Dr John Crippen
"There are now dozens of adverts for salaried GPs. These suit woman with children who want to work part-time, child friendly hours, and are grateful for the measly £50, 0000 they will be paid." I wouldn't mind being paid such a 'measly' figure!
£50000 is more than one third of a normal doctor's salary. Given that part-timers presumably don't have to take any of the decisions of running the business, or do any admin etc., how is that exploitation? Especially taking into account the other part-time jobs available to people qualified to degree level, but not requiring a specialist degree?
The alternative for these part-timers would be to club together to form their own practice where they all (except perhaps one or two) work part time. Presumably they do not wish to do this. Before you suggest this is unrealistic, the full-time admin, management, etc. could be done by a full-time, ambitious, but new GP, who would have the advantage of being surrounded by many experienced doctors.
I agree with points 2 & 3, but Trainers (I'm not one) have to jump through a million hoops & get paid a pittance. Both my trainers worked very hard when I was a trainee, including many evenings spent helping a group of us for MRCGP.
They could earn much more doing something else.
By and large I agree with you. But (there's always a but after a statement like that isn't there?) I do have to question why a nurse can't give me my depo (sp??) injection every 12 weeks considering I have been on it for years and do not have any problems and the doctor does not do anything other than administer said injection and prescribe the next one. Well, we have a nice chat; me being a secondary school teacher means that we actually have a lot in common!
Doc...very interesting to hear how that £250 grand is possible, even though we know there are only a handful of GPs getting it. (I think we can all see how you guys are being stitched into a PR corner by dark forces at the Treasury, just because they don't like the way the DH have given away the store. Get ready for the usual cyclical pay "retrenchment").
But now you've opened up the subject- and I apologise for sounding like HJ- I'm wondering quite how your market works. Why is it that you can hire salaried GPs at £70 grand when they're worth £120 grand +? Why don't they just rent a shop and set up themselves? What are the barriers to entering the NHS GP biz?
To follow on from Wat's point, why do they not take two £50000pa part time jobs?
Reading this gives me chills. Not the ill, cold-like kind. The other kind, y'know?
Come on Crippen,
How many part time jobs with chld-friendly hours are there in any other line of business that pay £50k plus generous pension rights?
I can't think of any.
£50,000 is something like a fortune to me... certainly not "measly"!
Given that part-timers presumably don't have to take any of the decisions of running the business, or do any admin etc., how is that exploitation
the women doctors who do that kind of job at my GPs' surgery don't feel exploited at all, they like not having to do admin. etc.
(My GPs probably earn less than Dr Crippen, Welsh doctors are less well paid -- but still doing OK.)
I have to echo HJ's comment above, I'm afraid. £50,000 is not a measly salary: I am sure that you may consider it so after all of the training, etc. that you have to do but, for child-friendly part-time work, it's really not bad.
Considering that the most I have ever earned is just less than half of that (and I had to work an enormous amount of overtime to bump my salary by £5,000) I can only look on in envy...
DK
PS. My GPs' practice has 4 partners, a registrar, usually another doctor, and 2 nurses (plus receptionists and 2 secretaries and a manager). I see doctors. I can see a nurse if I want to, and they do some things the doctors don't do but I don't get pushed into seeing a non-doctor... .
Um, in your three ways to get 250 grand you seemed to miss the REAL big earner - pharmacies. Its all the rage in lincolnshire from whence i hail. The GP surgeries provide their own pharmacy services which they charge a tidy sum for.
You obviously are much more knowledged about these matters than myself, but I recall that service being one hell of an earner for the big rural practices.
HJ from what I've seen of GP hours i think the phrase 'child friendly hours' is reallllllly a stretch. most of the ones i know of have to provide their own out of hours cover (which usually means each partner providing 24hr cover at least 1 week a month) plus half of them go in to the surgery by 7 [pre-patient meetings about the practice, new targets and the like] and leave after 7 [post patient meetings, consultations about patients, paper work blah blah blah].
child friendly is a thing of the past, GPs these days seem to have easily as much workload as hospital docs.
#2 sounds like the church of England before the 19th century pay reforms.
A couple of points:
My understanding is that this figure of 250K came from a firm of accounts who claimed to have GPs as clients. If, as you suggest, one scam is to hire in 'salaried' labour and then swan off to conduct private work then a figure of £250 is NOT a 'flat' GP salary as is being portrayed.
Secondly, given your dislike of practitioners and their ilk, where do you stand on the 'practise manager' Seems to me there's a lot of admin, data collection, form filling and other routine procedures that 'should' be delgated to others and leave you and your colleagues to focus on those patients who need your specialist skills. Presumably funding for 'managers' receptionists, etc comes out of your 'salaries'
" These suit woman with children who want to work part-time, child friendly hours, and are grateful for the measly £50, 0000 they will be paid."
I rest my case. I find you greedy b****rds disgusting.
Ruth
most of the ones i know of have to provide their own out of hours cover
no they don't; they can give up £6000 per year per partner and it will be arranged for them. They can work a 4-4.5 day week.
Also the doctors working the child friendly hours are working part-time (part of the 4-4.5 days) for £50000 a year.
The mean full time pay of a chartered engineer in this country is around £50k. These are people who design medical equipment, bridges, aeroplanes, safety-critical equipment, etc. Most, of course, have far fewer pension rights than GPs and much less job security (the number of electronics engineers employed in the UK has shrunk by 30% in the last 5 years due to international competition and high costs in the UK). Most engineers work way over their contract hours and I have never heard of one getting paid overtime - they're professionals. The difference is that they work in industries that tend to have to compete internationally. Doctors in India earn a fraction of what they earn here - were there a free market, one wonders whether this differential would be maintained.
It's hardly surprising that applications for engineering courses in the UK have plummeted in recent years whilst those for medical courses are overwhelmed with applications.
Here's a quote (with which I wholeheartedly agree) in yesterday's Times by Stephen Pollard, who is something of an expert in health economics:
"Lord Heseltine’s description of the public sector is, unwittingly, one of the most accurate and succinct imaginable. It is indeed bloated, badly run and an inefficient impost on the taxpayer’s back. Yesterday’s revelation, for instance, that some GPs are earning £250,000 a year is typical. It may be that in a market, where the public can choose how and with whom its money is spent, GPs would earn similar sums. But because of the way the system is structured, we will never know. Under the existing system GPs are handed taxpayers’ money not because of any increased efficiency or success in proving their worth but because the British Medical Association knows how to work the system and has stiffed the Department of Health in negotiating their contracts."
To answer Jamie F: There are two part time GPs at my local surgery plus 4 full time (actually, no one does more than 4 1/2 days). Nobody offers 24 hour cover or anything like it.
In fact, in recent years they have closed their evening surgeries and stopped opening on Saturday mornings - now strictly office hours only, starting at 9am (every office I've ever worked in starts at 8, so they have plenty of time to do admin before they open). Neither can you book more than 48 hours in advance - you must ring between 8 and 9am (and persevere as others are trying to do the same) to get an appointment.
My point is this: How come their pay has gone up so much yet their responsiveness to market demand has gone down? I know the answer, but you get my point.
Responsibility for primary medical acre overnight and at weekends now lies with the primary care trusts.
So it isn't clear to me why Jamie's doctors have to arrange cover.
HJ I had an even worse appointments problem (ring at 8.30 for a same-day appointment); after quite some months my doctors realised that wasn't good enough and added pre-bookable appointments (bookable from Friday afternoons, for the next week).
I imagine you, like me, often can't see the doctor of your choice.
this explains the out-of-hours system now (it was written before it began).
Whilst considering doctors pay in this country you have to remember the sort of debts they're gathering by pursuing a 4-8 year course of study in expensive city centres. More and more people on the 5 year courses are graduates already, and the opportunities to work during both degrees whilst trying to jump through all the hoops for UCAS forms/F1F2 job forms are somewhat limited. People say you can work in the holidays, but I would like to point out that between years 3 and 4 and 4 and 5 of the standard, less intensive course "summer holidays" often consist of a weekend off, so there's not much of a chance to get rid of that debt before you graduate.
Also, what's with picking on just the doctors while the hospital managers are hardly on stingy wages? They can earn more than your average GP, yet they don't have to spend 8 years at university for it. They've obviously found themselves a more discreet accountant.
Dr John Crippen - what exactly is the Expert Patient Programme, and what do you think of it?
"Also, what's with picking on just the doctors while the hospital managers are hardly on stingy wages? They can earn more than your average GP, yet they don't have to spend 8 years at university for it. They've obviously found themselves a more discreet accountant."
Say what? Some chief execs earn a lot, but according to a recent survey, median salary for chief execs is currently £119,235 (it ranges from about £210,000 down to about £48,000). Almost all hospital managers earn less than six figures, and the majority can only aspire to the "measly" £50,000. Doctors' earnings should surely reflect their training, experience and out of hours work, but don't assume managers are raking in the same wages; most NHS chief execs are earning less than GPs (and about a quarter of what they could get in the private sector).
I don't mind the amount GPs get paid. I just wish they took more responsibility.
My GP is a single dr practice, and has just employed a trainee. Yet she couldnt fork out for the tests I needed for a chronic illness to be diagnosed, so I had to scrimp and go private for the tests.
Yet, I have to have a med check each year, so I suppose she gets paid for that.
I am angry. The whole system stinks.
Another way for GPs to earn extra cash is by volunteering for more hours a their co-op. As I understand it, all the doctors in a co-op pool responsibility for out-of-hours care. Those same doctors then work for the co-op on the nights that they choose. Some docs work very few hours and get (relatively) little extra remuneration. Other doctors pick up the slack, work many nights per month, and reap the benefits.
Oh....I forgot to say, the med check is done by a nurse, so my GP doesnt have to waste her time on me!
Hi Dr Crippen,
I have been following your blog for some weeks and find it amusing and VERY pertinent. I am a GP in a suburban London practice - incidentally we each are now earning approx £100,000 pa after practice expenses and our superannuation deductions. I don't think this is excessive for looking after 2000 patients each from 8am-6.30pm 5 days a week.
With regard to Mr Bliar's new "reformed" NHS, I thought that you may be amused by something in our mail today. It is 4 x A4 pages, closely typed, following one of our patient's contact with a nurse-led Walk in Centre. The reason for the call was "3 days of neck pain much improved after one dose paracetamol taken previous day and associated with sore throat, runny nose and fever" My 30 yrs of experience as a Dr leads me to think that this was a common cold - some of your non medical readers may have guessed the same! However, it took the nurse following the computer-led alogorithm 4 pages to reach the same conclusion. Why? Becuase the computer insists on ruling out serious but improbable causes FIRST. First question on protocol "Have you struck your head in past few days/weeks" Second "Severe pain in eyes on exposure to light?" "mental confusion" "non-stop headache like a thunderclap" etc etc for 4 pages!
All this for a runny nose and sore throat that had already improved with paracetamol (acetominophen)!!
A long anecdote but indicative of where we're going/being pushed. It may seem cheaper in the short term to use these protocols etc but in the long term it will increase costs through unecessary referrals - it only takes the patient to answer yes to one of those questions - after 4 pages most people would feel obliged to say yes to something!- and they're sent off to A&E.
I have a question for you Dr Crippen. And I mean it with the most serious intent and with interest in your opinion. Do you think that your country would have been better off without the NHS altogether than to have this (what seem's to be) inevitable land slide of political knitpicking - driving the NHS back towards what I think you are admirably and candidly characterizing as a perverted non-free market economy? I mean, isn't this what America might expect if we were to ever create a socialized health care system? Could you, in good conscience, recommend this grand experiment to the colonists across the pond? Or would you tell us to keep health care in the free market and live with some inequities? Inquiring minds want to know...
I was told this 30 years ago by a doctor when I talked of wanting to become a doctor myself.
If you took the effort required to become a physician, the deferred gratification, the debt (at least in the USA), and put it into any business you liked, devoted that energy to the business, you would probably be better off in the long run.
There's a book "The Millionaire Next Door", describing the statistically typical millionaire in the USA really is a small businessman. Remarkably, fewer physicians showed up as millionaires.
To Jennyta, and the many others who have made this point, including HJ and Wat Tyler.
""There are now dozens of adverts for salaried GPs. These suit woman with children who want to work part-time, child friendly hours, and are grateful for the measly £50, 0000 they will be paid." I wouldn't mind being paid such a 'measly' figure!"
I probably was not as clear as I should have been...but you are all taking the remark out of context.
I did NOT mean to suggest that a salary of £50,000 is measly in general terms - of course it isn't.
What I meant was, if you take a GP who is earning £250,000 he is not doing this by seeing NHS patients full time. It is not possible. So he pays part-time doctors a salary which IS measly, in terms of his earnings, to do his NHS work for him.
This is allowed under the government's new contract lump sum pay system. You can now pay someone else to fullful you NHS committment whilst you bunk off into private work.
It stinks.
John
Marcin
Strong points. Of course not all salaried doctors are abused. Nonetheless, they do not get a brilliant financial deal.
So why do they take it?
Well over 50% of entry into medical school is now female. Women have babies. They do not want to work full time. They are glad of the opportunity to work, say, 5 sessions a week at school friendly hours.
That is fine.
So, you are a principal in general practice. You employ two part-time female doctors at £50,000 a year each, each doing 5 sessions. That more than covers your patient committment.
You are already £150,000 ahead of the game. Then you go out into the private sector and earn some serious money.
We are not getting a rising number of GPO entrepreneurs who are doing precisley this.
Is this a good use of tax payers money?
Is this where you wanted the increased funding of general practice to go?
If you are happy with all this...fine.
I merely point it out.
John
The idea that 50k is "derisory" is an absolute joke! I am an academic and earn 30k for a 50-60 hour week, with huge amounts of administration, responsibility for departmental management and student health and welfare issues. Those who make it to the top of the profession (Professor), who probably only make up 30% of the workforce at most, will be lucky to earn 60k. That is after 8 years of training, decades in the job, publication of at least 3 books, numerous articles etc. There are no opportunities to speak of to work part time. A friend is a salaried GP, she works 2.5 days a week, and her day includes coffee breaks, a lunch hour, and protected staff development time. I am glad she has the chance to work in such favourable conditions, but GPs need to realise that they are far from hard-done-by.
David B
Trainers and trainess.....sure, most trainers put a lot of work and effort into it and give their trainees a really good deal.
Some do not.
We have all seen it.
And good deal or not, it is still a free pair of hands.
Why otherwise is there a surplus of trainers? Too good a deal to miss.
John
Hi EW
"By and large I agree with you. But (there's always a but after a statement like that isn't there?) I do have to question why a nurse can't give me my depo (sp??) injection every 12 weeks considering I have been on it for years and do not have any problems and the doctor does not do anything other than administer said injection and prescribe the next one. Well, we have a nice chat; me being a secondary school teacher means that we actually have a lot in common!"
No reason at all. Far better to have a depot injection for a nurse than a doctor, that's for sure.
Excellent use of nursing role.
John
Hi HJ - robust as always. You say:
"Come on Crippen,
How many part time jobs with chld-friendly hours are there in any other line of business that pay £50k plus generous pension rights?
I can't think of any.
HJ "
I am not suggesting it is a bad deal compared with other salaries in the community. But since you mention it, there are better paid part time jobs for women in city solicitors/accountants and so on.
But that is not the point.
For once HJ I am coming from the same side as you. The money that has been thrown at general practice has enabled certain business orientated GPs to make personal fortunes out of tax payers money.
Still, I suppose you would call this the free market! 
John
Hi magwitch
"A couple of points:
My understanding is that this figure of 250K came from a firm of accounts who claimed to have GPs as clients. If, as you suggest, one scam is to hire in 'salaried' labour and then swan off to conduct private work then a figure of £250 is NOT a 'flat' GP salary as is being portrayed.
Secondly, given your dislike of practitioners and their ilk, where do you stand on the 'practise manager' Seems to me there's a lot of admin, data collection, form filling and other routine procedures that 'should' be delgated to others and leave you and your colleagues to focus on those patients who need your specialist skills. Presumably funding for 'managers' receptionists, etc comes out of your 'salaries'
magwitch
Yes, I think the figure did come from one of the accountants who specialise in GP finance. We use one of them. We see their figures for the highest earners.
I don't know quite what you mean by a "flat" salary. Remember GPs are in fact selfemployed. Each practice now gets a lump sum which can be used (within broad margins) as the GPs see fit. So, yes, if they can take on salaried docs and get more free time to do private practice, their income goes up. These accountants firms are quoting TOTAL income earned by GPs from all medical sources, not just the NHS lump sum.
I think the lump sum should NOT be used to facilitate leaving your patients in the hands of other doctors.
++++
Practice Managers, secretaries, receptionists - of course we have those. Could not work with out them. But we always had those, and their salaries were partially reimbursed.
JOhn
Um, in your three ways to get 250 grand you seemed to miss the REAL big earner - pharmacies. Its all the rage in lincolnshire from whence i hail. The GP surgeries provide their own pharmacy services which they charge a tidy sum for.
You obviously are much more knowledged about these matters than myself, but I recall that service being one hell of an earner for the big rural practices.
Jamie F
Yes, thanks Jamie.
I don't know too much about GP pharmacies. We cannot do it. We have 3 chemists within half a mile.
But, yes, it has always had the reputation for being a major earner.
John
" These suit woman with children who want to work part-time, child friendly hours, and are grateful for the measly £50, 0000 they will be paid."
I rest my case. I find you greedy b****rds disgusting.
Ruth
Anonymous
Well, Hi, Ruth Anonymous.
I have already explained that I did not mean that £50K was measly in general terms, only in terms of the principal earning 5 times that amount.
Ruth, doctors are highly trained professionals. You have to pay them reasonably well.
I do not know what "reasonably" means.
How much do you think a full time doctor should be paid?
John
Hi K. You said:
Dr John Crippen - what exactly is the Expert Patient Programme, and what do you think of it?
K | Edit comment
I do not know much about this other than what I have read in the papers.
I fear it is more plausible crap from Nu Labour. What are they meaning? Are they meaning that patients should train themselves up to be their own doctors and so save the NHS money?
That's a good one, isn't it!
I strongly support the idea of patienets learning about their own illness, and how to manage it. This is absolutely cruicial for something like diabetes and asthma. And the doctors and nurses should help to educate the patients to educate themselves.
You just cynically fear that patients will suddenly be deemed capable of managaging their own illness and then be deprived of access to a doctor.
I am deeply suspicious of anything this goverment does.
Anyway, it is all at:
http://www.expertpatients.nhs.uk/
John
I don't mind the amount GPs get paid. I just wish they took more responsibility.
David Holland | Edit comment Delete comment | Email | 21.04.06 - 1:42 pm | #
David, I do not know what you mean. Can you explain?
John
Hi Dr X
Thanks for that. I agree entirely. This is nurse led walk in centres/NHS Redirect.
You and I know that it is codswallop.
What drives me to despair, is trying to make people understand that learning competent diagnostic skills takes years and requires aptitude and intelligence.
As to salaries?
Well, as Wat Tyler has said somewhere above, the government is not softening us up for a pay cut.
John
Hi Puzzled:
"The idea that 50k is "derisory" is an absolute joke! I am an academic and earn 30k for a 50-60 hour week, with huge amounts of administration, responsibility for departmental management and student health and welfare issues. Those who make it to the top of the profession (Professor), who probably only make up 30% of the workforce at most, will be lucky to earn 60k. That is after 8 years of training, decades in the job, publication of at least 3 books, numerous articles etc. There are no opportunities to speak of to work part time. A friend is a salaried GP, she works 2.5 days a week, and her day includes coffee breaks, a lunch hour, and protected staff development time. I am glad she has the chance to work in such favourable conditions, but GPs need to realise that they are far from hard-done-by.
puzzled
Yes, again, I am regretting the use of the word measly. I only meant it in the context of the doctor earning 5 times as much.....
.....As I said to Ruth Anonymous, how much do you think that doctors should be paid?
John
Fascinating that anyone thinks Dr.Crippen meant the 50k was a paltry sum in real terms, as opposed to the context in which he wrote it. Never even occured to me that anyone could actually misinterpret Dr.Crippen's point. Supose it's just the intellectual superiority of us docs :P
I guess hatred of the medical profession has clouded HJs inability to see things clearly though. As for Ruth...psych referral?
Hi Arf
You said:
"I was told this 30 years ago by a doctor when I talked of wanting to become a doctor myself.
If you took the effort required to become a physician, the deferred gratification, the debt (at least in the USA), and put it into any business you liked, devoted that energy to the business, you would probably be better off in the long run.
There's a book "The Millionaire Next Door", describing the statistically typical millionaire in the USA really is a small businessman. Remarkably, fewer physicians showed up as millionaires.
arf "
I understand that applications for med school in the UK are beginning to drop off. We are now on the USA system. No student gratns and you have to pay your own academic fees. Unilke the USA, we have not had 20 years notice so that parents can have any sort of savings plan to help out.
I also know that 22 year olds going into the city are earning £100K and more within a couple of years. But they of course are managing our pension funds. And everyone makes money out of those except the pensioners themselves.
One of the many things that Nu Labour has done to destroy the fabric of out society is stealth tax pension funds.
So, they have ruined secondary education, they have ruined university education, they have screwed up health care and now they have stolen most of our pensions.
C'est la vie.
John
Hi Philip. You said:
"I have a question for you Dr Crippen. And I mean it with the most serious intent and with interest in your opinion. Do you think that your country would have been better off without the NHS altogether than to have this (what seem's to be) inevitable land slide of political knitpicking - driving the NHS back towards what I think you are admirably and candidly characterizing as a perverted non-free market economy? I mean, isn't this what America might expect if we were to ever create a socialized health care system? Could you, in good conscience, recommend this grand experiment to the colonists across the pond? Or would you tell us to keep health care in the free market and live with some inequities? Inquiring minds want to know...
Phillip Gordon "
Wow. How long have I got.
I am totally committed to a reasonable standard of health care being available to all in the UK, independent of income and means.
But what we are doing at the moment is not working. Health care is being rationed by stealth and by dumbing down the service. Not a day goes by without seeing another example. In the Times today I read that ambulance drivers are now going to staff A & E departments and sent home patients who they do not beleive have "appropriate" conditions for A & E.
How will these ambulance men know? They have been re-branded by Nu Labour as "Emergency care practitioners" so in terms of PR and SPIN that sounds good. Personally I do not think you can turn a van driver into a medical diagnostician by sending him on a two week skills acquisition course. However, you are not allowed to say that, because it is not PC
I beleive we need a front end charge for all patients, properly safety netted, and that we need to privatise most of medical care.
Read James Bartholomew's "The Welfare State We're In" which is available here:
http://www.amazon.co.uk/exec/obi...J&
link_code=as1
John
Dr. Crippen is being coy with us.
He SAYS he was on vacation in the Lake District.
He was really at the reception with Bill Gates and Hu Jintao.
All the British GP's were there.
".........Or would you tell us to keep health care in the free market and live with some inequities?"
Inequities are inevitable. To complain about two-tiered health care is like complaining about the weather. You can't do anything about it.
There is two-tiered health care in the UK, as there is anywhere else. Any doubts? Two words......."Tony Blair".
The job is not to complain about two-tiered health care in the USA (as that's the country mentioned). The job is to make sure the bottom tier is something you'd be satisfied with, if it were you or a family member in that tier.
Hi Crippen, John
Doctors in the UK
are above the law
are protected from global competition
(witness today's protest marches)
are arrogant, bullying and overpaid
They come second on my sh!tlist
above Arms Dealers
and Drug Dealers
but below
IRA murderer thugs
(just so's you know John)
How much do I think they should be paid ?
well here's the point...
If I take my custom elsewhere, i.e. choose to buy medical and healthcare from outside the NHS, it won't affect the GP's pocket will it.
How about the market rate ?
Regards
(with venom carefully interwoven)
Ruth
Ruth,
"How about the market rate ?"
I'll ask my dad. He's a paediatric consultant, and showing his age after a lifetime of toil in public health. He'll be delighted to know that his work in neonatal intensive care is considered more evil than the trade in both narcotics and weaponry. And as an ex-army MO, I imagine he has had rather more experience of IRA murdering thugs than you.
I assume you must have some deep seated and personal reason for hating drs - because even in the context of the internet, that was pretty low.
Hi again Ruth
Hi Crippen, John
Doctors in the UK
are above the law
are protected from global competition
(witness today's protest marches)
are arrogant, bullying and overpaid
They come second on my sh!tlist
above Arms Dealers
and Drug Dealers
but below
IRA murderer thugs
(just so's you know John)
How much do I think they should be paid ?
well here's the point...
If I take my custom elsewhere, i.e. choose to buy medical and healthcare from outside the NHS, it won't affect the GP's pocket will it.
How about the market rate ?
Regards
(with venom carefully interwoven)
Ruth
+++
Never been compared to an arms dealer before.
I do not think doctors are above the law.
Yes, doctors tend to be a bit arrogant; they tend to be quite caring too, in an arrogant sort of way.
I agree we should ideally be paid the market rate. But there is not a real market, so how do you decide.
Go on, put a figure on it, I dare you!
John
Hi Chris
I always felt neonatologists got just about the rawest deal in the NHS. Intolerable hours, no prospect of private practive, incredible stress and a job which (and I was that man for a year) SHOs find harder to master than most, and so are calling in seniors more frequently than in most specialities.
I have not got a clue what doctors should be paid, but I see no reason why we should not be well paid.
As I said recently, a while ago there was an article in the Times detailing how many London Solicitors and Barristers now earned over a million pounds a year.
On the opposite page was an advert for the Head of Paediatrics at Addenbrookes Hospital, starting salary £70K.
This year, over 3000 (yes, three thousand) people in the city got January bonuses in excess of a million pounds.
Something wrong somewhere.
John
-the rawest deal in the NHS.
He does look pretty careworn. As a child, I learnt to dread the words "acute on-call."
-This year, over 3000 (yes, three thousand) people in the city got January bonuses in excess of a million pounds.
I hear shares in PFI firms (Laing etc) are particularly strong. Marvellous news.
Three ways?
The fourth way is being used by some GP practices who "train" medical students...... ..."could the eight of you please pop into the nursing home next door for a couple of hours and get BPs and BMIs for each and everyone old dear?" Kerching-kerching
And then there was the GP who gave "smoking cessation advice" to a 73 year old lady who had not only never smoked, but also been given such advice eight years earlier! Kerching.
Dr John
Our fight is off (for now). I am now fighting with Ruth. Doctors are not below terrorists and so on. I take exception to that. As a trained pugilist, I am reluctant to strike a female, however, in this age of equality...As a compromise, I will let her wear headgear and have one hand behind my back.
You have the email addresses - I'll get in touch with Don King
Ruth is a scumbag, end of story.I'm confident I've never called anybody that before. I'm a neonatal doctor. I'm quite junior. I spent last wednesday in tears after my shift as we were unable to save a tiny baby born in terrible condition. We work damn hard. We sacrifice our social lives to care for other peoples' babies. I was going to rant on and on about this, but my rage levels are sky high, and I think it would be a bad idea. above the law and comparable with arms dealers. What a fucking dickhead she is. apologies for use of swear words.....I have in the last month missed my godson's christening, my best mate's wedding and my parents birthdays becasue I was on call. So Ruth's remarks do grate a bit.
Well said big guy. Sorry about the little one and thanks for all that you do.
Don't worry about Ruth - after the fight this Blog will be Ruthless!
John
I am not fighting you!
Lets disagree by all means, and argue and discuss...
...that is what it is all about
John
Ok - I admire a man who says he doesn't want to fight. But Doc - in a street situation never trust someone who says that - it is often a distraction technique. Before you know it you're surrounded by a load of NPs and a maxillfacial surgeon.
And John - bit of support for the junior doc wouldn't go amiss
Best
John
Now I understand why British GP's are making a little more on average than USA GP's.
All along I thought it was a higher overall cost of living.
Now I see. Guns are more readily available in the USA, just go to a gun shop. They're harder to get in the UK, hence a higher price for the arms dealer/terrorist/general practitioner.
And they say the free market does not apply in medicine.
You see, I do agree with Ruth. We've been dealing with the likes of Dr. Crippen and his followers in the United States for some time. Ever since Dr. Crippen came to visit the USA, it's been downhill ever since.
http://en.wikipedia.org/wiki/Crips
Hi Dr. Crippen,
As a Canadian medical student considering family practice a lot of what you're saying really resonates. We are in the midst of a battle of private vs. public. Right now we have a "hidden" private system - our healthcare system is supposed to be exclusively public but people can go and pay for non-essential services in Canada or go to the United States for their MRI if they have the money. Our public system is in shambles and many people want to throw the baby out with the bath water and instead of trying to fix what we have go with a two-tier system. I am VERY opposed to this movement but, as our government follows the conservative trend of the US, I see it in our future. There is a very large shortage of family physicians (GPs) in Canada mostly due to the lack of good pay, lack of incentives to join a family practice, and physicians' desire to live in major cities instead of practicing in rural areas. When people try to convince me of the virtues of a private system to save an ailing public one I always use the NHS as the example of how that doesn't work (sorry, but I lived in Scotland for a while and saw its strengths and weaknesses). If only I could convince everyone else that fixing our system first before looking to the "free market" for solutions is the best course of action!
Kate
"........I am VERY opposed to this movement but, as our government follows the conservative trend of the US, I see it in our future......"
I do understand it's fashionable to blame the USA for everything in the world, but the USA does not take the blame for this one, thank you. The impetus for this one came from north of the border. Dr. Chaoulli, among others.
http://en.wikipedia.org/wiki/Cha...rney_General%
29
A Canadian lawsuit, in a Canadian court.
It's not just "non-essential" health services that can be provided privately. It's sort of like the opting-out you see with US Medicare. You are 100% in, or 100% out. There are private healthcare clinics around Canada that provide full-range services, but they can accept no government money. Pursuant to the Chaoulli case, there will be more of them in the future.
It's like on this page:
http://www.canadian-healthcare.o....org/
page6.html
"Under federal law, private clinics are not legally allowed to provide services covered by the Canada Health Act. Regardless of this legal issue, many do offer such services."
It's illegal, but they do it anyway?? I had a hard time with that one, then I realized the clinics don't get shut down because they provide no services under government funding. The government occasionally tries to shut down those clinics anyway, but it seems they don't really have a legal leg to stand on.
Say, I just noticed this, even the Canadian Medical Association has come out in support of private insurance.
http://www.cmaj.ca/cgi/rapidpdf/
...aj.051035v1.pdf
Actually the private system is not “hidden”. It’s right out in the open. There are private clinics around the country, up to and including surgical centers. They have Web sites. They’re in the phone book. Here’s a news article on one, and I bet they loved the free publicity.
http://www.ctv.ca/servlet/Articl...0675?
hub=Health
I cited it because it mentioned the ability to “Opt-out” or “de-enroll”, although there may be a few provinces where that is not possible. I would be interested to know if the prohibition has been challenged in those provinces.
"I do understand it's fashionable to blame the USA for everything in the world, but the USA does not take the blame for this one, thank you. The impetus for this one came from north of the border. Dr. Chaoulli, among others."
For the record, I was not blaming the movement towards the privitisation of healthcare in Canada on the USA. I was merely stating the fact that our government has taken a turn for the conservative, which seems to be a trend in North America that was started with the US. Canadians voted the new federal conservative minority government in, that's for sure, and one of the platforms of the conservative government was privisation of healthcare. I'm sorry if what I was saying was misunderstood as blaming our privitisation on the US.
The CMA has come out in support, but the CMA supports many things that all CMA members (such as myself) do not agree with. Yes, there are many private clinics operating that do provide "non essential" services for private fees that have not been shut down despite violating the law. I'm not disputing any of that. Just merely stating that I don't agree with going that direction. I believe that everyone should get the care they need in our public system and that we should address the concerns we have with that system before moving into a full-blown two-tier system. And, yes, I think it's funny that the government isn't trying to shut these private clinics down eventhough they're illegal. Maybe politicians are frequenting these clinics themselves..
The reason the private health care system has been called "hidden" is that many Canadians are not aware that Canada has private healthcare clinics. Many still believe that our system is 100% public. Not because they're not in the phonebook.
"......Maybe politicians are frequenting these clinics themselves......"
Maybe ??
When King Hussein of Jordan died, Jean Chrétien did not make it to the state funeral. There was controversy over that, very public at the time. His public excuse was he was skiing the Canadian Rockies and could not get out in time.
Thing is, when a Canadian Air Force jet enters US airspace, carrying their Prime Minister, it does get duly noted by our State Department.
He must have wanted to go cross-country skiing, because there aren't many mountains in Rochester, Minnesota.
Reported in the Calgary Herald in 2002, I found a reprint here:
http://www.mapleleafweb.com/foru...aded&show=&st=&
Fair enough, you're not blaming the USA. Thanks. I would suggest you don't necessarily want to blame your current government either.
The Chaoulli ruling preceded your current Prime Minister; I have lost track how long it took to get the case heard, it's been rattling around for years. Chaoulli was one stubborn Frenchman. I admire that.
"And, yes, I think it's funny that the government isn't trying to shut these private clinics down eventhough they're illegal."
You miss my point. The government does not shut down those clinics because they ARE legal. I mean they can pass laws trying to make them illegal, but as long as they do not accept one loonie of government money, the government can't do a thing about them. If they shut them down AND the clinic owners were as stubborn as Chaoulli, they would just win again in court.
THAT'S why the government does not shut them down, they know they would lose, and the precedent would be disastrous for the government.
Look, I'm just trying to keep you from getting grey hairs like me. You're fighting two-tiered health care in Canada; you might as well fight against gravity. The result will be the same.
You already have a two-tiered system in Canada, as does the rest of the planet Earth. Jean Chrétien gets health care at Mayo (actually I think it was a family member that time). Same with other major politicians, same with sports figures, same with civil servants, police, etc. They skip ahead in line because they are felt more important to civic life. A Worker's Comp orthopedic injury waiting months for surgery, that's a lot of time loss to pay.
Some are more equal than others.
Instead of railing against a two-tiered system, you may want to make sure the bottom tier is acceptable were it your own family using it.
"Some are more equal than others."
Well, I guess that's where we fundamentally disagree. I believe that in society the fortunate have an obligation to take care of those less fortunate. We all have a fundamental right to be as healthy as we possibly can be with the cards we have been dealt. We are all different but, I believe, equal. In my opinion, when the fortunate take care of others that doesn't mean giving them the scraps they throw away, it means treating them as we would like to be treated and if that is the case there would be no need for a second tier. Although we can never reach the ideal of being treated exactly perfectly (because hell, I'd like to be served caviar in the hospital on a silver platter while getting my MRI 20 minutes after I asked for it -- well maybe not a silver platter because in an MRI that would be a disaster) we should strive for the highest standard possible and accept the same standard for everyone. I don't think privelege makes you better than someone else, just as I don't think an autoworker (needed to drive the economy!) is any more valuable or worthy of speedy high quality healthcare than an artist.
You should have said that to Jean Chrétien when he flew his family to Mayo.
And, it would appear from the Calgary Herald article, forced the Air Force to lie about it.
Wading into the debate with both feet wet........
Arf
Damn rights blame America- you all made a movie about blaming Canada. WHat's fair is fair. There is a move to decentralization, privatization, laissez faire, deregulation, private enterprise with no checks here in Canada. Couple that with insurance companies always looking to increase their market share....figure it out. When we privatized and deregulated car insurance here the costs SKYROCKETED!!! Electricity and natural gas are triple and quadruple the cost in other provinces that have not deregulated these industries. Yada Yada Yada. We were touched by Enron's greed, we too have paid for a lot more than the cost of doing business in this free economy.
C'est la vie you may say- not so much. We have watched the American medical system implode with a free market. We see friends pay thousands in extra costs- with health insurance coverage. Have a baby take out a mortgage. Have a C section take out two. Move back to Canada if you have a life threatening illness because you will be poor afterwards.
Thankfully where I live our government (provincial) just announced that they will not be pursuing private health care for now. One of their premiere examples of a public private mix is Britain, which is not as wonderful as it could be by a LOOOONNNNGGGGG shot.
They wanted nurses to be doctors, and pharmacists to prescribe drugs- I think that will still happen, but I need to see. The government has put out a lot of fancy pamphlets talking about patients and their care providers- and they sometimes do NOT mention doctors.
Public Access is very canadian. There are problems there are issues and there can be waits, but it also is better than being without a safety net.
Signing off and going back on the beach.....
Hi Dr Crippen
Now you see the fact that my fathers life was saved by a doctor leads me to believe that you can never pay a doctor enough.
What makes me rage is the people who kick a ball around twice a week and get paid millions of pounds for serving no useful purpose.
I know doctors who are arrogant tossers, who are only interested in money and themselves, however, they are in the minority.
The people that have had bad experiences with Docs will never agree with me and I fully understand that, but you can't put a price on saving lives!
I'd like to make a few points about GPs salaries etc.
I've been ill since I was 24. I have been fobbed off by numerous GPs over the years who have patronised me and told me I'm depressed, take it easy, maybe you working to hard...... maybe a bit of talking therapy will sort it out...... etc. This went on for 6 years until I became so ill I had to give up my work.
I used to manage a business with a turnover of £100million+ which involved chemical, physical and explosive hazards. I worked 60+ hours per week, sometimes through the night. I loved it. I worked hard and I had many people keen to work for me. I am a well trained and motivated professional (chartered engineer and chartered scientist) which took 10 years+ of training at both university and 'on the job'. If I was no good at my job I'd get the sack. I would not earn £140,000 per year. One half would be more like it.
Anyway, I went private as I had to find an answer to my illness. I knew there would be an answer. My doc took 10 minutes to tell me that I was indeed ill with a treatable bacterial illness. It can be seen clearly under a microscope. I saw the critters for myself. I also had a gut parasite infection and I have hypothyroidism. None of the above was identified by NHS GPs in 6 years!
So, I took the initiative, found the basic cause of my problem, paid for it myself, and slowly I am getting much better. Good oh. So what about those folks with no scientific training - they have to go to the local GP...... That is what they are there for isn't it? it is near impossible for many good folks of this country to realise they are being sold short.
My condition should have been diagnosed when I was 24 not 30. It is not rocket science. It does appear to be way outside the box of the GP. The GP who is trained to be conservattive, lacks innovation, is partronising and arrogant, is very well paid indeed..... Why?
Why is it that GPs spend their days prescribing drugs to help to eleviate symptoms. Drugs which are sold by pharma companies who want lots of profit. Why are the GPs who see most of us folks with chronic illness not creating a fuss and demanding better treatments based on the basic causes of illnesses rather than sheepishly dolling out the quick stickyplaster fixes? Why are they not shouting? Why do they not understand this arguement? Is it up to someone else to take the lead? I'd respect the doc who shows leadership. For £140k per year should the patient not be expecting this kind of behaviour and attitude in all GPs they encounter?
Why are patients like me given no advice about management of pain? Even when we ask repeatedly. Is that not the job of the GP? Why do I get smiled at patronisingly when I have developed a new symptom and I'd like to exclude it from my current illness? Lower left side abdominal pain (I was not examined) It kept me awake for 2 weeks non stop and was painfull for 6 months+. I went back twice and still no interest. That is the problem. I am not interesting. My illness is not sexy. Those with my illness are told 'it' does not exist - in their opion. (60% of GPs in Wales reported this in a survey recently). Opinion. Thanks very much. I'd prefer to be told facts based on objective evidence not opinion based on hot air.
We have a poor record of treating and managing the long term chronic sick (MS/ME/FM/etc) in this country. My evidence for this - go speak to those who cannot work, who have MS (80,000), who have ME (160,000), who have fibromylaygia (1,000,000). They have the same or similar bacterial infections to me. The cost to the UK economy is estimated at £8 billion per year (ME patients only)! The GP remains uninterested. They will not benefit (financially) if I stay sick, stay the same or get better. They are unmoved by my physical and mental pain.
These are not new revelations. The evidence for these bacterial infections started to be published in the medical literature before the Second World War.
Can doctors not read? Can they not innovate? Can they not listen and communicate? Is there pressure for GPs to improve their communication skills, work alongside and with patients to get themselves well? What motivates docs to stay up to date. There appears to be no requirement for them to do any of this. I would respect them if they did. GPs pay is not affected if they are good or poor at their jobs.
Dr Crippen - GPs are not all highly motivated, keen individuals with their patients best interestes at heart. If so the patient would be able to see a doctor at a reasonable hour and not have to take time of work to do it. Why can I not see a well paid profesional GP at 8pm at night or on a Saturday? Routinely if necessary. Do we have to pay the GP more if this is to happen? Can they be bothered?
I have admittedly had a poor experience with GPs over the last 8 years. I think that many folks like me too have had simialar experiences.
If my GP was open minded, not patronising, was happy to openingly discuss test results with me and not fob me off with antidepressants (the uninterested GPs cure all pill to get rid of you) then I'd begin to consider that they should be renumberated well. By that I mean in line with other professions. I do not believe that currently this is the situation.
As soon as I have the stamina I will be on the hunt for a new GP. I hope I find him or her. I am willing to keep an open mind and I'm positive I will find one. I would like to have some medical support in my local community. One that I don't have to pay for. I think it will take time.
War and Peace over.
Joanie
Well written, but let me bring it down to earth.
This is fantastic. When I go off climbing with my doctor friends, I will no longer have to put up with their endless whinging on about how much I earn!
Dewi
Corgi plumber(30k-40k gross @ 48h/week at customers requested hours)
To paraphrase Mark Steyn:
"Of course Canada has got a private healthcare system for the great and good, it's called America."
I'm sorry but you are not helping your case.
Anyone who earns £140K and has had pay rises of 20-25% is so much more fortunate than most of the population that justifications won't be listened to.
It doesn't matter how long you trained to get there, or how hard you work; people will just see you as a fat cat.
Disclaimer - I don't necessarily agree with their point of view - but that is what they will think.
I'd like to add to the "I wish I had such a measly sum as 50k" comments. It is not much below twice what I get paid, so I suppose that my 7 years of training to PhD. level in microbiology and virology were wasted.
However, it does explain what people mean by "proper doctor".
"I'd like to add to the "I wish I had such a measly sum as 50k" comments. It is not much below twice what I get paid, so I suppose that my 7 years of training to PhD. level in microbiology and virology were wasted.
However, it does explain what people mean by "proper doctor".
knirirr | Edit comment Delete comment | Email | 24.04.06 - 4:42 pm | # "
Knirrir
With you all the way. The pay rates of hospital scientists is an absolute scandal. Trouble is, the general public barely knows that you exist, so the goverment can get away with it.
It's a disgrace.
BUT, just to make the point yet again, I was not meaning that £50K was measly taken in comparison to salaries in general. I mean it only in contrast to the £250,000 the principal is earning doing private work.
John
Dr. Crippen - thanks for the clarification, I misunderstood you.
I ought also to point out that I don't do medically related work any more (I used to do cancer research), but research in relation to the effects of atmospheric pollution upon the marine biosphere. So, I'd expect a GP to get paid more than me because people don't die if I cock it up (though we're all a bit stuffed in 100 years if I and all of my colleagues get it wrong). However, the pay discrepancy does seem rather large.
The readers of 'Nursing Times' seem to think you're worth it.
http://www.nursingtimes.net/nav?
...esource=4664146
Well, SOME of them do...
http://www.theregister.co.uk/200...5/poll_scandal/
Priceless!
gps are greedy arrogant and ignorant pigs.
"gps are greedy arrogant and ignorant pigs.
Anonymous"
+++
Thanks, anonymous, for this helpful contribution.
John
Why were GPs paid such a big rise to do less work ? No wonder the NHS is running out of money for the patients.
Scotland doesnt need so many GPs. Anyway some of them are only in it for the money and what a waste of money on those greedy manipulative
waste of space beings.
Hi anonymous
"Why were GPs paid such a big rise to do less work ? No wonder the NHS is running out of money for the patients.
Scotland doesnt need so many GPs. Anyway some of them are only in it for the money and what a waste of money on those greedy manipulative
waste of space beings.
Anonymous "
Wrong.
GPs ARE having to do a lot more work to jump through all the government hoops.
The much better question, and one whic h I would support all the way, is why are we being paid all this money to do work that has so little to do with genuinie health care.
John
Dear Dr Crippen,
Thank you for your reply and may I also say that it is good to be allowed to have our say with you.
Stay with us. Anon
I think gps should be paid 10p a week. That should about cover the work they do.
good site
ganiyari bilaspur
Commenting by HaloScan
