The cynical betrayal of junior hospital doctors continues
Ging gang gooley, gooley, gooley, gooley, watcha
Ging gang goo, ging gang goo
Ging gang gooley, gooley, gooley, gooley, watcha
Ging gang goo, ging gang goo
Heyla, heyla sheyla, heyla shey-la heyla ho
Heyla, heyla sheyla, heyla shey-la heyla ho
Golly wally, golly wally, golly walla, golly walla
Um-pa, Um-pa, Um-pa
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After five or six years at medical school, most newly qualified doctors have educational loans far higher than other students. And when they start work, most of them have no alternative but to live for at least part of the week in hospital accommodation. The hours may not be as long as they were but the shift system still means unsociable start and finishing times and that makes commuting difficult. Rotating jobs means it is impossible to settle in one area. Buy a house in Birmingham and then your next job is in Manchester. It was hard enough for a newly qualified doctor to buy a house in the first place. Now (s)he is forced to pay huge sums of money for tatty hospital accommodation, it is impossible.
The use of university halls-style rooms in their first year after graduating has been used as an excuse to keep the starting salary of junior doctors low, just £21,000 this year, compared to the average graduate's first salary of £24,000. But the provision of free accommodation has been removed without any compensatory pay rise. (source)Remember also that newly qualified doctors are not “average” students. They are la crème de la crème. How do other high-flying graduates fare?
As a trainee solicitor in London you will earn £37,500 in year 1, and £41,500 in Year 2. Once you're qualified, this rises to £66,000 plus a bonus scheme. (CMS Cameron McKenna)
Graduate Starting SalariesSo a newly qualified doctor thus earns little more than a nurse or a paramedic. Why bother to train as a doctor?
STARTING SALARIES for graduate Lawyers have shot through the £60,000 mark for the first time – more than twice the level they were a decade ago. But some graduates can expect to earn less than £15,000 per year in their first graduate role. Newly employed solicitors from London’s top firms have seen salaries rise by sixteen percent in the last twelve months to £64,000. Many trainee solicitors can expect to earn ‘only’ £35,000 – the same amount as trainee accountants. High-earning graduates often see their pay packet swell with a £10,000 Golden Hello on top of their annual earnings.
Investment banker £33,000
Management consultant £24,000 – £35,000
Junior doctor £20,741
Police constable £20,397
Teacher £20,133
Nursery manager £20,000
Nurse £19,683
Civil service administrator £19,387
Paramedic £19,195
Electrical engineer £17,000 – £27,000
Soldier £15,700
Library assistant £15,000
Full-time shop assistant £13,000 – £16,000
Teaching assistant £11,000 – £14,000
Fashion model £10,000 – £15,000
Regional newspaper reporter £10,000
Part-time nursery nurse £7,500 – £10,400 (Student Direct)
Labels: abusing doctors, accommodation, junior doctors
77 Comments:
and cue torrent of abuse against junior doctors...
You forgot to mention the small case of a rough average of £25,000 worth of debt we have on our shoulders which very few if any of the people in other professions have.
Also, if you look back into past Doctor and Dentist Review Body (DDRB) reports, they used to give the reason 'you get free accommodation' not to give junior doctors a pay rise. They conveniently forgot that suddenly. Strange that.
I am a mature student. I own a house. If my hospital placements are not commutable (and we rotate every 3 months), I am planning on camping or sleeping in my car - I can see no other option. At least hospitals have showers. The photograph may well prove to be very accurate. NZ looks more and more appealing...
There is also no point in us complaining about it - we are over a barrel: an over-supply of students, no recourse with strike action and the need to keep everyone sweet for your career progression. Essentially, we just have to put up with it or emigrate (which the government have stated that they are quite happy for us to do).
I just wouldn't like to be the patients being treated by doctors who have to sleep rough/bivvy out, but I am sure that is what it will come to. I have many friends who cannot afford to service their debts and absorb the price of hospital accomodation.
I have no idea where the figure of £24000 comes for the average graduate starting salary. My friend, who is graduated 7 years with a Law and Italian degree, is currently earning less than £23000. And yes, her job does require a degree. I have just completed a PhD and have starting salary of under £31000. There are a lot of injustices in the world that affect more than doctors.
Incidentally, I am one of the more sympathetic people to the current witch hunt of GPs.
It would be nice if someone would tell me how much we're going to be earning come August. Hopefully it'll be enough to start paying off the £35,000 I owe from the last 5 years.
"I have no idea where the figure of £24000 comes for the average graduate starting salary."
This figure was quoted in the Telegraph article. Maybe average for graduates working in central London but certainly not in Birmingham or Manchester. Likewise, the enormous salaries enjoyed by solicitors working for corporate law firms in London are not comparable with those paid to graduates employed by firms in the provincial cities.
While NZ is a lovely place to work (I was in christchurch) the right to free accommodation there for house officers was removed 20 years ago, as well as beds in on call rooms.
Lots of drugs and rapes in NZ as well. Its not all "Home and Away" and "Neighbours" in the Antipodes.
I'm in NZ for my elective and I'll definitely be using the opportunity to explore the options of training over there...
When I started med school I was certain that I wanted to stay in the NHS but times have changed and you meet so many juniors who are emigrating to the Antipodes it makes you start to wonder...
I would dearly love to know what I'll be earning come August as well.
Except nobody knows because the shiny new European working time directive compliant rotas aren't ready yet. Because they can't figure out how to get a bunch of doctors from 65+ hours a week down to 48 hours a week with no extra staff at all, not even nurse practitioners!
Still at least the area I'm going to is amazing and pretty much all the staff are really nice. The nurses are friendly and very experienced. They'll even "mother" us a bit as well, they're great! There's even a ward clerk, so all the notes are properly filed and accessible.
Dr Crippen.
Have you picked up the comments on other blogs about medical student "negative monthly money".
I have a couple of friends who got in to London for F1 and ended up getting unbanded jobs.
Now like me they are graduate students so 7-8 years at uni.
Now they have been told they are on just over 21k for F1 year and have to pay £500 a month for accomodation and with professional studies loand and student loans they will have to take out loans to live.
£1370 a month take home
take away 500 rent, 500 prof stidies loan, 50 student loan and you are left with 300 a month to pay for petrol, food, phone, bills, council tax etc.
The guys seem at a loss as to how they will live next year.
Anon7:54,
The same way they got the hours down last year. You will be "audited" which may well be while you are on holiday or not on call to ensure you comply....the people i take over from just tell me they really do 60-70 hours a week just on the time sheet they are "EWTD compliant".
Sure a graduate trainee at a top city law firm earns a lot of cash, but not all lawyers work in the city. Law schools are full of not too bright people with no training contract or if they're lucky being paid £12,000 a year to train having spent £20,000 on law school. Fair enough. Could doctors' salaries be skewed because variations in salary are (especially post-MTAS) more or less arbitrarily distributed across the spectrum of talent? Bob who scraped through some pants touchy-feely medical school gets paid the same as Bill who aced an elite medical school -- that's where the unfairness lies.
you really need to tone down this creme de la fucking creme bollocks
how many times have we analysed just what bollocks self perception this is based upon
a bit of pride is good, arrogance especially when it is misplaced is bad
if you were that good we wouldnt have health as the worst performing business in the country bar none now would we
Hi no one
Perhaps if they did not treat doctors like shit, things might be a bit better! ??
John
Barristers earn far less than doctors or solicitors, around £12,000 in their first year.
Also, CMS Cameron McKenna are a bit of an elite exception to the solicitor rule, most solicitors will be on about £15,000 in their first year.
From Broke Baby Barrista
I should probably also point out that with university fees = £9,000, Bar Vocational Course fees = £12,500 and the additional cost of living and other loans, the legal profession are probably the worst off of all after their education.
My loans are around £40,000 and that's pretty average
Funny pseudonym and anonymous at 4.50, if you have press contacts then 'doctors' negative pay' type stories would make good copy - as would a junior doctor having to camp out in his car. Not being unsympathetic - awful situation - but to raise awareness. Even the press forum at DNUK might be worth a shot?
This sounds like a lot of people are getting unbanded jobs this year - odd as even an EWTD compliant rota which includes nights can get you a 50% banding.
The ongoing we-don't-earn-like-the-other professions is an old story - and we're public sector workers so no point comparing us to private sector lawyers. As mentioned above, criminal barristers and solicitors for government institutions like the Treasury aren't paid in line with Magic Circle firm trainees either, though I suspect their career prospects are better. However, the point still stands...pay peanuts get monkeys etc etc.
Good luck to everyone with new jobs in August.
Things must have worsened significantly over the past few years. When I was a House Officer, back in 2002, I had a take-home of £1850/month - circa £33k/yr, IIRC.
That was for a band 2A job, but I was pretty chuffed. And it got better from there...
your figures for investment banking are wrong. For the top 4/5 investment banks the figure for someone starting with a PhD 2 years ago was £58,000 pa. But there was an extra £18,000 "relocation" and guaranteed £35,000 bonus.
Other banks pay less, and people joining departments such as IT through general market recruitment rather than the graduate round get less. But still its a lot of money.
I don't know about free housing and I don't care. I am pleased now that we are training enough doctors and we no longer need fear being held ransom by them. Who would have thought that boosting numbers would have weakened the medical profession so quickly and dramatically?
Why bother becoming a soldier - they get far less than a junior doctor and they're putting their lives at risk every day.
I agree with no one (only partially, for the first time ever) that you need to tone down the creme de la creme business. Medics are high average, but they are by no means the smartest nor do they have the most strenuous course.
I'm not saying they're not smart, but I know medical students and I know maths students and I know physics students and classics and all sorts of other students. I wouldn't say that on average the medics are any smarter than the others.
Also, medical students have pretty good job security compared to these others. Even if they can't get a job in this country, they can elsewhere.
And why bother becoming a doctor instead of a nurse or paramedic? Partially to avoid the sneering comments that are often directed at these two professions (as a short look in the archives of this very blog can show), and partly because in 10-20 years, Doctor will be raking it in while Nurse and Paramedic are only marginally better off than when they first came out of uni.
'we no longer need fear being held ransom by them.'
Oh do piss off. How are doctors doing this, exactly?
If you mean trying to provide the best health care we can despite, rather than because of, many of the 'initiatives' we are now exposed to, then I suppose we are guilty.
'medical students have pretty good job security compared to these others. Even if they can't get a job in this country, they can elsewhere'
No so true anymore, every market becomes saturated after a while.
'And why bother becoming a doctor instead of a nurse or paramedic?'
Because some of us are stupid enough to believe in what we are doing, and pick a career accordingly. Why do people become nurse and paramedics rather than supermarket staff? Or do you look down on them, as well?
Err... with the why bother becoming a doctor instead of a nurse or a paramedic I was quoting Crippen...
I was offering an answer to his question. I think you've misinterpreted me, or I wasn't clear.
Yes, the market becomes saturated after a while, I will agree with you there - but it still stands that out of a medical student and classics student of the same calibre, the medic is going to find it easier to get a job.
anonymous at 9.53 - when in extremis, do you really want to be treated by a member of a 'weakened' and resentful profession? I would suggest that's a risky strategy. If, when I was a house officer, I'd been forced to commute two hours to get in at 7 am, let me suggest that my diagnostic faculties would be (unintentionally) a little slower, and my pick-up of your unusual but life threatening condition a little delayed. You might not be too pleased. What affects doctors affects patients - not ransom, just cause and effect.
Helen, I don't think anybody can still say "medicine" and "job security" in the same sentence following the MMC fiasco. AS for working abroad, our qualifications are not recognised in the US and much of the rest of the world, and even within the Commonwealth we are entitled only to two years before having to requalify in our specialty.
As for the creme de la creme - it's an exaggeration, but to be honest wouldn't you prefer that the profession at least tried to attract the creme de la creme? Surely otherwise everybody will suffer.
Well, I'd rather there was less focus on the creme de la creme because in my experience it often leads to people who go to become medics because it is seen as the creme de la creme rather than because they want to be a doctor. Admittedly a lot of these people will drop out, but a fair percentage stick to it, not because they want to help sick people but because they want the prestige of being a doctor.
I'm only judging this on my own experience, and I know the majority of medics become medics for all the right reasons. I'm not saying that they should let everyone into med school or lessen the restrictions in any way. But while medicine courses are awarded a higher status in people's minds than a maths or physics course, you'll still have the people going to study medicine for the prestige rather than because they really want to be a doctor.
Why aren't the medics striking? This is ridiculous. If everyone strikes-then either things have to change or the system collapses and they realise your worth while forking out millions to emergency locums.
Sorry, but if they don't organise and strike then they deserve what they get. Doctors need to be able to stand up for themselves before they can stand up for their patients effectively. I would not want to be treated by either a demoralised low paid doctor OR a cowering obedient at all costs one.
Get it together. Strike. Full withdrawal of all labour. No cover. No exceptions. Give adequate notice and just do it.
And don't come back until your conditions improve.
It's not so easy for medics to strike.
What happens to their patients while they're striking?
Let the classics students look after them...
Remember also that newly qualified doctors are not “average” students. They are la crème de la crème. How do other high-flying graduates fare? dr crippen
God you writing like an elitist snob .. i laughed when i read this .. but could nt read any further due to the tears in my eyes ..
anonymous 10:46, what are you trying to say?
i suppose you ll be arguing next that GP's are the creme de la creme too ...
haha you are too funny .. you missed your calling as a deadpan stand up comedian ...
haha
Ellie - out of the question for doctors, especially hospital doctors, to strike. Profoundly unethical because it's impossible to keep the patients safe. It was mooted - and quickly discarded - around MTAS time.
Helen, you're right about attracting the wrong people to medicine. I was one of them, but I've found my niche - a lot of people don't. Perhaps recruitment has to take motivation more carefully into account, but strigent academic criteria have got to stand, as you say.
I've ranted a lot tonight, but it comes down to this: we're decently intelligent, very highly motivated graduates who could earn a lot in the private sector and have knowingly chosen not to take that path because we enjoy/believe in our work. We don't expect equivalent money, but a little respect for that choice would go a long way. End of ranting.
verity, I agree with you entirely. I just wanted to point out (somewhat clumsily) that medics are not unique in this, and that they are in some ways better off than other intelligent and motivated people. That's not to say I don't think medics more than deserve a payrise.
I went to a junior doctors Q&A with the local BMA recruiting sergeant a few weeks ago. You know the sort of thing: bring us all your employment problems and we will promise to solve them after you have pad a small membership fee...
Anyhow, one of the housemen raised the loss of free a/c. He got very short shrift from the BMA guy, who asked why he was bothered, given that it wasn't going to affect him, but only the subsequent year's juniors!
With friends like that...
This is an unusually woolly post Crippen. I agree that junior doctors have been badly treated, with their wages falling spectacularly in the coming year. However, your case for improving their lot is weak.
Simply alluding to starting salaries in other industries and presuming they show injustice is no argument at all. Front office investment banking is far more competitive than medicine, with minimal job security. New hires work 80 hours per week or more, with little job security. Furthermore the calibre of people entering will be as high, if not higher than in medicine, although their salaries reflect all of the above (£36,000 base + 50-100% bonus +relocation allowance +sign on bonus).
Please lose the crème de la crème elitism, it simply isn’t true. Medics have been shoddily treated, but their job security is high compared to the private sector. Even if they don’t get a training post, they will get a non training post. Their earnings potential is also significantly better in the long run. Become a doctor because you have a certain altruism, but also because you’re savvy enough to know there will always be a market, especially as we will be inundated with coffin-dodgers, and all their expensive, life-prolonging treatments, as the population ages.
I don't know about free housing and I don't care. I am pleased now that we are training enough doctors and we no longer need fear being held ransom by them. Who would have thought that boosting numbers would have weakened the medical profession so quickly and dramatically?
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could the idiot who wrote that (or anyone else for that matter) give me one single example of British junior hospital doctors holding ANYONE to ransom?
John
Observations from someone who has worked in investment banking, management consulting and, latterly, medicine:
- There were some complete numpties at my medical school (a nice old one, not a new one for those who have an issue with these things.) Some of my fellow students were seriously lacking in brainpower, social skills, ethics etc. Good extra currics, though. At least 10-15% of them should never be let near a patient. Things may have changed since your day, Dr C.
- Not everyone can become a banker. Those who do have to have excelled on a good course at a good uni (so, the same grades as a medic plus you are graded which does happen these days but didn't used to), have good extra currics (like a medic) and then you only have a very small chance of being taken in the milk round (unlike a medic). So, the salaries given for I bankers represent what you can earn if you are the creme de la creme de la creme, if you will, and if you like such terms. Also, there's no EWT for bankers.
- Ditto management consulting. Very, very hard to get into. Ditto the EWT point.
- Law: ditto for the magic circle, as previously pointed out. Again, no EWT. Their hours would make your eyes bleed.
If the Tele and others are going to be so selective about the data the chose to use for their earning potentials, how about comparing a conveyancing solicitor with a cosmetic surgeon 15 years out?
That being said, the removal of accommodation is a terrible decision.
It most certainly is NOT unethical for doctors to strike, verity!
There have actually been articles published in medical journals about this. If the medical profession is being eroded and systematically destroyed and downgraded, then it is, far from being unethical to strike, it is unethical NOT to strike to prevent future illness, diability and death as a result of substandard care and services.
Furthermore, we have had two strikes in NZ this year already in an attempt to retain doctors here. The seniors all get together, back us up and provide cover while we strike. Hence the patients are in better hands during the strike then before! The main effect is cancellations of routine ops, clinics, and massive increased costs for the health service as a result of consultants covering at very high rates of pay as well as the costs of cancelled ops. It hits the management where it hurts-in the wallet!
For those who think the grass is greener in New Zealand... junior doctors here have had strikes due to low pay and the expiration of the multi employer collective agreement contract. Also, Home and Away and Neighbours are both Australian soap operas, they are not from NZ
Those in Management in the NHS thinks that they should be paid commercial rates and slipped in performance bonuses years ago when I was still working, so did those at the BBC now. All at the London Mayor’s office of Ken’s days sent themselves all round the world (what has that got to do with London) plus other things they do and now the mess with the C charge meant that the Porsche lawyers are claiming 400 K. No wonder everybody wants to be a lawyer. Failing that why bother to study medicine, just go into Management, even of the NHS. None of them stay in one place for longer than 5 years. They go in, cut, cut, cut to save some money, get the bonus and then leave: MRSA or otherwise.
Better still, be a management consultant, the greatest growth industry. Who hires them: government departments. A lot of true government spending is hidden this way.
Should the BMA not negotiate for doctors for what they might get in the outside world, outside of England? I suspect though that if all Hospital Consultants go completely private, the government had years of practice with the rhetoric of the Dental Service and could not care less. They have planned it as everything is devolved to the PCTs.
GPs and Hospital Consultants must indeed unite, so must everybody else at the service end in the health service.
The Cockroach Catcher
"professionals endure financial struggle post graduation shocka.."
anyone entering what is, in the long run, a well paid profession (law, medicine, accountancy, etc etc) gets shafted in their first few years training on the job.
Appreciate some medics find it hard, but suck it up, and in a few years you'll strike the proverbial gold.
The proof will be if there is a significant long term drop in applications to medical school from 2009 onwards. Betcha there won't be. Ditto application for LPC/BVC.
And to any medic planning on buggering of to NZ, reflect on how much your highly subsidised training has cost the UK taxpayer thusfar.
i would say that if you accept a subsidied place at medical school (i.e. don't pay the same fees as a non-EU student) then there should be a general rule that you should be required to work X number years for the NHS and hence taxpayer who funded most of your expensive studies.
ditto dentists who train on the cheap via the NHS then only do private work.
barristers don't complain they have to pay big money for their professional training then act as skivvys for a few years before hitting thr big money.
and to compare nurses starting salaries with medical salaries is, frankly, foolish. What is the salary of the average medic at 35 and the average nurse (not that medics don't deserve the higher pay of course).
it's as foolish as saying the secreatries/PAs at top law firms earn more than trainee solicitors, so young solicitors are being screwed.
dr crippen, you're ace, and your blog is too - but you're being less than objective here. How much should a recent med-school graduate be on?
"professionals endure financial struggle post graduation shocka.." anyone entering what is, in the long run, a well paid profession (law, medicine, accountancy, etc etc) gets shafted in their first few years training on the job.
[there is some truth in that; of course it is going to be hard in the early days; trainees lawyers have to work very hard but they are much better paid and they are not required to sleep in the office AND pay rent for so doing]
Appreciate some medics find it hard, but suck it up, and in a few years you'll strike the proverbial gold.
[Gold? Not really. Doctors staying in hospital medicine/surgery will not get to a consultant’s post until they are in their early thirties and will then get a salary roughly equal to that of a newly qualified 25 year old solicitor. GPs do better, quicker but then plateau – and in any case at the moment they are having so much shit thrown at them that most are dreaming of leaving. Yes their pay has gone up in the last three years, but over the last 15 years, averaged out, they have fallen behind]
The proof will be if there is a significant long term drop in applications to medical school from 2009 onwards.
[Agreed. Can’t fault that. I don’t know if there will be an overall fall. The vocational attraction of medicine is strong and few teenagers think of money when they are applying to university. BUT look at the percentage of newly qualified doctors who are leaving medicine altogether and compare it with 10 years ago. More importantly, look at the demographics. Something like 75% of the entry to medical school is female and, as they feed through, medicine will gradually become a part time profession ]
Betcha there won't be. Ditto application for LPC/BVC. And to any medic planning on buggering of to NZ, reflect on how much your highly subsidised training has cost the UK taxpayer thus far.
[That will not cut any ice at all. ALL students in this country are subsidised not just doctors and doctors come out with the largest loan debts. Why should they put up with being treated like shit? ]
i would say that if you accept a subsidied place at medical school (i.e. don't pay the same fees as a non-EU student) then there should be a general rule that you should be required to work X number years for the NHS and hence taxpayer who funded most of your expensive studies. ditto dentists who train on the cheap via the NHS then only do private work.
[You could do that, but it would have to be for ALL UK graduates. Why just doctors? But a tad Stalinist don’t you think? Don’t think Ms Chakrabati would approve!]
barristers don't complain they have to pay big money for their professional training then act as skivvys for a few years before hitting thr big money.
[with respect you are wrong there. Young barristers are having a bad time at the moment for reasons very similar to why young docs are having a bad time. Top down control and cost cutting ]
and to compare nurses starting salaries with medical salaries is, frankly, foolish.
[No it isn’t. Doctors need five years to train in a course that is far more intellectually demanding than a three year nursing course. You have to reward expertise ]
What is the salary of the average medic at 35 and the average nurse (not that medics don't deserve the higher pay of course). it's as foolish as saying the secreatries/PAs at top law firms earn more than trainee solicitors,
[They don’t! Trainee solicitors start on in top London firms start on £35 - £40 and two years later will be on the same as a consultant physician. The secretaries don’t come anywhere near. ]
so young solicitors are being screwed. dr crippen, you're ace, and your blog is too - but you're being less than objective here. How much should a recent med-school graduate be on?
Thanks for the kind words. I think a newly qualified houseman in London should be on about £35,000 with no deductions for the crappy accommodation
John
hey dr crippen,
thanks for comments on my post. I *am* a little stalinist in my attitude to NHS trained doctors buggering off to NZ. Agree it is not workable in practice, but I see a certain moral obligation to repay the society that subsidised the education. Do others see a moral obligation?
Yes, all degrees in UK are heavily subsidied - but medicine and dentistry more so than any other (presumably because the products of this education are so important). If you get a place at medical school - you're very, very fortunate and it seems wrong, somehow, to allow them to bugger of to Oz.
I bet if the rules changed (highly subsidised place, but you have to work off your debt for 5 years before hitting Bondi beach, or doing dental veneers for $$$$$$) they would still apply in their droves. Medicine is, and always will be a well-paid, challenging career attracting bright, well motivated kids.
I think London salaries (esp in professions) are always high, so it is probably worth considering what the lot of a trainee solicitor in the provinces is like too (pay for LPC out of own money, then skivvy for 2 years on ca. 20k?). London is perverted. Also, city jobs are nowhere near as secure as the NHS. GPs are pretty safe during credit crunches - corportate lawyers less so...
Don't think city lawyers on 40k get (real) protection from EWTD, and plenty of sleeping in the office there (without paying for it, I agree!)
In provincial law firms, the PAs are very likely to be on similar or greater money than the trainee solicitors.
so when you say
"So a newly qualified doctor thus earns little more than a nurse or a paramedic. Why bother to train as a doctor?"
i would say, because by the time they hit 'peak' years they will be on a lot more than the nurse or paramedic (and rightly so).
As to why bother? Medicine (and nursing too) are vocations. I think the government abuse that in many ways in order to control wages (interesting that nurses are always cast as 'angels' rather than professionals by the tabloid media. If i were a nurse, i'd find that an insult to my professionalism)
FWIW, fresh out of university, a medic (still being trained, of course) getting 30k to 35k inclusive of all allowances seems about right, taking into account dodgy shit patterns and general responsibilty. and, if hopsital accomm is availble then should be paid for at a fair price?
I think my point that all professions endure a couple of years of expense, hard work, and being crapped on from a great height, before acheiving very respectable salaries is valid.
keep up the good work - mean that seriously.
Hey annonymous at 10.53 am. You aren't Ben Brashaw are you? He seems to have it in for GPs too.
Well wisher
(I wish you were down a well)
Anonymous does make one point worth considering, however.
The increase in the number of medical school places and therefore trained doctors over recent years may well turn out to be very useful to HMG as part of a well tried political ploy. Potential unemployment does weaken the workforce, and makes them more docile. The Thatcher government knew this well, and used it, despite their pretence about their desire to reduce unemployment. One could almost suggest it was planned, but we are talking about Nulabour.
Here we go again.
Sad NHS supporter
What is the salary of the average medic at 35 and the average nurse (not that medics don't deserve the higher pay of course). it's as foolish as saying the secreatries/PAs at top law firms earn more than trainee solicitors,
[They don’t! Trainee solicitors start on in top London firms start on £35 - £40 and two years later will be on the same as a consultant physician. The secretaries don’t come anywhere near. ]
so young solicitors are being screwed. dr crippen, you're ace, and your blog is too - but you're being less than objective here. How much should a recent med-school graduate be on?
Thanks for the kind words. I think a newly qualified houseman in London should be on about £35,000 with no deductions for the crappy accommodation
++++++++
Dr C, I love your blog, but on this point you are, in my opinion, barking up the wrong tree.
You can't compare the average medic grad with the top 1% law grad which is what you do each time you use the starting salary at "top London" law firms as a comparator. This point has been made in several ways by several posters but you are yet to acknowledge this.
There are an awful lot of mediocre medical grads, each of whom gets one of the top 5 paying grad jobs.
Sadly, this low risk / reasonable return profile (along with all the good motivations of being a doc) is still encouraging a huge number of 17 yr olds to apply to medicine. The "poor" pay and lack of guaranteed career progression is surely not a secret anymore and yet year on year prospective med students queue up to throw themselves on the bonfire.
There is a large supply of UK and EU medical grads and this supply is not showing any signs of drying up, not with tuition fees, not with removal of accommodation, not with MMC screw ups... what will it take to stop the demand for med school places?
I suspect the market will have to sort this one out - perhaps when the F1 year becomes part of the degree course and is unpaid...
This point has been made in several ways by several posters but you are yet to acknowledge this.There are an awful lot of mediocre medical grads, each of whom gets one of the top 5 paying grad jobs. Sadly, this low risk / reasonable return profile (along with all the good motivations of being a doc) is still encouraging a huge number of 17 yr olds to apply to medicine. The "poor" pay and lack of guaranteed career progression is surely not a secret anymore and yet year on year prospective med students queue up to throw themselves on the bonfire. There is a large supply of UK and EU medical grads and this supply is not showing any signs of drying up, not with tuition fees, not with removal of accommodation, not with MMC screw ups... what will it take to stop the demand for med school places?I suspect the market will have to sort this one out - perhaps when the F1 year becomes part of the degree course and is unpaid...
++++++
I am not ignoring anything, but I can't answer each and every point. And, yes, I am generalising.
So, take five of the top London teaching hospitals, say, Guys, Kings, St Thomas', Barts and St Mary's
- the will get and can choose from the best of medical graduates.
Then take Allen & Ovary, Clifford Chance, Slaughter & May, Linklaters and Lovells (for sake of argument)
The starting salaries for housemen/women in all those hospitals will be about £21,500 (including the paltry London weighting) and before accommodation. After two years, in time of good behaviour, they may get onto a higher training rotation at one of those teaching hospitals, and their salaries will break into the £30,000 plus level.
Look now at their friends who are doing law in one of the top five London firms. They will have STARTED on £35 - £40,000 and will have numerous fringe benefits like BUPA, use of gym, fabulous air conditioned offices, secretarial and administrative support. They will have to work even harder than the doctors because for some reason EC working time directives don't apply to them. After two years, in time of good behaviour, they will be on £60,000 + and, by the time they are 30 they will have more than doubled that. They will have bought their flat on the river at 25 and will now be trading up to their houses in Islington.
The doctors meanwhile, will be commuting in from their pokey flats in Forest Hill, Tulse Hill and so on.
The differences are absurd.
++++++++
As to the SUPPLY of doctors, as I said above, idealistic vocationally motivated 18 year olds do not think about these sort of issues. But, again as I said above:
More newly qualified doctors are leaving the profession
More than 75% of the intake is female and most of them are looking at marriage and children and part time work (and don't come the sexist crap.. I know women don't all do that, but a lot do)
Interestingly, the CHILDREN of doctors who, 20 year ago, frequently went into medicine are much less likely to now having seen what their parents are putting up with.
No, I don't think all medical graduates are brilliant, of course not. BUT, the ones who are have no change of commanding anything like the earning power of their friends who do law.
It's a fact. It's not open to argument. The argument SHOULD be "what, if anything, do you want to do about it?"
John
Architectural graduates will start at around £15000 after 4/5 years study. Technicians start even lower. I'm 6 years out of uni and still below £20000. The only way to raise it - work for the council technical dept and join the union.
It's not just doctors.
Sarah
No, of course it is not just doctors. And I know architecture is tough, very tough, with no guarantees of progression at all.
But that doesn't justify shitting on doctors.
And you don't see doctors telling architects to "stop moaning" or saying "anyone can do your job - the builder's wife does a nice line in house design, or you can always give the quantity surveyor a pencil and ruler and he can draw a plan"; and you are not under attack from architect quacktitioners (are you?) - I hope you are not.
John
Could not agree more. We get the payment shaft, the debt shaft, and later on, the government reimbursement shaft (if you go private in America).
"It would be nice if someone would tell me how much we're going to be earning come August. Hopefully it'll be enough to start paying off the £35,000 I owe from the last 5 years."
Hi Little Medic. I can tell you that right now I'm an F1 and banded at 1B.
I don't pay accomodation, and make about £1800 after tax per month.
I have £110 deducted per month for student loan, and £165 per month goes to paying off my £7000 professional development loan.
My Student loan is circa £27000 (i took out full loan each year but was lucky enough to go to cambridge for my undergrad years which is both cheaper and more supportive to poorer students).
My student Loan interest is about £120 a month.
If you haven't done the maths that basically means that for the last year the monthly payments i make of my student loan are not even enough to cover the interest.
So don't be thinking about when you'll pay off your student loan little medic, because it is many many MANY years away.
Jamie
Its amusing how many people get offended and wound-up by the "creme de la creme" description of medical graduates. A description which when looked at objectively seems rather accurate.
Chip on shoulder or left-wing authoritarian/ communist perhaps?
One way to see that the situation is bad for the junior doctors in the UK, is that I hear a lot of my colleages say they hope their children don't want to become doctors.
Dr Crippen has pointed out the real problem in one of his replies. All the girls want to get a medical degree and from that moment on work part time. There should be no free accommodation for that class of medic. Doctors are working far fewer hours than ever before and still demanding pay rises! Grow some balls.
Here is a sexist article from Ireland which supports my comment: http://www.independent.ie/opinion/columnists/kevin-myers/feminism-in-medical-world-a-prescription-for-disaster-1429866.html
I can understand why some people get rattled about the 'creme de la creme' label for doctors. i suppose the question here is how you define 'creme de la creme'?
Because applications vastly outnumber places, medical schools take the easiest option to wheedle the application numbers down and use acedemic prowess as the standard marker. This, of course, means that only the academically best get offered a place at medical school. But academic intelligence does not make a good doctor. I know, I've worked with doctors who are academically brilliant, yet still very poor doctors. This way of deciding who gets into med school is, I suspect, the reason why often the wrong people end up becoming doctors. Is it time for a rethink of how medical school places are allocated? OK, so you need a level of academic intelligence that will enable you to cope with the workload and retain and understand the studies, but that can't be all that matters? How many perfectly good potential doctors are being turned away at the first hurdle because they don't have the traditionally acceptable education?
On the topic of wages: I strongly believe that medicine, along with nursing and most other health professions (by which I mean actual professions - SALT, OT, physio, paramedic, not NHS pen-pushing jobs) is a vocation. Medicine is a vocation that, stick with it long enough, will greatly financially reward it's graduates, unlike most other vocations. OK, so doctors graduate with more debts than other health professionals, and I do feel desperately sorry for them, but no more than I do for the new-graduate nurses and other health professionals (physios and OTs have been particularly hard-hit) who are also working in a saturated market and desperately competing for jobs and when they find one are earning a pittance.
How much are doctors worth in relation to nurses? I can understand why people (doctors are usually the first) argue that because of the longer study and higher level of academia doctors should rightly earn more than other health professionals, but fact remains that doctors would be unable to do their jobs without nurses.
Dr C,
Apologies: I wasn't intending to cast aspersions on your commitment to replying to comments. You do indeed make a large effort and address most issues raised... perhaps that is why it is noticeable when you do not!
However, the comparison with the magic circle firms remains shaky: they attract the best talent from around the world. So if you are to make a comparison, it should be with the best paying medical systems globally.
You also have to compensate corporate lawyers for doing such a deathly dull job that clearly fails the rocking chair test. As an ex-lawyer, you know that...Their hours are unbelievable too - they sit at the bottom of the financial food chain and carry the can for any mistakes.
Finally, Linklaters lawyers can get fired at the drop of a hat so the risk / return ratio for them is about right. It's a bit unreasonable to expect signficant job security and upper centile pay.
Even with the recent changes to the medic career structue, the employment rate is still way higher than for the majority of other professions.
I absolutely take your point on the rigid pay scale UK medics have to accept.
However, your fringe benefit comments are out of date: these days BUPA, etc are deducted from the gross numbers your quote. Plus, there's no cushty guaranteed benefits pension for lawyers. Finally, I would hope that medics get expedited access the medical care with nobs on. They did when I was in the UK and working in a London teaching hospital.
I have to say I never, ever, no matter HOW many times I hear it, understand the "you trained at the taxpayers expense so you must stay where you trained" argument.
I trained in Ireland. At the taxpayers expense, though I paid the hefty capitation fees like everyone for six years (med was a 6 year course when I did it). I then graduated. They forced me to work 36 hour shifts, 100 hours a week for too long. They denied me sick leave when I became ill from exhaustion. They treated me like garbage. I cracked. And left for NZ.
Thing is, during the three years I was in Ireland-I PAID TAXES! I paid about 20,000 euro a year in taxes. I put other people through college, funded their healthcare, funded their disability benefits, their dole payments etc. I don't expect to somehow claw it back from them. Why would I?
We have a socialised system that taxes everyone and uses it to provide public services and fund education. Everyone pays tax. Everyone who gets in gets a subsidised education. Everyone gets some kind of questionable free healthcare. This is what we agreed to do, and until the free marketeer libertarians rise up, demand a revolution and change this system, it will continue. I see no reason why I "owe" people something that it would wreck my life and health to provide just because we all take part in this system. I didn't want to leave. I'm homesick and I want to go home. But the conditions are such that I cannot work there, and hence would have no meaningful income to live on apart from locum work payments, which are no guarantee.
If they made the conditions better, the pay more reflective of the responsibility and workload, and maybe, just maybe, a parking space when you're on call, then ok. But I don't owe people who condone the kind of working hell on earth we endured anything. Least of all my career and working life.
People keep saying "oh, NZ has it's problems, it's not all wine and roses".
Ummm...okaaayy. It's pretty sweet. Ok, the pay seems a bit low to me, coming from being paid euro at a local rate, but we're paid more than quite a lot of others in the hospital, and no-one begrudges us. We work 12 day weeks when we're on at the weekend, it's true, and do 15 hour days regularly, but that's still a HELL of a lot better than 36 hour days where people ended up in car accidents driving home afterwards. We don't have free accommodation-but we don't need it as we're only on site for reasonable periods of time when we are supposed to be working, and they pay for my taxi home after a long day! The nurses help you and are nice to you and thank you for doing things, and everyone is lovely to everyone else. No resentment and no vendetta against doctors.
Come on down people! There's beautiful scenery, wineries, skiiing and snowboarding now, and fantastic summers! You can work flexibly if that is your wish, and be paid at relief rates! you may get homesick, but I guarantee your working life will be SWEEEEET.
Medical students are usually quite well prepared for the idea of spending crazy amounts of time in the hospital. Some of us actually want to (yes, even the female ones, we're not all looking to settle down and breed as soon as we've finished draining the taxpayer with our time at medical school). It's rewarding. We get experience, we learn how to spot signs, we get to follow patients for their whole stay in hospital. Our older colleagues appreciate the effort. The best scenario we've got to look forward to for our F1/F2 is that the EWTD is complied with, and that we can live somewhere affordable yet still somehow gather enough experience not to kill our patients later on. The reality is that the figures get diddled, the F1s & F2s still have to be there and pay for the hospital accommodation as well as the place out in the more affordable suburbs they've rented. I really, genuinely would have been happy to essentially live in the hospital for a couple of years with the free, slightly tatty hospital accommodation. What I'm not happy about is being conned. I will need to be in the hospital, I will need to pay for accommodation there (The F1/F2s who try to rely on public transport to get in from where they live when they're on early starts often seem to look sicker than the patients). It's not a great deal, but I'll go along with it. What hurts is the bureacrats pretending that it is a great deal.
how much do CPS solicitors get paid compared to city lawyers?
private sector wages always going to be higher.
NHS/public sector work has other benefits (job security, pension, defined career structure)
not a justification - statement of fact.
Maybe all the junior doctors could get jobs as physician assistants or medical care practitioners as apparently their starting salary is £22,500 - £32,000 after only 2-years of studying.
"NHS/public sector work has other benefits (job security, pension, defined career structure)"
Job security...if you dont care where in the country or what you are doing
Pension - the pension scheme has been cut back significantly now
Defined career structure...at the moment this is fluid at best.
VHey annonymous at 10.53 am. You aren't Ben Brashaw are you? He seems to have it in for GPs too.
Well wisher
(I wish you were down a well)
Wednesday, July 09, 2008 1:13:00 PM
No I was just pointing out to dr crippen what a pompous prat he sounded in his rant about med students / junior drs being the creme de la creme .. not saying he is a pompous prat just that what he writes is pompous and prattish .. at times ... and he sounds at times like a big snob with a superiority complex .. covering a big chip on his shoulder no doubt .... so i was being sardonic with my comments about GP's
Anonymous at 11.15:
A) Medics cannot (unless grossly negligent) be sacked with no notice, unlike those in the private sector. Unless you've wokred in banking or law, you won't have seen colleagues marched our of the office by security and packed into a cab with a bin bag of their belongings. At that point, you'll be making that ~500 a month you've earned more than your uni mate who is a HO last until you find another job. Even if grossly negligent, it takes a while to prove and suspension on full pay is typical. Also, there are few med grads who want to do medicine that are unemployed. They just don't have the job, prospects or the conditions that they wanted or expected. As I say, it's a low risk / medium return environment with regard to wages. True, it's not as good as it used to be.
2)"Pensions cut back significantly". Nonsense. If you've contributed to both guaranteed contributions and guaranteed benefit penions in your life, you'll know the difference. For my last private pension I was putting ~GBp8k a year in. If I were to do this until I was 65 I would have a retirement pension of ~20k pa (according to the people who were managing my fund). I was in the USS scheme many years ago putting 1.2k a year in (adjusted from 1995 to today's money)... at 65 I would have received 30k (in 1995 money plus a lump sum). If you're in public scheme, be it NHS or USS or whatever, and have never had to fend for yourself you have no idea of what it's like in the real world of pensions. Bear in mind I'm being devil's advocate here as someone with a medical career - if you don't concede the pensions point early, you will lose all credibility in a pay argument.
3) The career structure remains defined, but more challenging.
PJ, the physician assistant starting salary is also the stoppng salary.
In medicine, you have the potential to earn a lot of money.
Admittedly, this may not happen.
As an assistant, it will not happen.
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lionel, that may well be the case, but can you come up with any rational justification for starting people with half the training of junior doctors, but doing essentially the same job, on a higher salary? Sure their salary may not go up as much, but that is a pretty crap reason for starting them on a higher salary - any rational pay structure would just allow their pay to rise with experience.
I point out in my post that you would be able to employ a registrar doctor for what the more experienced physician assistants get paid.
Lionel,
Your comments were pretty much on target until last year.
Now it seems many doctors are not being "sacked" without notice...they know they won't have a job in august. I have a small but significant number of people i have worked with who have left medicine or the country due to lack of a job.
Job security? Well ok for those who make it, the cohort graduating in 2010 (i.e. the summer after next) will have the problem that there are more students than F1 places. No one will issue a statement saying these people will have a job even for one year when they graduate.
The career structure is not defined. I am on a post grad steering committee and have been since i was a medical student. Even there there is no idea if they will be keeping F2 after next year, if CT training will be 2 or 3 years, what will happen to those who don't get run through after two years in an FTSTA, there are the first lot of 100 people with Post CCT placements starting soon.
Some Surgical ST posts have been extended due to the new system turing out people (who have less years with less hours) required more experience before the surgical college would deem them "trained".
GP training is being extended by two years.
We don't know if there will be any run through training in the future or if not where the break will be for competition.
The future is hazy and to think it is "defined" is just not the case.
As for pay, i don't care about "how much i will earn in the future". It's bollocks, i want to be able to live now...what happens if in the future with extra competition wages decrease significantly...do i have any gaureentee of earnign more in the future? No, thus i want a living wage now. I have many years of debt a head of me, and i have already posted on people who have posted their worries about having all unbanded jobs, having to now pay £500/pm hospital accom and bank loans having outgoings higher than wages. This is before they feed themselves.
I am pretty sure we would take the risk of lower wages in the future to get a decent one now.
FP - concede that things are changing. For the worse.
Do not concede many of your points particularly on notice:
Your friends who know they won't have a job in August do indeed have notice - at least three weeks as of today. No notice is just that: there's your stuff in a box, give me your pass and get out.
There is still structure. The details are indeed uncertain, as you point out, and there is now competition for places. Medical careers in the UK are now like other career, which is not the best outcome if you're a medic. The government looked to break the closed shop and they have by increase supply to daft levels.
Of course you care about what's happening now. The accommodation change is mean spirited in the extreme and you have my sympathy. But of course you should care about what you earn in the future,or you should. There is no cap on how far you can go in the medical profession which is one of it's attractions - that is not the same for other practitioners (although nurses are catching up on the bureaucracy side). Otherwise you may as well as done as many of my school friends did and leave school at 15 to work and earn what was then a decent wage... it's just that they're still earning the same wage today many years later.
Dr. Crippen, you describe educational debt of UK physicians.
I thought education was free in your country. Apparently I'm wrong.
What does undergraduate and graduate education cost in your neck of the woods?
...........arf
Hi Arf
Currently, fees for UK students are £3125 a year, I think.
Then you have to live and eat, buy books etc.
Thats £8 - 10,000 a year, I guess. X5 for a medical student.
It's all new to us. You guys are used to it. But in the UK as yet parents have not been saving for their children's university education since birth. They will be now, if they can afford it. If not, medics will start professional life with a £30,000 debt
This is Tony Blair's new labour. Just as the previous labour governments made decent secondary education something only the children of the well of could afford, now they have started the same process with universities. Bang goes social mobility. That's socialism in action for you
John
Arf and Dr C.
MEdical students only pay fees for the first 2 years.
They then get them paid for by the NHS bursary scheme.
However, books living expenses and travel for medical students is a bigger burden than for almost any other group of students. Average EWnglish medical student debt now tops £30K ($60K). Thats for those doing undergrad medicine, it seems to be about 10-15 K more for those on graduate entry medicine.
FP,
Really?? I and my peers in my year paid fees for 4 years before the NHS Bursary bailed me out
Really?
I honestly was under the impression you got 3 years paid for like we on the GEP did.
SO for us we pay the first year then get fees paid for the following 3 years i thought you paid for 2 years then got 3 years paid for.
12.5K extra in fees would have crippled me.
Government schemes (subsidized school loans) make things worse. Tuition skyrockets in price. Colleges do not compete on price.
At the same time, the colleges sit on unbelievably large endowments. Harvard has more money than a small country. The income on their endowment could pay the tuition for all their students, undergraduate and graduate, and still have more than enough for improvements.
The worst, but hardly the only example. The schools collude on financial aid packages so there is no way to shop for price, a student with multiple college acceptances will find the aid packages all the same. They don't compete on price. There was litigation over this a few years ago which put a dent in the practice, though it wasn't eliminated.
Some of the schools are starting to open up their financial aid packages, because politicians (both parties by the way), have made noise about removing their tax-exempt status if they don't.
Since they don't compete on price, they compete on amenities. Unfortunately, not necessarily academic amenities. Palaces. Nice to be a student there, but when you come out with a quarter-million-dollar debt, you may find your career options limited.
If you attended a private university and a private medical school, all on loans, and you did postgraduate training and let your debt interest grow while in training, you could find yourself with that much debt.
I only had forty grand debt in the 1980's. State university and a full merit scholarship, so only medical school debt for me. I considered myself lucky.
.......arf
I was lucky & trained such a long time ago that I actually got a grant! As a result of being so old I am now a consultant anaesthetist in NZ. To answer the points about the grass being greener here I think it is certainly a more pleasant environment than working in the NHS. However, if we are talking money, in the long term you are better off in the UK, I earn half what I was on a couple of years ago in a similar position in the UK a couple of years ago. You are a junor doctor for approx 10 years & a senior one for approx 20.
Also, I am now a part-timer because of being one of those sell outs who has the audacity to have a life outside medicine. Doing this as a consultant in my speciality is relatively easy but as a junior is much, mich more difficult than in the UK. You also end up much poorer as paid mat leave is 6 weeks rather than the generous 6 months in the NHS (I have done both!).
Incidentally all of our juniors & a large number of seniors are off to Australia - much more lucrative than here - so lots of jobs here!!
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