British urologists provide a cost effective service

EDITOR,—The juxtaposition of Linda Beecham's article on NHS doctors' pay1 and Charles-Gene McDaniel's article on American doctors' income2 leads to comparisons of the earning capacity of different doctors. It would be fair, however, also to compare the work that each of the two groups does, and I have considered urology on the two sides of the Atlantic. For a current maximum annual salary in Britain of £52 440 and an average American salary of £100 000, the two groups of urologists do quite different average amounts of work.

The ratio of population to consultants in urology in the United States is roughly 200 million to 9000, whereas in Britain it is roughly 60 million to 300. If the ratio was the same in Britain as in the United States there would be over 2000 consultant urologists in Britain. This implies that we are offering a service to nine times as many patients as the average American urologist. On that basis, if British urologists were reimbursed at the same level as American urologists we would be getting paid £900 000 a year rather than £52 440.

This can be further broken down by looking at the average costs of individual procedures. In my practice, where a prostate operation takes an average of half an hour, I work roughly 60 hours a week for the NHS. This implies that I am paid about £17 for each hour that I work, not including the on call commitment. The income before tax, therefore, for the average 30 minute prostate operation is £8.50. If all of the outpatient and inpatient work relating to such an operation is also included the cost does not rise above £20 for the entire treatment episode.

This represents an extremely cost effective service, and comparisons based simply on income across the Atlantic are inadequate to explain the dedication and effort put in by all the doctors in Britain.