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FEATURE: Laurence Buckman Is doctors' self interest undermining the National Health Service? BMJ 2007; 334: 235 [Full text]

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How much are doctors worth? - the future of medical practice

Graham Neale   (5 February 2007)

How much are doctors worth? - the future of medical practice 5 February 2007
Graham Neale, Retired physician 30 Bevin Square London SW17 7BB Send response to journal: Re: How much are doctors worth? - the future of medical practice	Medicine in the UK is moving away from being a profession to becoming a business with business ethics. Targets are set and increasingly doctors are being conditioned to practise solely to meet such targets. This leads to payment by results and as Fiona Godlee puts it “more money for less and less autonomy”(1). Dr Buckman states that “without adequate pay there is no morale”. The morale of individuals working in a profession depends on their knowing that they have performed to the best of their ability and that they are continuing to learn to do better next time. In the early days of the NHS junior doctors worked very long hours on a pay scale relatively considerably less than that of today – yet there was little talk of low morale. Most doctors were proud to be part of building the National Health Service. And Dr Buckman continues “……….demanding and receiving proper pay and conditions is a right, not self-interest. Self-interested doctors would go and work elsewhere.” Exactly where? An article in the concurrent issue of the New England Journal of Medicine describes health improvement in Ghana at a standstill and attributes this, at least in part, to the exodus of doctors and nurses from the developing world to the USA and the UK. Ghana has 13 physicians and 92 nurses per 100,000 population, just 5% and 10% respectively of human resources in the USA. Yet 25% Ghanaian-trained physicians are practising in the USA, the UK or Canada (2). The earnings of doctors in the countries of Western Europe (3) pale into insignificance compared with the pay of Ghanaian doctors even though this is better than in most African countries “A trained physician can make more in London in two months than in a year in Ghana”(2) If the medical profession in the UK were prepared to address the problems of providing global health care, and regain the moral high ground, perhaps British doctors might consider increasing their commitment to the developing countries. Would that not be a more satisfying way of improving morale than proudly heading the league table of doctors’ earnings in Europe? Godlee F How much should doctors earn? BMJ 2007;334:214. Mullan F Doctors and soccer players – African professionals on the move. NEJM 2007;356:440-3. Day M. So how much do doctors really earn? BMJ 2007;334: 236-7. Competing interests: None declared