Doctors and the 7 Day Week

Man of Honour
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24 Sep 2005
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Lot's of attention on social media at the moment regarding this letter to Mr. Cameron:

Dear Mr Cameron,

On Wednesday morning this week I returned to work at 0800. I worked the weekend in Intensive Care as a junior doctor, for your information I was working from 2000 to 0900 on Friday, Saturday and Sunday i.e. I was part of the team that provided a 24 hour, 7 days a week, 365 days a year service. My consultant started his weekend of work at 1700 on the Friday. He finished at 0800 on Monday morning. He didn't go home until well after we had started our night shift and he was in before we went home in the morning. We also disturbed him overnight to tell him about our unstable patients. He didn't grumble once. Our anaesthetic consultant didn't grumble when we took a patient back to theatre for bleeding in the middle of the night, nor did he grumble when he was anaesthetising an emergency case the following night. The consultant surgeon also didn’t grumble. Your irresponsible colleague Jeremy Hunt seems hell bent on suggesting to the public that there is no 7 day a week service and that consultants do not work weekends. I have submitted a request, via the Freedom of Information Act, to the Department of Health last night to quantify how many consultants currently opt out of weekend working. I look forward to finding out.

In the middle of the night my colleagues (doctors AND nurses AND radiographers AND healthcare assistants) and myself were assessing patients with multi-organ failure being supported with complex devices, these patients are teetering on the brink of death all the time. At the end of my 3 night stint, just when I was at my lowest ebb, a patient got really sick. You try managing that after you've been up all night and then tell me the NHS isn't 24 hours 7 days a week 365 days a year. When you have personal experience of that, I would like you to look me, and every other doctor in the NHS, in the eye and tell us that you genuinely believe that we are being adequately paid for all the responsibility that rests on our shoulders.

Let's put things in to context. An Assistant Manager in Pret-a-Manger has a salary of £29,500 and a Manager £40,800. In other roles their starting hourly rate is £7.70/hr everywhere except inside London where they pay £7.90/hr. On the current pay system a doctor has to work for a minimum of 9 years after graduating from their 5 year degree course before they have a basic salary higher than a Manager who works in Pret. How much student debt did people working in these roles accrue?

On Monday night I did something Jeremy Hunt has openly chastised. I worked another night shift as a locum in another hospital. Why did I do this? Because I, 34 years old, did not want to have to borrow money, yet again, from my elderly parents. It's embarrassing but you see I studied medicine as a second degree. I am Scottish but studied in England and therefore was liable for all my tuition fees and did not receive the NHS bursary, unlike my European colleagues. Sadly, during those four years, the student loans did not even cover my rent. I accumulated £20,000 professional studies loan and £7000 of credit card debt. Over £1000/month of my salary is used for debt repayment and I still have 26 more months to pay before I am only left with my student loan repayment. Living in London, my rent is £926/month. How much of my salary do you think I actually get to enjoy? Do you think I will ever be able to afford to buy a one bedroom flat in London? I don't think it's unreasonable to want to own the flat I live in, neither do you apparently but yet you seem hell bent on making it impossible for me.

This month I have to pay £325 upfront in cash for a mandatory course as part of my training in anaesthesia. I will get that money back, eventually, but to be honest it will then be used up as I need to sit an exam, again, mandatory for my training. Those exams are tough and I may not pass it on my first attempt. Surprisingly enough, the NHS doesn't pay for continuing professional development, I will need to study for this in my free time if I want to progress and yet you claim to want a world class service? How do you anticipate that will happen when you and your Health Minister have no idea what life as a doctor is like? I would relish the opportunity to have you shadow us on a night shift, but you won’t.

Has any of the above made you think that it's not quite such a rosy life being a junior doctor?

Do I have to remind you that in order to get a place to study medicine I had to excel academically? I had to be better than all those other applicants who wanted to study medicine. I studied medicine at the University of Cambridge. In many other professions that would have been my ticket to earning mega bucks. As people frequently and correctly point out medicine is a vocation. I truly love my job and my career but I think you have lost sight of the bigger picture. It's all very good claiming you want a world class health service but if you continue to act irresponsibly and vilify doctors by suggesting we don't provide a 7 day a week service you will destroy the NHS.

My basic salary is less than £50,000 after working for almost 4 years since graduation. I studied for 4 years on an accelerated medicine degree while a newly qualified TFL Tube driver earns £49,673. Can you put your hand on your heart and tell me you think this is fair? "Making work pay" is your party's current slogan. Can you explain to me exactly how all my hard work is being rewarded? My reward isn't financial is it?. If you pay peanuts you get monkeys. If you want a world class health service you need to ensure that medicine remains an attractive career and a competitive degree course. The more you continue to vilify doctors and bully us financially the more unattractive you make it. It doesn't take a genius to realise that results in a lower calibre of applicant and a lower calibre of doctor in the long run. Being blunt, to make it through medical school requires an immense capacity for knowledge, problem solving, resilience and good old fashioned intelligence with an enviable work ethic. You and your party have behaved disrespectfully towards my profession and the NHS as a whole. It disgusts me.

Congratulations on your inflation busting pay rise by the way. I believe you think the right thing to do is accept it, despite stating that you think it was the wrong decision to award it. A classic statement from a politician, if ever I heard one.

The sad thing Mr Cameron, when one of your friends or family members or even just someone you pass in the street becomes critically unwell in front of you, you will realise that whether it is the middle of the night or the middle of the day, a massive team will leap into action and that team consists of more than doctors, more than nurses, more than healthcare assistants, more than porters and more than the technicians in the labs running all the tests that we need to manage the patient. That patient will get everything they need. Perhaps then you might actually appreciate all the work we, as a team, do. You might then actually help us become a world class health service instead of working against us.

You need to get real, not doctors. You can't even pay doctors and nurses and all the allied health professionals an adequate salary for their scheduled hours and you certainly don't pay us for all the extra hours that we do outside of what we are supposed to. You do realise that Trusts across England actively discourage us from reporting the actual hours we work because they can't afford for us to breach the European Working Time Directive or actually pay us for the extra hours.

In summary you need to pay doctors, nurses and all the allied health professionals an appropriate salary that reflects the important roles we actually do in providing the 7 day a week service that we currently provide. If you genuinely want to improve patient safety then you just need to provide more staff at every level, patients would be safer if you adopted mandatory minimum safe staffing levels and ensured these were enforced. I realise this simple, yet effective solution, is costly and perhaps that is the reason Jeremy Hunt has chosen to deliberately attack Doctors.

I look forward to your response,

Janis Burns
I have a lot of thoughts on this... but not too much time right now! :o So I will succinctly say that although Mr. Hunt said a few things that ultimately came across badly, I think this letter (despite getting a lot of support) comes across really badly too. I fail to see the relevant of comparing the role of a doctor to someone working at pret-a-mange and, ultimately, why anyone should deserve to earn a certain amount of money when there is always the choice to work in another role that provides different pros and cons.

Thoughts?
 
I think the point she made was that for similar money she could have forgone 5 years at university with all it's associated debts, not have to work nightshifts, 12+ shifts, on call duty, or have responsiblity for the care of some very sick people.

This government are destroying the NHS and what was left of our morale.
 
Having seen various shows on TV about trainee doctors etc and the hard work and hours they have to go through for awful pay is ridiculous. It's a wonder anyone wants to put themselves through 5yrs of hard studying and crap pay for the first few years:eek: when as she says someone can probably leave school with nothing and work there way up to as/manager in retail for almost the same money.
Nhs/government needs to give more incentive to people to go into healthcare etc.
 
I don't know how I feel about this. My wife to be phoned this morning for a prescription and was told they are taking appointments for the 22nd August. After explanation she has chemo they found an appointment the next day with an option Thursday, Friday or Saturday.

We appreciate the care but WTF?
 
The salary is relevant because:

1- if you don't pay doctors a decent wage why will they train for 5-6 years and work shifts for 45 years? Prospective doctors are all very able, they'll just do something that pays better.

2 - you want to have someone motivated, competent and able looking after you. Not the cheapest Locum available trained in god only knows where.

3 - plenty of medics are already training in the UK then moving elsewhere to avoid the NHS, there's plenty of better paying jobs elsewhere, several colleagues of mine have gone to the U.S. and Australia/NZ.

4 - every day I go to work someone might die, and I'll have to deal with that, or someone will beat up their kid and I'll have to handle that (and the court case years later) or I could **** up and have to live with both a potential harmful/fatal mistake and the fallout. If my pay is cut will I still get out of bed and face that every day?
 
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Whilst I believe doctors are not treated quite fairly, I do know and have a number of friends whom are "just qualified" doc's, none of which have as big a pay issues as the man above claims to have.

Trust me, there are far far worse situations to be in pay wise. Try be at the bottom of the pilot tree, having forked out high 5 to 6 figures for your training (not government loaned), then pay further to get a job and then end up with a wage potentially less than £20k per year. Oh and weekends, what are they? 15hr days? Night shifts? They're par for the course too, no extra pay too either! And what's that, not getting paid for the hour of work before and after your flight(s) is/are done? Oh, never mind good thing you get a solid contract of employment from your airline... actually zero hour contracts and agencies are more the norm.

But you sign up to a career you know what you're getting into, you didn't become a doctor thinking you'd work mon-fri 9-5, so deal with it! I knew the first 5+ years as a pilot would be tough but you deal with it and work towards the end goal without moaning to the government via facebook (yes I realise I've just had a big moan too).

I've never met a poor doctor. Stressed, overworked, yes, but this guys post ****ed me off.
 
I don't know how I feel about this. My wife to be phoned this morning for a prescription and was told they are taking appointments for the 22nd August. After explanation she has chemo they found an appointment the next day with an option Thursday, Friday or Saturday.

We appreciate the care but WTF?

Sounds like sensible prioritising. Some minor complaint, wait a few weeks. Something more urgent sorted straight away :confused:
 
It's not just doctors though, support staff (IT, clerical/admin, receptionists, cleaners, pharmacists etc etc) and as usual people seem to be ignoring nursing staff.

Even if they have the clinicians they still need to get more staff who assist the clinicians and keep systems and frankly people/buildings working. Managers aren't popular but they're absolutely essential in reality.
 
What's a shame is it's all totally pointless, no government is going to grow a pair of balls and do what's needed.

There's only two real options.

A) pay way more tax, unpopular won't get votted for by public.
B) two tier system, NHS only treats certain conditions. Price of life is drastically lowered, so terminal patients dont get drugs to just extend their life by months or years. And then we have optional private healthcare to top up to a higher level. Also very unpopular and won't be voted for.

So people like to blame government, but it all comes back to us as the public and who we would vote for if governments did such things.

So status quo. Do you up wages, or buy modern treatments and have a high life price, where we spend 10s of thousands to extend terminal patient lives by a bit. Of course it's the latter.
 
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Loads of crying...

'Train drivers have it easy and get paid loads' - go be a train driver.

'Working in Pret pays more' - go work in Pret.

It's not secret what a doctors life is like/ how much hard work it is and no matter who or where you work someone some where will say you have it easier / better.

Can't believe someone this educated has thrown his toys out the pram and let this get to him so much.

'WWaaahhh I went to uni (In England) I have a student debt that i have to service, waaaaah, I live in London its expensive.' - all his life choices.

Someone this clever arguing over starting salaries... Tube driver will only ever earn £50k a year. Pret manager will only ever earn £40k a year. Doctor... well... a lot more.
 
It's not secret what a doctors life is like/ how much hard work it is and no matter who or where you work someone some where will say you have it easier / better.

It may be not be a secret what a doctors life is like, but does that mean that you can throw in paycuts and pension cuts as part of the deal?

A&E is the perfect example of what happens when you make medicine unattractive as a career. No one will train in that area and hospitals haemorrhage cash hand over fist to staff their A&Es with locums many of which have trained overseas and quality drops as you can't train your workforce as they are transient employees.
 
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What's a shame is it's all totally pointless, no government is going to grow a pair of balls and do what's needed.

There's only two real options.

A) pay way more tax, unpopular won't get fitted for by public.
B) two tire system, nhs only treats certain conditions. Price of life is drastically lowered, so terminal patients font get drugs to just extend their life by months or years. And then we have optional private healthcare to top up to a higher level. Also very unpopular and won't be voted for.

So people like to blame government, but it all comes back to us as the public and who we would vote for if governments did such things.

So status quo. Do you up wages, or buy modern treatments and have a high life price, where we spend 10s of thousands to extend terminal patient lives by a bit. Of course it's the latter.

Now I don't normally agree with you, but this is a very accurate observation.

The NHS simply can't afford modern medicine much longer, let alone cutting edge medicine.
 
Its just PR for the next election, regardless of the fact that there arent enough doctors in the first place, regardless of the fact they missed their target for that already.

NHS is unwieldy, you cannot have perfect healthcare without it being literally the only thing the nation pays for, its just irresponsible and wasting money that could be spent on research instead.

Privatize it and forget.
 
Loads of crying...

'Train drivers have it easy and get paid loads' - go be a train driver.

'Working in Pret pays more' - go work in Pret.

It's not secret what a doctors life is like/ how much hard work it is and no matter who or where you work someone some where will say you have it easier / better.

Can't believe someone this educated has thrown his toys out the pram and let this get to him so much.

'WWaaahhh I went to uni (In England) I have a student debt that i have to service, waaaaah, I live in London its expensive.' - all his life choices.

Someone this clever arguing over starting salaries... Tube driver will only ever earn £50k a year. Pret manager will only ever earn £40k a year. Doctor... well... a lot more.

True, but typically doctors wouldn't respond in this way - most if them understand what they got themselves into. It's what Hunt said about weekend working that has riled some of them up and caused these defensive comments to prove a point. Is it OTT? Probably, but that's sometimes what you need to do to get a point across.
 
The majority of the developed world manages to have social healthcare so I'm not convinced the issue with the UK system is "it's not privately owned".
 
It may be not be a secret what a doctors life is like, but does that mean that you can throw in paycuts and pension cuts as part of the deal?

Happens in any job.

Private sector went through the pension cuts many moons ago.

End of the day it's again a choice, public sector, everyone knows how volatile it is.
 
the health service should just be fully privatised.

want to be seen on a saturday afternoon? pay for it.
want treatment? pay for it.

can't afford it? tough.

capitalism at its best. =)
 
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