What are "junior" doctors complaining about?

Junior doctors are probably going to strike against changes to their contracts. But most of the public don’t really know what a junior doctor is, let alone why they might want to strike. So I’m going to try to explain (like others before me) what I know about the issues.

Disclaimer: I’m not actually a doctor, I’m just a web developer. But my wife is a “junior” doctor (an ST3 anaesthetist), and so I know a fair bit about the issues. I’ll try to stick to facts here, but if I get anything wrong, please correct me in the comments (please provide references if you can).

What is a “junior” doctor

“Junior” doctors make up 60% of all NHS doctors, and will include most doctors that you’ve met.

The somewhat confusing term refers to any doctor from when they graduate from their 5 or 6 year degree until they fully complete their training, potentially 9 or more years after graduating. Almost any doctor who isn’t yet a consultant or a full GP is a junior doctor.

Therefore, this new contract will effect the majority of doctors in the country.

How much do junior doctors earn?

This is a somewhat complex question. Because “junior” doctors have anything from 0 to over 9 years of experience on top of their 5-6 year degree. However, NHS.uk explains it fairly well:

All doctors in training earn a basic salary and may be paid an additional supplement depending on their working pattern.

In the most junior hospital trainee post (Foundation Year 1) the basic starting salary is £22,636. This increases in Foundation Year 2 to £28,076. For a doctor in specialist training the basic salary is between £30,002 and £47,175.

Doctors in the specialty doctor grade earn a basic salary of between £37,176 and £69,325.

This is very much in line with other skilled professions. For example, a graduate civil engineer with a 4-year degree may earn £23,500, or £26,500 with a year’s experience.

Doctors also have to pay a lot out of their salary for courses, exams, memberships and insurance.

How many hours do doctors work?

Doctors often work overtime and “unsocial hours”, and are paid extra accordingly as a percentage of their basic pay. Currently, any hours outside 7am to 7pm on a weekday are considered unsocial, although Jeremy Hunt is trying to change that (see below).

The European Working Time Directive in theory limits doctors to working a maximum average of 48 hours a week over a 26 week period, and a maximum of 91 hours in any individual week. However, despite attempts to enforce these hours, some doctors still work 100-hour weeks.

What other difficulties do doctors face?

As already mentioned, doctors have to work long and irregular hours. They often get rotated on night shifts for a few days followed by long days, meaning they have to switch their body clock around extremely fast. And they have to do this at the same time as revising for and sitting very tough exams, to eventually complete their training, up to 15 years after starting university. And they have to pay for myriad subscriptions, courses and insurance all out of a not particularly impressive salary.

In addition to this, doctors get regularly rotated between NHS trusts, every 4 or 6 months. This means doctors often have to move house, or stay in temporary accommodation. My wife and I have had 5 addresses in 5 years.

All in all, being a doctor is a fairly all-consuming profession. You have to dedicate your life to it. It’s not a good choice for either getting rich quick or having an easy life. The only logical reason to struggle to become a doctor is for the desire to help people.

What are these contract changes?

Coming hot on the heels of his attempts to force consultants to work weekends, Jeremy Hunt wants to impose a new contract on “junior” (most) doctors.

The main change in this contract is to redefine “social hours” from “7am-7pm on a weekday”, to “7am-10pm Monday through Saturday”. This is a step towards the government’s promise of “seven-day NHS services”.

Jeremy has tried to reassure doctors that basic pay will be adjusted so that the average doctor won’t see a pay cut, and that doctors won’t be working longer hours.

So what are doctors complaining about?

This is a huge change for doctors as it will mean they get paid the same for 9pm on a Saturday night as 9am on a Tuesday morning. Despite Jeremy’s reassurances, many doctors who currently work unsocial hours will definitely see a significant pay cut.

In addition to this, the changes will obviously mean that doctors are more often working late evenings and Saturdays. Being a doctor already means you have hardly any free time at useful hours, and this will make it even harder for them to make social appointments, meet up with friends etc. Ultimately this contract, which is seen as punitive for doctors, will further damage the NHS.

The BMA is also concerned that the new contract will weaken the safeguards ensuring doctors aren’t overworked. There is no guarantee that NHS employers will have to ensure the Working Time Regulations are adhered to.

Doctors and the public have been speaking out about the contract changes using the hashtag #NotFairNotSafe. Over 20,000 protested in London, Nottingham and Belfast last weekend. The BMA are balloting for strike action, which I think will probably go ahead, based on the feeling I get from the doctors I know.

What’s this 7-day NHS thing about?

The reason the government is making these changes is because of a Conservative campaign pledge that David Cameron made to deliver 7-day NHS services.

The government is committed to working with the NHS so that 7-day services are available in all hospitals. Patients should get the same high quality, safe care on a Saturday and Sunday as they do on a weekday.
Government policy paper: 7-day NHS services: a factsheet

As many have pointed out, NHS hospitals already operate 7-days a week. According to Jeremy Hunt, patients are 15% more likely to die at weekends, but he’s now being accused of misleading parliament. This “weekend effect” is in fact observed internationally, and is no worse in England than anywhere else.

I’m hoping to write more about the 7-day NHS pledge more in depth (and in a less neutral tone) soon.

In summary

Doctors’ working hours are already at the limits of what is legal in the EU, and their salaries are nothing special.

Jeremy Hunt wants to impose a new contract on 60% of NHS doctors to make them work Saturdays and evenings more often. Many doctors will see a pay cut of up to 40%.

Doctors are rightfully unhappy about it, have protested in huge numbers and will probably call their first general strike in 40 years.

By @nottrobin