I am one of the least qualified, least skilled and lowliest paid doctors in my hospital. My days are spent searching for missing heaps of patient notes, running errands and chasing up blood test results. I am a “junior house officer”, a useful but dispensable cog in a vast machine. Despite my humble position, I am paid a whopping £37,000 a year.
If I became a consultant, the taxpayer would be sending me home with about £90,000. Were I to prefer a nine-to-five job as a GP, I would be raking in a fat £100,000 – even more, if I played the system well. The overstretched NHS budget sets aside enough cash to ensure that the doctors’ car park is packed with luxury motors, and that we can leave the chaotic communities which throng our hospital for big houses in the charming villages and estates out of town.
We are quick to justify our pay with a battery of compelling arguments: we work hard (I know that from experience); we have big responsibilities (I know that from watching my seniors); we are also well qualified and have to endure a protracted training, both at university and on the job. Teachers, social workers and other professionals in the public sector work long hours, too, however, some of these at home and unrecognised. While people’s lives don’t depend upon their decisions, life opportunities and security do. It is unfair that our salaries dwarf theirs.
In medicine there has been a long-standing acknowledgement that nurses work hard and are underpaid. A nurse starts on a relatively modest £16,000, and regularly works nights and weekends. It is usually nurses who give patients most support during their stressful stay in hospital. If a nurse reaches the very top and becomes a nurse consultant, he or she will just about earn what I do now. This pay inequality does nothing to ease our occasionally stormy relationship. The unseen, grey-clad auxiliary staff who work so hard to keep the wards clean receive piffling sums. Doctors have succeeded masterfully in condemning such meanness while never questioning the justice of their own salaries.
Amazingly, no one objects to our pay, but then we hide the numbers so well behind a tangle of pay bands and percentages that it is unlikely that anyone really knows the scale of the opulence. And who is going to criticise the pay of such awesome life-savers?
Writing this will certainly earn me a few enemies: doctors enjoy the money they earn and most feel that it is well deserved. They will not appreciate anyone suggesting that their salaries are on a scale that is unjustified, or that it reflects badly upon their motives for joining their profession. To our shame, there has not been so much as a whisper in the medical press questioning the generosity of salaries, only a clamouring for more money.
Could doctors’ pay be redistributed to the more stingily paid members of the health professions and other public sector workers to reflect workload, training and responsibility, rather than assumed social standing? Bringing some pay equality into the public sector would thrill those who rightly feel underappreciated. Maybe money freed could go towards more drugs, machines or nurses. There are never enough. (Last week our ward closed due to a shortage of nurses. The doctors and beds sat idle.)
Alternatively, that extra money could be used to address the social deprivations that the medical profession knows are the cause of so much ill-health.
Some doctors would certainly rebel, throw down their scalpels, ditch their stethoscopes or fling their couches from the window. They would go private, go to Australia and go loudly. But when the dust settled, we would be left with the doctors whose motivation is caring for their patients, and there are many of those. The vacancies created would be filled from the queues of doctors who are on the dole and, later, by the hordes of clever sixth-formers desperate to enter medical school.
Doctors often compare their salaries to those for high-flyers in the private sector. This is irrelevant: we are state-funded service providers, and salaries that befitted this role would be more appropriate than the present excess. We do work hard for our patients, but we could serve them even better if we stepped off the golden pedestal where we have allowed ourselves to be placed.
Mark Jopling is on the staff of a hospital in Nottingham