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Diary of an FY2 – What Am I Worth?

September 28, 2015

What am I worth?

As the issue of junior doctor contracts, after weeks simmering on the hob, boiled over today, with around 5000 doctors and medical students protesting at Whitehall, this is the question I am drawn back to. What am I worth?

Before we tackle that existential and economical enquiry, let’s recap. The Department of Health and the BMA have been trying to hash two new contracts, one for consultants, one for junior doctors, for some time now. In late 2014, these negotiations reached an impasse. Everyone went outside for a 5-minute cigarette break and the contracts were reviewed by the Doctors and Dentists Review Body. They came back this summer with a number of recommendations for the proposed contracts.

These included:

  • Extending plain, ordinary, sociable time from 9am-5pm to 7am-10pm (and thus shrinking what counts as unsocial working hours)
  • Removing the financial sanctions on Trusts that work their doctors for too long (though the European Working Time Directive remains in force)
  • Raising the base rate of pay but dissociating pay progression from experience in training.

With the DDRB’s recommendations in hand, the Department of Health came back to the negotiating table…with an odd opening gambit. None of those headlines were up for negotiation, only the jots and tittles, and if the BMA did not negotiate, they would go through with the contract anyway. That doesn’t really sound like negotiation to me. The Junior Doctor Committee of the BMA declined to re-enter negotiations. Predictably, the Department of Health announced that junior doctors would be getting their new contract, the one that no one had agreed to, in August 2016.

Many, many bloggers have already made words on the iniquity of this new contract, far better than I could. In short, based on the calculations that NHS Employers released, most doctors would be looking at ~20% paycut…except NHS Employers have turned around and said those were only examples and we’d be foolish to base any hard sums on them. So what will pay look like in 2016? Uh, nobody knows, nothing has been written down yet, NHS Employers say. There are other issues, like the lack of pay progression unfairly targets those who step out of training, like women raising families or doctors taking time out for pursuits, academic or otherwise. Also, there are concerns that doctors will be vulnerable to being overworked with the new contract, leading to burnout and impacting on patient safety.

After a few weeks of general rumblings, including flurries of blogs, open letters on Facebook going viral and calls to strike, or at least emigrate to where the grass is greener, the BMA showed their hand on Saturday. In his first act as the new BMA Junior Doctor Committee Chair, Dr Johann Malawana declared that the BMA would ballot for strike action. Up the workers!

After the BMA walked away, NHS Employers arranged a roadshow of open meetings to speak with doctors directly. These have all been cancelled on the same day that 5000 doctors and medical students marched on Whitehall. But that couldn’t be the reason, could it? It is also the same day that Health Secretary Jeremy Hunt invited Malawana to meet to discuss this pesky contract. NHS Employers want to see how this meeting turns out – As do we all.

There’s been so much emotion and #Solidarity on Twitter tonight that I’m only just beginning to see the ripples.

Jeremy Hunt has largely stayed out of the contract affair so far. Before Parliament’s summer recess, he was all for a seven-day NHS (…Which we have already? Or don’t we?) and kicked off a briefly inspiring #ImInWorkJeremy hashtag. That he’s getting involved now means things are progressing. I dare say doctors balloting to strike has innervated the Department of Health because, obviously, they don’t want us to strike, but crucially, they think we actually will strike.

I am reminded of this quote from von Clausewitz;

War is not merely a political act but a real political instrument, a continuation of political intercourse, a carrying out of the same by other means.

Before, I have been ambivalent about the thought of a doctors’ strike. It is potentially the most self-destructive tool in medical politics, risking the essential goodwill of the public that generations of doctors have worked hard to earn. Further, it is only an effective statement if the Government is prepared to listen which, before today I didn’t think they were (Please refer to the industrial action of 2012). Now, things have changed. Someone’s listening.

The feeling is certainly there for a strike, and quite possibly the numbers too. The important next step is that doctors can’t let this slip into a “greedy doctors” narrative. We need to make it clear that mass medical emigration, tumbleweeds in training posts and burnout doctors are all really bad things.

But enough of my rambling. Where was I? Ah. What am I worth? Everyone wants more doctors – we need more doctors – but nobody seems to want to pay for them. The Government’s golden vision for a seven-day NHS will need a lot more doctors. If doctors came cheaper, we could afford more…but with diminishing returns if they’re all miserable, asleep or arranging antipodean work visas.

But what am I worth? What do I deserve to be paid? How much should I charge for every discharge summary, every referral letter, every prescription I write? What is the going rate for a catheter for a man in agony with acute retention? Explaining to someone that after all we’ve done, their mother is still dying but we’re going to do our best to keep her comfortable – what does that cost? Taking the fear and anger of someone at their most vulnerable and trying to make them feel a little better, a little safer – What is the flexible pay premium for that?

The answer is…I don’t know. I have this real disconnect between what I do day-to-day and payday. I guess I’m lucky, privileged, to think that way. There’s no bureau de change I can take my work too. If I am to be paid less under a new contract, did the art of medicine get cheaper? But those values never entered the equation to start with. How could they? Most of what I do (And nearly all of what nurses do) does not, cannot, carry a price-tag, to be itemised and inventoried.

In the end, like ePortfolio and ARCP, what I am paid will always be a surrogate marker of my worth as a doctor. It might be the only marker that some choose to see. In an ideal world, I could ignore tickboxes and contracts. But I don’t live there. There is ePortfolio and there are wages and as long as I want to progress with training and have a roof over my head, I have to deal with them. I am taking a deep interest in the price of a doctor. But that’s not what I’m worth.

2 Comments leave one →
  1. Denise permalink
    October 7, 2015 10:48 pm

    FAB POST !! Well worth reading!!!


  1. Diary of an FY2 – Continue? | Quinnfeld

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