Working for nothing

Back when Aneurin Bevan promised to “stuff the doctors’ mouths with gold”, and indeed, for all the decades since 1948, there has been a useful misconception that consultants are paid vast amounts of money.

Well, compared to the average wage, we are.

However, from 1948 to 2004, when the new Consultants’ Contract came in, we worked a lot of the time for nothing.

Nothing. Zip. Zero.

I was working more than every fourth weekend for my first 10 years as a consultant, for no payment at all. None. Plus the midweek on call. These weren’t just “call me if you need me” weekends, it was always consultant-led, as it still is. I can’t vouch for all branches of medicine, or even all other surgical specialties, but some weeks I’d do more work unpaid, than I did paid, and the latter was often very busy indeed. Doctors who did on call got paid no more than those who didn’t – sometimes less. There was no time off in lieu during the week.

The reason for this was an archaic historical view that mysteriously, once you stopped being a junior (modest payment for out of hours work), you hardly did anything when on call. The opposite turned out to be true. There was, and still is, a significant number of cushy junior jobs. We consultants were working pro bono, as m’legal friends would call it, but we had no choice in the NHS. All those hours in the hospital, at any time of day or night, neglecting your family, missing out on all sorts of things. I love the job, but this was, frankly, taking the piss.

And the legal comparison is frequently rolled out. They are our peers, sort of.  Not many lawyers work pro bono.  A bit of medicolegal work soon opens your eyes as to the amount of money floating around the legal world, especially with the QC’s. All of which came to mind when I read Guy Walters’ amusing and truthful polemic on working for nothing.

As a very fine historian and author, he describes all the things he’s been expected to do for nothing – talks, reviews, judging panels, forewords etc – and he’s had enough. I don’t blame him:

The problem with all these activities is that nobody actually wants to pay you to do them. Instead, you are given vague assertions that it will be good for sales, good for your profile, and if you do all these things, then my son, there will be jam for tea.

Well, I’m now 41, have written 10 books over 12 years, and for me it’s tea time. The kettle has come to the boil, the Crown Derby is laid out, the bread is sliced and I need the jam right now. In short, I want to be paid for what I do.

In any other profession or trade, asking for money is not such a strange thing, is it? Next time you get a lawyer to drive 250 miles and then speak to you for an hour, try paying him with a few bottles of Spanish dry white and see what he says.

Anyone who’s reading this and is feeling a build up of rage towards this whining self-pitying wimp (me), needs to know that there’s another moan coming. When the media take it upon themselves to publish stuff like this:

Consultants are being warned to put in more hours on Saturdays and Sundays to prevent unnecessary deaths.

Experts say patients are up to 16 per cent more likely to die if they are admitted at the weekend because junior doctors on duty make more mistakes than senior colleagues.

Consultants are accused of merely popping in for a few hours to see critically-ill patients who have just been admitted to hospital.

…then I tend to see red. Most of us ‘senior’ types are in at weekends and evenings, without the protection of the European Working Time Directive or the New Deal, beloved of a certain class of junior (and legally ‘binding’, in the NHS).

Very little of this is about preventable deaths, or dealing with true emergencies. Even the most jaded and cynical of us have some sort of moral code and professional standards, without being prodded by the papers, the government and the BMA politicos. A lot of it is about meeting the ever more fatuous political targets for non-urgent work.  Not that the government will admit it.

The reason why the GP’s don’t work out of hours now, causing mayhem in A&E (and entirely predictably), is that the Labour government gave them a strong financial disincentive to do so, with their new contract.  They’re only human.

Conversely, if you really want lots of  extra non-urgent work, go back to to Bevan, and start stuffing.

Nobody works for free these days.

...if only...
…if only…
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