tony de wonderful

Who wants to do anything except for material gain?

What goalposts are you talking about Jacko? Where are they?

john banks

TDW, you will no doubt be familiar with surveys that compare trust in doctors, politicians, teachers, journalists etc. Maybe this strike and press coverage over the last five years will unwind that favour somewhat.

What income do you think an experienced, full time doctor who carries legal and clinical responsibility for their patients (as in they don't have anyone senior they report to) should make and why? Please fit some other professions around this level who earn a bit more and a bit less and say why they should?

Or am I missing your point?

scoobyster

How about mental health professionals who typically help the most vulnerable in society deal with their problems? Let's take Clinical Psychologists as an example. Degree trained (2:1 or above, not just a Pass), clinical training, clinical experience, doctorate. Pay starting at £18k, 30k once fully qualified, as defined by AoC which was designed to make pay fair across the NHS. Responsibility at least on a par with a GP I'd say, they have to actually think rather than just prescribe antibiotics again

john banks

In your reply you could consider equivalents to some of the responsibilities of doctors:

Life and death decisions, not figurative ones, but literal - ie deciding on whether to resuscitate a patient, deciding how to resuscitate a patient including not missing the fatal but hidden causes of their collapse, determing and certifying causes of death including signing the papers that lets the body be cremated destroying the evidence forever, deciding clinical management plans that if incorrect will miss the diagnosis of or mistreat any number of problems that can result in premature death, sometimes many decades worth.

Important decisions - sectioning under the mental health act, diagnosing and treating debilitating yet obscure and hidden but not (unless mismanaged) usually fatal diseases, safe and effective prescribing of drugs, certifying people fit to work/drive HGVs/use firearms, spotting abuse whilst not throwing around wild accusations, managing criminals/addicts/alcoholics/the "entitled", some very nasty people, managing the general public, managing staff/premises/business, all under considerable budgetary pressure, justifying your prescribing to an inquiry like I had to last night (successfully I might add).

Just a few ideas...

I'm well aware there are jobs that involve attaching a piece of pipework that if you get wrong could kill many. But they are quite well paid for the guy that carries the can for it and supervises.

john banks

See my reply above and consider again whether it is just antibiotic prescribing. Today I cut a lump off someone's neck that was in interesting proximity to his carotid artery, I told a mother her child did not have any signs of meningitis, I diagnosed raised intracranial pressure without a scan and took the appropriate action. Obviously I didn't think about any of these, and obviously if I got any of them wrong it wouldn't matter

Let's take a clinical psychologist indeed. What are the entry requirements? Do they carry a legal responsibility for their patient under the Medical Act? Do they make diagnoses and undertake treatment that if incorrect will often lead to the death or debility of the patient? Do they stick knives and needles into difficult parts? Do they section patients under the mental health act? Do they prescribe dangerous drugs?

A useful bunch, but mostly if they get it wrong, not a lot happens, they just end up at my door again, not usually under a train, but it does happen.

Another question would be, what can a clinical psychologist do that a doctor can't? What dangerous and risky things do they do apart from talk? What special legal rights and responsibilities do they have? If everything they did in a day was a gross error, what harm would arise? Why do they take 9 months in my area to see a patient, by which time they have relied on other professionals to support them through an illness that has usually been treated by then?

I'm not rubbishing clinical psychologists, especially if you are one, but do some of these factors above indicate why they are not paid as much to you?

tony de wonderful

I don't know John, but I'd ask why Doctors pay and pensions should not rise and fall similarly to the rest of the economy.

It's not about justifying pay and pensions but saying why the above proposition (contained in the question) is unjust.

john banks

Doctors' pay and pensions does rise and fall similarly to the rest of the economy. There was a blip in 2004 that was clawed back. In real terms I'm behind where I was 10 years ago like many others in our economy. A doctors in the 1950s, 1970s, 1990s and now have a similar standard of living.

Midlife......

iTrader: (2)

Blimey John, you were going some to be near the Internal Carotid

Shaun

john banks

Superficial of course, I'm only a GP and should only be prescribing antibiotics after all, but they did give me a bachelor of surgery for a reason It was quite exciting because it was bouncing up and down with his pulse. I was careful to really check for blood free aspiration before putting the lidocaine in and not too aggressive with the cauterisation.

False peril in ice road truckers style perhaps, but it was exciting enough for me.

scoobyster

Yes I'd argue it can lead to death or debility of the patient (or others!) if a psychologist gets things wrong. No surgery but surgery is a (highly) skilled trade rather than a profession per se if you ask me, surely it's all about practice rather than intellect. I would have thought a psychologist or other mental health professional's opinion will have the biggest impact on whether a patient gets sectioned, surely the doc just signs the form to suit (I assume only doctors can do this by the fact you are asking the pointed question). No, psychologists do not prescribe as they're not getting the bungs from the antidepressant manufacturers that the docs are

Indeed it does happen and I can only imagine the horror for the mental health professional who was seeing them weekly and trying to sort things out for them. Inevitably a GP will be less personally involved since they have so many more patients on their books.

Presumably because there's no money for mental health as it's all spent on consultant doctors.

No, I'm an engineer, generating wealth for UK plc and paying doctors' salaries and pensions. I do know a psychologist well so have some insight but can't pretend to know everything about it. It sounds like you're a capable GP but in my experience that is a rare creature, so it grates when doctors are treated so well to the detriment of the rest of the NHS, and insist on being treated as some superior beings.

john banks

Your experience of clinical psychology is rather different to mine I have to say.

Most psychiatric illness is treated by the GP and we have the most contact with these patients, this includes those on the fringes of psychiatry such as personality disorders, nasty people, manipulators, addicts and attention seekers, but also schizophrenia, bipolar affective disorder and the whole range of unipolar mood disorders and anxiety/phobia. Some have a community psychiatric nurse, a smaller number still have a psychiatrist, and even fewer have a psychologist. The GP or the psychiatrist are the ones who do the mental health act detention and make the decisions that are dangerous, whereas the psychologists just talk. A mental health officer who is a social worker trained in mental health adds an independent opinion when available, but I've never seen them disagree, although it potentially adds a layer of protection for the patient when their liberty is being encroached. I've not seen a clinical psychologist involved in this process. Their main role that I see (and I see it all as I get all the letters from psychologists for my patients detailing their contacts) is in CBT and cognitive function assessments in dementia patients, but I can't think of any of my patients who know their psychologist better than their GP. Psychologists try to stick to brief interventions if they can it seems. Non-attendance soon sees them dropped, but they keep returning to us as we cannot drop them, neither can a responsible psychiatrist. A typical patient waits for months, gets sent a letter from psychology asking if they still want the appointment, they patient doesn't reply and they don't get seen. The GP is expected to go knocking at their door when they go loopy and "not responded to letter" with someone who is seriously ill would be seen as negligent.

Whilst I can respect them as professionals, locally, they don't get stuck in with critical or urgent situations, aren't available quickly enough to avoid us having to use drugs instead even where CBT may have good evidence, and when the patients are really sick to the point where they can't engage with therapy they disengage and put them back to GP or psychiatric care. They just don't seem to be heavy hitters in any respect.

Now if you ask me about a district nurse, yes the good ones really get stuck in, and if value is proportional to amount of $**t waded through then these people are truly gold, but they still work in a relatively narrow remit as part of a team. They can prescribe from a very limited range, do not diagnose, work very much to protocols, and cannot take "lead clinician" role for a patient which has to be a doctor. They can do far more harm than a psychologist if they don't know what they are doing IMHO, but are paid similarly, and locally are far more useful to more of my patients. When you're seriously sick, recovering or dying, these are the people you want on your side.

thesyn

Sorry Scoobyster just not so; clinical psychologists do a superb job managing up to moderate depression however if they perceive any concern that in their opinion there is any risk of self harm to a patient I receive a phone call and respnsibility is passed back to me.

Invariably this will occur in the early evening whilst I am trying to admit an acute abdomen to hospital and organise changes to pain control to a terminally ill patient at their home.

It will invariably not be easy to locate the depressed patient but this has to occur and an assessment carried out to determine whether a psychiatric assessment is required immediately or perhaps they can come into surgery the following morning for review.

This scenario is not that unusual and means me working far beyond the contracted hours for a day. It is one of the reasons that I enjoy my job in that
I have trained for this for a long time and I am effectively managing a number of potentially life or death situations simultaneously. It is not easy and is highly stressfull as the buck really does stop with me.

The point is that there will effectively be no strike that will effect patient care as I will be at work that day and if anyone phones and says that they need to be seen I will see them as per usual.

tony de wonderful

Medicine is probably the last bastion of traditional authority. It's adepts and initiates can still claim to be able to control magic.

mrtheedge2u2

John, if you was my doctor and you saved my life or that of one of my loved ones then you are worth your weight in gold to me and should be paid very handsomely indeed.

You are not my doctor but I still acknowledge your skills and dedication and, last time I looked, it was a free market economy and you get what you can

The way I see it is if people have really big issues with doctors earning what they do then they should take a stand; stop seeing doctors; dont go to A&E.....but dont complain when you drop down dead

tony de wonderful

It's not a free market when you have unions such as the BMA making a monopoly of labour.

john banks

How does that monopoly of labour work when I'm not in the BMA?

Leslie

A doctor has an extremely responsible job and they deserve the respect that most people accord them. Anyone who is into life saving is generally regarded in that light.

No one can be blamed for getting upset when they find their terms of employment and pensions being changed from what they were promised when they started out in the job.

Les

tony de wonderful

Without you is the answer. A union doesn't need all the labour in a industry to be a member of it to be able to exert economic leverage.

GlesgaKiss

A union can be present in a free market. What isn't an element of a free market is the NHS - but then it isn't supposed to be.

tony de wonderful

How is forming a monopoly of labour anything to do with free markets?

GlesgaKiss

The main principle of a free market is voluntary agreement by individuals, i.e. they choose what to do. Therefore individuals are free to choose to form a union. The opposite of a free market is central regulation or direction of the market, which is what happens if action is taken to prevent unions by law.

thesyn

THe strike organisedd is perhaps ill conceived and will upset the general public the point is that it has to be about something. The problem is that the BMA has been legally advised that this strike cannot be about proposed changes to the national health system.
In the near future a company may set up a clinic to perform say coronary artery bipass surgery staffed from country X at NHS local hospital cost minus 30%.
In the brave new NHS there will be enormous pressure for GP comisssioning groups to use this cheaper service.
The point that I am trying to make is that private medicine ia absolutely brilliant if you have a sports injury or hernia which requires day surgery and no need for overnight stay. The lower costs reflect minimal overnight cover so that if severe complications do occur and an immediate transfer to intensive care is required your life might be at a greater risk than if the operation had been performed at an NHS hospital.
In general doctors are helpful and pleasant people who know that they are well off compared to many. The truth is that finance does come into the equation but there is a lot more to it than the government would have the general public believe.

tony de wonderful

No it's voluntary agreements between buyer and seller not 'individuals' as that could mean that seller and seller collude against buyer i.e monopoly.

GlesgaKiss

It is between anyone in the market for anything. A 'free market'. The people within it are free to act as they wish, and they're certainly free to get together and bargain for better pay.

What you're describing is a free market with govt regulation against monopolies. It's not a feature of a free market per se. It's your idea of what a free market should be.

Dingdongler

I think the issue is TDW you just don't know or understand the dedication involved. You don't have it and that's why you left your job as the work was as you said making you ill. My 'job' as often made me ill, threatened relationships etc but I would never leave it.

And let's not forget this is not just about GPs.

I'm a consultant in an acute speciality and am over fourty years old. On Thursday I started work at 0730hrs and finished at midnight. I could have had been called back again but luckily wasn't. I then went back to work at 0730 on Friday and worked until 1730hrs.

During my Thursday shift I dealt with everything from a gunshot wound, a lady bleeding to death from a ruptured ectopic, an emergency c section for fetal distress and much more. I didn't really get to eat properly, was dehydrated and my back and feet were in agony because we were so busy. No allocates lunch or break times.

I was the senior person of my speciality for all these cases and the buck stops with me. Many times I had to make a decision within seconds, the wrong decision and we have a dead man or a brain damaged/dead baby. As painful and stressful as it is at the time I love it and am honoured to earn a good living from what I love to do. But do I deserve to be well paid for it? Hell yes.

I'll be doing this until I'm at least 60 btw. It may all sound a bit melodramatic but myself and thousands of other senior doctors up and down the country do this sort of thing day in day out.

If you have never shown the dedication to something to keep going even when you are hungry, thirstyyour back aching, blisters on your feet (I kid you not) and your stress levels through the roof you will never understand. You'll never understand that some jobs need to be treated and rewarded differently.

pslewis

At the end of the day ..... there will be zero public support for any strikers who are hurting patients because they want MORE than a £68,000 annual pension AND more than a £194,000 Tax Free lump sum!!

Midlife......

iTrader: (2)

For me it's not the job now.........it's the years being a dogsbody / underling of a junior member of staff !!

Shaun

Dingdongler

Well said Shaun. I didn't even mention the 10 odd years I spent working 80 hours a week and earning less per hour than the cleaners. It was pure hell, physical and mental torture, during this 80 hour week we also e had to find time to study to pass our post grad/fellowship exams.

Back in those days docs were to scared to ask for a day off when their wife was about to deliver.

It may sound like we are patting ourselves on the back but some people have no idea what it takes to go through this and stick with it.

TonyBurns

iTrader: (3)

Pete, you being a Nuclear Scientist and all, what was your lump sum and what is your pension?

Tony

pslewis

Tony ...... I'm not striking to get what I could have had in previous years!

The contributions I made went up 400% with a reduction in benefits .... quite a few years ago now.

The Public Workers are just now getting hit with what the Private side were hit with a decade ago ...... it's long overdue.

And, I have to say, we acknowledged that we were living longer than the Pension thought we would ... the model had changed and so we had to.

To strike because £68,000 a year isn't enough is a disgrace.

To strike because £194,000 Tax Free Lump Sum isn't enough is a disgrace.

Do you, really, want to have to work and pay taxes until you are 90 so that Doctors can retire at 60 on the above ...... do you, REALLY??