Pay in the NHS: who earns what?
BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h6250 (Published 26 November 2015) Cite this as: BMJ 2015;351:h6250
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I was very interested to read the article on NHS Pay. However I have to seriously question the methology behind the charts.
One extra-ordinary chart broke down NHS jobs and compared them with other professions. But looking back at the source date quoted for the image, I find it very odd that the chart compares the average earnings for large heterogenous groups of professionals with sub-groups of seniority within the NHS. It's really is comparing apples and oranges - how can you compare the Consultant Doctors salary (the senior most grade in one profession) with the AVERAGE salary for a whole profession?
Secondly I note some interesting selection in the professions included for comparison with various high paid groups from the original Office for National Statistics data selected out: Brokers, Marketing and Sales directors, Information Tech and Telecommunications Directors, etc. I'm not sure this dramatic appearing chart is necessarily an accurate representation of reality.
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Do the consultants' salaries include waiting list initiatives? If so, that's very skewed by specialty and difficult to average. Can't see how you make these figures without.
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Appleby’s analysis of NHS pay is highly relevant and informative given the current negotiations about a new junior doctor contract. That junior doctors have experienced one of the largest reductions in average real incomes of all NHS staff is striking, but perhaps doesn’t tell the entire story.
Appleby compares doctors’ pay with non-healthcare workers but junior doctors have to incur a vast number of expenses in order to complete mandatory tasks such as postgraduate courses and exams, as well as often personally having to fund higher degrees and conference costs (1). These are, of course, in addition to subscription fees to the General Medical Council, British Medical Association, royal colleges and medical indemnity providers. The financial support from deaneries is inadequate and junior doctors have no option but to use personal finances to follow their desired career paths (2). As employees in other sectors typically have their training and travel costs fully reimbursed, his occupational comparison is somewhat misleading.
(1) Oakland K, Bola S. Financial burden of surgical training. BMJ Careers. 05 Aug 2015 http://careers.bmj.com/careers/advice/Financial_burden_of_surgical_training
(2) Stroman LS, Weil S, Butler K, McDonald CR. The cost of a number: can you afford to become a surgeon? Bulletin of The Royal College of Surgeons of England. 2015. 97(3): 107-111.
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Re: Pay in the NHS: who earns what?
Dr St Leger raises an important point about the validity of comparisons of jobs/occupations. First, to point out that the bubbles in the main chart refer to the approximate size of the workforce in each group. As can be seen, a number of the NHS groups are large compared to non-NHS occupations shown. So it's not true to say that the chart compares 'large heterogeneous groups of professionals with sub-groups of seniority within the NHS'. On the other hand, there is an issue with respect to scale; St Leger is right to note that consultants are a subset of doctors, which is in turn a subset of health care workers....I tried to compare like with like by taking the ASHE four digit level occupation categories and showing a variety of jobs/occupations spanning the range of the earnings data....but inevitably it's not perfect; but I would argue more like comparing types of apples rather than apples and oranges.
And further re my selection of jobs from ASHE, I did not leave out some high paid jobs to make some of the NHS earnings look excessive! I used the 4 digit level of occupation from Table 14.7a of the ASHE; due to small samples there is no pay data for Brokers and the others mentioned. They may well have median earnings that exceed consultants', but the data isn't available via the ONS survey (otherwise I would have used it).
As for what's included in the earnings data for consultants (Dr Kay), the data is from the NHS payroll and reflects actual payments to staff for whatever work was done.
Different occupations have different costs of employment of course (Dr Rashid). That can make it difficult to make comparisons, but not impossible at a broad level. This data does not, for instance, account for differences in pension arrangements or work benefits or costs.
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