Yes, it is about the money, and why not?
In yesterday’s Independent, Mary Dejevsky accused junior doctors of displaying ‘a hugely inflated sense of entitlement’ in arguing for the right to strike over a new contract of employment. Here, four doctors respond…
For junior doctors (up to the age of 35 on average) the NHS is a single-monopoly employer. Australia offers three times the salary, lower living costs and, crucially, equivalent training to consultant level that is recognised in the UK. Excellent weekend services are provided and doctors are paid a premium to provide them. It is a nobrainer: live in the sun for 10 years, save some money, finish your training (and perhaps a PhD) and come back to the UK as a well-qualified consultant with enough cash to buy a house. Or just stay and enjoy three times the salary as a consultant. Ditto Canada and Singapore.
Meanwhile, the NHS has to pay expensive locum rates to fill the gaps, and the rewards of investment in training are reaped by another country. Junior doctors’ pay has fallen in real terms by 25 per cent since 2009, so this had already started to happen before Jeremy Hunt’s imposed contract. At the other end of the profession, the removal of final salary pensions (despite generating a surplus to their pension fund) means GPs and consultants are taking early retirement and then hiring their services back to CCGs [clinical commissioning groups] and trusts at inflated locum rates.
It is indeed all about the money, and yes, they are entitled: the job is complex, highly skilled and there are grave consequences for error. Of course it’s about money. Are you telling me my services as a doctor are worth 40 per cent less than I’m being paid, and that I should be working significantly more hours? It’s all good and well to claim that doctors should work for the principle of doing good, but are you suggesting we shouldn’t be remunerated for our compassion and hard work? For having to make impossible decisions any time of day or night, and still bring a smile and fresh mind to our next patient?
You speak as if working 90 hours a week is something every person in the country does. When divided by the actual hours a week I work, my salary barely comes above the minimum wage.
The fact is, if you pay peanuts you’ll get monkeys. And when you treat highly trained, professional people as monkeys, they have a right to stand up and remind you just how far
from the zoo they really are. Yes, Mary Dejevsky, it is sometimes about the money. As doctors we are not expecting bankers’ salaries or anything similar to those in the private sector. What I do expect after eight years in the NHS at 32 years old is to be earning more than a manager of a fast-food chain.
Why should doctors not just work for the job satisfaction, you say? Because we are human beings too, who have lives, mortgages, families. I invite you, Mary, to come and join me on a 13-hour labour ward shift where there is often no time to eat, drink or pass urine. Where your actions can have implications on the outcome of a birth for a mother and a baby. Once you have done that you can tell me if I am worth my £47,000. By the way, that is the whole pay with the extra hours. A junior doctor is a term that’s poorly understood. A junior doctor is anyone who has completed a medical degree but is not yet a consultant. The Centre forWorkforce Intelligence says it takes a median 15 years from finishing medical school to become a consultant.
Among the issues exercising junior doctors are the change of hours and the way they are remunerated. Currently, “plain time” is 7am to 7pm, Monday and Friday. Any hours a junior doctor is rostered to work beyond 7pm on a weekday, and any hours on a weekend, are paid at a small premium. This is anything from 20 per cent to 50 per cent of the plain time rate depending on the intensity of the workload. The new contract stipulates that plain time will now extend to Saturday and from 7am to 10pm. This means an extra 30 hours a week will be considered plain time, rather than unsocial hours. I do not agree that working beyond 7pm on Monday to Friday and also on a Saturday (all day) is plain time.
These are unsocial hours and should be remunerated as such. No doctor is unwilling to work these hours – but we often have to sacrifice much of our personal lives for our job and there should be some level of recognition for this. Junior doctors often have to work 12 days in a row, and some will be 12-hour shifts.
In 2003, the Government sought to accelerate junior doctor training by creating a more structured programme; it also agreed to the EWTD [European Working Time Directive] to reduce working hours to a maximum of 48 hours by 2009. To ensure this would happen, NHS Trusts faced financial penalties for introducing unsafe working rotas and were required to pay doctors overtime.
The new contract removes many of the contractual safeguards protecting junior doctors from working excessive hours. For instance, junior doctors are entitled to one 30-minute break for every four hours they work, but the new contract stipulates that doctors will only be entitled to one 20-minute break in a shift of up to 11 hours. Jeremy Hunt is right to say he wants to ensure there are fewer deaths in hospital, but a tired, hungry and demoralised doctor is hardly the correct prescription.
Changes to the pay progression rules will penalise doctors who are taking time out of their regular training to contribute to research in medicine, carry out humanitarian work or have a family. Creating disincentives for taking time out of training risks undermining the potential to create the clinical leaders of tomorrow.
We are keen to return to negotiations. However, junior doctors agree with the BMA that we need concrete assurances before this can happen. These include the following:
Proper recognition of unsocial hours as premium time;
No disadvantage for those working antisocial hours compared with today’s system;
No disadvantage for those working less than full-time and taking parental leave/ research time compared with the current system; Pay for all work done
Proper hours safeguards to protect patients and their doctors.
There is also a risk that these changes could drive younger doctors to seek more favourable working conditions in Australia and Canada. About one in four of my junior trainees have made such a decision.
This dispute is not solely about remuneration. This proposed contract has real potential to create an unsafe working environment for doctors, the wider healthcare team and patients.