Doctors’ pay – communism v capitalism

The Knife has written before about the alarmingly Soviet nature of the NHS:  a doomed-to-failure command economy, clinicians as serfs, and a huge and increasing gap between political dogmatists and the staff who have to follow their increasingly  bizarre diktats. I could go on.

There is another aspect to this, which has particular relevance to the recent imbroglio about the government raid on doctors’ pensions.  One of the key bludgeons being used in the remarkably aggressive media reporting of this being the cliche of   “fat cat GP’s”.  Yet many of us are not GP’s, and in fact feel no great affinity with our colleagues in General Practice, a small minority of whom are indeed of the fat cat persuasion.

The new NHS headquarters

However, GP’s always boast about being self-employed contractors – which they are – and that they can’t be pushed around. But they can. They only have one main employer, the government/taxpayer, who could call the shots on what they expect from the contract. They don’t, but instead allow the GP’s to concentrate on huge preventive medicine projects which are lucrative, but of dubious clinical value. Out of hours medicine outwith hospital has virtually collapsed in large swathes of  the UK  as a result. It doesn’t pay enough.

Nevertheless, these dodgy behaviours are wrongly extrapolated to all doctors, and us poor hospital slaves take a kicking in the press, get our pay frozen (two years and counting), agree to an increase in our pension contributions, then get a kick in the balls with a further swingeing non-negotiated increase.

Here is Peter Hitchens, in the Mail on Sunday:

Material equality is plainly absurd, cannot be brought into existence and is only maintained as a propaganda fiction in societies whose elites keep their privileges secret through censorship, and preserve them inviolate through terror. It is not desirable, for if all are rewarded equally, and people vary in their talents and energies, then many will suffer, talents will wither unused and corruption will be widespread . Some instances : under the Soviet system, all doctors, good or bad, were paid the same. It did not take long for the acute citizen to find out who the good ones were, but their services could only be secured through bribes. The same rule applied to places in better schools, or the allocations of apartments in better districts. Elite privilege carried more weight than bribery, but was in itself corrupt, as it secured the silence and uncritical support of those (the ‘Nomenklatura’) whom the elite admitted to privilege.

Hitchens is actually writing about the hypocritical elitism in Soviet Russia (where he lived for a while), despite it being ostensibly an egalitarian society. However, the example he gives is telling: all doctors, good or bad, were paid the same.  Well by a remarkable coincidence, that’s pretty much what we have  with NHS consultants,  with all the deleterious effects that flow from that.

The Knife, as a consultant surgeon, gets paid the same as a consultant psychiatrist of the same seniority.

So what, you might say, but here’s the difference: I work 8-6.30 or 7 most days, when I’m not on call. When I am on call I’m in till 8 or 9 usually, and all weekend, as well as being called in fairly often. My direct clinical care sessions – as the contract terms have it – are spent operating, doing clinics of 20-30 patients, on the wards, checking results etc etc.  That’s what it takes to be a proper surgeon.

A psychiatrist fills his or her week with…er…two or three clinics.

I can work up to 104 hours straight when on call, in theory, and being up all night then working the next day still happens. This can’t happen to a junior doctor, it would be illegal.

Try and find a psychiatrist, or a pathologist, or a rheumatologist in those hours. You won’t. Yet we all get paid the same.

The modest bonuses of merit awards or clinical excellence awards are being phased out completely in Scotland, and on the ropes in England and Wales.

The reasons, however, why this peculiar state of affairs exists in the UK, are mixed. One is the historical precedent from when the NHS was founded. We only started get paid at all for out of hours work as consultants a few years ago, when the new contract came in. These precedents therefore save money for the government. Another very important reason though, has been to prevent the government of the day controlling us with a “divide and rule” policy. It would suit them very well to have the medical profession squabbling within itself about cash and conditions, yet that day is fast approaching.

In a way though, I’ll be glad when it does. This is a peculiarly British thing, compared to most G7/8/20 countries. A radiologist in Canada can earn a stack of money because they’re in short supply – market forces – and a surgeon like me can earn a whole lot more because of the nature of the job, and because our treatments actually work pretty well .

This is the same situation as exists in one part of UK medicine, which is, strangely, one of the props currently supporting the tottering, inefficient NHS, namely the private sector (where The Knife doesn’t work, for the record).  There a surgeon – who looks after the patient for all their stay – will earn three time what the anaesthetist gets, who’s only there for the operation. Sounds about right to me.

All this complaining though has a purpose. It’s time for hospital doctors to free themselves from the yoke of being associated with the GP’s. In addition, differential pay rates between the specialties seems to be the logical response to the political meddling in our pay cheques and our clinical practice, given the obsession that politicians of all colours have with waiting times for treatment.

If they want it that way, they should pay for it. Right now, some of us have all the downsides of being lumped together as one mass of medics, with no evident upside.

And then, just like in nearly every other developed country, unlike Soviet Russia, we’ll all get what we deserve.

Psychiatry: add your own caption

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