Doctors’ pay and hours
BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c228 (Published 27 January 2010) Cite this as: BMJ 2010;340:c228
- Maria Juarez, specialty trainee year 5, rheumatology1,
- Devendra Mahadevan, specialty trainee year 4, trauma and orthopaedics2,
- Bennett Ahlijah, senior house officer3
- 1Rheumatology Department, Great Western Hospitals NHS Foundation Trust, Swindon SN3 6BB
- 2University Hospitals of Leicester, Leicester
- 3Plymouth Hospitals NHS Trust, Plymouth PL6 8DH
- mariajuarezp{at}gmail.com
Abstract
Maria Juarez and colleagues ask, “What do patients really think?”
In the current economic climate, doctors are working within the framework of a cost cutting NHS. Departments are expected to make annual savings while maintaining and improving standards. The general population is, however, not aware of these constrictions because media coverage focuses on failure to meet standards of care,1 high doctors’ salaries,2 and decreased productivity levels.3
Doctors’ pay has been a controversial issue for a number of years. Newspapers have covered the topic repeatedly, and the new contracts for general practitioners and consultants have been under scrutiny, with headlines suggesting that doctors’ high salaries are responsible for the financial crisis in the NHS. But do these headlines reflect the thoughts and feelings of our patients?
We conducted a survey to ascertain what patients thought doctors earned and whether this was appropriate for the number of hours they work and the nature of their job.
Methods
One hundred and one patients were invited to complete an anonymised questionnaire. Patients were randomly selected from outpatient clinics and inpatient wards at Derriford Hospital NHS Trust. Questionnaires comprised demographic data and questions relating to doctors’ working hours and salary. Doctors were classified into three groups: surgeons, physicians, and general practitioners (GPs). Data were analysed using SPSS16.0 for Windows (SPSS Inc; Chicago, IL).
Results
One hundred and one patients returned completed questionnaires (response rate 100%); 45.5% were female and the age range was from 24 years to 91 years.
Salary was stratified into five categories (£40 000-59 999 a year; £60 000-79 999 a year; £80 000-99 999 a year; £100 000-119 999 a year; and £120 000 or more a year). Patients believed that surgeons were the highest earners and GPs were the lowest earners. The distribution of responses per category and group showed that 78% of patients thought that surgeons fell into the categories of £60 000-79 999 a year, £80 000-99 999 a year, or £100 000-119 999, with the majority in this group estimating a surgeon’s salary to be £80 000-£99 999 a year. The distribution of categories was equal for physicians and GPs. Eighty seven per cent and 83% estimated that the salaries of physicians and GPs, respectively, were in one of the following categories—£40 000-59 999 a year; £60 000-79 999 a year; or £80 000-99 999 a year. The distribution within these categories was different for the two groups, however, with the majority of physicians’ salaries estimated at £60 000-79 999 a year and that of GPs’ at £40 000-59 999 a year (fig 1⇓).
Working hours were also stratified into five categories (less than 34 hours a week; 35-44 hours a week; 45-54 hours a week; 55-64 hours a week; and 65 hours or more a week). Most patients estimated that doctors in all three groups worked 35-44 hours a week, 45-54 hours a week, or 55-64 hours a week. Within these categories, the majority of patients estimated that surgeons and physicians worked 45-54 hours a week and GPs either 35-44 hours a week or 45-54 hours a week (fig 2⇓).
Fifty per cent of patients responded when asked whether doctors were being overpaid or if they worked excessive hours. The vast majority of patients (98%) felt that doctors were not overpaid (fig 3⇓). There were, however, considerable differences between groups. Only 2% felt that surgeons were overpaid, whereas up to 24% felt GPs were overpaid (P<0.001). More than 65% of patients felt that hospital consultants (surgeons and physicians) worked excessive hours but only 45% thought GPs were overworked (surgeons v GPs (P<0.01); physicians v GPs (P<0.05); fig 4⇓).
Discussion
The average pay for consultants in England is estimated at £115 848 a year.4 Basic salary ranges from £73 403 a year to £100 446 a year and is based on 10 programmed activities that equate to 40 hours a week.5 Additional programmed activities, on calls, clinical excellence awards, and other fees and allowances supplement the basic pay. The average number of hours worked by full time NHS consultants is 50.7 hours a week. Interestingly, the amount of private practice work done by consultants has remained relatively unchanged between 2004 and 2007 (4.7 v 4.6 hours).6 Only 26% of patients in our survey put surgeons in the £100 000-119 999 a year category, where the actual estimated pay for consultants falls, whereas 11% put physicians there. Our findings suggest that the majority of patients underestimated NHS consultants’ salaries and those of physicians. For working hours, the majority of patients placed hospital consultants in the 45-54 hours a week category, thus reflecting the average calculated hours for full time NHS consultants.
The average income for GPs is £106 681 a year for non-dispensing GPs and £127 061 a year for dispensing GPs. Salary also differs between GPs working under the personal medical services (PMS) contract and those on the general medical services (GMS) contract. The average income of PMS GPs (£126 189 a year) is about 10.9% higher than that of GMS GPs (£113 770 a year).7 Full time GP partners work an average of 44.4 hours a week, and the average number of hours worked by all full and part time GP partners is estimated at 38.2.8 The average number of hours worked by all GPs decreases with practice size, and GMS GPs work longer hours on average than PMS GPs.8 In our survey, only 12% of participants accurately estimated a GP’s salary to be in the £100 000-119 999 a year category. Furthermore, almost half the patients (42%) thought that GPs are paid £40 000-59 999 a year. This suggests that patients significantly underestimate GPs’ income. As was the case for hospital consultants, patients were accurate in their estimation of GPs’ working hours.
The majority of respondents felt that surgeons’ (98%) and physicians’ (90%) salaries are not excessive, and a smaller proportion (76%) had this opinion about GPs’ salaries. Sixty five per cent of the patients consulted felt that hospital consultants work excessive hours, whereas only 45% felt that GPs do.
Factors that influence patients’ opinion of doctors can be divided into those relating to the doctors’ personal characteristics and those relating to the working environment. Studies show that gender may determine patients’ satisfaction with their physicians (male physicians being rated higher than female physicians) and that personality traits such as openness and conscientiousness are associated with the highest patient ratings.9 An effect of patients’ characteristics on ratings has also been identified, with older patients and patients with higher disease burden giving doctors the highest ratings.9 Current research is aimed at identifying other personality traits that facilitate or undermine communication, trust, and patient adherence to treatments. Factors external to doctors’ personality include duration of consultation, waiting times, and patients’ choice. Surveys show that brief consultations can contribute to dissatisfaction with overall services and doctors’ pay in particular.10 Consistent reduction in waiting times and waiting lists, and increased patient choice (the choose and book service), have improved overall perception of the NHS and NHS consultants, which may help explain our findings.
Conclusions
Despite newspaper coverage suggesting rising doctors’ salaries and decreasing productivity levels, our survey suggests that patients are appreciative of the work of hospital consultants and GPs. In general, patients do not feel that doctors are overpaid, but they feel that they work excessive hours.