How Much Do UK Based Doctors In Specialty Training (in Residency) Earn?

We don’t like to say it, but we are still allowed to still think it- how much do doctors actually earn? Over the years the advice from adults we deem to be wiser than ourselves is transforming from ‘You want to be rich? Study medicine’ to ‘You want to be rich? Study computer science’. 

Ultimately, when you enter a career in medicine the driving force behind every decision is the patient - not the money. What you need to push you forward through the many hurdles is the desire to continuously learn, the ability to communicate effectively with patients and colleagues alike, and a whole lot of empathy.

While it’s important to put altruism in the forefront, it’s also very realistic to question the earning potential of a career that will be your livelihood. This article aims to simplify what doctors in specialty training can expect to see on their payslip.

 

Where does specialty training slot into the career path?

Even beyond medical school, the structured path of career progression continues. After graduation, doctors must complete two years of foundation training and then subsequently can apply for specialty training. 

Specialty training programmes are part of the route required to become a consultant in the NHS, with posts being nationally available each year during a specific application window. The exact structure of the training programme differs depending on what type of consultant you are aiming to be, but with most lasting between six to eight years. 

Specialty training is usually subdivided into core training (medical or surgical) for the first two to three years and then higher specialty training for the subsequent four to six years. For example, if you wanted to be a consultant neurologist, you would do three years of internal medical training and then reapply for five years of specialty neurology training. However, in recent years there has been increased opportunities to apply to specialty run through training – for example if a foundation doctor knew they wanted to be a general surgeon from the off then they could apply for a run through programme of eight years of general surgical training.  Below is a table showing a rough guide to the structure of medical training in the UK and where specialty training fits in. For more specific details, BMJ Careers has a series of ‘How to become..’ articles where you can gain further information on your specialty of interest.

Type of training		Step by step progress through the official training programme	Approximate number of years	General terms
Foundation training		FY1, FY2	2	Junior doctor
Core training	Specialty run through training	Core Surgical Training (ST1, ST2) or Internal Medical Training (IMT1-3)	2-3	Junior registrar
Higher specialty training		ST3/4-ST9	5-6	Senior registrar
		Consultant		Consultant

Table 1. The journey from junior doctor to consultant.

 

How much can I expect to earn?

At the core of earning potential is the ‘basic salary’. The basic salary is a fixed amount and the gross annual salary before tax. This is in relation to a full-time job and covers 40 hours per week of work during normal shift hours and does not include any additional or unsociable hours. Basic salary can still vary depending on location, both with regards to what country in the UK you are based and also the more immediate geographical area. 

The basic salary range is calculated on an average of 40 hours per week. During foundation training, the junior doctor salary ranges from £28,243 to £32,691. On progression to specialty training, the basic salary range increases from £38,694 to £52,036. As you progress through the training programme, is it expected that the annual basic salary will gradually climb through these ranges. Below is the average pay for the specialty training based on different stages of training.

 

Grade	Stage of training	Value (£)
Internal Medical Training/ Core Surgical Training	IMT 1, IMT2/ ST1, ST2	38,694
	IMT3	49,036
Specialty Registrar (Run-Through Training) / Specialty Registrar (Higher-Training)	ST1, ST2	38,694
	ST3, ST4, ST5	49,036
	ST6, ST7, ST8	52,036

Table 2. The average basic salary for doctors within specialty training. These figures are from the 2020 pay and conditions circular document for junior doctors and dentists in England. Other countries in the UK present their data in a different table format but the figures are largely similar.

 

One size does not fit all

Though easy to simplify basic salaries, there will always be factors that cause variation. As well as location, the specialty you go into and your rota layout can largely affect your salary. 

Employees will be paid for any additional contracted hours over 40 (up to maximum of 48, or 56 for doctors who have opted out of the European working time directive (WTD)), have a 37% enhancement of hourly salary between 9pm and 7am, a weekend allowance for any work at the weekend and an availability allowance if you are required to be available on-call.

Long story short, if you have a greater workload intensity, you get paid more. 

Specialties which tend to have a higher proportion of night and on-call shifts tend to be those which incorporate a need for urgent care in emergencies that could happen at any time of day, such as emergency medicine, acute medicine, cardiology, obstetrics, and general surgery.

Another way in which salaries can differ is due to flexible pay premia. This is an incentive used to recruit doctors for ‘hard-to-fill’ training programmes and doctors on these training programmes get a surplus to their basic salary each year. In recent years this has been specialties such as GP, psychiatry and emergency medicine. 

 

Applicable training programme	Full time annual value (£)
General Practice	8,789
Psychiatry Core Training	3,573
Psychiatry Higher Training	2,680
Emergency Medicine	3,063

Table 3. The hard to fill training programmes and their annual pay premia. The full-time annual value will vary depending on the length of the training programme for each specialty e.g. If your psychiatry higher training was four years then annual pay premia would be £2,680 (as above), but if the training programme was condensed to three years then the annual pay premia would be £3,573. 
 

Bonus tip – How to supplement your salary

If you find that your basic salary is not making ends meet or you feel like your rota has room for a few more shifts, there is the option to do locum shifts which usually pay an hourly rate. 

On deciding you want to work additional hours to your rota, you should inform your employer and must initially offer these to the NHS by joining an NHS staff bank. NHS Medical staff banks are managed by the local NHS trust and provide temporary medical staffing cover. The work is flexible, meaning it is up to you to self-define your spare capacity and offer your availability at the times that suit you.  As well as benefiting yourself by allowing you to work in any specialty you wish to develop skills in, working for the NHS staff bank also benefits your local trust by helping them provide the best quality care at a lower cost than external agency staff, which is accompanied by additional fees. 

The staff banks themselves have the authority to set the hourly rates for locum work, but it can be expected to be around £25-35 per hour. If there is not work available through an NHS staff bank you can opt to work for an external locum agency which usually has a higher hourly rate. 

As a junior doctor in the NHS, you can work up to a maximum average of 48 hours per week under the WTD, therefore if your basic contract were 40 hours per week you could make it up to 48 hours with additional locum shifts. If you still need to work additional hours, doctors can ‘opt out’ of the WTD requirement but, where they do, must work no more than 56 hours per week under all their contracts, including any additional locum work.

Though it is simple and flexible to take up locum shift you are required to ensure that any additional hours of work do not breach any of the safety and rest requirements or interfere with patient safety.

 

References: 

1. Savvy IMG - https://thesavvyimg.co.uk/how-much-do-doctors-in-specialty-training-residency-earn-in-the-uk/