Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Remuneration of GPs
- Elizabeth Marsh (2 February 2007)
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A question of worth?
- Malcolm J Bourne (2 February 2007)
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Time for a balanced debate
- Michelle C Quilter, Rajnish Attavar (2 February 2007)
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Worth it if done properly
- graeme mackenzie (5 February 2007)
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GP pay
- S Geethavani (5 February 2007)
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doctors earnings
- sriramashetty vengopal O.B.E, BIRMINGHAM B16 9JT (5 February 2007)
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Doctors are worth every penny
- claire L chambers (5 February 2007)
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The distortion of Value
- Richard Rosin (5 February 2007)
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The value of income remains relative
- Nicholas F. Grigoropoulos (5 February 2007)
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Unscientific article with no proper analysis
- Ram Kumar (5 February 2007)
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Get the facts straight
- Graham Wheatley (6 February 2007)
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Is this really relevant?
- Rachel J Smith (6 February 2007)
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The locum effect
- Paul HJ Donachie (6 February 2007)
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Response to how much do doctors really earn
- Arunima Bhattacharyya (6 February 2007)
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Systematic devaluation is underway
- Amit Patel (7 February 2007)
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Recycling inaccurate information
- David Clough (7 February 2007)
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Leave us alone
- Emily H Ball (9 February 2007)
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Dull and lazy article
- ian nesbitt (11 February 2007)
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Science or Politics?
- Salman A Mushtaq (12 February 2007)
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Time for a more considered response from the medical profession
- Kelsey D J Jones (13 February 2007)
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Re: Time for a more evidenced response from the public health profession
- Graham Wheatley (17 February 2007)
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Re: Re: Time for a more evidenced response from the public health profession
- Kelsey D J Jones (23 February 2007)
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Productivity is what matters
- Graham Wheatley (24 February 2007)
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Keep Your GP's Happy!
- James L. Krantz, M.D. (24 March 2007)
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Spend and Tax
- Maybelle Wallis (26 March 2007)
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Elizabeth Marsh, Writer DT4 9QU
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Perhaps the fact that this is an issue at all reflects a deeper undercurrent of dissatisfaction within the NHS and its' fiscal management. If doctors (GPs) were paid sufficiently, no-one would question otherwise; it is only when any balance is tilted that the question of disproportion ever becomes relevant. Whether the figures used by any newspaper are accurate, or whether they are only 50% so is not the issue, for once the question or thought of being overpaid reaches the public consciousness, this is what matters. How many GPs would be willing to acknowledge that with the resultant loss of hours contracted to work, combined with a signifcant increase in pay - that this is fair? Unfortunately, whilst GPs may not govern their pay structure, it is the NHS and those of us who use it, who have to pay for any increases, albeit indirectly. Whilst doctors may not be responsible for paying themselves large increases in salary, the question remains - what are patients getting in return for this investment? Less access to a GP does not sit comfortably with the general public. Competing interests: None declared |
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Malcolm J Bourne, Consultant Child & Adolescent Psychiatrist Accrington
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Ironically, neither the editorial nor feature article actually delved into the headline question of how much Doctors are actually worth. Whilst recent pay rises have given rise to media headlines and attempts from within our profession to defend these (alleged) salaries, I find it disappointing that the actual worth of what we do is not emphasised more. Even a salary of, say, £120,000 a year reflects an hourly rate of around £50-60, for 12 to 10 sessions, respectively. This is slightly less than, for instance, I have been charged by my physiotherapist for some recent treatment, and fractionally over what my hairdressers' rates work out at, and I begrudge those not at all. The arguments over health staff "worth" are well rehearsed, in terms of years or training, skills, etc; and I am the first to acknowledge that the majority of our clinical colleagues trained as nurses, therapists, etc., are even more underpaid in public service. But I also reflect that the hourly rate I quote is well under that billed by lawyers, accountants, etc., and that it would be rare indeed to find a surgeon willing to perform a hip replacement or cosmetic procedure on a private basis for much under a few hundered pounds per hour. Whereas the forces that determine medical pay are varied, chiefly determined by what taxpayers are prepared to offer; and the Faustian if unwritten bargain about having less clinical autonomy in return is something requiring further consideration; to suggest that doctors are overpaid appears ludicrous to me. Malcolm Bourne Competing interests: None declared |
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Michelle C Quilter, SHO SW17 7DJ, Rajnish Attavar
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Dear Sir/Madam, A small minority of senior doctors earn the figures as quoted in popular media and your article. I understand this figure is based on the additional duties over and above what is stipulated in the GP's contract. I also understand that patient satisfaction of their GP's performance has improved yearly since the implementation of the new contract. This proves that GPs are good value for money. There is also considerable uncertainty due to implementation of MMC changes. We know of doctors who have had to change their preferred career pathway to ensure employment and also doctors have had to move around the country to seek jobs to complete/improve their training. Doctor's pay should be comparable to what other professionals with similar expertise and training would earn eg. Lawyers and Accountants. Doctor's continue to work in the NHS because they value the difference they can make for patients and the satisfaction they derive from it. It is unfortunate that the trial of doctor's pay has been played out in the media. This gives a skewed version of events to the public and it is used as a smokescreen for the financial deficits for the "dys"management of finances in the NHS. Competing interests: None declared |
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graeme mackenzie, OUT OF HOURS GP CUMBRIA CA13 OLA
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I am in a interesting position to comment. I have just left a practice as a full time principal and after 20 years as a GP partner and principal in three different practices. I have switched to full time out of hours post. I have taken a potentially significant drop in remuneration. I use the word "potentially" as my initial gross monthly pay has increased. However there is something odd about the way GPs get their hands on the money and in my three practices, the money in my hand never seemed to equate to what the accounts stated. This is because of superannuation and other deductions and of course the increased contributions with the new contract have increased this odd discrepancy. In addition GPs now get a big extra payout when the QOF returns are in. However the tax inspectors interpretation of these payouts and when we needed to pay tax on them meant that in essence we were paying significantly more tax up front. This is also because you pay heavily in terms of tax when you have a rising income because it is assumed your income will continue to rise. Tax is paid on gross profits. If you invest in your practice because you see a rising income you actually get a double whammy of paying a high tax bill in the year you are investing and of course that investing immediately lowers your take home pay, so you are paying more tax out of less income. I know it "all comes out in the wash" but at times myself and some of my partners actually worried about our rising income because of the inevitable tax bills. However my main point of this reply is that a full time GP earning the amounts stated is working at a very high level with layers of complex, subtle and ongoing (crucial point) responsibility. Most days in my last practice (average list size, average town), a day meant 8.30 am to 6 pm + with almost no break. Computer searches can make an estimate of work done by telling you how many "notes" you opened and I would regularly "open" 80 + sets of notes in a day. This would include patients seen and talked to of course, but also all the lab results, letters received, reports, DLA reports and many other things. Patients can regularly bring 5 items for "treatment", usually on a background of multiple pathology and polypharmacy. Often their needs are addressed in 10 mins. It was too much for me. I have a basic enjoyment of GP but I felt overwhelmed constantly. As an out of hours GP, life is a lot easier despite choosing often not to sleep the next day after a night shift. Fewer patients, more time for patients, single problems, more doing and less worrying. I have every respect for the effective daytime GP with the average list. Of course one could argue that the job would be easier if GPs took less money and employed more colleagues... that is another debate and of course would not reduce the NHS bill Competing interests: previously high earning GP |
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S Geethavani, GP trainee North London
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Dear Editor An average GP's list consists of a 1000 patients and an average GP's salary now is aroung 95000 pounds - about 10 pounds per month per patient. I am still to find an insurance policy worth this money that will promise to provide treatment no matter what illness afflicts one, no matter what stage of illness one is in, no matter what one's occupation/age/social situation is?. In addition where necessary one's GP promises to arrange a home visit when one is not able to attend surgery. Is it good value for money? I think my GP is worth every penny and I shudder to think what a private insurance policy would offer for such money. Competing interests: will train to be a GP whatever the pay |
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sriramashetty vengopal O.B.E, retired gp pricipal 24,melville rd, BIRMINGHAM B16 9JT
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I am a retired gp on old pension rules.I am amused at the present discussion on doctors' earnings. The present gp contracts are over priced for the work the present gps undertake with all possible help in the practices, a practice manager, practice nurses, plenty of rceception staff and many others. Almost all practices have appointment systems and very occasional home visits. No gp does OOH. If one compares our work load of 24hrs commitment with all OOH work and with very meagre ancilliary staff the present gps look as if they are on holidays. Along with present discussion can someone at BMA and GPC also think about their retired colleagues who find it difficult to cope with their pentions with high inflation and living costs. We also gave excellent gp services to our patients as real family doctors. we undertook all that happens in present improved gp surgeries and more, conducting even home cofinements. I am not sure how much improvement has resulted in the health status of our patients since present gp contract, even with our previous working methods there was no higher mortality and morbidity. Competing interests: None declared |
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claire L chambers, 4th year Medical student Leicester Glenfield hospital
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It really angers me that the question of how much doctors are worth is ever raised. Doctors undergo one of the most rigorous, lenghty undergraduate training programmes of all, and then face years of hard work, often putting in up to 80 odd hours work each week. To say doctors are not worth the money is a joke; health care is vital for people and so you must pay doctors a very good wage to equal other professions such as law/accountancy. If the public think doctors are going to go through 15+ years of training and exams plus work more hours than most other professions, and on top of that have the stress of uncertain futures and litigation, then they need to think again. Competing interests: None declared |
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Richard Rosin, Attending Psychiatrist Westside Mental Health Team, Vancouver BC, Canada
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"How long is a piece of string?" goes the old saying. How do you determine the value of anything. There's the old cliche about supply and demand. There's also the old Marxian notion about the social determination of the 'value' of money and commodities. There is of course the time-honoured labour theory of value. So how do you determine the value of anything? For example how valuable is education? Most people would say that a good education is very valuable. So how is that teachers are so poorly paid if what they do is so valuable. Most people would agree that good medical care is very valuable so why the fuss about doctors being paid well, why the endless scrutiny? Why do we not see the same preoccupation with lawyers and businessmen? With education and health we speak about value to society. In the case of business, accountancy and law value refers to how much profit can be generated. Those who provide socially valuable services such as nurses, teachers, firemen and doctors are expected to be 'dedicated' rather than interested in money and therefore their claims to better remuneration are taken as rather distasteful since their goal is supposed to be to provide a service and perform 'duty'. Coupled with that, at least in the case of doctors, is a traditional notion that 'doctors are rich'. There are some doctors who are rich and relative to other equivalent professions, doctors might once have been comfortable. It simply is no longer true that in general doctors are rich. But doctors are important and there has been a campaign in recent years to render them unimportant, disempower them and control them. I know of no doctor who gets a multi- million pound sign-on bonus nor any who after being struck off might walk away with a multi-million pound severance package. Yet these practices are common in the upper echelons of industry among CEOs. This whole debate is full of ideologically-determined straw-men. It should be clear that noone has had an honest discussion about value or values. The same people who have the knives out for doctors' earnings are rolling out the proverbial red carpet for those in the finance sector. This fact alone should tell us all what values are considered more important. It does not seem to cross too many pundits' minds that these values are utterly distorted. The same honesty should apply to discussions about others who provide such essential valuable services to our society. Perhaps if doctors, firemen,nurses, teachers and cleaners withdrew their services for a while we might see an appreciation of their value - in more ways than one. Competing interests: None declared |
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Nicholas F. Grigoropoulos, SpR Haematology Queen Elizabeth Hospital, Gayton Road, King's Lynn, PE30 4ET
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It would be erroneous to assume, as the author suggests, that the higher income earned by UK doctors compared with their continental counterparts necessarily translates to better pay. The figures quoted take no account of the substantially lower cost of living in the vast majority of other European countries. When this cost is factored into the comparison with US physicians who, in addition to higher salaries also enjoy a lower cost of living, the actual gap widens significantly. Competing interests: None declared |
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Ram Kumar, Locum consultant Alder Hey Hospital
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The facts and figures and the graphs in the article are misleading without context. Purchasing power parity might be better to look at. One way of doing it is to work out how long a doctor would have to work (after all taxes) in each country to buy a McDonald's hamburger (or a pizza) or a ticket at the cinema, or pay utility bills, or pay just to go to work including paying parking fees. Or perhaps how long the average doctor in each country has to work to afford a lawyer, a plumber, child care. I appreciate doctors earn higher than average in this country, but Britain has a large proportion of people with low skills and low qualifications who bring down the average. Are British MPs the highest paid in Europe, and also British medical journal editors, British freelance journalists, all British services (outsourcing anyone)? This in its own way contributes to the high cost of living in the UK. Maybe we are all overpaid in this country and are heading for a national pay cut? If pay rise is less than inflation, then we already are. Also, you need to know the "productivity" of the doctors (oh no, I'm going all Maynard). What are the number of doctors per head of population, per patient seen in out-patient clinic or per ward round? In summary, this article should not be in the BMJ. There is no scientific analysis to it. I could do better if I had the time but I'm too busy treating patients. Competing interests: Jobbing clinician |
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Graham Wheatley, GP Munro Medical Centre
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To see the wanton inaccuracies in The Independant retailed as fact in Michael Day's poorly researched piece of tabloid journalism is particularly disappointing in a medical journal of record such as the BMJ. One can only react with wry amusement at the assertion that for the first time GPs will have to pay "employees superannuation" - in fact they've always paid this, the new payment being the employERs' contribution which costs 14% of income, wiping out much of the quoted new contract gains for the typical GP. GPs would say that we provide an extensive array of chronic disease management and extended services for any extra funding. The BBC news comment sites show that a surprising and gratifying large majority of the commenting public agree, and are supportive of GPs and the services they provide, despite an seemingly well organised campaign of vilification mounted against them by sections of the media, politicians and other political chattering classes. I don't expect the BMJ to be uncritically supportive of the medical profession, but I would expect a degree of accuracy better than that found in your average red top newspaper. The idea that there is "a groundswell of opinion that GPs are being too generously rewarded" is laughable and I suggest exists only in the slightly precious and envious world of health economists, journalists and politicians quoted by Day. As the prime minister had the humility to point out this morning on radio 4, journalists and politicians languish at the opposite end of the spectrum in public approval ratings to GPs - they should spend more time considering why. Competing interests: None declared |
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Rachel J Smith, Medical Student UCH
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Why are the authors of this article and the general public so concerned about the amount earned by GPs? We don't see articles questioning whether other groups are earning an appropriate amount. A salary of £120,000 is equivalent to about £50-£60 per hour, less in those hard working Gp's who work extra hours doing paperwork. This is similar to what hairdressers, masseurs, musicians, physiotherapists etc charge per hour, and we are not questioning them. Being a GP is like being the managing director of a company, and if you can make the company successful then you do! What we should be questioning, is why hospital doctors are earning considerably less than Gps. An NHS consultant earns approximately £60,000, this is half that of GP's. Does this not suggest hospitals might run more effectively if the consultants/registrars ran each department as a business, using a similar approach as GPs? Competing interests: None declared |
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Paul HJ Donachie, Medical Statistician Leicester
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There is no mention in this article of the effect of locum doctor pay on these figures, as the standard locum pay for a consultant can be double the permanent contract rate, this has an effect of increasing the total amount payed to doctors but not the number of doctors beeing payed, thus overestimating the average pay. Otherwise a very good and informative article. Competing interests: None declared |
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Arunima Bhattacharyya, Post doctoral Research fellow University of Glasgow G12 8TA
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Quite an interesting article! Lots of figures and graphs have been presented to support the findings regarding GP earnings. From a general point of view a GP is an enormously important person being the first point of contact between the patient and the health service. But for a general article like this, there should be an equal emphasis for the consultants who deliver highly skilled and specialised services to the patient. But these highly skilled group only received few lines like "Between 2003-4 and 2004-5 their earnings rose by around 20% as the number of work sessions they attended rose from 10 to 12". Moreover, in the article a very important control comparison is absent. When comparing the earnings of the specialist doctors like consultants (not the general doctors) it should not only be compared with their European counterparts but also needs to be compared with other skilled professional from the same country of origin, e.g consultant doctors of UK should be compared with financial consultants of UK. If that control would have been done, I am sure, a completely different inference could have come out of that. Therefore, I feel the results mentioned in this paper are not sufficient to prove a case. Competing interests: None declared |
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Amit Patel, Academic Clinical Fellow & Specialist Registrar in Haematology The Hammersmith Hospitals NHS Trust, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK
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Day’s discussion on pay for doctors provides some interesting threads.[1] Whichever way one reads this article and the recent media reports on the issue, the implication is that pay is too high, doctors are unproductive and NHS debt would be solved with fewer doctors paid less. Is there such a public debate regarding the pay of other professionals, including lawyers and politicians? I think not - what proportion of politicians are drawn from the legal profession? Is there a government solution to reduce pay? There might be. Day suggests that relatively low pay in Italy might stem from flooding of the marketplace.[1] I wonder what might happen in the UK after recent government-driven changes to postgraduate training through MMC[2], which will create lots of trained ‘specialists’ in the face of reduced consultant posts.[3] The cost of anything is related in some way to demand and perceived value. Therefore, the systematic devaluation of the profession may be taking place. It is very sad that the government is utilising media to try to drive public opinion and trust away from doctors. I am surprised the old ‘Shipman’ beating stick did not warrant a mention. However, I am pleased to read that a recent MORI poll sampling 2,074 UK adults ranked doctors as the most trusted of all professionals, including judges and politicians.[4] There is hope yet that most patients realise that despite the very obvious exaggeration and misrepresentation of our pay, the only voice to trust is their doctor’s. [1] Day M. So how much do doctors really earn? BMJ 2007;334:236-237 [2] How is medical training changing? http://www.mmc.nhs.uk/download_files/What%20is%20changing%20at%20MMC.pdf [3] http://uk.news.yahoo.com/04012007/143/leak-shows-nhs-future-staff -problems.html [4] http://www.rcplondon.ac.uk/news/mori_results.asp Competing interests: None declared |
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David Clough, Accountant/Chairman AISMA London NW2 5JA
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Michael Day's article recycles information first published in The Independent that was wrongly attributed to the Association of Independent Specialist Medical Accountants (AISMA). The figure for GP's average earnings obtained by The Independent came from sources other than AISMA, and in our opinion the basis for the earnings calculation and other statistics was flawed and misleading. David Clough Chairman Association of Independent Specialist Medical Accountants Competing interests: None declared |
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Emily H Ball, GP Reg PR8 3HW
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We work hard for the money and jump through enough hoops to get it, but in addition to this we need to earn that much. We need to pay the physio when our backs go from sitting badly for long surgeries, the accountant to sort out tax payments, the lawyer when some thankless deluded patient tries to sue us (only a matter of time) and the counsellor when it all becomes too much. These people all have hourly rates approximately equal to ours or even more. No-one seems to mind. I am fed up of being compared to other people within the public sector (esp teachers - my mum is one) and having to explain that yes they are being underpaid but it doesn't mean we should be too. It is demoralising to be treated like this day in day out by people who think they have a right to abuse me. Currently we are expected to have a shortage of over a thousand GP's in the next few years - it will be a darned sight more if this keeps going on........and the worst thing? It's being led by a bunch of people who just awarded themselves a nice pay package (incl expenses) thats larger than mine by some way and who seem to do nothing but behave inappropriately leading to tabloid front covers and fall asleep on TV having eaten a nice House of Commons lunch before having a nice long summer break. No-one remembers that we could have all chosen a more lucrative career with our A-Level grades but actually felt moved to help people. Why bother! Competing interests: GP Reg taking flak |
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ian nesbitt, Consultant Anaesthetist Newcastle NE7 7DN
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This is yet another poorly researched (was it actually researched?) article published simply to generate some debate. Please try harder. As Kumar says (and should be evident to anyone who spends a few seconds thinking about the subject), purchasing power parity is the key to understanding how much UK doctors earn in comparison to other doctors, and to other professionals in the UK. I've worked in New Zealand (for a much lower gross income, but much higher purchasing power) and Australia (likewise). If the BMJ wants to question how taxpayers cash is being wasted in the public sector, why not dig out information on the estimated £500 billion black hole of PFI schemes, NfIT, Choose & Book and all the other stuff that our children will be paying for in years to come. Competing interests: None declared |
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Salman A Mushtaq, SHO Psychiatry Caludon Centre, CV2 2TE
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Articles like this are very worrying, not only because it’s poorly researched, trying to compare economies which are not comparable and presenting stats in such a way, that do not represent the real facts, but also because it gives a wrong impression to the public. It’s trying to portray a picture that doctors are being overpaid and probably not doing their job, which can generate an anti doctor sentiment, which I see as a dangerous thing. We all know that govt is desperate to compensate NHS deficits and the easiest solution they see is by cutting down the number of medical staff and doctors salaries, but at what expense? That’s another debate… The fact is that among all professionals, doctors have to spend most years in training working very hard and than spend most of their life working more hours than any other professional, doing one of the most stressful jobs at the expense of their personal, social and family life. No pay can compensate for that. The question of comparison is quite pointless, but for the sake of argument if we must compare than doctors should be compared with other professionals of UK who work within the same economy. My friends who started their career at the same time as me, now working as IT Analysts and Accountant are earning nearly double the amount that I earn and work less hours. A plumber’s hourly rate is more than a junior doctor’s hourly rate. If this article was published in ‘Daily Sun’, it would make sense because that’s how they do business but seeing a politically motivated article like this with no valid evidence base being published in a scientific journal like British Medical Journal, is surprising. Competing interests: None declared |
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Kelsey D J Jones, Academic FY2 in International Public Health UCL Centre for International Health and Development, The Institute of Child Health, London WC1N 1EH
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50% of the Government’s £5.9 billion extra investment in the NHS has been spent on wages, both increasing staffing levels and addressing historically poor pay for all healthcare workers (1). Better remuneration for committed doctors, nurses and other professionals is to be welcomed, but increases in specialist and (particularly) GP salaries mean that UK GPs are now the best paid in Europe (even after adjustment for purchasing power), while NHS performance sometimes lags behind our neighbours’ health systems (2). The notion that doctors’ pay is an issue that politicians shouldn’t talk about is absurd. The public has a right to demand that NHS money is used to best improve productivity and patient care, as well as to provide a good standard of living for staff. Politicians must respond to public concern that GP salaries have risen dramatically while their availability is perceived to have decreased. There is no benefit in taking a protectionist stance as regards medical pay: Doctors have professional bodies more than able to fight their corner, and we need to acknowledge that current salary levels are unsustainable if the NHS is to provide the 21st century service that the public expects. The idea that doctors are in some way hard done by in their work, pay and conditions demonstrates a desperately blinkered view of the UK in 2007. 1. The NHS Confederation. Money in the NHS: the facts. London. NHS Confederation Publications, 2005. 2. OECD, IRDES. OECD Health Data 2006. http://www.irdes.fr/ecosante/OCDE/1.html (accessed 10 Feb 2007). Competing interests: None declared |
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Graham Wheatley, GP Munro Medical Centre, West Elloe Avenue, Spalding PE11 2BY
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Interestingly, the evidence from the OECD that Jones quoted in his response ("Time for a more considered response from the medical profession"), in order to show greater public dissatisfaction with the NHS than in other countries with their own systems, although dated 2006, in fact was derived no more recently than 2002 - well before the large pay rises for UK doctors that he criticises. Jones also gives no evidence to support his statement about "public concern" over rises in GP pay - and public responses to the recent media campaign targeting GPs has been overwhelmingly positive, as evidenced from responses on the BBC website. I'd suggest this concern exists in a subculture of politicians, journalists and health economists who perhaps should first look at their own cost-effectiveness and public standing. It seems bizarre in this context that he chooses to identify GPs as being "particularly" well paid, when there is a long standing differential (better) in public satisfaction ratings for general practice than the hospital sector. This presumably was in the prime ministers' mind when in parliament on 31st January 2007 he described UK GPs as "the best in Europe" who "deserved to be the best paid". Perhaps if there was a more balanced and evidenced-based response from public health colleagues, rather than these slightly resentful personal views, the prime minister could be saying the same of that group of doctors too! Competing interests: None declared |
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Kelsey D J Jones, Academic FY2 in International Public Health UCL Centre for International Health and Development, The Institute of Child Health, London WC1N 1EH
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Wheatley is right to point out that the OECD data I quote is slightly out of date, though this in no way alters or diminishes my arguments (1,2). I primarily included it as several correspondents had requested information on International salary differentials in terms of purchasing power. He is also absolutely right that there is a paucity of high-quality data on public attitudes to recent medical salary rises. However, the ‘overwhelmingly positive’ public response to these increases on the BBC website comments page is questionable: Wheatley doesn’t reference these claims, and I have failed to locate such a response. Indeed, on the comments board "Is your GP worth it: What are your views on GP salaries", the postings are very evenly split (3). An illustrative scan through the first few pages reveals that 101 of the first 200 (of 891) respondents think GP salaries are appropriate, while 99 think they are too high – the majority if we exclude GP, GP spouse, and medical student comments. To say that this was evidence of public dissatisfaction with GP salary rises would be wrong for a multitude of reasons that scarcely need outlining; the figures on which the debate is based are questionable, the correspondents are self-selecting, competing interests are not declared, the comment board is internally moderated, and so on. Internet comment boards are a breeding ground for gossip and rumour, and should not be regarded as representative of public opinion (4). It is likely that if asked directly ‘Should you GP be paid £100 000?’, a high proportion of people would say ‘yes’. Difficulty arises when most people would probably also agree with the statement ‘Increases in NHS funding should be used in ways which directly increase productivity and improve patient care’. The two are contradictory, since salary increases do not inherently improve productivity (though I accept that the design of the contract has addressed this to some extent). Arguing that salary rises are appropriate in the same breath as criticising underfunding or misuse of resources in the NHS is difficult to sustain. I hope that Dr. Wheatley doesn’t think I’m part of a “well organised campaign of vilification mounted against [GPs] by sections of the media, politicians and other political chattering classes” (5). I still think that to respond to media criticism of significant pay increases for some doctors with upset and indignation is unhelpful, and that some humility in analysing whether large salary increases are the best use of tight financial resources would be welcome. (1) http://www.bmj.com/cgi/eletters/334/7587/236#159584 (2) http://www.bmj.com/cgi/eletters/334/7587/236#159824 (3) http://newsforums.bbc.co.uk/nol/thread.jspa?sortBy=1&threadID=1540&start=0&tstart=0&edition=2&ttl=20070223085357&#paginator (4) http://www.theregister.co.uk/2006/04/25/poll_scandal/ (5) http://www.bmj.com/cgi/eletters/334/7587/236#156779 Competing interests: None declared |
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Graham Wheatley, GP Munro Medical Centre, West Elloe Avenue, Spalding PE11 2BY
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Dr Jones clearly states, perhaps without realising it, his misunderstanding of recent pay agreements with GPs and consultants. Whilst I would agree with him that "pay rises do not inherently improve productivity", it is exactly the wrong argument to use against the new GP contract, which saw virtually the entire increase linked to specific quality markers with agreed evidenced based outcome measures. This made it clear what the NHS was receiving for its investment. Ultimately this is the only justification for increased pay - that high productivity, accurately measured, is rewarded. To say that pay rises are "difficult to sustain" and are somehow a "misuse of resources" misses the point - the NHS will never be adequate unless necessary services are provided in a cost-effective way. This is the underlying theme in the current shift towards more NHS services being provided by GPs - hardly evidence that GPs are poor value for money. Dr Jones need not worry - I would not describe his own contributions as "vilification", a "campaign" or for that matter "well organised". I would suggest that to uncritically accept that the media are inevitably correct is an unusual position to take. Some humility would be useful when considering the value of the contribution to clinical care of GPs and consultants, particularly when public health doctors insist that their own pay is linked to the level of their clinical colleagues. Competing interests: None declared |
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James L. Krantz, M.D., Private practice--Family Practice Frederick, Maryland
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It is fascinating to read the outcry over GP compensation in the U.K. Class envy bordering on class warfare has been commonly directed towards "rich doctors" in the U.S. for some time. Keep in mind that the GP's are likely one of the major reasons for health cost containment in the U.K. In the U.S., GP's are the absolute bottom of the health care barrel; not surprisingly, most U.S. medical students choose specialty care. Who wouldn't choose a job with greater pay and less breadth of knowledge? Overuse of specialty care is one likely reason that the U.S. pays nearly 14% of GDP for Medicare (65+ health scheme in U.S.) alone. Most industrialized countries care for everyone for that share of their GDP. Primary care by GPs is a good investment for everyone and the NHS would be well advised to keep GPs efficient, happy, and well paid. Competing interests: None declared |
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Maybelle Wallis, Consultant Pediatrician, Sandwell Sandwell Hospital B71 4HJ
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Dont forget that salary increases to doctors fall in to the 40% tax band. By the time income tax, national insurance contributions and superannuation have been deducted, and value added tax added to the cost of anything we have bought with our salary increase, around 70% of the salary increase will have gone straight back to the Treasury. Competing interests: I am a hospital consultant |
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