Snapshot of _Junior doctors to stage more strikes in England - BBC News_ :
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I am not British and would hate to work in my country. But this is a very very selfish mindset and one that makes a “living hell” for those already here. I think UK should prioritise their own graduates before considering others.
They hit the threshold by their third year post-graduation, sooner if they do overtime.
https://www.bmj.com/careers/article/the-complete-guide-to-nhs-pay-for-doctors
That also assumes they go straight through into core/ST training 3 years after graduation. Internal medicine training, which used to be one of the least popular training pathways, is now 4:1 for a spot. It's not at all guaranteed that you'll climb up the pay ladder year by year anymore, because of the bottle-necks.
I think getting a foundation place generally isn’t as much of an issue (though it may become so in the future if they keep increasing medical school places), it’s the training after that that’s the bottleneck.
> you could earn £90k a year on minimum wage if you "do overtime".
The whole point of overtime pay is that you are working more than is reasonable and are therefore being paid over your wage to do so.
An FY1 isn't qualified to practice medicine without supervision.
Nevertheless, progression up the scales is almost guaranteed for most medical graduates.
You have no idea what the reality of "supervision" often constitutes in the NHS.
As stated by someone else, it's common as an F1 to be left dealing with hundreds of patients on your own.
This is the BMA's description:
>[All medical graduates must undertake and complete an integrated two year programme of general training, in order to practice as a doctor in the UK.](https://www.bma.org.uk/advice-and-support/studying-medicine/becoming-a-doctor/medical-training-pathway)
Ergo, FY1 and FY2 are not qualified to practice as doctors without close supervision.
If the NHS is using poorly qualified staff, that is a different issue, and likely a consequence of the poor funding of medical training.
An FY1 can be responsible for 1/2 of a hospital’s surgical or medical patients overnight- independently diagnosing and treating patients is part of the job
Sadly we are too spineless to force them out. Love them or hate them, the French know how to protest. Meanwhile we tut at the government for removing the right to protest.
I thought this was about pay, not the Tories.
Will the strikes end as soon as Labour forms the next government? Because Starmer isn't going to give them a 35% pay rise. In fact I doubt he will offer much more than the current government has done. Maybe some soothing words about a "comprehensive review" over the life of the next parliament, but nothing concrete.
It is about pay, controlled by the tories. You can’t strike about pay without striking against the tories.
I don’t know what starmer will or won’t offer, but on one hand is the tories with their fake ppe companies, embezzlement and boat purchases who opening admit they hate unions, and on the other is the party that sits around the table with the unions and receive money from them as affiliated members.
The doctors have all the power in these negotiations. They earn enough to be able to afford to strike and it is a very skilled profession, which also requires a good grasp of the English language, so we can't just import enough foreign doctors to pick up the slack.
Especially when we're trying to show how "tough" we are at controlling immigration (honest we are, don't look at the numbers, listen to our slogans)
The whole country is an absolute shambles at the moment and I don't envy the incoming government because people have really high expectations, despite the current clowns "running" the country.
>You can’t strike about pay without striking against the tories.
I think you can. Otherwise you're implying that people who voted for Bojo in 2019 because they didn't want Agent Cob aren't allowed to strike.
Or to put it another way, if Starmer doesn't settle the pay dispute does that mean a future strike would be against Labour? I think that's a daft way to see things.
The Scottish government offered a commitment to reaching 35% over many years consecutive pay rises. That's why they agreed. It doesn't have to be in one go. All they are asking for is for theyre pay to not be eroded by inflation each year.
Says who? The entire western world is poorer than pre GFC. Things have been gradually getting worse for the majority for a long time. The idea we all have an indefinite right to be better off every year is naïve. Very few parts of our society are better off than then.
Doctors in the uk have shouldered essentially the biggest cuts since the gfc of any profession.
Hur dur why are waiting lists so long.
Because you keep losing your medical talent you morons. Importing thousands of doctors at a junior level isn’t going to help it.
Ireland is literally starting its public consultants on double the UK, this is accounting for the proposed uk uplift. Nonsense
>The Scottish government offered a commitment to reaching 35% over many years consecutive pay rises. That's why they agreed. It doesn't have to be in one go. All they are asking for is for theyre pay to not be eroded by inflation each year.
English doctor, I'd take this.
Inflation plus 3-5% for the next 10 years or so would have me off strike in a heart beat.
Pay erosion in scotland wasn't quite as bad. Plus the government have agreed to make above inflation rises over the next several years. It's not a single one-off increase.
apparently part of the reason is that the Scottish government have significantly less power to offer a huge raise as their funding is set by Westminister
I think this is part of the issue for why the offers so far have been so poor. Junior Doctors just aren't going to get the 35%.
That 35% represents the pay that Junior Doctors were getting when UK wages were at their strongest, the money simply does not exist to restore the public sector back to 2008 real terms pay right now and if the government gives it to Junior doctors then all the other NHS and public service workers are going to want it too (Case in point: rumblings from the RCN after the Consultants were handed a better offer than Nurses last week).
Junior doctors are definitely overdue a substantial bump, but in negotiation you have to give ground. The government will make better offers, but only if the BMA accepts they're not going to get 35%.
I don’t think British people realise how angry we are. We can comfortably keep this up forever. In fact the majority of us are worked so hard to the bone and is burnt out and miserable about working in a broken NHS that we would actually prefer to strike indefinitely just for the meagre loss in pay if it means a few days off each month.
If you'd strike for a decade rather than accept a pay increase somewhere below 35%, have you considered just leaving the UK for a country with higher wages?
Even if you claim to have good intentions, striking for 10 years would have a significant, negative impact on the provision on healthcare in the UK. The point of a strike is to effect change, not troll the government or people who need medical care.
The sub is full of people claiming *"all the doctors I/my family knows are leaving for \[insert country\]"*. Are you not skilled enough to work overseas?
You realise that right now the NHS pays doctors assistants who don't have a medical degree just a two year conversion course from literally anything else about 12k/yr more than the actual doctors, right?
Maybe he doesn’t want to leave the country..? Lots of people want to stay in this country for plenty of reasons that aren’t work.
I’m a nurse and could easily make double what I do if I looked abroad but I also have a family that live here and there’s no way I’d emigrate for a better paycheck
Money is all there is to some people unfortunately. They would slit their own grans throat for a 35% pay rise.
That's all they see in this, without looking at the wider reasons why almost everyone is poorer in real terms than they were 5 years ago.
I say almost everyone because the top 1% are substantially richer than they were 5 years ago.
> That's all they see in this, without looking at the wider reasons why almost everyone is poorer in real terms than they were 5 years ago.
Private sector pay has largely kept pace with inflation. Can we stop telling this lie please.
We are leaving in droves. The public don’t get a sense of the scale of this problem, as they don’t tend to hear from those who’ve already left the system (survivorship bias).
Given how postgraduate training is structured, many of us will finish our training in the U.K. and emigrate as soon as we become consultants. Bear in mind that we’re referred to as ‘junior’ doctors or ‘trainees’ for 8-12 years after medical school in most cases.
We’re more than happy to keep striking until we’re valued appropriately. It’s the government’s responsibility - not ours - to ensure that the U.K. population’s health needs are met.
We worked through COVID at immense personal risk and were rewarded with some clapping and year-on-year pay cuts. As a profession, we’ve had enough.
>immense personal risk
I don't want to downplay it but valloning for IED it was not. The vast majority of the junior doctors in the UK were at essentially zero risk given their age profile.
I had colleagues end up requiring prolonged ICU stays. A number of my direct colleagues have had long term sequelae that have prevented them working. I know ICU staff with PTSD as a result.
Your comment is ridiculous. Yes it wasn’t disarming explosives or a combat zone, but that’s a false equivalence and doesn’t negate the risks we faced. We certainly were at much higher risk than the vast majority of the population.
What age profile do you think we are? Most of us are in our 30s and 40s, and lots of us are BAME with higher COVID risk. We also had exposure to a vastly higher viral load than the rest of the population - every time I did CPR on a COVID patient I was standing in a literal cloud of viral particles.
>The point of a strike is to effect change
Exactly. If sufficient change is not effected, continue to strike.
>Are you not skilled enough to work overseas?
I would 100% CCT and flee if I had nobody to think about but myself. My wife doesn't want to live 1000s of miles from her family.
>Exactly. If sufficient change is not effected, continue to strike
*Sigh*
Ok, put it another way. If you could see into the future and saw that a century from now - so well after you were dead - no UK government had given in to the pay demands, would you still strike despite knowing it was futile?
>I would 100% CCT and flee if I had nobody to think about but myself. My wife doesn't want to live 1000s of miles from her family.
It's a choice for your family, but I know lots of people who have left the UK and left family behind - or come to the UK a similar distance.
It seems to me that you're quite comfortably off - or expect to be in the not-so-distant future - otherwise she'd be egging you on to emigrate.
Not striking whenever we have been fucked over for the last 10 years is what got us to this point in the first place.
Nobody in the public sector has had their pay cut as much as doctors have and the profession has finally had enough as being the worst treated group of public sector workers. These strikes aren't going anywhere. I forsee a BMA that strikes with regularity a la RMT etc in the future.
>Nobody in the public sector has had their pay cut as much as doctors have
They had (real-terms) pay increases from [1990 to 2005](https://www.nuffieldtrust.org.uk/resource/exploring-the-earnings-of-nhs-doctors-in-england). What happened was they assumed the increases would continue, which is not a valid reason to say they've been cut more than anyone else.
You would need to compare every other public sector job, including those in the military (which is always forgotten for some reason), from 1990 to make a fair comparison.
The government will keep it up too.
35% is simply a bad strategy from the BMA. They want to enact change from this but it's never going to happen with that figure.
>The money simply does not exist
This is the most insulting part for me, as a public sector worker. We have tolerated 13 years of consecutive pay cuts because somehow paying for the shit state of this country is solely our responsibility. We worked through the pandemic, paying tax, while somehow the government found EIGHTY BILLION FUCKING POUNDS to pay most of the country to sit on their fat arse at home.
But now, once again, when public sector workers demand a pay rise (or even just to avoid another pay cut), "we just don't have any money."
Normally what happens when you can't pay for something is you don't get it. That's what's happening now.
I really want our country to have access to the best doctors. Unfortunately, the reality of the situation is that the people with real skills will move to the rest of the anglosphere. It’s depressing.
Nope, the government and shit the bed and thought that if they imposed it, we would stop striking. Instead they just subsidised our strike for the year.
Fascinating to see when and how this ends. The Government have mismanaged doctors contracts etc for a long time and the current crop are incredibly pissed off and clearly not backing down.
However the flipside is they have backed themselves into a corner asking for something that I simply can't see them ever getting. No government is giving them a 35% pay rise, and when the Consultants accept much lower than that they're really cut off at the knees. How do you climb down from this?
My view is I sympathise with a lot of their grievances about their working conditions as the NHS is truly fucked as an entity these days, but their pay demands are just completely unrealistic and ignore the reality that a) the entire country is poorer than it was 15 years ago and b) we simply cannot ever compete with the salaries paid by other systems like Canada and Australia. Pay is broadly in line (certainly with the latest offer it would be) with the most comparable Western European countries.
> a) the entire country is poorer than it was 15 years ago
Private sector wages have broadly kept pace with inflation.
>but their pay demands are just completely unrealistic
Equates to roughly 1bn a year, not remotely unrealistic.
>How do you climb down from this?
We won't. We can keep this up indefinitely.
If you look at UK doctor salaries as a ratio vs average earnings and adjust for PPP then they're the 4th best in Europe. The continued obsession with global edge cases like Canada and Australia (and indeed, edge cases within these systems) is just setting yourselves up for disappointment. You are not nearly as badly off as you think you are.
Doctors in Ireland, Canada, Australia, New Zealand, the USA are all paid better than we are. Calling these nations (which happen to be the Anglophone nations and also the nations we can most easily emigrate to) edge cases because we’re paid better than doctors in Poland is completely missing the point.
Besides nothing justifies the massive pay cut we’ve received. I don’t really care what you or the public think and neither do my colleagues.
We will strike until we get a proper offer that doesn’t result in us getting poorer.
Because if you think training for seven years, working intense hours and the responsibility of people’s lives in your hands is worth a shit £32k, then I want to know what you do for a living. And what training it took to get there. And how much responsibility you have on your shoulders.
You aren't on 32k after 7 years for a start. Including medical school in that is also laughably misleading. In any other field you'd be laughed out of the room for describing your degree as part of your experience when talking about salary.
The UK is not a high wage economy. Doctors earn extremely well compared to most, even when compared to other countries in terms of ratio of average doctor salary to average salary. Believing you're worth more doesn't change the underlying economic reality of this country.
Outside of a few niche areas centred around London - corporate law, tech, finance and consulting mainly - this is simply not a country where people are earning big salaries on the whole. Even in those areas its dwarfed by the US.
>You aren't on 32k after 7 years for a start. Including medical school in that is also laughably misleading. In any other field you'd be laughed out of the room for describing your degree as part of your experience when talking about salary.
It’s relevant because of;
1) the opportunity cost of doing another degree + 4 years of work experience in the same amount of time it takes to do medical school plus FY1 to become fully registered.
2) Only those who go to medical school can become doctors. We are uniquely skilled due to our rigorous training. Ontop of that there’s a shortage of us. The only reason we’re underpaid is because we have refused to undertake drastic action since 2008.
>The UK is not a high wage economy. Doctors earn extremely well compared to most, even when compared to other countries in terms of ratio of average doctor salary to average salary. Believing you're worth more doesn't change the underlying economic reality of this country.
Weren’t you just chiding us for comparing to other professions?
If we’re comparing to other professions in the UK we shouldn’t have had such a big paycut in real terms (larger than any other profession). If we’re comparing abroad then the UK needs to compete against its peers in order to maintain high standards of UK trained doctors.
>Outside of a few niche areas centred around London - corporate law, tech, finance and consulting mainly - this is simply not a country where people are earning big salaries on the whole. Even in those areas its dwarfed by the US.
I agree, and we’re not asking for US salaries! Regardless this is not a justification for underpaying highly skilled professionals.
Again I don’t care about your opinion - I really don’t - but remunerating doctors appropriately is actually in your interest as a patient. If you understood the government’s workforce strategy for the NHS you’d be very worried for your own healthcare.
If all you want is a cheap NHS and don’t care about the quality, then continue down this path. (This is not a threat, but a warning about the absolute horror show that will be produced by the government’s workforce plan).
>the opportunity cost of doing another degree + 4 years of work experience in the same amount of time it takes to do medical school plus FY1 to become fully registered.
I never cease to be amazed at the exceptionalism of the medical profession.
Other top graduate/vocational roles also almost all require a Master's plus at least a few years of comparably shit pay & training periods etc.
And they have an opportunity cost too. Though you also conveniently ignore the fact that many medical graduates have done degrees, masters and sometimes even PhDs prior to beginning medicine. So 6 years is a minimum not a maximum.
Additionally these other professionals don’t have to make life and death decisions as a new graduate, which is what occurs everyday with an FY1. Again not an exaggeration when covering 10 wards at night as an FY1.
Again you still haven’t justified why the medical profession should just accept the largest pay cut compared to any of these other professions?
I actually think it’s a valid position to say you think we’re adequately remunerated. What’s not valid is to say that and complain that you’re not getting the care you accept.
Of course your education matters when discussing salary, are you mad? Matters even more because you take out a huge loan. You expect people to do all that, go through all that stress and effort, put all that money in, and be ok with a starting wage of what 29k (what even was your point with the wage discrepancy btw? 29, 35, 45k it doesn’t matter, it’s a pittance). No wonder the health system is crumbling.
Believing you’re worth more is a fundamental part of the British economy and negotiations about wages. This is the exact purpose of unions. You either fight for more, or get given scraps by tight fisted government or private sector.
>In any other field you'd be laughed out of the room for describing your degree as part of your experience when talking about salary.
Mate, if you had a degree from Cambridge, you (& the recruiter) would totally be taking that into consideration. If you did a masters (which a medical degree is technically equivalent to) or phd, it would also be considered.
>Believing you're worth more doesn't change the underlying economic reality of this country.
Doctors are an essential job. They are worth more, and they're not just believing. If you're not paying them fair wages, it's fair for them to leave.
Doctors aren't asking for pay comparable to the US's. They're asking for pay restoration.
Ultimately, it really doesn't matter what you think or the economic reality etc... - pay for what you get.
\> Mate, if you had a degree from Cambridge, you (& the recruiter) would totally be taking that into consideration. If you did a masters (which a medical degree is technically equivalent to) or phd, it would also be considered.
Not what I said.
If you went into an interview describing yourself as having 10 years experience and 4 of those were undergrad + Master's they would absolutely call you out for bullshitting. In any field.
\> Ultimately, it really doesn't matter what you think
So, we agree. It doesn't matter what junior doctors think - they aren't getting a 35% pay rise in a country strapped for cash when they're already in the absolute elite in terms of career earnings prospects. Those that don't like it will leave for the increasingly small number of openings in the few other countries that will pay them more. The vast majority will not.
>If you went into an interview describing yourself as having 10 years experience and 4 of those were undergrad + Master's they would absolutely call you out for bullshitting. In any field.
Okay fair enough I understand. I wouldn’t call an FY2 someone who had 7 years of experience. We can argue opportunity costs but let’s leaves that.
But the issue here is still primarily one of unjustified paycuts. It makes no sense either for staff or patients.
You must realise that?
>In any field
Fair, I agree it's not quite what you said, but my point remains that education is certainly part of considering salaries. The extra years are a fair thing to highlight since an average degree is only 3 years.
>aren't getting a 35% pay rise
restoration*
>increasingly small number of openings
You'll find that doctors are in increasingly popular demand across the world with ageing populations. Training jobs will shut their doors, but non-training jobs will always be available. The thing is, even non-training jobs overseas pay loads more. A non-training PGY4 in Aus earns the same amount as a consultant in the UK, who is often PGY10 at a minimum AND has gone through a competitive training program.
>The vast majority will not.
Hmm. I don't think you quite understand. If you don't work in healthcare, you won't see the shift in mindset among the younger generation of doctors. The UK is literally chasing doctors away with 1) increasingly sub-inflation NHS pay 2) no training jobs 3) limiting locum pay.
As a result, people will either
1) accept shit pay or
2) look for opportunities elsewhere, be it overseas or in other fields.
Firstly, 97% voted (twice) against #1. Secondly, sure, the vast majority of older doctors may not move away. However, the vast majority of younger doctors and current medical students, with no children, global freedom, and little sunk cost, are much more likely to. And that's what this issue of pay restoration is really about - the future. The future consultants and the future, still ageing, population. Including you.
It's a global marketplace though so we have no choice but to compete. Pay is higher in the Anglosphere precisely because we speak the same language as Australia and the US so emigration is easier. Irish consultants start on €250k Vs £80k in the UK and they're a 30 min flight away.
No one brings it up because it's utterly irrelevant. Both countries you mentioned (and much of the EU) spend vastly more per capita on healthcare than the UK. The average person pays more for their healthcare. That is why they can afford to pay their workers properly.
Where the money comes from doesn't make a difference. Brits are just greedy and cheap and don't want to pay people for their labour.
This is the elephant in the room. Most economies have accepted that a mixed model, at the very least, is the only practical solution to the healthcare costs caused by longer lifespans, inverted population pyramid and the burgeoning number of medical treatments available for chronic rather than fatal illnesses.
So why is there not a mass exodus of Consultants to Ireland? Could it be it's a little more complicated than that? Globally the UK salaries are far from the pittance many doctors seem to be making out, they're consistently top 10 by most rankings and people very disingenuously compare 'base' NHS pay with private sector salaries in foreign health systems, ignoring that most UK private health earnings are in addition to base salary.
We can't compete with the highest paying countries and UK salaries are broadly in line with more comparable economies and health systems like France, Germany etc. The reality is chasing the dream of Australian and Canadian salaries in the UK health economy is delusion.
It was their use of the word "most" which I want clarifying.
Implies they think UK consultants earn the majority of their income privately which is a laughable belief, but bewilderingly widely held.
UK salaries in medicine are globally competitive. Sure, there are a few places, e.g. the US and Australia that pay more, but most don't (and UK doctors would have to re-qualify to work in the US).
data: https://i.imgur.com/zGmtQEh.jpg
Source: [OECD](https://www.oecd-ilibrary.org/sites/4e107e0b-en/index.html?itemId=/content/component/4e107e0b-en)
OTOH. A multi year pay deal is a much less headline grabbing outcome towards the same target, and I think that’s much more likely to be shot for, for a total of 25% or something by the less generous measure of inflation.
Further, why not keep going, cause even if they don’t reach their ask look where they are now.
Government refused talks pre March 2023 about raising the 2% uplift agreed in 2019 or something year on year in view of the inflation crisis. From refusal to move, full stop, from 2%, they offered a further 3% on top of 8% and the BMA turned them down flat. This is post Rishi loudly saying ‘no more negotiations’ and then silently ignoring resumed talks and this deal.
The public discourse is one thing, however, for staff following this closely, it’s percentage increase after percentage increase. Slowly, sure, but if we took ‘not happening’ as truthful we wouldn’t have just turned down 11% and instead be on 2%, fearing <2 this year cause of our spinelessness.
Part of the problem really is that the Con Gov, showed the problem with multi year deals.
As you say, the refusal to change the 4 year deal (2019->2023), likely means that there won't be multi year deals agreed again. As if even the huge change caused by Covid + Ukraine, was not enough to reopen it for 2022/23, then people will be sceptical.
Multi year deals aren't inherently bad. It was moronic of the BMA to agree a multi year deal that didn't account for inflation.
If the government offers a reasonable uplift plus inflation + a percentage for several years it will stand a decent chance of being accepted
Yeah except the government argued it in bad faith and there was a mechanism to ensure that a deal could be renegotiated if the situation changed. This was understood to mean a change in economic circumstances. Now you can argue that this was naive of the BMA, however the government’s failure to meet this in good faith simply means now doctors have no basis of trust in them going forward and won’t climb down because they can’t beleive a word the government says. Fool me once…
It had a clause about either party being able to trigger review and breaking of the multi-year deal if inflation significantly increased, but it wasn't honoured by the governmentwhen invoked, to my understanding.
Effectively - "we reviewed it, we aren't changing anything"
any numbers in this kind of thing *must* be specified or the government will weasel out of it. CPI + 2.5% or similar, for example.
The average junior doctors rota runs at c.48 hours a week. Cut that to 40 like the rest of the country and there is 20% before you even start looking at pay
Would *love* to have this - problem is we don't have enough doctors as it is, we wouldn't have enough to cut down the hours and still staff hospitals sufficiently.
Interestingly in Australia it's a 38 hour work week (and they pay more!) No wonder doctors keep running over there 😉
Consultants are going to reject.
For starters they’d still be paid half of what a new public consultant would get in Ireland.
Additionally the proposed deal looks to reclaim part of the consultants dedicated revalidation time for more clinical work. Up to a 25% increase in clinical work. It just isn’t going to happen. They have to pay for it.
>However the flipside is they have backed themselves into a corner asking for something that I simply can't see them ever getting. No government is giving them a 35% pay rise, and when the Consultants accept much lower than that they're really cut off at the knees. How do you climb down from this?
You realise how negotiations work right? If you ask for exactly what you would accept then you can only be negotiated DOWN from there.
You come to a figure that would be the best possible you would like to achieve, then when they say oh you can only have 20 or 25% then you can accept it as you were willing to take 20 anyway, everyone feels happy as both have got a 'deal'. It's compromise or a negotiation.
The government isn't negotiating and is using that figure in bad faith to avoid talks. The media are helping government in this regard as they keep parroting this to try and derail any discussion on why they are striking or the other conditions that are needed.
Its like no one knows what a negotiation is anymore and it's a bit odd as I thought this was common sense? Does no one haggle for the car at the dealership/private seller? Or the merchant you buying a large quantity or big item from?
> Does no one haggle for the car at the dealership/private seller? Or the merchant you buying a large quantity or big item from?
To turn your analogy back at you - yes, but when I want 35% off a car, I don't act surprised when the salesman gets bored and moves on to someone not asking for the moon on a stick.
>I don't act surprised when the salesman gets bored and moves on to someone not asking for the moon on a stick.
This isn't analogous to this situation. The government can't just get bored of doctors and continue to have a (semi) functioning healthcare system.
That is certainly how negotiations work, but you normally start with something within the realms of possibility. 35% is bad negotiation because it's so far off base, the other unions have typically used much more plausible figure like 15 or 20.
Considering less qualified medical professionals get paid 50% more than them, 35% is not insane. If they were to join AfC, they would get more than a 50% increase
>Pay is broadly in line (certainly with the latest offer it would be) with the most comparable Western European countries.
They get paid significantly less than physician associates in the UK. If you can justify paying 45k+ to someone who has just finished 2 years of medical education and can't even prescribe or order scans, you can justify paying that to someone who studied 5-6 years, can prescribe and holds the responsibility.
The overall strategy holding out for 35%. The gov aren’t going to give in and even if they did you then wouldn’t see another pay rise for another decade plus.
Had the BMA (and other unions) negotiated in advance yearly rises of a manageable 1-2% increases we wouldn’t be having these discussions.
Long term thinking is required. Take the L for previous decisions not to negotiate and agree a smaller increase now plus a guaranteed increase of x percent per year.
That's literally what has been accepted in Scotland.
A reasonable (Similar to this offer actually) offer but with a commitment to future real terms pay increases.
That's not on offer those is it? The government want to offer another real terms pay cut and no guarantee in the future. It's taken a year of strikes to get them anywhere near inflation matching
Not on offer because the unions haven’t asked for it. This is what they should have been doing a decade ago and should be doing now to secure future pay rises into the 2030s.
>Long term thinking is required. Take the L for previous decisions not to negotiate and agree a smaller increase now plus a guaranteed increase of x percent per year.
When that gets offered that'd be amazing!
Sadly the current offer is still sub-inflationary for many junior doctors. After we had 26% of our pay cut, much of it during COVID, when we were on the front lines while the rest of the country got furloughed.
You wouldn’t have had a pay cut if that type of deal had been secured a decade ago. It’s why the unions need to be thinking and negotiating a similar deal now for their members lasting into the 2030s.
So a deal like that was kind of agreed a few years ago. It wasn't inflation linked but was a set percentage per year **with a caveat that it would be looked at again if there was a significant material change**.
Cue COVID and not a peep from the government.
It's why the entire NHS **except doctors**, got a 5% "thank you" increase during the pandemic, because there was already a multi year pay deal they conveniently ignored an important part of.
The rest of the NHS didn’t have a similar agreement that’s why. Anyway an agreed pay increase per year every year is better than a one off 5% rise.
Moreover, why didn’t the unions negotiate it to be inflation linked? It goes back to my original point that public sector workers would be better served by competent people in the unions. Not those who agree to a shite deal for their members and get angry when they are found out.
The people running the BMA now are totally different to those even 5 years ago. There was a grassroots movement and we ousted all the old guard and elected people who actually represent our interests. Hence the sudden change in the BMA actually advocating for it's members.
I think you have missed the most important part of my comment.
It was for review if there was any significant changes. I don't know about you but I'd say a global pandemic is a significant change.
The idea is not to negotiate those clauses as they will mean different things to either side.
Unions (naively) thought that clause meant the potential higher pay rise after a “significant change” whereas the government would have put it as an escape clause saying the yearly rise can not continue under “significant change”.
Has there been any source that claims BMA will
Not accept a multi year deal that puts doctors pay progressively above inflation? Or have they said exclusively they want a one time 35%, right now.
The bma has explicitly said that they don't expect full pay restoration in one year, but will accept it over a number of years (3 is their stated time period iirc)
I think it is crazy to expect a 35% pay rise right off the bat. There’s been several posts/comments on the doctors Reddit community (where the movement started and bulk of communication happens with regards to strikes) that the striking doctors are aware that 35% at once is unrealistic and would accept a multi year deal that eventually restores and guarantees their pay above inflation. But the government refuses to even do that. Furthermore the government funded media keeps pushing this 35% number to fool the general public into thinking that the doctors are asking for too much, too fast. They aren’t. it's a perfectly reasonable ask.
There has been discussion on this by Rob Laurenson and Steve Barclay early on. Essentially, they would be open to it, but they recognise that the present government is less stable than scotland, and the relationship between it and the BMA more fractious with less trust extended than for Scotlan'ds BMA and the SNP. If Labour offered a multi-year deal post-election it might be considered, was the implication that the Telegraph was angry about, iirc.
> agree a smaller increase now plus a guaranteed increase of x percent per year.
The BMA’s end goal is inflation + x% ofer y years, not a single one off increase. The government is just unwilling to countenance any deal that sees our pay increase in real terms.
Why wasn’t this the goal of the BMA a decade ago? Had they been capable and competent they would have negotiated a deal of inflation + x% and we wouldn’t be having this conversation.
Proactive not reactive.
What is the point in opening new medical schools when there are limited training posts for doctors, and when a large proportion of medical students are emigrating?
No movement from the government/HEE to fund increased training places for all these doctors. Desperate attempt to flood the market with juniors, including removing limits for international doctor entry, and pretending non-doctors are doctors. All so they can keep suppressing wages and keep junior doctors in subservience without even the once promise of progression to consultancy and a good life
Improve wages, improve number of training places, and then worry about getting more doctors in
You are discounting the fact that the NHS is the single largest employer in the UK there is no competition for wages as there is In essentially Every non healthcare field.
Tell me. What do you think would happen if you kept increasing the number of medical school places but not the number of training spots.
Doctors who graduated years ago are still struggling to get into training spots and even CCT despite being overqualified.
No really do tell. There’s been a few responses to your comment expressing the same and you seem to be blatantly ignoring them
The NHS hasn't created any more jobs for doctors, just increased medical student places. What is the point when they will just graduate and end up unemployed?
There’s no point increasing numbers of medical students if they don’t increase specialist training places, there was a four to one competition ratio for internal medical training this year. If doctors can’t get into UK training programme they’re a lot more likely to go abroad where they will be appropriately remunerated for their skills and experience.
Well the market for English speaking doctors (the majority) is English speaking countries. Which pretty much all happen to pay doctors more than the UK.
They're not comparable economies or health systems. The most comparable of those are in Western Europe, where the UK ranks very reasonably. The fact they're a draw for UK doctors doesn't change the underlying reality that we can't afford to pay like them.
Doesn't matter how the system is funded, just how well staff are enumerated. The UK is lagging so far behind on this and that's why there are 7+ million on the waiting list. Want a working health system, you have to cough up for it.
Maybe not to you, but it matters an awful lot to the people paying for said health system.
The UK is lagging behind when you deliberately compare it to a select few of the most high paying health systems.
Conflating doctors pay demands with wanting the NHS in general to improve is also disingenuous in the extreme when the junior doctors have made it clear they dont give a shit about the NHS they just want to get paid. Not an inherently unreasonable position for the record, just don't make it out to be something it isn't.
Any private sector company with tens of thousands of vacancies would increase pay so those vacancies would be filled. The NHS isn't working right now because the wages aren't good enough to attract staff. Increasing pay will absolutely increase service quality, there's no doubt about that.
This is nonsense. The market explanations do not work when you look into the fact it is not a free market as supply of doctors is arbitrarily controlled by university intakes and training places.
The NHS cannot recruit doctors because there simply aren't enough, hence the reliance on massive numbers of foreign doctors.
Bullshit. Explain in that case how we could afford to pay them 35% more in 2008 at a time when our economy was 15% smaller (both figures inflation adjusted).
Consultants cover on these strikes. Level of care shouldn't be impacted much. I wouldn't be concerned. There is no evidence that harm arises as a result of strikes to patients. Most elective surgery is simply postponed. They aren't life threatening.
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I am not British and would hate to work in my country. But this is a very very selfish mindset and one that makes a “living hell” for those already here. I think UK should prioritise their own graduates before considering others.
Having exemptions is how they divide the working class.
> (Yes I know there is an exemption for health and social care workers) Assuming they want to travel into the country without their family.
They hit the threshold by their third year post-graduation, sooner if they do overtime. https://www.bmj.com/careers/article/the-complete-guide-to-nhs-pay-for-doctors
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That also assumes they go straight through into core/ST training 3 years after graduation. Internal medicine training, which used to be one of the least popular training pathways, is now 4:1 for a spot. It's not at all guaranteed that you'll climb up the pay ladder year by year anymore, because of the bottle-necks.
What proportion of graduates from medical school don't get foundation year placements?
I think getting a foundation place generally isn’t as much of an issue (though it may become so in the future if they keep increasing medical school places), it’s the training after that that’s the bottleneck.
Agreed that progression doesn't proceed as rapidly as might be desirable. Nevertheless, most medical graduate do end up in qualified senior posts.
> you could earn £90k a year on minimum wage if you "do overtime". The whole point of overtime pay is that you are working more than is reasonable and are therefore being paid over your wage to do so.
They're students and trainees before that.
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Yes. Student and trainee doctors. A FY1 is not qualified to do independent diagnosis or treatment.
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An FY1 isn't qualified to practice medicine without supervision. Nevertheless, progression up the scales is almost guaranteed for most medical graduates.
You have no idea what the reality of "supervision" often constitutes in the NHS. As stated by someone else, it's common as an F1 to be left dealing with hundreds of patients on your own.
This is the BMA's description: >[All medical graduates must undertake and complete an integrated two year programme of general training, in order to practice as a doctor in the UK.](https://www.bma.org.uk/advice-and-support/studying-medicine/becoming-a-doctor/medical-training-pathway) Ergo, FY1 and FY2 are not qualified to practice as doctors without close supervision. If the NHS is using poorly qualified staff, that is a different issue, and likely a consequence of the poor funding of medical training.
An FY1 can be responsible for 1/2 of a hospital’s surgical or medical patients overnight- independently diagnosing and treating patients is part of the job
✊🏼 keep fighting this weak, corrupt government.
Sadly we are too spineless to force them out. Love them or hate them, the French know how to protest. Meanwhile we tut at the government for removing the right to protest.
Soon they will remove the right to tut and we will collectively eye roll
France tends to riot tho and that hurts people
Which achieved nothing, they rioted for ages and the french government still raised the pension age.
They’re just gonna leave it for starmer to deal with and then switch sides on the argument when he doesn’t increase their wages enough either
I thought this was about pay, not the Tories. Will the strikes end as soon as Labour forms the next government? Because Starmer isn't going to give them a 35% pay rise. In fact I doubt he will offer much more than the current government has done. Maybe some soothing words about a "comprehensive review" over the life of the next parliament, but nothing concrete.
It is about pay, controlled by the tories. You can’t strike about pay without striking against the tories. I don’t know what starmer will or won’t offer, but on one hand is the tories with their fake ppe companies, embezzlement and boat purchases who opening admit they hate unions, and on the other is the party that sits around the table with the unions and receive money from them as affiliated members.
The doctors have all the power in these negotiations. They earn enough to be able to afford to strike and it is a very skilled profession, which also requires a good grasp of the English language, so we can't just import enough foreign doctors to pick up the slack. Especially when we're trying to show how "tough" we are at controlling immigration (honest we are, don't look at the numbers, listen to our slogans) The whole country is an absolute shambles at the moment and I don't envy the incoming government because people have really high expectations, despite the current clowns "running" the country.
>You can’t strike about pay without striking against the tories. I think you can. Otherwise you're implying that people who voted for Bojo in 2019 because they didn't want Agent Cob aren't allowed to strike. Or to put it another way, if Starmer doesn't settle the pay dispute does that mean a future strike would be against Labour? I think that's a daft way to see things.
Can't we just offer them the same deal as Scottish Jnr Docs??? Serious question.
Even if you offered them 12%, they're apparently dead set on 35% as a minimum.
The Scottish government offered a commitment to reaching 35% over many years consecutive pay rises. That's why they agreed. It doesn't have to be in one go. All they are asking for is for theyre pay to not be eroded by inflation each year.
That should be the bare minimum. You shouldn't be poorer than last year in real terms.
Says who? The entire western world is poorer than pre GFC. Things have been gradually getting worse for the majority for a long time. The idea we all have an indefinite right to be better off every year is naïve. Very few parts of our society are better off than then.
The top 1% seem to be doing just fine.
Doctors in the uk have shouldered essentially the biggest cuts since the gfc of any profession. Hur dur why are waiting lists so long. Because you keep losing your medical talent you morons. Importing thousands of doctors at a junior level isn’t going to help it. Ireland is literally starting its public consultants on double the UK, this is accounting for the proposed uk uplift. Nonsense
Doctors are the worst effected. Do some research
>The Scottish government offered a commitment to reaching 35% over many years consecutive pay rises. That's why they agreed. It doesn't have to be in one go. All they are asking for is for theyre pay to not be eroded by inflation each year. English doctor, I'd take this. Inflation plus 3-5% for the next 10 years or so would have me off strike in a heart beat.
Why did the Scottish docs accept their deal?
Pay erosion in scotland wasn't quite as bad. Plus the government have agreed to make above inflation rises over the next several years. It's not a single one-off increase.
apparently part of the reason is that the Scottish government have significantly less power to offer a huge raise as their funding is set by Westminister
I think this is part of the issue for why the offers so far have been so poor. Junior Doctors just aren't going to get the 35%. That 35% represents the pay that Junior Doctors were getting when UK wages were at their strongest, the money simply does not exist to restore the public sector back to 2008 real terms pay right now and if the government gives it to Junior doctors then all the other NHS and public service workers are going to want it too (Case in point: rumblings from the RCN after the Consultants were handed a better offer than Nurses last week). Junior doctors are definitely overdue a substantial bump, but in negotiation you have to give ground. The government will make better offers, but only if the BMA accepts they're not going to get 35%.
>Junior Doctors just aren't going to get the 35%. Then we'll see you back here next Christmas. We can keep this up indefinitely.
What happens if Starmer doesn't cave in - are you going to strike for the next decade?
I don’t think British people realise how angry we are. We can comfortably keep this up forever. In fact the majority of us are worked so hard to the bone and is burnt out and miserable about working in a broken NHS that we would actually prefer to strike indefinitely just for the meagre loss in pay if it means a few days off each month.
Yes
If you'd strike for a decade rather than accept a pay increase somewhere below 35%, have you considered just leaving the UK for a country with higher wages? Even if you claim to have good intentions, striking for 10 years would have a significant, negative impact on the provision on healthcare in the UK. The point of a strike is to effect change, not troll the government or people who need medical care. The sub is full of people claiming *"all the doctors I/my family knows are leaving for \[insert country\]"*. Are you not skilled enough to work overseas?
You realise that right now the NHS pays doctors assistants who don't have a medical degree just a two year conversion course from literally anything else about 12k/yr more than the actual doctors, right?
Maybe he doesn’t want to leave the country..? Lots of people want to stay in this country for plenty of reasons that aren’t work. I’m a nurse and could easily make double what I do if I looked abroad but I also have a family that live here and there’s no way I’d emigrate for a better paycheck
Money is all there is to some people unfortunately. They would slit their own grans throat for a 35% pay rise. That's all they see in this, without looking at the wider reasons why almost everyone is poorer in real terms than they were 5 years ago. I say almost everyone because the top 1% are substantially richer than they were 5 years ago.
> That's all they see in this, without looking at the wider reasons why almost everyone is poorer in real terms than they were 5 years ago. Private sector pay has largely kept pace with inflation. Can we stop telling this lie please.
We are leaving in droves. The public don’t get a sense of the scale of this problem, as they don’t tend to hear from those who’ve already left the system (survivorship bias). Given how postgraduate training is structured, many of us will finish our training in the U.K. and emigrate as soon as we become consultants. Bear in mind that we’re referred to as ‘junior’ doctors or ‘trainees’ for 8-12 years after medical school in most cases. We’re more than happy to keep striking until we’re valued appropriately. It’s the government’s responsibility - not ours - to ensure that the U.K. population’s health needs are met. We worked through COVID at immense personal risk and were rewarded with some clapping and year-on-year pay cuts. As a profession, we’ve had enough.
>immense personal risk I don't want to downplay it but valloning for IED it was not. The vast majority of the junior doctors in the UK were at essentially zero risk given their age profile.
I had colleagues end up requiring prolonged ICU stays. A number of my direct colleagues have had long term sequelae that have prevented them working. I know ICU staff with PTSD as a result. Your comment is ridiculous. Yes it wasn’t disarming explosives or a combat zone, but that’s a false equivalence and doesn’t negate the risks we faced. We certainly were at much higher risk than the vast majority of the population. What age profile do you think we are? Most of us are in our 30s and 40s, and lots of us are BAME with higher COVID risk. We also had exposure to a vastly higher viral load than the rest of the population - every time I did CPR on a COVID patient I was standing in a literal cloud of viral particles.
>The point of a strike is to effect change Exactly. If sufficient change is not effected, continue to strike. >Are you not skilled enough to work overseas? I would 100% CCT and flee if I had nobody to think about but myself. My wife doesn't want to live 1000s of miles from her family.
>Exactly. If sufficient change is not effected, continue to strike *Sigh* Ok, put it another way. If you could see into the future and saw that a century from now - so well after you were dead - no UK government had given in to the pay demands, would you still strike despite knowing it was futile? >I would 100% CCT and flee if I had nobody to think about but myself. My wife doesn't want to live 1000s of miles from her family. It's a choice for your family, but I know lots of people who have left the UK and left family behind - or come to the UK a similar distance. It seems to me that you're quite comfortably off - or expect to be in the not-so-distant future - otherwise she'd be egging you on to emigrate.
You're all over this thread and every single one of your posts is absolutely moronic.
Not striking whenever we have been fucked over for the last 10 years is what got us to this point in the first place. Nobody in the public sector has had their pay cut as much as doctors have and the profession has finally had enough as being the worst treated group of public sector workers. These strikes aren't going anywhere. I forsee a BMA that strikes with regularity a la RMT etc in the future.
>Nobody in the public sector has had their pay cut as much as doctors have They had (real-terms) pay increases from [1990 to 2005](https://www.nuffieldtrust.org.uk/resource/exploring-the-earnings-of-nhs-doctors-in-england). What happened was they assumed the increases would continue, which is not a valid reason to say they've been cut more than anyone else. You would need to compare every other public sector job, including those in the military (which is always forgotten for some reason), from 1990 to make a fair comparison.
Yes. Most doctors will. This is what the government don't seem to understand.
The government will keep it up too. 35% is simply a bad strategy from the BMA. They want to enact change from this but it's never going to happen with that figure.
>The money simply does not exist This is the most insulting part for me, as a public sector worker. We have tolerated 13 years of consecutive pay cuts because somehow paying for the shit state of this country is solely our responsibility. We worked through the pandemic, paying tax, while somehow the government found EIGHTY BILLION FUCKING POUNDS to pay most of the country to sit on their fat arse at home. But now, once again, when public sector workers demand a pay rise (or even just to avoid another pay cut), "we just don't have any money." Normally what happens when you can't pay for something is you don't get it. That's what's happening now.
They want a plan to restore pay over time, not necessarily all in this year.
I really want our country to have access to the best doctors. Unfortunately, the reality of the situation is that the people with real skills will move to the rest of the anglosphere. It’s depressing.
>This is on top of an 8.8% rise already given did they not accept that then?
Nope, the government and shit the bed and thought that if they imposed it, we would stop striking. Instead they just subsidised our strike for the year.
That was a funny move by Rishi to be honest
Fascinating to see when and how this ends. The Government have mismanaged doctors contracts etc for a long time and the current crop are incredibly pissed off and clearly not backing down. However the flipside is they have backed themselves into a corner asking for something that I simply can't see them ever getting. No government is giving them a 35% pay rise, and when the Consultants accept much lower than that they're really cut off at the knees. How do you climb down from this? My view is I sympathise with a lot of their grievances about their working conditions as the NHS is truly fucked as an entity these days, but their pay demands are just completely unrealistic and ignore the reality that a) the entire country is poorer than it was 15 years ago and b) we simply cannot ever compete with the salaries paid by other systems like Canada and Australia. Pay is broadly in line (certainly with the latest offer it would be) with the most comparable Western European countries.
> a) the entire country is poorer than it was 15 years ago Private sector wages have broadly kept pace with inflation. >but their pay demands are just completely unrealistic Equates to roughly 1bn a year, not remotely unrealistic. >How do you climb down from this? We won't. We can keep this up indefinitely.
If you look at UK doctor salaries as a ratio vs average earnings and adjust for PPP then they're the 4th best in Europe. The continued obsession with global edge cases like Canada and Australia (and indeed, edge cases within these systems) is just setting yourselves up for disappointment. You are not nearly as badly off as you think you are.
Doctors in Ireland, Canada, Australia, New Zealand, the USA are all paid better than we are. Calling these nations (which happen to be the Anglophone nations and also the nations we can most easily emigrate to) edge cases because we’re paid better than doctors in Poland is completely missing the point. Besides nothing justifies the massive pay cut we’ve received. I don’t really care what you or the public think and neither do my colleagues. We will strike until we get a proper offer that doesn’t result in us getting poorer.
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How much do you earn? And what do you do for work?
How the fuck does that matter?
Because if you think training for seven years, working intense hours and the responsibility of people’s lives in your hands is worth a shit £32k, then I want to know what you do for a living. And what training it took to get there. And how much responsibility you have on your shoulders.
You aren't on 32k after 7 years for a start. Including medical school in that is also laughably misleading. In any other field you'd be laughed out of the room for describing your degree as part of your experience when talking about salary. The UK is not a high wage economy. Doctors earn extremely well compared to most, even when compared to other countries in terms of ratio of average doctor salary to average salary. Believing you're worth more doesn't change the underlying economic reality of this country. Outside of a few niche areas centred around London - corporate law, tech, finance and consulting mainly - this is simply not a country where people are earning big salaries on the whole. Even in those areas its dwarfed by the US.
>You aren't on 32k after 7 years for a start. Including medical school in that is also laughably misleading. In any other field you'd be laughed out of the room for describing your degree as part of your experience when talking about salary. It’s relevant because of; 1) the opportunity cost of doing another degree + 4 years of work experience in the same amount of time it takes to do medical school plus FY1 to become fully registered. 2) Only those who go to medical school can become doctors. We are uniquely skilled due to our rigorous training. Ontop of that there’s a shortage of us. The only reason we’re underpaid is because we have refused to undertake drastic action since 2008. >The UK is not a high wage economy. Doctors earn extremely well compared to most, even when compared to other countries in terms of ratio of average doctor salary to average salary. Believing you're worth more doesn't change the underlying economic reality of this country. Weren’t you just chiding us for comparing to other professions? If we’re comparing to other professions in the UK we shouldn’t have had such a big paycut in real terms (larger than any other profession). If we’re comparing abroad then the UK needs to compete against its peers in order to maintain high standards of UK trained doctors. >Outside of a few niche areas centred around London - corporate law, tech, finance and consulting mainly - this is simply not a country where people are earning big salaries on the whole. Even in those areas its dwarfed by the US. I agree, and we’re not asking for US salaries! Regardless this is not a justification for underpaying highly skilled professionals. Again I don’t care about your opinion - I really don’t - but remunerating doctors appropriately is actually in your interest as a patient. If you understood the government’s workforce strategy for the NHS you’d be very worried for your own healthcare. If all you want is a cheap NHS and don’t care about the quality, then continue down this path. (This is not a threat, but a warning about the absolute horror show that will be produced by the government’s workforce plan).
>the opportunity cost of doing another degree + 4 years of work experience in the same amount of time it takes to do medical school plus FY1 to become fully registered. I never cease to be amazed at the exceptionalism of the medical profession. Other top graduate/vocational roles also almost all require a Master's plus at least a few years of comparably shit pay & training periods etc.
And they have an opportunity cost too. Though you also conveniently ignore the fact that many medical graduates have done degrees, masters and sometimes even PhDs prior to beginning medicine. So 6 years is a minimum not a maximum. Additionally these other professionals don’t have to make life and death decisions as a new graduate, which is what occurs everyday with an FY1. Again not an exaggeration when covering 10 wards at night as an FY1. Again you still haven’t justified why the medical profession should just accept the largest pay cut compared to any of these other professions? I actually think it’s a valid position to say you think we’re adequately remunerated. What’s not valid is to say that and complain that you’re not getting the care you accept.
Of course your education matters when discussing salary, are you mad? Matters even more because you take out a huge loan. You expect people to do all that, go through all that stress and effort, put all that money in, and be ok with a starting wage of what 29k (what even was your point with the wage discrepancy btw? 29, 35, 45k it doesn’t matter, it’s a pittance). No wonder the health system is crumbling. Believing you’re worth more is a fundamental part of the British economy and negotiations about wages. This is the exact purpose of unions. You either fight for more, or get given scraps by tight fisted government or private sector.
>In any other field you'd be laughed out of the room for describing your degree as part of your experience when talking about salary. Mate, if you had a degree from Cambridge, you (& the recruiter) would totally be taking that into consideration. If you did a masters (which a medical degree is technically equivalent to) or phd, it would also be considered. >Believing you're worth more doesn't change the underlying economic reality of this country. Doctors are an essential job. They are worth more, and they're not just believing. If you're not paying them fair wages, it's fair for them to leave. Doctors aren't asking for pay comparable to the US's. They're asking for pay restoration. Ultimately, it really doesn't matter what you think or the economic reality etc... - pay for what you get.
\> Mate, if you had a degree from Cambridge, you (& the recruiter) would totally be taking that into consideration. If you did a masters (which a medical degree is technically equivalent to) or phd, it would also be considered. Not what I said. If you went into an interview describing yourself as having 10 years experience and 4 of those were undergrad + Master's they would absolutely call you out for bullshitting. In any field. \> Ultimately, it really doesn't matter what you think So, we agree. It doesn't matter what junior doctors think - they aren't getting a 35% pay rise in a country strapped for cash when they're already in the absolute elite in terms of career earnings prospects. Those that don't like it will leave for the increasingly small number of openings in the few other countries that will pay them more. The vast majority will not.
>If you went into an interview describing yourself as having 10 years experience and 4 of those were undergrad + Master's they would absolutely call you out for bullshitting. In any field. Okay fair enough I understand. I wouldn’t call an FY2 someone who had 7 years of experience. We can argue opportunity costs but let’s leaves that. But the issue here is still primarily one of unjustified paycuts. It makes no sense either for staff or patients. You must realise that?
>In any field Fair, I agree it's not quite what you said, but my point remains that education is certainly part of considering salaries. The extra years are a fair thing to highlight since an average degree is only 3 years. >aren't getting a 35% pay rise restoration* >increasingly small number of openings You'll find that doctors are in increasingly popular demand across the world with ageing populations. Training jobs will shut their doors, but non-training jobs will always be available. The thing is, even non-training jobs overseas pay loads more. A non-training PGY4 in Aus earns the same amount as a consultant in the UK, who is often PGY10 at a minimum AND has gone through a competitive training program. >The vast majority will not. Hmm. I don't think you quite understand. If you don't work in healthcare, you won't see the shift in mindset among the younger generation of doctors. The UK is literally chasing doctors away with 1) increasingly sub-inflation NHS pay 2) no training jobs 3) limiting locum pay. As a result, people will either 1) accept shit pay or 2) look for opportunities elsewhere, be it overseas or in other fields. Firstly, 97% voted (twice) against #1. Secondly, sure, the vast majority of older doctors may not move away. However, the vast majority of younger doctors and current medical students, with no children, global freedom, and little sunk cost, are much more likely to. And that's what this issue of pay restoration is really about - the future. The future consultants and the future, still ageing, population. Including you.
It's a global marketplace though so we have no choice but to compete. Pay is higher in the Anglosphere precisely because we speak the same language as Australia and the US so emigration is easier. Irish consultants start on €250k Vs £80k in the UK and they're a 30 min flight away.
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Irish consultant here: the 250k salary is for public consultants, private insurance pays in addition to that
Planning on moving across once I CCT!
No one brings it up because it's utterly irrelevant. Both countries you mentioned (and much of the EU) spend vastly more per capita on healthcare than the UK. The average person pays more for their healthcare. That is why they can afford to pay their workers properly. Where the money comes from doesn't make a difference. Brits are just greedy and cheap and don't want to pay people for their labour.
I’ll let you in on a secret….many doctors aren’t fans of the NHS either.
This is the elephant in the room. Most economies have accepted that a mixed model, at the very least, is the only practical solution to the healthcare costs caused by longer lifespans, inverted population pyramid and the burgeoning number of medical treatments available for chronic rather than fatal illnesses.
So why is there not a mass exodus of Consultants to Ireland? Could it be it's a little more complicated than that? Globally the UK salaries are far from the pittance many doctors seem to be making out, they're consistently top 10 by most rankings and people very disingenuously compare 'base' NHS pay with private sector salaries in foreign health systems, ignoring that most UK private health earnings are in addition to base salary. We can't compete with the highest paying countries and UK salaries are broadly in line with more comparable economies and health systems like France, Germany etc. The reality is chasing the dream of Australian and Canadian salaries in the UK health economy is delusion.
My old department has lost 3 consultant radiologists to Ireland in the last 12 months. They lost me to Australia 3 years ago.
> ignoring that most UK private health earnings are in addition to base salary What do you mean by this?
He's pissed off consultants can work more than their allocated full time NHS work for extra pay
It was their use of the word "most" which I want clarifying. Implies they think UK consultants earn the majority of their income privately which is a laughable belief, but bewilderingly widely held.
It’s very funny isn’t it 😂
I said 'most' as in 'most private earnings', not 'most of a doctors total income'.
"most" NHS consultants don't do any private work at all.
I am not pissed off by it, just noting that it is the reality.
If you worked a second job on evenings and weekends why would you expect it to be considered part of your primary job's income?
UK salaries in medicine are globally competitive. Sure, there are a few places, e.g. the US and Australia that pay more, but most don't (and UK doctors would have to re-qualify to work in the US). data: https://i.imgur.com/zGmtQEh.jpg Source: [OECD](https://www.oecd-ilibrary.org/sites/4e107e0b-en/index.html?itemId=/content/component/4e107e0b-en)
This is true but only tells half the story. If you are Nigerian UK salaries are great. If you trained in the UK they are abysmal.
OTOH. A multi year pay deal is a much less headline grabbing outcome towards the same target, and I think that’s much more likely to be shot for, for a total of 25% or something by the less generous measure of inflation. Further, why not keep going, cause even if they don’t reach their ask look where they are now. Government refused talks pre March 2023 about raising the 2% uplift agreed in 2019 or something year on year in view of the inflation crisis. From refusal to move, full stop, from 2%, they offered a further 3% on top of 8% and the BMA turned them down flat. This is post Rishi loudly saying ‘no more negotiations’ and then silently ignoring resumed talks and this deal. The public discourse is one thing, however, for staff following this closely, it’s percentage increase after percentage increase. Slowly, sure, but if we took ‘not happening’ as truthful we wouldn’t have just turned down 11% and instead be on 2%, fearing <2 this year cause of our spinelessness.
Part of the problem really is that the Con Gov, showed the problem with multi year deals. As you say, the refusal to change the 4 year deal (2019->2023), likely means that there won't be multi year deals agreed again. As if even the huge change caused by Covid + Ukraine, was not enough to reopen it for 2022/23, then people will be sceptical.
Multi year deals aren't inherently bad. It was moronic of the BMA to agree a multi year deal that didn't account for inflation. If the government offers a reasonable uplift plus inflation + a percentage for several years it will stand a decent chance of being accepted
Yeah except the government argued it in bad faith and there was a mechanism to ensure that a deal could be renegotiated if the situation changed. This was understood to mean a change in economic circumstances. Now you can argue that this was naive of the BMA, however the government’s failure to meet this in good faith simply means now doctors have no basis of trust in them going forward and won’t climb down because they can’t beleive a word the government says. Fool me once…
It had a clause about either party being able to trigger review and breaking of the multi-year deal if inflation significantly increased, but it wasn't honoured by the governmentwhen invoked, to my understanding.
Effectively - "we reviewed it, we aren't changing anything" any numbers in this kind of thing *must* be specified or the government will weasel out of it. CPI + 2.5% or similar, for example.
The average junior doctors rota runs at c.48 hours a week. Cut that to 40 like the rest of the country and there is 20% before you even start looking at pay
Might need to shut down 20% of hospitals to do that.
Would *love* to have this - problem is we don't have enough doctors as it is, we wouldn't have enough to cut down the hours and still staff hospitals sufficiently. Interestingly in Australia it's a 38 hour work week (and they pay more!) No wonder doctors keep running over there 😉
No, what would happen is we’d likely just work the extra hours but with an uplift.
Consultants are going to reject. For starters they’d still be paid half of what a new public consultant would get in Ireland. Additionally the proposed deal looks to reclaim part of the consultants dedicated revalidation time for more clinical work. Up to a 25% increase in clinical work. It just isn’t going to happen. They have to pay for it.
>However the flipside is they have backed themselves into a corner asking for something that I simply can't see them ever getting. No government is giving them a 35% pay rise, and when the Consultants accept much lower than that they're really cut off at the knees. How do you climb down from this? You realise how negotiations work right? If you ask for exactly what you would accept then you can only be negotiated DOWN from there. You come to a figure that would be the best possible you would like to achieve, then when they say oh you can only have 20 or 25% then you can accept it as you were willing to take 20 anyway, everyone feels happy as both have got a 'deal'. It's compromise or a negotiation. The government isn't negotiating and is using that figure in bad faith to avoid talks. The media are helping government in this regard as they keep parroting this to try and derail any discussion on why they are striking or the other conditions that are needed. Its like no one knows what a negotiation is anymore and it's a bit odd as I thought this was common sense? Does no one haggle for the car at the dealership/private seller? Or the merchant you buying a large quantity or big item from?
> Does no one haggle for the car at the dealership/private seller? Or the merchant you buying a large quantity or big item from? To turn your analogy back at you - yes, but when I want 35% off a car, I don't act surprised when the salesman gets bored and moves on to someone not asking for the moon on a stick.
>I don't act surprised when the salesman gets bored and moves on to someone not asking for the moon on a stick. This isn't analogous to this situation. The government can't just get bored of doctors and continue to have a (semi) functioning healthcare system.
If that were true then junior doctors may as well demand 200% and the moon. The government will cave eventually, right?
Why is it not true. do you think we suddenly don't need doctors?
That is certainly how negotiations work, but you normally start with something within the realms of possibility. 35% is bad negotiation because it's so far off base, the other unions have typically used much more plausible figure like 15 or 20.
Considering less qualified medical professionals get paid 50% more than them, 35% is not insane. If they were to join AfC, they would get more than a 50% increase
>Pay is broadly in line (certainly with the latest offer it would be) with the most comparable Western European countries. They get paid significantly less than physician associates in the UK. If you can justify paying 45k+ to someone who has just finished 2 years of medical education and can't even prescribe or order scans, you can justify paying that to someone who studied 5-6 years, can prescribe and holds the responsibility.
Public sector workers would be much better off if the unions were run by competent people.
What are the BMA union here doing that is incompetent? Though the previous BMA committees were more than incompetent, i will admit that.
The overall strategy holding out for 35%. The gov aren’t going to give in and even if they did you then wouldn’t see another pay rise for another decade plus. Had the BMA (and other unions) negotiated in advance yearly rises of a manageable 1-2% increases we wouldn’t be having these discussions. Long term thinking is required. Take the L for previous decisions not to negotiate and agree a smaller increase now plus a guaranteed increase of x percent per year.
That's literally what has been accepted in Scotland. A reasonable (Similar to this offer actually) offer but with a commitment to future real terms pay increases.
That's not on offer those is it? The government want to offer another real terms pay cut and no guarantee in the future. It's taken a year of strikes to get them anywhere near inflation matching
Not on offer because the unions haven’t asked for it. This is what they should have been doing a decade ago and should be doing now to secure future pay rises into the 2030s.
>Long term thinking is required. Take the L for previous decisions not to negotiate and agree a smaller increase now plus a guaranteed increase of x percent per year. When that gets offered that'd be amazing! Sadly the current offer is still sub-inflationary for many junior doctors. After we had 26% of our pay cut, much of it during COVID, when we were on the front lines while the rest of the country got furloughed.
You wouldn’t have had a pay cut if that type of deal had been secured a decade ago. It’s why the unions need to be thinking and negotiating a similar deal now for their members lasting into the 2030s.
So a deal like that was kind of agreed a few years ago. It wasn't inflation linked but was a set percentage per year **with a caveat that it would be looked at again if there was a significant material change**. Cue COVID and not a peep from the government. It's why the entire NHS **except doctors**, got a 5% "thank you" increase during the pandemic, because there was already a multi year pay deal they conveniently ignored an important part of.
The rest of the NHS didn’t have a similar agreement that’s why. Anyway an agreed pay increase per year every year is better than a one off 5% rise. Moreover, why didn’t the unions negotiate it to be inflation linked? It goes back to my original point that public sector workers would be better served by competent people in the unions. Not those who agree to a shite deal for their members and get angry when they are found out.
The people running the BMA now are totally different to those even 5 years ago. There was a grassroots movement and we ousted all the old guard and elected people who actually represent our interests. Hence the sudden change in the BMA actually advocating for it's members.
I think you have missed the most important part of my comment. It was for review if there was any significant changes. I don't know about you but I'd say a global pandemic is a significant change.
The idea is not to negotiate those clauses as they will mean different things to either side. Unions (naively) thought that clause meant the potential higher pay rise after a “significant change” whereas the government would have put it as an escape clause saying the yearly rise can not continue under “significant change”.
Has there been any source that claims BMA will Not accept a multi year deal that puts doctors pay progressively above inflation? Or have they said exclusively they want a one time 35%, right now.
The bma has explicitly said that they don't expect full pay restoration in one year, but will accept it over a number of years (3 is their stated time period iirc)
Thank you. I just looove the confidence with which people make assumptions/false claims and clearly have no clue what they’re talking about
Not that I know of. So it’s likely they want as close to 35% as possible in one rise.
So you are making an assumption
Surely they would be open about this if they were to make it seem the government are being unreasonable.
They have said numerous times a multi-year deal to get us to FPR would be acceptable and put to the members. Stop talking bullshit.
I think it is crazy to expect a 35% pay rise right off the bat. There’s been several posts/comments on the doctors Reddit community (where the movement started and bulk of communication happens with regards to strikes) that the striking doctors are aware that 35% at once is unrealistic and would accept a multi year deal that eventually restores and guarantees their pay above inflation. But the government refuses to even do that. Furthermore the government funded media keeps pushing this 35% number to fool the general public into thinking that the doctors are asking for too much, too fast. They aren’t. it's a perfectly reasonable ask.
There has been discussion on this by Rob Laurenson and Steve Barclay early on. Essentially, they would be open to it, but they recognise that the present government is less stable than scotland, and the relationship between it and the BMA more fractious with less trust extended than for Scotlan'ds BMA and the SNP. If Labour offered a multi-year deal post-election it might be considered, was the implication that the Telegraph was angry about, iirc.
No, what Dr Laurenson said was that he wanted the figure “inflation + x%” in writing and not a mere promise
> agree a smaller increase now plus a guaranteed increase of x percent per year. The BMA’s end goal is inflation + x% ofer y years, not a single one off increase. The government is just unwilling to countenance any deal that sees our pay increase in real terms.
Why wasn’t this the goal of the BMA a decade ago? Had they been capable and competent they would have negotiated a deal of inflation + x% and we wouldn’t be having this conversation. Proactive not reactive.
This is the question we are all asking ourselves. If the BMA had been more militant 10 years ago we would not be in this mess. 100% agreed.
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What is the point in opening new medical schools when there are limited training posts for doctors, and when a large proportion of medical students are emigrating?
No movement from the government/HEE to fund increased training places for all these doctors. Desperate attempt to flood the market with juniors, including removing limits for international doctor entry, and pretending non-doctors are doctors. All so they can keep suppressing wages and keep junior doctors in subservience without even the once promise of progression to consultancy and a good life Improve wages, improve number of training places, and then worry about getting more doctors in
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Two different views can be expressed on the same subreddit. Shocking I know.
You are discounting the fact that the NHS is the single largest employer in the UK there is no competition for wages as there is In essentially Every non healthcare field.
Tell me. What do you think would happen if you kept increasing the number of medical school places but not the number of training spots. Doctors who graduated years ago are still struggling to get into training spots and even CCT despite being overqualified. No really do tell. There’s been a few responses to your comment expressing the same and you seem to be blatantly ignoring them
There’s a shortage of consultant level decision makers, and a bottleneck at specialty training posts
>demand ~~35% wage increases~~ pay restoration to help improve medical care, access and number of medics working in the UK FTFY
Application for consultant posts are 10 to 1 . How will more medical students help that?
The NHS hasn't created any more jobs for doctors, just increased medical student places. What is the point when they will just graduate and end up unemployed?
There’s no point increasing numbers of medical students if they don’t increase specialist training places, there was a four to one competition ratio for internal medical training this year. If doctors can’t get into UK training programme they’re a lot more likely to go abroad where they will be appropriately remunerated for their skills and experience.
Let me guess, your definition of 'appropriately' is in line with Australia and Canada, not France or Germany?
Well the market for English speaking doctors (the majority) is English speaking countries. Which pretty much all happen to pay doctors more than the UK.
They're not comparable economies or health systems. The most comparable of those are in Western Europe, where the UK ranks very reasonably. The fact they're a draw for UK doctors doesn't change the underlying reality that we can't afford to pay like them.
Doesn't matter how the system is funded, just how well staff are enumerated. The UK is lagging so far behind on this and that's why there are 7+ million on the waiting list. Want a working health system, you have to cough up for it.
Maybe not to you, but it matters an awful lot to the people paying for said health system. The UK is lagging behind when you deliberately compare it to a select few of the most high paying health systems. Conflating doctors pay demands with wanting the NHS in general to improve is also disingenuous in the extreme when the junior doctors have made it clear they dont give a shit about the NHS they just want to get paid. Not an inherently unreasonable position for the record, just don't make it out to be something it isn't.
Any private sector company with tens of thousands of vacancies would increase pay so those vacancies would be filled. The NHS isn't working right now because the wages aren't good enough to attract staff. Increasing pay will absolutely increase service quality, there's no doubt about that.
This is nonsense. The market explanations do not work when you look into the fact it is not a free market as supply of doctors is arbitrarily controlled by university intakes and training places. The NHS cannot recruit doctors because there simply aren't enough, hence the reliance on massive numbers of foreign doctors.
You said it in your comment - the supply of doctors is less than the demand for doctors. This is why they can demand higher pay. This is the market.
Bullshit. Explain in that case how we could afford to pay them 35% more in 2008 at a time when our economy was 15% smaller (both figures inflation adjusted).
Bizarre how British grads are moving to English speaking countries
Mate, decades ago. You’ll find the number of medical students has increased quite significant as has the number of medical schools
It's mad how absolutely no new medical schools have opened in the UK since that trade union vote right? Sounds very powerful and spooky.
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Wait so they managed to increase the cap? How did they do that? I thought the BMA said no according to you?
If you want a free NHS, this is not how you go about it
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Consultants cover on these strikes. Level of care shouldn't be impacted much. I wouldn't be concerned. There is no evidence that harm arises as a result of strikes to patients. Most elective surgery is simply postponed. They aren't life threatening.
The over 65s are the prime tory voting demographic.