I am. I see it every day. I spend a lot of time with doctors and spend a lot of time being pissed off at how basic stuff isn't happening quickly enough for patients because seniors aren't getting their fingers out and giving junior doctors the guidance they need.Originally Posted by randomlegend
The strike days so far have been interesting in that regard too. No juniors = stuff happening quickly. It isn't the fault of the juniors, but that's the reality.
Of course, apologies if it sounded like that. I was simply making a comparison with real business - also, I believe you are quite young (and probably went into doctoring from college) - so it's not entirely unlikely that you haven't got years of "real world" (ugh) experience.
I'm nearly 25, I'm practically middle aged
But yes, there's no doubt I'm extremely sheltered from what it's like to work a job at all (I dunno if it's clear I'm still a student), especially one not in the bizarre world of the NHS.
25? You're still a young whippersnapper. Either way, the NHS seems pretty fucked up - so good luck!
Maybe they'll privatise it and we'll get paid loads.
More like you'll get all fired.
And replaced with Mexicans, I presume.
One for every ten of you, yes.
I would agree with the view that there should be 'seven day' coverage. Now, whether they're (the government) going about fixing it the right way or not is a different question. As you say, the solution may be to train more people, not necessarily doctors, and be 'smarter' about the way to provide care. One of the consequences of these strikes could be demonstrating to hospital administrators that having too many junior doctors who just rotate off after four months into another speciality isn't the way to go about things. Could you see a decrease in the number of junior doctors accepted at your hospital on the back of the findings from these strikes? That'd be an irony.
Regardless, the locuming culture is absolutely rotten. You simply cannot have doctors standing on the picket line one day and the next they're holding the hospital to ransom when they're desperate for resource. The hypocrisy is astounding.
I think much of it boils down to an outdated view that being 'a doctor' is a high social status profession and therefore we, the ordinary folk, should respect them simply for being doctors.
The worst that happens if I fuck something up is that the client waits an extra period of time for us to fix it. I don't expect to be paid the same as doctors, but that's irrelevant to the point at hand - which is, it's a profession and whilst you start on shit money and do the hard yards for a few years, when you 'climb the ranks', as it were, you do very well and you can start to suit yourself a lot more. But you have to do the hard yards - you're not entitled to anything right off the bat.Apologies, appears I was wrong on accountancy. I'd seen a comparison where doctorising was shown to be lower paid than a load of other graduate jobs and I thought one was accountancy, but I've obviously misremembered and was too lazy to check.
Explains why GS is so butthurt though
With complaints such as weekend working, night shifts or staying late after your shift is over - you knew all that was either part of the deal or highly likely, particularly at junior grades, when you took medicine on at degree level. You can't really complain after the event.
Yes, we did know that. What we didn't expect was for it to get considerably worse and to get less money for it.
On numbers of qualified people required to a) keep the place safe and b) have a consistently high quality of care we'd defer to the consultant body. We'll make sure they know what we can pay for and help design the processes required for care to be delivered as efficiently/quickly as possible (the 'production/business process' and 'customer service' bits, basically) whilst the experts tell us what's necessary for the quality to be high. It's telling that the consultants are initiating conversations with us about how we might change move away from the traditional junior doctor heavy model in light of what has been learnt from the industrial action. I know similar conversations are taking place in other hospitals too.
There's a very real possibility that junior doctors, guided by the BMA it should be said, are taking action which will be the catalyst for a reduced junior doctor workforce in years to come. Which may well be great for patients, so good. But it will be bad for the BMA. They'll become increasingly marginalised ad they'll have done it all by themselves. It will take years to get there but I think that's the way things will go. It's already happening, albeit very slowly. The clinical workforce is diversifying as stuff that used to be really complex and thus the preserve of doctors only becomes less so due to a greater availability of educational resource to non-doctors and advances in medical science. But the current bollocks could really accelerate the process. By the middle of the next decade (to take into account the long training period) I think the BMA will look at this action as the moment they lost the plot and killed their influence.
When I accepted my graduate job, it came with TOIL. I got a leaflet two months before starting telling me that this was being sacked off, and I was instead going into firm-wide 'bonus pool'. This meant I lost several days TOIL a year in exchange for fuck all (my first bonus was a paltry £200 after the tax man had its way with it). Shit happens, basically. It's a profession - the rewards further down the line, and the qualifications, meant it was a worthwhile exchange regardless.
To reiterate the point I made to Lee, I don't disagree with the need for 'proper' coverage across the full week. Whether the government are going about it the right way is a different matter, but I simply cannot accept the hypocrisy of doctors ripping the shit out of the system when it suits them and then pleading a lack of fairness on the other.
GS is completely right here.
To steal a phrase, I'm no expert, I'm phonics but isn't the whole issue with the NHS that we have to hire a bunch of mercenaries and/or foreigners because there's not a wide enough pool of trained talent (whether that be nurses, doctors, radiologists etc.) and therefore going about a negotiation where the junior level have better paying, instant opportunities from abroad due to commonwealth visas and the like just fuck you even more and you eventually get to spending money like the U.S. does?
So however shitty your 'boss' tries to make your working conditions, however much they lie and belittle you in the press, however much you feel the proposals are unsafe (I know you lot love to make the discussion all about pay, but that's not what the vast majority of the junior doctors' complaints have been about) you should just accept it because 'shit happens'?
Nah, fuck that.
First time you read GS?
I think so? He's new isn't he?
I find it difficult to accept the idea that this is about 'patient safety' when they're happy to go on strike (what's this, the fourth time?) and routinely hold hospitals to ransom when they're seeking better locum pay. Medicine isn't a 'calling' - it's a career choice for the vast majority of people, and they want the best circumstances for themselves. This is perfectly fine - but the sanctimonious bollocks about how this is about the patients and not the doctors themselves simply doesn't cut it.
Now, again, I'm not saying that the way the government is going about 'reforming' the system is the right way to do it. However, there were certain practices which clearly needed to be addressed. Doctors cannot exercise this level of hypocrisy and expect everybody else to congratulate them on their principled stand. That doesn't mean Jeremy Hunt isn't a complete wanker, but we really need to move on from this idea that junior doctors are entitled to something simply because they're junior doctors.
Strikes which haven't compromised patient safety...
What else are they actually meant to do in protest when the government declares they will unilaterally impose something they fundamentally disagree with? Just suck it up is your position, I guess. I think that's bollocks.
You talk about this like every doctor is lining their pockets with high paid locum shifts every chance they get, which just isn't true.
If I didn't feel some sort of 'calling' (if that's what you want to call it) towards medicine there is no way in fucking hell I'd have gone into it and I would be very confident that's true for the vast majority of people I know. There are a million other things I could have done with my ability which would have been higher paid, less stressful, more prestigious and a better 'career'.
And it is about safety. It's about not treating someone after being on shift way too long and having worked way too many hours that week and making a prescription error because you're exhausted and harming someone.
Yes, they want to be paid fairly for what they do (i.e. they don't want a wage cut for more work), but amongst everyone I know the primary concerns are preserving the NHS (despite the fact they suspect they'd stand to benefit financially from it being privatised) and being a safe doctor.
Again, this is on the presumption every Dr is rolling in it from all the locum work they are doing. They aren't. You can't shit on a whole profession for 'hypocrisy' when - and I don't have figures but my experience is that - most people aren't doing what you are accusing them of.
They are entitled to something. They are entitled to work in decent conditions for decent pay and to be part of a system which allows them to practice safely. If they don't get that, you can't expect anything other than for them to fuck off.
But SAVING LIVES.
They've led to repeated cancellations of 'routine' surgery (if it wasn't needed, it wouldn't have been scheduled, would it), which causes a serious amount of inconvenience to the patient. Perhaps it does not directly lead to immediate safety issues for the patient, but one suspects that there are many vulnerable patients who have had surgeries reorganised or postponed indefinitely on the back of this action. And you don't know what impact on quality of life, however short or medium term that may have, that has.
You can fall back on the 'safety' argument if you wish, but let's not pretend there have been no consequences to patients arising from these actions. You're also about to go on full walk-out, including emergency care. This is definitely jeopardising patient safety, in spite of the contingency plans hospitals will put in place. This is also the view of the GMC.
On the subject of why you went into medicine, that may be why you went into it. However, training to be a doctor still has the perception as a high 'social status' profession and it is very well paid. This isn't the professional equivalent of digging wells in the depths of Africa for eight years to help poor communities. I have no problem with that, because you want the brightest people putting themselves forward for the job. It is living in a fantasy land to pretend that the 'vast majority' are only training in the profession because they perceive it as some great social enterprise to work in and defend the NHS.
With respect to the locum issue, you certainly can highlight the hypocrisy involved. If you've taken even one locum shift at an extortionate hourly wage, you've ripped the shit out of the system. Full stop. It's widespread practice, and I don't blame doctors for doing it - but if you have, you simply cannot turn around and pretend you're doing anything other than suiting yourself.
How much do you think doctors get paid, out of interest?
It would be good to see them just WALK OUT indefinitely until one side BOTTLES IT (most likely them). Randrew could be excused, like. They don't need him flagging on the picket line and using up all the strike fund on Lucozade.
I believe they start on somewhere around mid-twenties, with increases once you move outside your first two year training rotations. It's also dependent on whatever band you're in, but I don't know how that works. I'm also aware of locum hourly rates of £93 an hour for a 12 hour shift, which appears to be standard.
Again, starting salary isn't important in and of itself. It's about pay progression, which is very good because you should be earning very well after eight, ten, twelve years after starting.
'Routine' surgery means anything that isn't rushed in on an ambulance or burst inside of somebody already in hospital. Cancers and other urgent surgeries count as 'routine'. Somebody is going to die waiting and the doctors will look like cunts for saying they're not jeopardising patient safety. Stop saying it, for fuck's sake.
I haven't come across a junior taking away more than £65 per hour since the caps were introduced and that's an extreme example. Juniors haven't been too bad with the capped rates, but that's not saying much given that the rates are very generous.
Consultants are taking the piss though. It will be interesting to see what happens when the consultant contract is negotiated. I suspect they'll bend over, leaving the juniors isolated. Not a chance consultants will risk their cushy positions. Far too clever for that.
Are there increased rates for bank holidays / weekends / nights etc. for locum rates or how would it usually work? All I hear are the 'headline' figures whenever my mates (and, by extension, their 'work' mates) are talking about potential earnings.
There are. What we're finding is that juniors were more willing to work for the February rates but not the April ones (they've been capped in stages). So for a lot of weekday shifts we're paying out (April) weekend/bank holiday rates so we can keep services going. It isn't great and it's more than a bit annoying when the same doctors are being all pious about the necessity for industrial action.
The juniors are nowhere near as bad as the consultants though. One cunt refused to work for the internal rate and tried selling himself to me as an external locum for £120p/h. I paid more (in totality - it was less when you take into account NI etc) for another external to prove the point. I've also had consultants threaten not to deliver a service because of rate caps. You just have to hold your nerve and give it the old "go on then, lads" in the hope that they bottle it. They did, fortunately. I find the money side of things really pisses me off. I find it genuinely disgusting that people can be asking for so much money to deliver a public service.
The 'routine' surgery thing is a sore point as well. Before three of the four strikes we've had so far (I was abroad for one) I've personally made phone calls to patients awaiting surgery to tell them they can't have it. These people have spent weeks getting worked up, taking time of work, arranging for relatives to take time off work to care for them while they recover. It's fucking cruel. The BMA and the juniors can talk about how they're not risking patient safety but they're only right in the strictest sense. They ought to try being cried at down the phone by a woman with cancer who just wants the fucker cut out.
Yeah, I'm sure they're complete strangers to dealing with that kind of distress and emotion.
I think you just see the worst side of the situation I.e. the extortionate locum rates and forget that most doctors genuinely care and do a lot beyond their remit out of good will. People don't stayate to look after people because they think it will progress their career, they do it because they know the patients need looking after.
Or maybe your doctors don't, maybe you work with a bunch of cunts, but it's certainly not my experience.
Obviously they're not strangers to it. Even more reason that they should know better and stop lying with their patient safety message. I don't forget anything. I see doctors both good and bad. I'm just not conned into believing they're all virtuous souls because, unlike you, they're not what I aspire to be.
Of course doctors genuinely care. They're human. But equally some are in it for the locum money and others are in it for the cushy lifestyle they'll get if they make it to consultant level. Being a doctor doesn't make them more caring towards other humans than the IT bloke or the cleaning lady though. The self righteousness is annoying.
And yes, many stay late to complete jobs they've started. That happens in factories too. Although most are gone at 5pm. As they should be; they've done their bit and there are people to take over. The 'your doctors might be cunts' argument is piss weak. They rotate. We get new ones all the time. There's no reason why what I see shouldn't be representative. And in any case I speak to people from other hospitals regularly.
I don't hate doctors. I get on really well with most and my job means I've formed friendships with loads of them. Like any group in society they're mostly good. But also like any group there is greed and dishonesty in there.
You clearly find it very hard to see that doctors aren't all wonderful and that there's no way they can't be 100% correct on this matter. You go on as though they're poorly paid. They're not. When anybody mentions ridiculously high locum rates your response is that it's not the majority. I can tell you that I've never met a single junior doctor who hasn't been willing to work for mental rates. You're at pains to tell us that they care about patients. Good. That's the fucking minimum expectation, that they don't want people to die. And you parrot the 'routine surgery' line. It's bollocks.
On the principle of the matter the junior doctors are correct. But that doesn't mean they should be above criticism. Especially when some of those protesting are happy to rip the service off on other days and they're happy to let seriously ill patients down to make their point.
I also don't think it is a fantasy that most people who go into medicine don't do it for the career aspect.
The few I know who did are already deciding to finish med school and do something else.
Yeah, obviously we didn't all go and decide to spend our lives volunteering in Romanian orphanages, but I still find most peoples main motivations were fairly altruistic. Perhaps that's because I go to the fluffiest med school in the whole world and we are all the freaks.
This is too long to be doing on my phone. I'll respond later.
I don't doubt that most go into it for the right reasons. Just not any more so than any other person who gives a shit about other people. People generally want to do good, they just have different abilities and skills to enable them to do so. Doctors are privileged in that regard. And they aren't doing it for free. If they stay the career path they can become a consultant, end up basically rich and be among the most respected groups in society. Good luck to them too. But let's not pretend they're hard done to as a profession.
But isn't that the issue? Not the junior doctors. It seems very much stomp on the little man because we can save a few quid here but don't actually go after the people raking it in. Then by stomping over these people you're going to have less people in the talent pool to become consultants meaning they can charge even more money.
Very much like going after people's benefits and benefit fraud when tax fraud dwarfs it.
The consultants' turn is coming, I would imagine.
Having a smaller talent pool might be the way it goes, deliberately. If consultants cost us more in tbf long run than so be it. I've no issue with people being paid very well for being experts in their field.
Again, on the principle the junior doctors are right. But by making the argument public some of their hypocrisies are fair game too.
Also I obviously don't think all doctors are 100% wonderful and can't possibly be wrong.
I just think some of the opinions (like GS' that we are a primarily career-driven) put forwards are unfair.
It is. Negotiations are due any time. I doubt things will go the same way though. Neither side will be able to afford another argument like this.
It's all going to get privatised and this will be irrelevant anyway
There are blogs out there that would love this Fox stuff. Imagine if the anonymous 'Ginger Rodent' became a hate figure.
'Leicester may be top of the table but this Director of Operations is anything but *multi quotes every bus perv post he's ever made*'
I'm sure if you told doctors they would have no career progression and cut their wages in half, not very many would be prepared to stick it out because they're providing a valuable 'altruistic' public service. People like money. People are ambitious and want career progression. This isn't a criticism - but it really does need recognised that people go into these professions because they offer very generous pay packages, good career opportunities and a profession which carries social status.
As everyone's acknowledged the principle behind the protests is probably sound - but this could well prove a Pyrrhic victory for the BMA, if they even 'achieve' a victory at all.
That's all well and good, but if they were people's primary motivations they'd still have chosen something else.
'We just want to save lives.'
Hardly. The pay is very good (here). It comes with options, potential for an excellent pension and the opportunity to absolutely scam the system as a locum when you fancy earning a few extra quid. It is naive in the extreme to imagine that people are there exclusively because they want to help the masses, or that they're undertaking the training because they support 'our NHS'.
If they were / did, they wouldn't act as they do. Judge not what doctors say, but what they do. Everything else is just sanctimonious noise to justify their actions, past and present and future.
That's a point actually. The juniors seem at pains to point out that they compare badly to other professional training routes (they don't) but those in other professional fields aren't getting paid for overtime. The salary is the salary and the expectation is that you put in the hard yards early in you career.
This is true. As you say, my salary is my salary and that's it. Any overtime anybody does is without additional remuneration. We also can't undertake additional work when it suits us at inflated rates. Doctors have plenty of options open to them. There's also nothing about getting extra remuneration for working into the night or at weekends. I don't do this, but there are plenty of people who do and - again - it's just expected they will. It's the same with lawyers too.
Which reinforces the point that it's a very good career choice, irrespective of motive.
As if by magic, leaked emails indicate the BMA are considering that as an option: http://www.theguardian.com/society/2...finite-walkout
I've had enough of going over most of the stuff in this thread again and again, but I honestly can't get over the fact this is what you believe.
I'd be laughed out of the room if I said in a lecture that a junior should be going to their registrar with every single decision. Obviously they aren't deciding on what type of surgery someone will have for their cancer and there should always be someone on hand to ask things above their competence or they aren't sure about, but I just don't believe it's true that juniors aren't expected to make any decisions or manage anything for themselves.
They shouldn't need to go to a registrar every five minutes. They should be following an agreed plan. A clear plan is put in place for each patient upon admission to hospital. Any changes to this are put in place by the consultant leading the ward round each day. Jobs are distributed to juniors every morning by the consultant leading the ward round. The job of the junior is to learn by doing as they're told. They can challenge, of course (it's all part of their learning), but any decisions are made by consultants. Experienced registrars can do so if the consultant in charge deems it to be appropriate. A board/ward round isn't considered to have taken place if not led by a consultant or by a registrar with explicit delegated authority from a consultant.
It isn't safe for a person at that stage of their training to be making decisions about care. It's also against all (clinically developed) national guidance. If senior doctors are leaving juniors doctors to make decisions about the care of a patient that's real safety concern and is a disciplinary matter for the consultant in question. It's neglectful and can result in consultants being in the shit with the GMC, so they take it seriously.
What you're taught in lectures is clearly very different to what happens in a hospital. What I'm writing isn't "what I believe". It's what I see every day. It's part of my job to make sure it's happening. I have worked in two very different acute hospitals full time and have visited countless others all across England through my career so far, often with the sole purpose of observing clinical process to ensure we are doing the safest things possible. The expectations are the same everywhere. If a relative of mine died in hospital and I found that decisions outside of a consultant-agreed plan were being taken by junior doctors I'd be suing the fuck out of that hospital.
I'm not inventing this to make a point. It's my job to understand how hospitals work.
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