Are doctors' pensions too generous?

Are doctor's pensions too generous? asks The Guardian today:

http://www.guardian.co.uk/politics/reality-check-with-polly-curtis/2012/jun/21/are-doctors-pensions-too-generous?fb=native

A key point that the wonderful world of media seems oblivious too today is that "doctors'" pensions are no different than any other NHS worker: so that includes porters, nurses, lab workers, radiographers, secretaries, managers and chief executives (some of whom may have chosen not to opt for the NHS pension).

There is no such entity as "the doctors' pension"

Doctors have chosen and voted to take action today, but their actions, if successful, would safeguard pension arrangements for many NHS workers. I'm not going to be all one-sided about this - it will include higher-paid NHS workers earning the same as doctors. Nevertheless, doctors do make up a high proportion of well-paid NHS staff so stand to lose more than other groups that can't earn as much. For those naive patients thinking doctors are the best paid, think again - there are plenty of advanced and senior nurses earning as much and more as many junior doctors; some nurse consultant pay rivals that of medical consultants.

It's obviously a lot easier to vilify the minority of doctors who earn hundreds of thousands of pounds (just like all MPs were tarnished by the expenses scandal which was perpetrated by a minority of greedy MPs) than it is to actually bother to gather some facts, or at least some doctors who are representative of the whole debate. In our TOWIE/Kim Kardashian/"Look at me!" world, it's often whoever shouts loudest who gets their point across, rather than a sensible insult-free individual.

Take a listen here:

http://www.bbc.co.uk/news/uk-18537655

Dr Wendy Noble makes an admirable attempt to explain the BMA and doctor's opinion, but is it really in any doubt what the interviewer's position is?

I'm perhaps not surprised; a few weeks ago, the Daily Telegraph and Daily Mail emailed adverts looking for "doctors who oppose the strike" which ended up on Doctors.net.uk.

Media reporting

Something that really frustrates me about news and media is they way that few journalists are able to approach a situation from a neutral point of view. To try and balance this, they will often try to have two points of view, which supposedly makes a story "balanced" - the trouble with the BMA day of action is that it's easy to drag a member of the Patient's Association and present them as some learned source of information as to why "doctors pensions" are wrong.

Katherine Murphy, of the Patients' Association, said: 'The only people who will lose out in this are patients.

'Every extra day that someone waits in pain for an operation or treatment is a day too long.'

Read more: http://www.metro.co.uk/news/902742-just-eight-per-cent-of-nhs-doctors-in-england-take-part-in-strike#ixzz1yRmhyo4x

This kind of reporting makes my blood boil. This comment is idiotic on two fronts: firstly, no-one can disagree with the sentence (i.e. NO-ONE wants anyone else to suffer, do they?), but that doesn't make it particularly more relevant to today's action than on any other day. Secondly, the BMA and participating doctors have done their utmost to make today as disruption free as possible. Has any media outlet read the BMA press release?!

 The debate around this one comment is massive, but for me boils down to: if you want a free healthcare service within a limited budget, sometimes instant and all-encompassing care matched to whatever a self-defined patient will be impossible. The whole UK population needs to be considered, and that means everyone can't have what they want. If the PA or anyone else wants a system where there is true 24/7 healthcare, then someone somewhere is going to have to pay more for it.

I've just seen the BBC 6 o'clock news headlines, and predictably they've found a patient whose routine operation has been postponed (I doubt very much it was cancelled as stated). But good old North West Tonight, actually using a neutral phrase; "What impact has the action had?"

A tangled issue

You'll notice from my blogs that it is so easy to veer off and start discussing the meta-issue that is the very nature of the NHS itself. I haven't done a poll but base this comment on discussions with my own colleagues, but for many taking part in action today, the treating of the NHS as a big-old political game of Theme Hospital has engendered many negative feelings. The pensions dispute is simply the match to the well prepared fire-bed.

So are doctors' pensions too generous?

There's a nice graph at the bottom of this BBC news story:
http://www.bbc.co.uk/news/health-18523896

It shows how doctors earn more in their pension than anyone else they are compared to. I don't know what figures have been used to create this graph, and so it's hard to comment on it. I imagine that with the right amount of selection, I could also create a graph that shows doctors earn more than the Queen, Apple and the Chinese Space Agency.

It's quite a hard question that I'm still wrestling with. Just how do you compare doctors to nurses to judges to MPs to teachers to Tube drivers to the unemployed?
 It's complicated because public sector workers typically earn less than their private sector counterparts, in return for better job security and benefits such as pensions. The frequent comparison with private sector pensions is unhelpful - private doctors who have to have private pensions earn more in their day job so can afford more pension contributions.

For me, it boils down to fairness. Why don't we make all public sector pensions equitable - i.e. all public sector workers pay a fixed proportion of their wage into a scheme, with no differentiation between NHS staff, government staff or teachers? If it's fair for NHS staff, then it should be fair for civil servants too. The fact that it isn't says a lot to me about Andrew Lansley's views of NHS staff (and that's for another blog).

What do you think?

Tell your MP, and why not ask them what pension they will get, at what age and how much they need to pay into it. And then ask your GP the same. That way, you make up your own mind and not rely on the Daily Mail to tell you.

Fair, not preferential, treatment for all

That is, after all, what the NHS is founded upon right? That everyone in Britain gets the same treatment within the NHS, the general principle being that healthcare is a right to be enjoyed and respected by all, regardless of their background.


So why are "greedy" doctors asking for "more" pensions then? 


http://www.dailymail.co.uk/news/article-2160422/Doctors-Strike--100-000-pension-deals-1m-property-portfolios.html


Let's get one thing straight - you don't become a doctor in the UK if you want to be rich. Why? Well because of the NHS, there is limited scope for private practice, so there are relatively few doctors who can practise privately, especially once you leave Greater London. This is important because it is in private practice, where you can do as many clinically unneccessary tests and have multiple (chargeable) follow-up appointments as you are willing to pay for.

Without banging on about it too much, for those that think lots of tests and appointments "must be a good thing", ask yourself why, in the USA, where this is commonplace, is the President, who is hardly doing well in popularity polls, is so keen to make the healthcare system more like our beloved NHS? Because sometimes less is more. The NHS is, contrary to the daily newspapers, actually pretty good at stopping people dying, and making their lives healthier, and it does it all within a budget that other countries envy!

http://www.guardian.co.uk/world/2012/jun/17/us-healthcare-industry-waste-costs 


Becoming a doctor is quite an expensive pursuit.

Once you have paid your fees to become a doctor after at least 5 years as a medical student (and remember, the Government is considering making medicine a graduate-only degree, potentially adding a further 2-3 years) you will be in debt to a MINIMUM of five to eight years of £9000/year; an eye-watering £45 000 - £72 000. And that doesn't include the living costs associated with those years of study.

http://www.bbc.co.uk/news/health-18128637 


Once you have your medical degree, you'll then need to pay £420 a year to the General Medical Council, who are there to reprimand you if you do something wrong. Handy for the public, who can take on bad doctors without incurring personal cost (and thereby getting rid of the bad doctors), but not exactly a cheap "luxury" (GMC fees are not tax-deductable) item.

http://www.gmc-uk.org/doctors/fees.asp 


After two years of training as a Foundation Doctor, where pay has been frozen for several years;

http://www.guardian.co.uk/society/2011/sep/20/unions-pay-rise-nhs-2013 

and had the useful benefit of free accomodation (admittedly of a poor standard) removed, you get to apply for specialist training. 


This could be 3 years for a GP, 7 years for a paediatrician or 6 years for a psychiatrist. To become a specialist, you need to sit some pretty hard exams; again good news if you're a patient needing an operation, but another dent in your wage (that again, is not tax-deductible and considered a luxury by Inland Revenue). For a GP, the exam fees and regisration fee to be allowed to actually do the training cost about £3000 spread over three years.

http://www.rcgp.org.uk/new_professionals/associates_in_training/ait_membership/faqs.aspx 

 One of the psychiatry examinations costs nearly £2000 and has a pass rate that has never been above 50% (meaning most people need at least two tries to complete it).

It's a cost in time, as well as money.

As a junior doctor, you will be covered under the European Working Time Directive, which means your rota cannot exceed an average of 48 hours per week (That's the equivalent of a 6 1/2 day week for a sandard, say civil servant, office worker). It doesn't neccessarily work out that cleanly; I've been rostered for 52 hours 2 weeks ago, then 50 hours last week and will work 60 hours this week. And of course, it's most days where I leave 30-60 minutes after I'm supposed to, and having a 20 minute "break" where I eat my lunch whilst on the computer of telephone is a luxury.

During this training period before becoming a consultant, it is entirely plausible that you might have to move from locations classed within the same area every six months, with less than 6 weeks notice of this. Where I work, doctors might be working in Whitehaven (Cumbria) one day, and starting in Macclesfield (Cheshire) the next (a nice 150 mile journey covering 4 counties):

https://maps.google.co.uk/maps?oe=utf-8&client=firefox-a&ie=UTF-8&gl=uk&saddr=whitehaven&daddr=macclesfield&dirflg=d&geocode=Kde5vSvALWNIMRL-TK4zWNyp%3BKRFnYpMINnpIMZmOB5-SZOLB&ei=iJHfT_GsKcr28gOm_dG-Cw&ved=0CAsQ9w8wAA

And let's not add in the other costs incurred by being a junior doctor: stethoscopes, medical torches, pens, petrol, mandatory uniforms, parking,  and all sorts of things you don't have to provide in the private sector.

Ok, so you get the idea. Being a junior doctor is like, so totally hard okay yah?! The sceptics among you will be wondering then if it's all just a whinge, because we're actually all earning hundreds of thousands of pounds. I'm not sure I do... I'm four years into my training now and take home about £27 000 after tax. Pretty good for a graduate job, but do some maths based upon my hours and it isn't quite the golden handshake Andrew Lansley would have you believe. A benefit to working 6 and half days a week as standard is that you don't really have much time for a life outside of your job in which to spend your money, which is handy to pay off all those loans and fees.

So why on earth would anyone put themselves through this? Well, there's a light at the end of the tunnel. As a GP, I could typically work from 0730-1830 four and half days a week, woohoo! I'll earn more for this, obviously, and only partly because I'll be working more hours than I do now. As a GP, I will be personally responsible for thousands of people's lives. Believe me, when you're making life and death decisions every 10 minutes, it can sometimes be a bit hard to sleep at night, a single off-moment could prove disastrous. It happens, occassionally, but perhaps not as often as the Daily Mail would have you believe. It's a bit of a downer to think that you'll never be publically thanked for saving lives, but that one human mistake might cost someone their life. To have that level of responsibility needs an upside, that's why doctors do earn more than many other professions (although many still earn less than an MP/MSP/MEP/AM).
Average MP wage: £65 738
http://www.parliament.uk/about/faqs/house-of-commons-faqs/members-faq-page2/
"Salaried GPs employed directly by PCTs earn between £53,781 to £81,158, dependent on, among other factors, length of service and experience."
http://www.nhscareers.nhs.uk/details/Default.aspx?Id=553

Compared to many other highly specialised graduate professions though, a doctor's salary isn't neccessarily fantastic. That's ok though, because there are other benefits, such as the public sector pension...

http://www.guardian.co.uk/business/2011/feb/15/barclays-capital-average-pay-236000-pounds

WHOA THERE.

I finally made it. The pension. The reason why "millions of patients will suffer" (according to the Daily Mail)

http://www.dailymail.co.uk/news/article-2160049/A-million-patients-suffer-week-doctors-strike-time-40-years.html

Here are the myths and facts:

1. "Millions of patients will suffer". No-one, and I mean NOT ONE PATIENT AT ALL, will be harmed by the doctor's action on Thursday 21st June. Why? Because all doctors taking industrial action (crudely refered as a "strike" by many) will be at work, seeing "anyone who feels that they are ill". Pretty much like any other day then huh? We'll do blood tests, order X-rays, see patient's on ward rounds, answer patient's questions and provide all treatments just like we will on Wednesday or Friday. All we won't do is "anything that can safely be postponed".
2. "So you're saying no-one will die because of the doctors' action?" People will still die, just like any other day. Medicine can't fix everything, but you can be certain that of any day you might choose to be ill, doctors will certainly do their utmost to make sure you don't die on the 21st June. Some people might unfortunately not be able to be saved, but we'll do our best (just like any other day).
3. "Ah, but what if you had an operation planned that day that has been cancelled? Got you there!" What if you had an operation planned for Tuesday 6th June, the bonus bank holiday (where incidentally, all NHS staff worked as normal and did not have a day off)? No-one complained then about a day's delay. Urgent surgical cases - for example those with cancer, or, at least where I work, anyone that cannot be rebooked within a fortnight, will have their operation as planned.
4. "Well everything in hospital is urgent, how can you say you'll safely postpone it?". Examples of things that will be postponed are junior doctor training (ironically meaning there will be MORE, not less doctors on wards on Thursday!), paperwork, office hours or routine investgations/operations that can be rebooked within a short period.
5. "Will my GP turn me away if they don't think I'm ill?" No. If you think you're ill and need to see a doctor, then one will see you. GPs taking part in industrial action will likely cancel any pre-booked appointments to make sure that anyone who thinks they need urgent care can see a GP that day. So again, it will probably be EASIER to see a doctor on Thursday!
6. "Doctors should be grateful for what they've got - the whole country is suffering". We know, and we are. Doctors accepted a major pension reform of a system that was probably a bit too generous only 4 years ago, and agreed to a new system that became not only self-sustaining, but profitable: i.e. the amount junior doctors pay into the pension fund more than covers the cost of pensions projected to go out. A BMA calculation shows a surplus of more than £2 million pounds this year, which helps cover other NHS worker pensions. The new system meant doctors agreed to pay more (despite their salary freeze) to get less back and work longer. 
7. "The government must know what it's doing - doctors are just being selfish" Far from it. Civil servants, on the exact same wage as doctors, such as those working in the Home Office, will continue to pay half the pension contribution, get more out at the end, and have to work for less years to earn it. If we all need to shoulder the burden, then why aren't we ALL sharing it? 

 Doctors are an easy target for the Government though, because they would never harm patient care for their own gains, which is why Thursday's action is aimed at the Govermnent and not the public. If we don't stand up for ourselves now, then who knows what will happen in another 4 years - will the Government decide our contributions should become triple a civil servants'?!

I don't think I deserve more than anyone else. I enjoy my job, and accept many things about it that private sector workers don't have to... but that's partly because there's supposed to be some reward in it somewhere. Remove all the rewards, and being a doctor might not seem attractive anymore.

If you want to read more about how the Day of Action WON'T affect you:

http://www.bmaaction.org/index.html