of hospital administrations (example: no one at the hospital I work at can tell me what a “VP for Environments of Care” is responsible for, or what they contribute to patient care). As you point out, the US system is NOT a free market, fee-for-service system, except around the edges (cosmetic surgery as an example). Government mandates, regulations, and government payers have a huge distorting influence. My medical group’s payer mix has gone from ~40% government to ~65+% government payers in 14 years, largely goosed by Obamacare.
As for the “Doctors and nurses are saints” trope: I’m old enough (60s) to believe that it’s good medical practice to not abandon your patients, and that when one works every day with sick people, there is a risk that you may get sick. I worked through COVID as an anesthesiologist, and my group tried to help our ER and ICU colleagues with airway management early on (Lord knows we weren’t doing any elective cases!). But the “Healthcare Heroes” mantra wears very thin, and becomes hypocritical when I see it thrown around by the hospital administrators and bureaucrats who use it as emotional blackmail to get us to continually work more for less, pleading “financial crisis” after they pocketed $ incentives to care for COVID patients and now are deluged with pent-up demand for care and much sicker patients after the pandemic. When I’m told that “management thinks you can open more ORs by just working into the night, and on more weekends,” I’m very inclined to tell management to come down and sub for all the staff they cut during the pandemic and have not replaced.
Like my Canadian colleague, I don’t think that insisting on doing the same thing with more vigor will make things better. “First, do no harm.”
Chris Milburn
10 months ago
A Canadian doc chiming in. We have all of the same problems as you Brits, without the meagre safety net of a private system to back it up (that is illegal under the Canada Healthcare Act).
Our system is broken. Through generations of being public employees, docs have been reduced to whining about needing more and more funding every year as the only “solution” to our failures. We are no longer agents, we are cogs in the healthcare machine – one that only “experts” and politicians are qualified to tinker with.
And at the same time we act like cogs, we want to be paid like gods. At 53, I’m in the “bridge” generation. Not a complete dinosaur, but not a millennial either. Unlike my teachers’ generation, I didn’t spend every 2nd weekend on call, get called in to deliver babies at 2AM a few times per week, or miss out on 95% of social opportunities. But I was paid pretty much the same as them. New grads take extended parental leaves, don’t work any weekends or nights, or take every 2nd week off of salaried jobs like hospitalist or palliative care. And they get paid the same as I did for busting my ass 6 days per week. The same amount of pay is going out for physician services, and the public is getting less physician services for their tax dollar. Monopolies do not provide good service, and healthcare in numerous western countries is a monopoly (or, as in the case of the USA, so disfigured by government control that it is moribund and dysfunctional).
Doctors proved once-and-for-all that we are far from “healthcare heroes” when COVID-19 hit. We did as little work as possible for as much money as possible. We pretended to work, but unlike in communist systems the government actually did pay us – handsomely. https://pairodocs.substack.com/p/are-doctors-selfless-healthcare-heroes
I am a collapsatarian when it comes to government-run healthcare. In Canada at least, we have been on a downhill trajectory for 50 years. I don’t think that doing the same things, only more forcefully, will make things any better.
Last edited 10 months ago by Chris Milburn
Janet G
10 months ago
Two quotes from this article stand out for me:
“the sacred ministration of religion itself ‘ and
“The myth was also a product of subtle but deliberate NHS propaganda, in the form of TV hospital dramas, nurse recruitment films, and medical romance fiction.”
I recall the early 1960s in an Australian rural town. On Sundays a large proportion of the population attended church. At the Anglican church Sunday evensong saw a full congregation. Then, suddenly, the numbers at evensong dropped. What had happened to cause this? A tv station had programmed the American series Dr Kildare for Sunday evenings. The heroic surgeon was the new saviour.
We used to say we were “a Christian country”. No longer. Our religion is bodily health and fitness, hospitals serve as cathedrals, surgeons as priests and nurses as temple handmaidens.
Last edited 10 months ago by Janet G
Janet G
10 months ago
Two quotes from this article stand out for me:
“the sacred ministration of religion itself ‘ and
“The myth was also a product of subtle but deliberate NHS propaganda, in the form of TV hospital dramas, nurse recruitment films, and medical romance fiction.”
I recall the early 1960s in an Australian rural town. On Sundays a large proportion of the population attended church. At the Anglican church Sunday evensong saw a full congregation. Then, suddenly, the numbers at evensong dropped. What had happened to cause this? A tv station had programmed the American series Dr Kildare for Sunday evenings. The heroic surgeon was the new saviour.
We used to say we were “a Christian country”. No longer. Our religion is bodily health and fitness, hospitals serve as cathedrals, surgeons as priests and nurses as temple handmaidens.
Last edited 10 months ago by Janet G
rigby.kevinp
10 months ago
I’m a little worried about the quasi-religious manner in which we’re beginning to regard the NHS. I found the 75th anniversary service at Westminster Abbey somewhat weird.
Lindsay S
10 months ago
The NHS is the government’s way of promoting Private Healthcare.
Certainly extending the waits for surgery have aided the private sector, who train not one doctor or nurse too.
Important for folks to also understand – the private sector avoids the most complex stuff, including emergency medical care. Wants to cherry-pick the simpler stuff. That’s fine and can supplement NHS capacity, but we should recognise the limits before we assume private sector will willingly step in. Get seriously sick in a private hospital and good chance you’ll also be transferred to the closest NHS acute hospital.
Certainly extending the waits for surgery have aided the private sector, who train not one doctor or nurse too.
Important for folks to also understand – the private sector avoids the most complex stuff, including emergency medical care. Wants to cherry-pick the simpler stuff. That’s fine and can supplement NHS capacity, but we should recognise the limits before we assume private sector will willingly step in. Get seriously sick in a private hospital and good chance you’ll also be transferred to the closest NHS acute hospital.
Last edited 10 months ago by j watson
Lindsay S
10 months ago
The NHS is the government’s way of promoting Private Healthcare.
Rachel Taylor
10 months ago
I’m afraid I find the logic of the article rather confusing. Yes, there is a conflict between the NHS staff aspiration to sainthood and their going on strike. Yes, there is a guardian narrative of saintly doctors, nurses and midwives. But the central conflict is that the staff institutions of the NHS fight hard to retain their monopoly while refusing to accept the consequences of it. The situation is no different from the striking car, coal or steel workers who destroyed their industries while striking for better pay.
I agree that a lie is given to the term “calling” when even the consultants are on strike. As with most public sector jobs the starting salary is not reflective of the average salary and when you are on a path to anywhere near 100K a year it isn’t reasonable to be going on strike. Overtime is not only freely available but logged with military efficiency – unlike patient data.
To say that the risk of death “loomed over” doctors when such a tiny number actually died from (not with) Covid is hyperbolic. Before you look the figure up it would be best to bear in mind what you think it is. That they worked “impossible hours” is flat out wrong – no one could make them work an hour over their time if they didn’t want to – a far cry from the days of the family doctor.
There are things that I sympathise with the doctors on, hyperchondriacs taking up an inordinate amount of time, rude patients and poor equipment but if they don’t want these things then don’t work in the NHS. Plenty are moving away as the article states and I would encourage more to do so if that is what they want. Just don’t go on about how you want to serve the public when really what you want is a higher wage.
The statement of a “crisis of wellbeing amongst NHS staff” is an outrage. 1/10 having suicidal thoughts is excellent compared to the general population and when you take into account children as a sub-group this number is over half. A classic statistical manipulation on the part of the author.
Early on when we knew much less about the virus, and had limited PPE, many doctors and nurses were pretty heroic. As staff went ‘down like flies’ either with Covid or just frightened, a core kept the show on the road and the ‘espirit de corps’ behind that should not be under-estimated.
I do agree some of the hagiography is unwarranted though. Doctors and nurses divide between knights and knaves much as rest of population does. The dilemma for public policy is how one designs recognition systems that cater for both psychologies.
And the article never mentions just how many GPs work part time…a majority in fact I believe. They do this presumably because they can afford to.
Agreed. As the partner of a GP I am constantly reminding him that he is a business owner, and can charge a fair price for his time. While he acts like a state employee bound to help everyone and not charge more than the low government rebate for treating complex patients. Doctors wages are high because the population is overweight and old, and the number of doctors is throttled by both the government and the colleges who wish to retain higher earnings for their members. They earning multiples of the average wage working for the state, and as you point out, if this isn’t enough do what other employees do and leave for greener pastures.
The only thing which happens when you raise their income, is you get less doctor-hours, as they drop down to part time.
Early on when we knew much less about the virus, and had limited PPE, many doctors and nurses were pretty heroic. As staff went ‘down like flies’ either with Covid or just frightened, a core kept the show on the road and the ‘espirit de corps’ behind that should not be under-estimated.
I do agree some of the hagiography is unwarranted though. Doctors and nurses divide between knights and knaves much as rest of population does. The dilemma for public policy is how one designs recognition systems that cater for both psychologies.
And the article never mentions just how many GPs work part time…a majority in fact I believe. They do this presumably because they can afford to.
Agreed. As the partner of a GP I am constantly reminding him that he is a business owner, and can charge a fair price for his time. While he acts like a state employee bound to help everyone and not charge more than the low government rebate for treating complex patients. Doctors wages are high because the population is overweight and old, and the number of doctors is throttled by both the government and the colleges who wish to retain higher earnings for their members. They earning multiples of the average wage working for the state, and as you point out, if this isn’t enough do what other employees do and leave for greener pastures.
The only thing which happens when you raise their income, is you get less doctor-hours, as they drop down to part time.
I agree that a lie is given to the term “calling” when even the consultants are on strike. As with most public sector jobs the starting salary is not reflective of the average salary and when you are on a path to anywhere near 100K a year it isn’t reasonable to be going on strike. Overtime is not only freely available but logged with military efficiency – unlike patient data.
To say that the risk of death “loomed over” doctors when such a tiny number actually died from (not with) Covid is hyperbolic. Before you look the figure up it would be best to bear in mind what you think it is. That they worked “impossible hours” is flat out wrong – no one could make them work an hour over their time if they didn’t want to – a far cry from the days of the family doctor.
There are things that I sympathise with the doctors on, hyperchondriacs taking up an inordinate amount of time, rude patients and poor equipment but if they don’t want these things then don’t work in the NHS. Plenty are moving away as the article states and I would encourage more to do so if that is what they want. Just don’t go on about how you want to serve the public when really what you want is a higher wage.
The statement of a “crisis of wellbeing amongst NHS staff” is an outrage. 1/10 having suicidal thoughts is excellent compared to the general population and when you take into account children as a sub-group this number is over half. A classic statistical manipulation on the part of the author.
These days, only doctors think doctors are saints. And throughout Covid, there can hardly have been a more hackneyed and inaccurate line than “the public was unable to provide the NHS staff with the protective equipment they so desperately needed”.
Why is it untrue? Change “public” to “the government” and I think it’s pretty spot on, many healthcare workers didn’t have anywhere near enough PPE.
I fully support the doctors striking. If the money isn’t enough to retain skilled staff then it has to increase, same as any other profession
What is the money? Genuine question. Despite the acres of print I don’t actually know what the starting salary is for a newly qualified doctor. What he could expect to earn after 5 years. What an average salary is.
If journalists just provided a paragraph of basic facts instead of rhetoric I’d be in better position to make a judgement.
Whether it’s £10k or £100k is largely irrelevant, if it’s not enough to retain the staff then either that needs to go up or working conditions need to improve
It’s c£30k for a newly qualified junior doctor and c£90k for a Consultant. Obviously some get London Weighting (peanuts but something), and can do additional shifts as overtime. Pension and other terms and conditions are pretty good if one stays the course.
We need to recognise though the debt they start with and how medical students are often some of the most intelligent and highest performing students we have. Were they to go into other fields of work they likely excel and be paid more. Yet we need doctors.
They aren’t paid as well as US and Aus doctors and we are losing some to both, but a bit better than some euro countries. We did well from euro recruitment until Brexit made it more difficult.
Geez. Two-click “research” shows that a starting average for doctors here is about 168,000 pounds ($213K). They should come to the US where they can write opioid scripts for extra cash on the sly too. They’d have to live among Americans like me though.
Yep. One of the reasons why our NHS such good value for money. Furthermore much less ‘fee for service’ so less danger of over treatment to generate higher bills. Debate no doubt for another day.
Yep. One of the reasons why our NHS such good value for money. Furthermore much less ‘fee for service’ so less danger of over treatment to generate higher bills. Debate no doubt for another day.
Speaking as an NHS consultant, my concern about pay is not the absolute amount, but downward trajectory. In most walks of life, there is a correlation between pay and calibre. The only doctors we can attract to the NHS are those from poorer, worse healthcare systems than our own or those UK doctors who haven’t left yet. I can tell you, standards are dropping and when no top notch doctors are left in the NHS, this decline will be irreversible. Because reimbursement in the private sector has been dropping since the 1990s, this will become true for the private sector too. When the proverbial hits the fan at 3am, it makes all the difference if the doctor
you see has a high IQ, is well trained and has put the hours(years) in. These are exactly the people who are/will leave the NHS.
Geez. Two-click “research” shows that a starting average for doctors here is about 168,000 pounds ($213K). They should come to the US where they can write opioid scripts for extra cash on the sly too. They’d have to live among Americans like me though.
Speaking as an NHS consultant, my concern about pay is not the absolute amount, but downward trajectory. In most walks of life, there is a correlation between pay and calibre. The only doctors we can attract to the NHS are those from poorer, worse healthcare systems than our own or those UK doctors who haven’t left yet. I can tell you, standards are dropping and when no top notch doctors are left in the NHS, this decline will be irreversible. Because reimbursement in the private sector has been dropping since the 1990s, this will become true for the private sector too. When the proverbial hits the fan at 3am, it makes all the difference if the doctor
you see has a high IQ, is well trained and has put the hours(years) in. These are exactly the people who are/will leave the NHS.
It’s c£30k for a newly qualified junior doctor and c£90k for a Consultant. Obviously some get London Weighting (peanuts but something), and can do additional shifts as overtime. Pension and other terms and conditions are pretty good if one stays the course.
We need to recognise though the debt they start with and how medical students are often some of the most intelligent and highest performing students we have. Were they to go into other fields of work they likely excel and be paid more. Yet we need doctors.
They aren’t paid as well as US and Aus doctors and we are losing some to both, but a bit better than some euro countries. We did well from euro recruitment until Brexit made it more difficult.
Whether it’s £10k or £100k is largely irrelevant, if it’s not enough to retain the staff then either that needs to go up or working conditions need to improve
“The Department for Health & Social Care (DHSC) lost 75% of the £12 billion it spent on personal protective equipment (PPE) in the first year of the pandemic to inflated prices and kit that did not meet requirements – including fully £4 billion of PPE that will not be used in the NHS and needs to be disposed of.”*
‘PROTECT THE NHS’……………INDEED!
(* UK parliamentary Committee Report.)
The whole world was chasing PPE at the start of the pandemic, do you expect the prices to have remained the same in a time of such high demand? That’s not how capitalism works I’m afraid
From the moment I heard our wretched PM say “protect the NHS” I knew we were about to enter a period of public panic not seen since 1940. And so it has proved to be.
Thus, and through no fault of my own, I was offered the chance to make a modest investment in this PPE nonsense. As a result it has turned out to be the investment opportunity of a lifetime.
From the moment I heard our wretched PM say “protect the NHS” I knew we were about to enter a period of public panic not seen since 1940. And so it has proved to be.
Thus, and through no fault of my own, I was offered the chance to make a modest investment in this PPE nonsense. As a result it has turned out to be the investment opportunity of a lifetime.
DHSC isn’t the NHS CS. I think you recognise this but to some the distinction will be lost.
DHSC, and lots of Tory cronies, ran the procurement. Like ‘Test & Trace’ the Govt too easily then let them use the NHS brand despite serious concerns being voiced that they never fell under proper NHS governance.
Too true I’m afraid, hence offering an ‘amateur’ investor such as myself an opportunity of a lifetime!*
(*Annoyingly rather late for me, it must be said.)
Too true I’m afraid, hence offering an ‘amateur’ investor such as myself an opportunity of a lifetime!*
(*Annoyingly rather late for me, it must be said.)
The whole world was chasing PPE at the start of the pandemic, do you expect the prices to have remained the same in a time of such high demand? That’s not how capitalism works I’m afraid
DHSC isn’t the NHS CS. I think you recognise this but to some the distinction will be lost.
DHSC, and lots of Tory cronies, ran the procurement. Like ‘Test & Trace’ the Govt too easily then let them use the NHS brand despite serious concerns being voiced that they never fell under proper NHS governance.
You make comments just to tease, don’t you? But in this one you have a point. If staff leave in large numbers, pay them more. But not otherwise
I don’t think I do, I just don’t think I’m as tied to any particular ideology as most on here. To ensure the UK doesn’t have a shortage of medical professionals they need to do 3 things.
1. Train more doctors
2. Retain the ones they have
3. Import from abroad where necessary.
You can’t do the last two if the wages aren’t high enough for the working conditions
I don’t think I do, I just don’t think I’m as tied to any particular ideology as most on here. To ensure the UK doesn’t have a shortage of medical professionals they need to do 3 things.
1. Train more doctors
2. Retain the ones they have
3. Import from abroad where necessary.
You can’t do the last two if the wages aren’t high enough for the working conditions
What is the money? Genuine question. Despite the acres of print I don’t actually know what the starting salary is for a newly qualified doctor. What he could expect to earn after 5 years. What an average salary is.
If journalists just provided a paragraph of basic facts instead of rhetoric I’d be in better position to make a judgement.
“The Department for Health & Social Care (DHSC) lost 75% of the £12 billion it spent on personal protective equipment (PPE) in the first year of the pandemic to inflated prices and kit that did not meet requirements – including fully £4 billion of PPE that will not be used in the NHS and needs to be disposed of.”*
‘PROTECT THE NHS’……………INDEED!
(* UK parliamentary Committee Report.)
You make comments just to tease, don’t you? But in this one you have a point. If staff leave in large numbers, pay them more. But not otherwise
Why is it untrue? Change “public” to “the government” and I think it’s pretty spot on, many healthcare workers didn’t have anywhere near enough PPE.
I fully support the doctors striking. If the money isn’t enough to retain skilled staff then it has to increase, same as any other profession
These days, only doctors think doctors are saints. And throughout Covid, there can hardly have been a more hackneyed and inaccurate line than “the public was unable to provide the NHS staff with the protective equipment they so desperately needed”.
The biggest problem is that doctors and many other medical staff are not trained for the reality of the job: their training is making them ready to prescribe the drugs they are taught (indirectly) by the pharma industry, putting patients in diagnostic boxes which really work for only 30-40% of patients. Even though they want to care they are not taught how to do this effectively. The NHS is not a health service, it is an illness service responding principally to the needs of the health industry. https://www.bmj.com/company/newsroom/many-nhs-partnerships-with-drug-companies-are-out-of-public-sight/. https://publications.parliament.uk/pa/cm200405/cmselect/cmhealth/42/42.pdf
….. last year during the personalised medicine congress in London in June, Rangan Shatterjee said that there were 2 big problems with medicine: 50% of what doctors are taught is either untrue or not helpful (and that we do not know which 50% this is) and that there are too many egos in medicine. This was received with a big applause by the 800 strong audience and the ex health ministers and ex NHS bosses sitting on the podium…
The best way to be able to work in the illness industry that is our health service, is to ignore patients unless they (or their illnesses) comply with the rules: it a survival technique. If one of my children would have chosen to go into medicine I would have seriously argued with them; unless you want to work in the technical aspect of medicine where patient contact is minimum.
Unless we make the principal job of medicine to make people healthy (fostering health), that treating an illness is not sufficient unless the outcome is an improved health state, that we start researching how to make the whole person better rather than juts treat the boxed in diagnosis, (treat patients in stead of illness) nothing will change..
The biggest problem is that doctors and many other medical staff are not trained for the reality of the job: their training is making them ready to prescribe the drugs they are taught (indirectly) by the pharma industry, putting patients in diagnostic boxes which really work for only 30-40% of patients. Even though they want to care they are not taught how to do this effectively. The NHS is not a health service, it is an illness service responding principally to the needs of the health industry. https://www.bmj.com/company/newsroom/many-nhs-partnerships-with-drug-companies-are-out-of-public-sight/. https://publications.parliament.uk/pa/cm200405/cmselect/cmhealth/42/42.pdf
….. last year during the personalised medicine congress in London in June, Rangan Shatterjee said that there were 2 big problems with medicine: 50% of what doctors are taught is either untrue or not helpful (and that we do not know which 50% this is) and that there are too many egos in medicine. This was received with a big applause by the 800 strong audience and the ex health ministers and ex NHS bosses sitting on the podium…
The best way to be able to work in the illness industry that is our health service, is to ignore patients unless they (or their illnesses) comply with the rules: it a survival technique. If one of my children would have chosen to go into medicine I would have seriously argued with them; unless you want to work in the technical aspect of medicine where patient contact is minimum.
Unless we make the principal job of medicine to make people healthy (fostering health), that treating an illness is not sufficient unless the outcome is an improved health state, that we start researching how to make the whole person better rather than juts treat the boxed in diagnosis, (treat patients in stead of illness) nothing will change..
No one trusts the NHS anymore. It is hurting so many. The Excess Death bodycount from it converting into a Panicked National Covid Service cannot be masked and is a national scandal. Pity this death toll is not recorded daily on the BBC which so manipulated and warped popular hysteria out of its longstanding NHS-philia. The ‘heroic’ and ‘national religion’ myths are now a tired base lie. We were water boarded as a nation through lockdown to protect the REPUTATION of an unprepared chaotic NHS. We were imprisoned to protect IT. Yet It could not function in an epidemic for more than a few weeks because it had (doh!) got rid of hospital beds to meet some barmy efficiency targets. The Hard Left & NHS workers cling to this monolithic 1940s relic, but only ignorant dupes would put up rainbow posters now while the BMA, its super rich consultants and the equally gold-plate pensioned cold eyed (food bank my arse) young doctors happily cancel yet more grannys surgeries as they pant for more money. As with the nurses They have forever debased their professional status by inflicting this cruel second dose of misery on us…the inflation caused by the 2 year lockdown ‘protection’. Its serious now. We should be bashing pans in protest at them. We need to be free of the ‘NHS First’ opiate.
No one trusts the NHS anymore. It is hurting so many. The Excess Death bodycount from it converting into a Panicked National Covid Service cannot be masked and is a national scandal. Pity this death toll is not recorded daily on the BBC which so manipulated and warped popular hysteria out of its longstanding NHS-philia. The ‘heroic’ and ‘national religion’ myths are now a tired base lie. We were water boarded as a nation through lockdown to protect the REPUTATION of an unprepared chaotic NHS. We were imprisoned to protect IT. Yet It could not function in an epidemic for more than a few weeks because it had (doh!) got rid of hospital beds to meet some barmy efficiency targets. The Hard Left & NHS workers cling to this monolithic 1940s relic, but only ignorant dupes would put up rainbow posters now while the BMA, its super rich consultants and the equally gold-plate pensioned cold eyed (food bank my arse) young doctors happily cancel yet more grannys surgeries as they pant for more money. As with the nurses They have forever debased their professional status by inflicting this cruel second dose of misery on us…the inflation caused by the 2 year lockdown ‘protection’. Its serious now. We should be bashing pans in protest at them. We need to be free of the ‘NHS First’ opiate.
Since the Covid pandemic I have accepted it as fact that medical people, despite their intelligence and knowledge to heal, are the most gullible and senseless people on the planet. Those medical professionals that excel in their skill and craft frequently employ common sense in dealing with patients. Medical people are too quick to trust the medical system because they have their own job to do. I speak as a former patient who has needed their help.
Since the Covid pandemic I have accepted it as fact that medical people, despite their intelligence and knowledge to heal, are the most gullible and senseless people on the planet. Those medical professionals that excel in their skill and craft frequently employ common sense in dealing with patients. Medical people are too quick to trust the medical system because they have their own job to do. I speak as a former patient who has needed their help.
Someone I know well has just returned from 9 months as an A&E doctor in New Zealand. 4 years after graduation pay would be £50k for a 37 hour week compared to £35k for a 48 hours week. Commitment to family and friends means long term emigration is not an option. But the NHS treats its medical staff very poorly. Inflexible rotas and shift working is a dehumanising constraint. Amazing that few senior managers work nights and weekends but are paid more than senior doctors.
Do lawyers, bankers, accountants carry the risk and responsibility that doctors do? Your life in their hands! The pay differentials say what we think of doctors. Most will not be consultants until late 30’s having earned modestly and even paid for advanced training out of after tax salary. They have the most student debt.
I do not support strikes, but I fully sympathise with their discontent. The governments latest idea to shorten training won’t support quality! If mangers in the private sector produced such awful results with disaster outs staff retention they would be sacked. Not so the NHS and public sector manager!
I’m a doctor, and these figures can’t possibly be correct. A doctor 4 years post qualification working in A&E in the UK for 48 hours per week is either earning in the region of around £60k per year (if in training) or £90k+ per year (if all done as a locum and taking 10 weeks off per year). That’s to say nothing of the extraordinary pension scheme in the UK, which in early career is equivalent to around 50% more pay.
I’m a doctor, and these figures can’t possibly be correct. A doctor 4 years post qualification working in A&E in the UK for 48 hours per week is either earning in the region of around £60k per year (if in training) or £90k+ per year (if all done as a locum and taking 10 weeks off per year). That’s to say nothing of the extraordinary pension scheme in the UK, which in early career is equivalent to around 50% more pay.
Someone I know well has just returned from 9 months as an A&E doctor in New Zealand. 4 years after graduation pay would be £50k for a 37 hour week compared to £35k for a 48 hours week. Commitment to family and friends means long term emigration is not an option. But the NHS treats its medical staff very poorly. Inflexible rotas and shift working is a dehumanising constraint. Amazing that few senior managers work nights and weekends but are paid more than senior doctors.
Do lawyers, bankers, accountants carry the risk and responsibility that doctors do? Your life in their hands! The pay differentials say what we think of doctors. Most will not be consultants until late 30’s having earned modestly and even paid for advanced training out of after tax salary. They have the most student debt.
I do not support strikes, but I fully sympathise with their discontent. The governments latest idea to shorten training won’t support quality! If mangers in the private sector produced such awful results with disaster outs staff retention they would be sacked. Not so the NHS and public sector manager!
A Canadian doc chiming in. We have all of the same problems as you Brits, without the meagre safety net of a private system to back it up (that is illegal under the Canada Healthcare Act).
Our system is broken. Through generations of being public employees, docs have been reduced to whining about needing more and more funding every year as the only “solution” to our failures. We are no longer agents, we are cogs in the healthcare machine – one that only “experts” and politicians are qualified to tinker with.
And at the same time we act like cogs, we want to be paid like gods. At 53, I’m in the “bridge” generation. Not a complete dinosaur, but not a millennial either. Unlike my teachers’ generation, I didn’t spend every 2nd weekend on call, get called in to deliver babies at 2AM a few times per week, or miss out on 95% of social opportunities. But I was paid pretty much the same as them. New grads take extended parental leaves, don’t work any weekends or nights, or take every 2nd week off of salaried jobs like hospitalist or palliative care. And they get paid the same as I did for busting my ass 6 days per week. The same amount of pay is going out for physician services, and the public is getting less physician services for their tax dollar. Monopolies do not provide good service, and healthcare in numerous western countries is a monopoly (or, as in the case of the USA, so disfigured by government control that it is moribund and dysfunctional).
Doctors proved once-and-for-all that we are far from “healthcare heroes” when COVID-19 hit. We did as little work as possible for as much money as possible. We pretended to work, but unlike in communist systems the government actually did pay us – handsomely.
https://pairodocs.substack.com/p/are-doctors-selfless-healthcare-heroes
I am a collapsatarian when it comes to government-run healthcare. In Canada at least, we have been on a downhill trajectory for 50 years. I don’t think that doing the same things, only more forcefully, will make things any better.
Thank you for the Canadian perspective. As a doc in the USA, I have heard for years the advocates for a more centralized (government-run) healthcare system tout the NHS and Canadian systems as models to be emulated.
I have NO illusions that the system I work in here in the States is a bed of roses; far from it. Among the problems in the American system are the undue influence of Big Pharma and the amounts of money that get siphoned up by the health insurance company bureaucracies, to say nothing of hospital administrations (example: no one at the hospital I work at can tell me what a “VP for Environments of Care” is responsible for, or what they contribute to patient care). As you point out, the US system is NOT a free market, fee-for-service system, except around the edges (cosmetic surgery as an example). Government mandates, regulations, and government payers have a huge distorting influence. My medical group’s payer mix has gone from ~40% government to ~65+% government payers in 14 years, largely goosed by Obamacare.
As for the “Doctors and nurses are saints” trope: I’m old enough (60s) to believe that it’s good medical practice to not abandon your patients, and that when one works every day with sick people, there is a risk that you may get sick. I worked through COVID as an anesthesiologist, and my group tried to help our ER and ICU colleagues with airway management early on (Lord knows we weren’t doing any elective cases!). But the “Healthcare Heroes” mantra wears very thin, and becomes hypocritical when I see it thrown around by the hospital administrators and bureaucrats who use it as emotional blackmail to get us to continually work more for less, pleading “financial crisis” after they pocketed $ incentives to care for COVID patients and now are deluged with pent-up demand for care and much sicker patients after the pandemic. When I’m told that “management thinks you can open more ORs by just working into the night, and on more weekends,” I’m very inclined to tell management to come down and sub for all the staff they cut during the pandemic and have not replaced.
Like my Canadian colleague, I don’t think that insisting on doing the same thing with more vigor will make things better. “First, do no harm.”
Thank you for the Canadian perspective. As a doc in the USA, I have heard for years the advocates for a more centralized (government-run) healthcare system tout the NHS and Canadian systems as models to be emulated.
I have NO illusions that the system I work in here in the States is a bed of roses; far from it. Among the problems in the American system are the undue influence of Big Pharma and the amounts of money that get siphoned up by the health insurance company bureaucracies, to say nothing of hospital administrations (example: no one at the hospital I work at can tell me what a “VP for Environments of Care” is responsible for, or what they contribute to patient care). As you point out, the US system is NOT a free market, fee-for-service system, except around the edges (cosmetic surgery as an example). Government mandates, regulations, and government payers have a huge distorting influence. My medical group’s payer mix has gone from ~40% government to ~65+% government payers in 14 years, largely goosed by Obamacare.
As for the “Doctors and nurses are saints” trope: I’m old enough (60s) to believe that it’s good medical practice to not abandon your patients, and that when one works every day with sick people, there is a risk that you may get sick. I worked through COVID as an anesthesiologist, and my group tried to help our ER and ICU colleagues with airway management early on (Lord knows we weren’t doing any elective cases!). But the “Healthcare Heroes” mantra wears very thin, and becomes hypocritical when I see it thrown around by the hospital administrators and bureaucrats who use it as emotional blackmail to get us to continually work more for less, pleading “financial crisis” after they pocketed $ incentives to care for COVID patients and now are deluged with pent-up demand for care and much sicker patients after the pandemic. When I’m told that “management thinks you can open more ORs by just working into the night, and on more weekends,” I’m very inclined to tell management to come down and sub for all the staff they cut during the pandemic and have not replaced.
Like my Canadian colleague, I don’t think that insisting on doing the same thing with more vigor will make things better. “First, do no harm.”
A Canadian doc chiming in. We have all of the same problems as you Brits, without the meagre safety net of a private system to back it up (that is illegal under the Canada Healthcare Act).
Our system is broken. Through generations of being public employees, docs have been reduced to whining about needing more and more funding every year as the only “solution” to our failures. We are no longer agents, we are cogs in the healthcare machine – one that only “experts” and politicians are qualified to tinker with.
And at the same time we act like cogs, we want to be paid like gods. At 53, I’m in the “bridge” generation. Not a complete dinosaur, but not a millennial either. Unlike my teachers’ generation, I didn’t spend every 2nd weekend on call, get called in to deliver babies at 2AM a few times per week, or miss out on 95% of social opportunities. But I was paid pretty much the same as them. New grads take extended parental leaves, don’t work any weekends or nights, or take every 2nd week off of salaried jobs like hospitalist or palliative care. And they get paid the same as I did for busting my ass 6 days per week. The same amount of pay is going out for physician services, and the public is getting less physician services for their tax dollar. Monopolies do not provide good service, and healthcare in numerous western countries is a monopoly (or, as in the case of the USA, so disfigured by government control that it is moribund and dysfunctional).
Doctors proved once-and-for-all that we are far from “healthcare heroes” when COVID-19 hit. We did as little work as possible for as much money as possible. We pretended to work, but unlike in communist systems the government actually did pay us – handsomely.
https://pairodocs.substack.com/p/are-doctors-selfless-healthcare-heroes
I am a collapsatarian when it comes to government-run healthcare. In Canada at least, we have been on a downhill trajectory for 50 years. I don’t think that doing the same things, only more forcefully, will make things any better.
Two quotes from this article stand out for me:
“the sacred ministration of religion itself ‘ and
“The myth was also a product of subtle but deliberate NHS propaganda, in the form of TV hospital dramas, nurse recruitment films, and medical romance fiction.”
I recall the early 1960s in an Australian rural town. On Sundays a large proportion of the population attended church. At the Anglican church Sunday evensong saw a full congregation. Then, suddenly, the numbers at evensong dropped. What had happened to cause this? A tv station had programmed the American series Dr Kildare for Sunday evenings. The heroic surgeon was the new saviour.
We used to say we were “a Christian country”. No longer. Our religion is bodily health and fitness, hospitals serve as cathedrals, surgeons as priests and nurses as temple handmaidens.
Two quotes from this article stand out for me:
“the sacred ministration of religion itself ‘ and
“The myth was also a product of subtle but deliberate NHS propaganda, in the form of TV hospital dramas, nurse recruitment films, and medical romance fiction.”
I recall the early 1960s in an Australian rural town. On Sundays a large proportion of the population attended church. At the Anglican church Sunday evensong saw a full congregation. Then, suddenly, the numbers at evensong dropped. What had happened to cause this? A tv station had programmed the American series Dr Kildare for Sunday evenings. The heroic surgeon was the new saviour.
We used to say we were “a Christian country”. No longer. Our religion is bodily health and fitness, hospitals serve as cathedrals, surgeons as priests and nurses as temple handmaidens.
I’m a little worried about the quasi-religious manner in which we’re beginning to regard the NHS. I found the 75th anniversary service at Westminster Abbey somewhat weird.
The NHS is the government’s way of promoting Private Healthcare.
Certainly extending the waits for surgery have aided the private sector, who train not one doctor or nurse too.
Important for folks to also understand – the private sector avoids the most complex stuff, including emergency medical care. Wants to cherry-pick the simpler stuff. That’s fine and can supplement NHS capacity, but we should recognise the limits before we assume private sector will willingly step in. Get seriously sick in a private hospital and good chance you’ll also be transferred to the closest NHS acute hospital.
Certainly extending the waits for surgery have aided the private sector, who train not one doctor or nurse too.
Important for folks to also understand – the private sector avoids the most complex stuff, including emergency medical care. Wants to cherry-pick the simpler stuff. That’s fine and can supplement NHS capacity, but we should recognise the limits before we assume private sector will willingly step in. Get seriously sick in a private hospital and good chance you’ll also be transferred to the closest NHS acute hospital.
The NHS is the government’s way of promoting Private Healthcare.
I’m afraid I find the logic of the article rather confusing. Yes, there is a conflict between the NHS staff aspiration to sainthood and their going on strike. Yes, there is a guardian narrative of saintly doctors, nurses and midwives. But the central conflict is that the staff institutions of the NHS fight hard to retain their monopoly while refusing to accept the consequences of it. The situation is no different from the striking car, coal or steel workers who destroyed their industries while striking for better pay.