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How much should doctors earn?

BMJ 2007; 334 doi: (Published 01 February 2007) Cite this as: BMJ 2007;334:0
  1. Fiona Godlee, editor
  1. fgodlee{at}

    Everyone wants a health service manned (and womanned) by experienced, skilled, motivated, well informed doctors. Most people would agree that we have to pay for these things. The million dollar question is, how much?

    Are British doctors really earning the amounts being quoted in the press? Many doctors I talk to don't recognise these large sums. In this week's Head to Head debate on whether doctors' self interest is ruining the NHS (doi: 10.1136/bmj.39098.405602.BE), Laurence Buckman explains that the headline figure for average earnings for general practitioners, £118 000, is an overestimate because it doesn't take into account the need to pay employees' pension contributions. The BMA also says that the figure is based on a biased sample including too many high earning dispensing practices. According to Hamish Meldrum, chair of the BMA's GPs Committee, in 2004/5 self employed non-dispensing GPs were earning on average around £95 000. Buckman says that most general practices have seen profits fall in real terms as expenses have risen.

    Are British doctors overpaid compared with doctors elsewhere? Newly released figures from the UK Treasury suggest that even three years ago, before the recent pay increases, British doctors earned well above their European counterparts (doi: 10.1136/bmj.39112.426481.59).

    But whether these levels of remuneration are appropriate, and whether they have arisen through government bungling or brilliant BMA negotiation or both, they have consequences for medicine and health care in Britain.

    Firstly, there is the risk, as Alan Maynard argues in his side of our Head to Head debate (doi: 10.1136/bmj.39066.452847.68), that the move away from traditional non-financial incentives to payment by results undermines public service values. No longer are doctors trusted to behave efficiently for the good of their patients, they must be “incentivised” to do so and then policed, which increases the cost of every transaction. Nor is he convinced that the incentives are either evidence based or delivering better quality care. As reported by Michael Day (doi 10.1136/bmj.39112.426481.59), John Appleby believes this is where the government is already at work, seeking to regain lost face and to squeeze out more politically inspired productivity in return for existing levels of pay. And this is where the Faustian pact—more money for less and less clinical autonomy—may begin to bite for doctors.

    Secondly, there is the private sector waiting in the wings. A few weeks ago Bill Irish asked “Is greed good?” (BMJ Career Focus As a GP himself, he described how the new GP contract provides a powerful incentive to exploit nurses and salaried GPs in order to drive up practice profits. “I believe that we will end up paying a price for our short term greed….Commercially astute businesses are already eyeing us up with the light of avarice in their eyes.” As one GP friend of mine put it, general practice in the UK is being fattened up for take over. Will today's UK doctors be too fat to compete?

    Pay deals have consequences. Just so long as we know what we're doing.

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