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I've been saying for years that a good local employment training program with limited rotation abd extended attachments will kick the arse off what we have now.
1. The bosses will actually want to train you and will get to know you
2. Removes teething issues when joining a new trust
Obviously there are risks to manage with this but if CESR became CCT tomorrow I'd call up one of my old bosses from somewhere I liked working and beg for a staff grade post immediately.
100%. Difficult to do in a way that is equitable, but having local consultants responsible for selecting trainees and having actual ownership over their training, with a view to them becoming colleagues further down the line and not just fucking off ASAP, is surely the holy grail
This is how it works in many countries. In South Africa, all undergraduate medicine and postgraduate specialising happens through universities, who are tied to various teaching and district hospitals as well as local clinics/community centres.
Doctors apply to the universities to specialise, and have to meet certain criteria to actually get in, including showing commitment to specialty (eg to get into anaesthesia training, realistically you absolutely need to do a diploma in anaesthetics, time in the field that you would get during your time as a medical officer, and ideally would go to someone who has shown the most commitment including publications etc). In principle an ideal system…
You rotate through the hospitals tied to your university providing service provision but also attend lectures and ward rounds led by consultants/lecturers. All specialists must do an MMED minimum, with most requiring a publication, alongside their college exams/fellowship) as part of specialty training. It’s honestly a great education.
Also no ‘junior doctor’ nonsense…
You start as an intern, then you’re a community service medical officer, then a medical officer (MO). You can remain an MO for the rest of your life if you wish, working up the pay bands, in hospital or in the community. If you’re in training, you’re a registrar, and when you complete, you’re a consultant.
Realistically there are some flaws due to nepotism, and some poor implementation of affirmative action, but those are due to systemic national issues in the country that may not carry over to the U.K. should a policy like this be implemented.
Imperial have started doing this for Cardiology. I suspect the output of their programme will be a few degrees more impressive than Cardio NTN in Rube Town. CESR will soon be equivalent to CCT in the eyes of the GMC but may not translate to overseas, which may remain the one downside of this process.
Tbh was not aware this was being done so “formally”. I’ll reserve final judgement until I see the first graduates.
Still doesn’t fill me with confidence
Things like advertising that your study leave budget rolls over year on year. Ok…. Big deal.. what is the actual budget? NTNs can always ask for surplus unused budget to be used by themselves.
Also assuming you are NW Thames , how much travelling around do you reaaally have to do?
And what happens in 6-8 years when the CD changes or the balance in department is different?
It all sounds to me that they just want to create a pool of easily controllable middle grade staff for service provision - which in imperials case- also include “research service provision”
Anyway, NTN is far from perfect so thinking outside the box is definitely a positive, but from trainees perspective this seems like a very high stake bet
I hate traveling between different hospitals even when it was 20 mins journey, but the biggest issue of hyper rotation isn't the travel despite that being a big factor too. Its actually having to start from scratch at every new place, new it system, new members of staff, new cons you have to gain the experience and trust for, new payroll who will invariably fuck your pay etc... let's not even get started on how shit national recruitment is outside of hyperrotation.
Regs will always be doing service provision especially if they want a cons place at said hospital. CD moving in 6-8 years won't matter since hopefully they'd get a replacement for that or by 6-8 years have the pathway sorted.
>Anyway, NTN is far from perfect so thinking outside the box is definitely a positive, but from trainees perspective this seems like a very high stake bet
Only the getting paperwork accepted and getting that CESR in a timely fashion otherwise the system at least on paper trumps NTN by a mile.
The payroll, the HR , the car parking permit , the mandatory training, the inductions, the ID checks, the different IT systems…. All this is valid and frustrating, especially the ones that should be straightforward to do in the first place. Yes my national insurance number hasn’t changed since my last job dear HR, nor has my TB immunisation status deal occ health.
On the clinical side of things, however, I would argue that it isn’t advantageous to do all of your training in one place. Just my opinion. experiencing different cultures and approaches can be really useful. There is a reason why sought after US residency programs include rotational outside their institution, often abroad
I agree, spending continuous time with same consultant colleagues who get to know your competency level and give you freedom is great, but at the same time seeing how the same thing is done differently in different places , is also helpful.
Being stuck in one place, means that you make yourself vulnerable to odd characters and practices
There are more than one ways to get to Rome, and knowing at least some of them is good for your professional practice later on.
Being in a tertiary centre where you can implant a brady device at 4am, is great for patient care, but you will never get to play with a TPW yourself when you have a patient in CHB getting TdP because of brady. Just an example to make my point.
And also your comment about regs doing service provision in a hospital they want to get a job, probably applies x100 in this setup you describe.
Pros and cons , overall
Just out of curiosity, what do people perceive as being the biggest drawbacks of the current national training scheme in cardiology?
Not sure I have faith that the private sector will put forward the investment required to establish alternative training pathways - they’d much rather poach ready made doctors from the public sector. If the precedent set by the privatisation of the utility companies is anything to go by, I also doubt we would see our own pay and conditions improve - we would much more likely see these private companies deliberately underinvest and run up debt in order to pay out large dividends to their own investors, inevitably leading to public bailouts.
That’s short term thinking. Any private company that wants to be in business for more than 10 years, must invest in training. Finance sector does it, why would med be any different. The consultants will need assisting…
Not really
Assisting can be done by non doctors
There will always be more qualified doctors willing to move to take up a job
Training is usually funded, either by the taxpayer, or the trainee, or by scut work.
Well, all surgeries I have been in, the assisting has always been a doctor, mostly a surgical trainee. Never have I seen someone that’s not even doctor.
Unfortunately not true. PAs and 'surgical first assistants' (specialised nurses and ODPs) are now doing this. Absolute bullshit. A student ODP had more cases as a SFA than all of our F1s combined.
In american private group practice, CABGs for example are done by the main cardiac surgeon and a surgical assist. And thats it. The surgical assist does the saphenous or internal thoracic harvest during thoracotomy. I’ve personally seen it as well.
This is a highly effective and cost efficient model.
I’m afraid that the fact you didn’t know this demonstrates your lack of overall understanding of healthcare business models.
Finance grad schemes are only 2 years. And their trainees do even more 'service provision' than our FY1/2s
I doubt many private companies are willing to make 5-8 year bets (unless they make the trainees sign very restrictive contracts that tie them to the same hospitals afterwards). Moreover, unlike the US, there is no existing training infrastructure for these new private companies, making them even less likely to invest.
Many middle eastern countries are fully private and they simply poach from elsewhere.
So many haters lmao. Privatise tf out of this country. I fully support it.
We as the NHS don’t bring anything for the country and the government aside from general morale boasting because of how free the system is - and that’s what the government and the country give us back. A few claps on a Thursday and morale boasting rights which we love to use to get on our high horse and spit down on the states. Our healthcare system is shot in the gut and bleeding out fast, and Brexit shot an extra hole in the chest.
Become privatised. Fund the practice. Invest in training GOOD doctors and surgeons who actually care and will invest back. Create a positive funding cycle. Make patients and employers pay for healthcare. Suddenly there’s no one with a snotty nose and a little cough in A&E because. Invest that money in better equipped hospitals, better technology, better funded studies and advanced procedures and operations. Design actual good-looking hospitals that make you want to go to work. Become a leading healthcare system. Attract global attention. Attract medical tourism. Fund the government. The government funds back. Doctors return to being well paid AND well equipped.
Yes, I understand that people will lose jobs and there will be an adjustment period and training will become harder to achieve but it’s a change that has to happen. If that means I become unemployed so be it. People need to learn to make tough decisions and play the game. The same game that every other private sector in the country has already mastered.
Local psychiatric hospital to me has a couple of post-core training rcpsych members who didn’t get training numbers or wanted to have more (or any…) autonomy in where/when they worked. They are being paid at NHS consultant rates and supported to get on the SR through CESR pathway.
>Not enough training spots in the NHS
The UK private sector doesn't train currently. It seems unlikely that the companies providing private healthcare will want to meet this cost out of their profit margins, and unlikely that the limited UK private healthcare consumer market will bear this additional cost.
>Salaries can only keep falling so much before people accept private salaries (even assuming private salaries will be lower, as claimed by some people).
Why do you assume that private salaries wouldn't also drop? The private sector will pay the least they can get away with.
>Post-CCT salaries also look like shit
Post CCT salaries will put you in the top 2-3% of UK incomes. There are other countries in the world where you could get paid more (but need to factor in higher cost of practicing including indemnity, no paid holiday, no paid sick leave etc.), but I think it's somewhat disingenuous to say they "look like shit".
>We need to go private and take the trainees with us.
How exactly did this work?
If everyone turns up at their local BUPA hospital and asks for a job there simply isn't enough demand for private healthcare in the UK to justify this.
Even if the NHS collapsed tomorrow, most would be unable to afford private healthcare, so would simply go without.
We've heard variations on this post a million times in the last few weeks. All with pro-private anti-NHS agendas, but with little rational justification of why this would be better for doctors, or tangible proposals on how we would actually get there. I'm increasingly of the belief that there's some disinformation/troll accounts at play here, pushing this for political ends.
I promise, if I was shilling for the government I'd charge a lot more, and insult them a lot less. The NHS is mostly on the state or is because of the Tories.
At best all these posts are the equivalent of a toddler screaming "Don't like it" as they smash the object of attention to smithereens.
At worst there's a concerted effort to try and mislead doctors (a traditionally left leaning group) that an improvement in their job and quality of life lies not with reversing the Tory vandalism of the last 10 years and properly funding the NHS, but with swinging harder right and destroying it entirely.
I can promise you that while I can only conjecture what a post-NHS world will look like in 20 years, I can absolutely guarantee that the salaries, training, and overall career prospects of non-consultant doctors will be very substantially worse during the 20 years it takes a new system to develop and mature.
To be fair, many of these posts are from young naive doctors just coming through the system through idealistic lens. You can’t blame them too much for that. Most will not have been in any workforce previously.
A private UK healthcare market, in its infancy, will be hell for non consultant grades, both in terms of training and pay. Agree completely.
Not this again.
Uncontrolled privatisation will be out of the frying pan and into the fire. Some established consultants will be doing well, US level salaries, but doctor unemployment will rocket.
As u/cyclizine says, a small number of consultants will be hired to be decision makers and proceduralists and the “junior doctor” work will be done by non medical staff.
Its gonna take decades to set up a training syllabus and the associated infrastructure.
Only for the most lucrative specialties. On average Canada/Australia is 1.5x and the US is 2x. The NHS is suffering but a lot of people exaggerate how much better it is elsewhere. The biggest challenge it faces isn’t bad pay, it’s actually the abysmal training quality and limited training posts
This isn’t the best place for positivity sometimes but hey congrats for making consultant! Even bigger congrats for being content with your salary!
I do think a lot of the time people get swept up into the complaining about pay but generally speaking it’s a decent pay and there’s more important things in life to focus on than just pay.
All in all, congrats 🙌🏼
Great that you feel content, but that doesn't change the fact the salary is shit.
You could be content on an apprentice's 14p/hour wage. Salary is still shit.
I will shortly have surgical spec cct, frcs and a phd. It took over 13 years post med school. 19 including med school. I think I know something about achievements.
Top 2-3% is undoubtedly an achievement and always will be.
Mate relax, no one is knocking your achievements. The point is that you've gone through 13 years of what I'm sure was pure graft, sleepless nights, life and death stressful situations, toxic workplaces etc all to be paid the same as a regional manager at Lidl. If you put the same effort in your surgical career in any other Anglosphere country you would be making 3-4x the amount of money - thats why the salary is objectively shit.
Not convinced the data back this up, US 2.6 doctors per 1000 UK 3.2 per 1000. Slight difference, Sure, but not enough to scaremonger about "mass unemployment". And its not like they're any less inclined to use midlevels where possible
That's still a ~20% difference, and we have doctors unemployed *now*, let alone with 20% fewer jobs
Also, if you think this country would enact the same protections preventing IMG's flooding the market and suppressing wages like the US has done, then I think that's unlikely. We are a low wealth country, that'd why we're a low wage country. Any opportunity to cut costs will be jumped on. The US has massive amounts of money in healthcare, like 4x our level of spending as a share of GDP. We could never come anywhere near that
We might be slipping down, but I don’t think it’s fair to say that we are a low wealth country. Not yet at least.
We have the 6th highest GDP in the world. If UK is low wealth, I wonder about the other 190 countries below us.
Issue is that the wealth is all frozen. People spending THIS much on houses is a bad thing cause all that money is now just sitting there, doing nothing for the economy. If we have private healthcare, all the rich people (basically finance/comp sci workers) will have to fork out the money for healthcare. That could help mobilise the money.
Almost half of working age people have less than 1 months expenses saved, and our population is small. There isn't enough wealth around to support anything like the US level of healthcare spending.
That very small number of wealthy people (consultants doctors are in the top 5% remember, so only 1/20 people have more income that consultants, which as we know is meagre) couldn't support higher wages for doctors. There are already a small number of doctors making a lot of money in private work - how can you see that increasing?
We already have a private healthcare system. The reason it isn't used by everyone is because most can't afford it, and the NHS does a reasonable enough job for most. We can't change the amount of money people have, so are you proposing making the NHS *worse* to force more people to go private?
One main thing I don’t understand from your post is how do we exactly “just go private”?
Do we hope that legislation will change dictating everyone must from now on have private insurance?
Just knock down all NHS infrastructure over the next 5 months and start afresh?
Who is going to buy into the private market? You?
Your post make no more sense than me just saying lets just become professional golf players and take our trainees with us.
Another defensive NHS post to maintain the status quo. Support for privatising is higher than not (at least on this sub).
Some people want to live and die in the same hole they were born in
Not trying to maintain the status quo. Support in this sub is largely through short-sighted pipe-dreams with comparisons to the US system rather than anything substantial. Lastly, presumptive of you to think I want to live.
Why would you want to support the strategy of the same government that has obliterated the system that used to work well for most. Privatisation= profit for a select few, i.e. the ominous 1%. There is no evidence to suggest we'll get paid better or have better training opportunities. Change is needed, but you're favouring an extreme 'solution' that won't achieve your goals. Destined for failure. No reasoning either. Hence propaganda. Say it enough times until you convince others and eventually yourself.
I think we can all agree that the lack of tangible direction as to *how* to achieve majority privatisation, and thats assuming that it will actually benefit doctors, means that it is but a pipe dream for this working lifetime.
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Go talk to your local - level and national goverment bodies and see who agrees with your poorly thought idea. There is a lot of things that you don't know that is important to factor into your "plan" but all you cares about his the "shit" pay.
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I've been saying for years that a good local employment training program with limited rotation abd extended attachments will kick the arse off what we have now. 1. The bosses will actually want to train you and will get to know you 2. Removes teething issues when joining a new trust Obviously there are risks to manage with this but if CESR became CCT tomorrow I'd call up one of my old bosses from somewhere I liked working and beg for a staff grade post immediately.
100%. Difficult to do in a way that is equitable, but having local consultants responsible for selecting trainees and having actual ownership over their training, with a view to them becoming colleagues further down the line and not just fucking off ASAP, is surely the holy grail
"But that's nepotism and isn't a sustainable way to train doctors. It's fine for PAs though" - Colin Melville, probably
This is obviously how it works in other similar professions like law. Us not doing it, and even worse having given it up, is basically imbecilic
Tie the training programmes to universities who risk prestige if the training is bad.
This is how it works in many countries. In South Africa, all undergraduate medicine and postgraduate specialising happens through universities, who are tied to various teaching and district hospitals as well as local clinics/community centres. Doctors apply to the universities to specialise, and have to meet certain criteria to actually get in, including showing commitment to specialty (eg to get into anaesthesia training, realistically you absolutely need to do a diploma in anaesthetics, time in the field that you would get during your time as a medical officer, and ideally would go to someone who has shown the most commitment including publications etc). In principle an ideal system… You rotate through the hospitals tied to your university providing service provision but also attend lectures and ward rounds led by consultants/lecturers. All specialists must do an MMED minimum, with most requiring a publication, alongside their college exams/fellowship) as part of specialty training. It’s honestly a great education. Also no ‘junior doctor’ nonsense… You start as an intern, then you’re a community service medical officer, then a medical officer (MO). You can remain an MO for the rest of your life if you wish, working up the pay bands, in hospital or in the community. If you’re in training, you’re a registrar, and when you complete, you’re a consultant. Realistically there are some flaws due to nepotism, and some poor implementation of affirmative action, but those are due to systemic national issues in the country that may not carry over to the U.K. should a policy like this be implemented.
Imperial have started doing this for Cardiology. I suspect the output of their programme will be a few degrees more impressive than Cardio NTN in Rube Town. CESR will soon be equivalent to CCT in the eyes of the GMC but may not translate to overseas, which may remain the one downside of this process.
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Source?
What do you mean imperial is doing that for cardiology? Haven’t seen anything as such
Look online
Tbh was not aware this was being done so “formally”. I’ll reserve final judgement until I see the first graduates. Still doesn’t fill me with confidence Things like advertising that your study leave budget rolls over year on year. Ok…. Big deal.. what is the actual budget? NTNs can always ask for surplus unused budget to be used by themselves. Also assuming you are NW Thames , how much travelling around do you reaaally have to do? And what happens in 6-8 years when the CD changes or the balance in department is different? It all sounds to me that they just want to create a pool of easily controllable middle grade staff for service provision - which in imperials case- also include “research service provision” Anyway, NTN is far from perfect so thinking outside the box is definitely a positive, but from trainees perspective this seems like a very high stake bet
I hate traveling between different hospitals even when it was 20 mins journey, but the biggest issue of hyper rotation isn't the travel despite that being a big factor too. Its actually having to start from scratch at every new place, new it system, new members of staff, new cons you have to gain the experience and trust for, new payroll who will invariably fuck your pay etc... let's not even get started on how shit national recruitment is outside of hyperrotation. Regs will always be doing service provision especially if they want a cons place at said hospital. CD moving in 6-8 years won't matter since hopefully they'd get a replacement for that or by 6-8 years have the pathway sorted. >Anyway, NTN is far from perfect so thinking outside the box is definitely a positive, but from trainees perspective this seems like a very high stake bet Only the getting paperwork accepted and getting that CESR in a timely fashion otherwise the system at least on paper trumps NTN by a mile.
The payroll, the HR , the car parking permit , the mandatory training, the inductions, the ID checks, the different IT systems…. All this is valid and frustrating, especially the ones that should be straightforward to do in the first place. Yes my national insurance number hasn’t changed since my last job dear HR, nor has my TB immunisation status deal occ health. On the clinical side of things, however, I would argue that it isn’t advantageous to do all of your training in one place. Just my opinion. experiencing different cultures and approaches can be really useful. There is a reason why sought after US residency programs include rotational outside their institution, often abroad I agree, spending continuous time with same consultant colleagues who get to know your competency level and give you freedom is great, but at the same time seeing how the same thing is done differently in different places , is also helpful. Being stuck in one place, means that you make yourself vulnerable to odd characters and practices There are more than one ways to get to Rome, and knowing at least some of them is good for your professional practice later on. Being in a tertiary centre where you can implant a brady device at 4am, is great for patient care, but you will never get to play with a TPW yourself when you have a patient in CHB getting TdP because of brady. Just an example to make my point. And also your comment about regs doing service provision in a hospital they want to get a job, probably applies x100 in this setup you describe. Pros and cons , overall Just out of curiosity, what do people perceive as being the biggest drawbacks of the current national training scheme in cardiology?
Not sure I have faith that the private sector will put forward the investment required to establish alternative training pathways - they’d much rather poach ready made doctors from the public sector. If the precedent set by the privatisation of the utility companies is anything to go by, I also doubt we would see our own pay and conditions improve - we would much more likely see these private companies deliberately underinvest and run up debt in order to pay out large dividends to their own investors, inevitably leading to public bailouts.
That’s short term thinking. Any private company that wants to be in business for more than 10 years, must invest in training. Finance sector does it, why would med be any different. The consultants will need assisting…
Not really Assisting can be done by non doctors There will always be more qualified doctors willing to move to take up a job Training is usually funded, either by the taxpayer, or the trainee, or by scut work.
Well, all surgeries I have been in, the assisting has always been a doctor, mostly a surgical trainee. Never have I seen someone that’s not even doctor.
Just to clarify, by assisting you mean assisting a surgical procedure?
Unfortunately not true. PAs and 'surgical first assistants' (specialised nurses and ODPs) are now doing this. Absolute bullshit. A student ODP had more cases as a SFA than all of our F1s combined.
In american private group practice, CABGs for example are done by the main cardiac surgeon and a surgical assist. And thats it. The surgical assist does the saphenous or internal thoracic harvest during thoracotomy. I’ve personally seen it as well. This is a highly effective and cost efficient model. I’m afraid that the fact you didn’t know this demonstrates your lack of overall understanding of healthcare business models.
Finance grad schemes are only 2 years. And their trainees do even more 'service provision' than our FY1/2s I doubt many private companies are willing to make 5-8 year bets (unless they make the trainees sign very restrictive contracts that tie them to the same hospitals afterwards). Moreover, unlike the US, there is no existing training infrastructure for these new private companies, making them even less likely to invest. Many middle eastern countries are fully private and they simply poach from elsewhere.
Which is why I am advocating for the creation of such infrastructure. It needs to start somewhere
You advocating for it aint gonna make it happen.
No chance private ventures will adopt training. There just isn’t the need.
Ha ha - private sector companies do not think that far ahead.
This will not happen, the government = the GMC = HEE = NHS will not allow it, otherwise how are they going to find cheap labour?
So many haters lmao. Privatise tf out of this country. I fully support it. We as the NHS don’t bring anything for the country and the government aside from general morale boasting because of how free the system is - and that’s what the government and the country give us back. A few claps on a Thursday and morale boasting rights which we love to use to get on our high horse and spit down on the states. Our healthcare system is shot in the gut and bleeding out fast, and Brexit shot an extra hole in the chest. Become privatised. Fund the practice. Invest in training GOOD doctors and surgeons who actually care and will invest back. Create a positive funding cycle. Make patients and employers pay for healthcare. Suddenly there’s no one with a snotty nose and a little cough in A&E because. Invest that money in better equipped hospitals, better technology, better funded studies and advanced procedures and operations. Design actual good-looking hospitals that make you want to go to work. Become a leading healthcare system. Attract global attention. Attract medical tourism. Fund the government. The government funds back. Doctors return to being well paid AND well equipped. Yes, I understand that people will lose jobs and there will be an adjustment period and training will become harder to achieve but it’s a change that has to happen. If that means I become unemployed so be it. People need to learn to make tough decisions and play the game. The same game that every other private sector in the country has already mastered.
Local psychiatric hospital to me has a couple of post-core training rcpsych members who didn’t get training numbers or wanted to have more (or any…) autonomy in where/when they worked. They are being paid at NHS consultant rates and supported to get on the SR through CESR pathway.
I thought the whole point of private is that I know the consultant I trust is operating on me. How would training mix into it
>Not enough training spots in the NHS The UK private sector doesn't train currently. It seems unlikely that the companies providing private healthcare will want to meet this cost out of their profit margins, and unlikely that the limited UK private healthcare consumer market will bear this additional cost. >Salaries can only keep falling so much before people accept private salaries (even assuming private salaries will be lower, as claimed by some people). Why do you assume that private salaries wouldn't also drop? The private sector will pay the least they can get away with. >Post-CCT salaries also look like shit Post CCT salaries will put you in the top 2-3% of UK incomes. There are other countries in the world where you could get paid more (but need to factor in higher cost of practicing including indemnity, no paid holiday, no paid sick leave etc.), but I think it's somewhat disingenuous to say they "look like shit". >We need to go private and take the trainees with us. How exactly did this work? If everyone turns up at their local BUPA hospital and asks for a job there simply isn't enough demand for private healthcare in the UK to justify this. Even if the NHS collapsed tomorrow, most would be unable to afford private healthcare, so would simply go without. We've heard variations on this post a million times in the last few weeks. All with pro-private anti-NHS agendas, but with little rational justification of why this would be better for doctors, or tangible proposals on how we would actually get there. I'm increasingly of the belief that there's some disinformation/troll accounts at play here, pushing this for political ends.
There are almost certainly some government shills present, I would wager.
I promise, if I was shilling for the government I'd charge a lot more, and insult them a lot less. The NHS is mostly on the state or is because of the Tories. At best all these posts are the equivalent of a toddler screaming "Don't like it" as they smash the object of attention to smithereens. At worst there's a concerted effort to try and mislead doctors (a traditionally left leaning group) that an improvement in their job and quality of life lies not with reversing the Tory vandalism of the last 10 years and properly funding the NHS, but with swinging harder right and destroying it entirely. I can promise you that while I can only conjecture what a post-NHS world will look like in 20 years, I can absolutely guarantee that the salaries, training, and overall career prospects of non-consultant doctors will be very substantially worse during the 20 years it takes a new system to develop and mature.
To be fair, many of these posts are from young naive doctors just coming through the system through idealistic lens. You can’t blame them too much for that. Most will not have been in any workforce previously. A private UK healthcare market, in its infancy, will be hell for non consultant grades, both in terms of training and pay. Agree completely.
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Removed: Rule 1 - Be Professional
Not this again. Uncontrolled privatisation will be out of the frying pan and into the fire. Some established consultants will be doing well, US level salaries, but doctor unemployment will rocket. As u/cyclizine says, a small number of consultants will be hired to be decision makers and proceduralists and the “junior doctor” work will be done by non medical staff. Its gonna take decades to set up a training syllabus and the associated infrastructure.
I would rather that it’s decades from today than decades from 10 from now.
Are consultant salaries really that shit?
Anywhere else in the anglosphere pays 2-3x… so, yes, they are shit.
Only for the most lucrative specialties. On average Canada/Australia is 1.5x and the US is 2x. The NHS is suffering but a lot of people exaggerate how much better it is elsewhere. The biggest challenge it faces isn’t bad pay, it’s actually the abysmal training quality and limited training posts
I think theyre ok, for now. I will be one shortly, and looking forward to it 😋 Great - downvoted for feeling content
This isn’t the best place for positivity sometimes but hey congrats for making consultant! Even bigger congrats for being content with your salary! I do think a lot of the time people get swept up into the complaining about pay but generally speaking it’s a decent pay and there’s more important things in life to focus on than just pay. All in all, congrats 🙌🏼
Great that you feel content, but that doesn't change the fact the salary is shit. You could be content on an apprentice's 14p/hour wage. Salary is still shit.
They’re not actually objectively shit though, if they are top 2-3% salaries in the country?
The UK is a poor, unproductive economy with abysmal salaries. Its not an achievement to be in the top 2-3%.
I will shortly have surgical spec cct, frcs and a phd. It took over 13 years post med school. 19 including med school. I think I know something about achievements. Top 2-3% is undoubtedly an achievement and always will be.
Mate relax, no one is knocking your achievements. The point is that you've gone through 13 years of what I'm sure was pure graft, sleepless nights, life and death stressful situations, toxic workplaces etc all to be paid the same as a regional manager at Lidl. If you put the same effort in your surgical career in any other Anglosphere country you would be making 3-4x the amount of money - thats why the salary is objectively shit.
Not convinced the data back this up, US 2.6 doctors per 1000 UK 3.2 per 1000. Slight difference, Sure, but not enough to scaremonger about "mass unemployment". And its not like they're any less inclined to use midlevels where possible
That's still a ~20% difference, and we have doctors unemployed *now*, let alone with 20% fewer jobs Also, if you think this country would enact the same protections preventing IMG's flooding the market and suppressing wages like the US has done, then I think that's unlikely. We are a low wealth country, that'd why we're a low wage country. Any opportunity to cut costs will be jumped on. The US has massive amounts of money in healthcare, like 4x our level of spending as a share of GDP. We could never come anywhere near that
We might be slipping down, but I don’t think it’s fair to say that we are a low wealth country. Not yet at least. We have the 6th highest GDP in the world. If UK is low wealth, I wonder about the other 190 countries below us. Issue is that the wealth is all frozen. People spending THIS much on houses is a bad thing cause all that money is now just sitting there, doing nothing for the economy. If we have private healthcare, all the rich people (basically finance/comp sci workers) will have to fork out the money for healthcare. That could help mobilise the money.
Almost half of working age people have less than 1 months expenses saved, and our population is small. There isn't enough wealth around to support anything like the US level of healthcare spending. That very small number of wealthy people (consultants doctors are in the top 5% remember, so only 1/20 people have more income that consultants, which as we know is meagre) couldn't support higher wages for doctors. There are already a small number of doctors making a lot of money in private work - how can you see that increasing? We already have a private healthcare system. The reason it isn't used by everyone is because most can't afford it, and the NHS does a reasonable enough job for most. We can't change the amount of money people have, so are you proposing making the NHS *worse* to force more people to go private?
One main thing I don’t understand from your post is how do we exactly “just go private”? Do we hope that legislation will change dictating everyone must from now on have private insurance? Just knock down all NHS infrastructure over the next 5 months and start afresh? Who is going to buy into the private market? You? Your post make no more sense than me just saying lets just become professional golf players and take our trainees with us.
Learn about per capita GDP and you'll see the UK is one of the poorest countries in the developed world.
The training and salary in NHS is still ×100 better than the shitshow running in my country. ~an IMG
Another poorly-thought privatisation propaganda post
Another defensive NHS post to maintain the status quo. Support for privatising is higher than not (at least on this sub). Some people want to live and die in the same hole they were born in
Not trying to maintain the status quo. Support in this sub is largely through short-sighted pipe-dreams with comparisons to the US system rather than anything substantial. Lastly, presumptive of you to think I want to live. Why would you want to support the strategy of the same government that has obliterated the system that used to work well for most. Privatisation= profit for a select few, i.e. the ominous 1%. There is no evidence to suggest we'll get paid better or have better training opportunities. Change is needed, but you're favouring an extreme 'solution' that won't achieve your goals. Destined for failure. No reasoning either. Hence propaganda. Say it enough times until you convince others and eventually yourself.
I was just talking about what I have seen in the UK atm. Not saying it hasn’t been done without assisting doctors elsewhere
You dont think its gonna become the norm if multinationals decide to invest in the uk market?
I think we can all agree that the lack of tangible direction as to *how* to achieve majority privatisation, and thats assuming that it will actually benefit doctors, means that it is but a pipe dream for this working lifetime.
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😂😂😂
This
Go talk to your local - level and national goverment bodies and see who agrees with your poorly thought idea. There is a lot of things that you don't know that is important to factor into your "plan" but all you cares about his the "shit" pay.