GP Salaries
20 June 2012, 09:55 PM
#1
GP Salaries
Heard an article discussed on Radio 4 on my way home from work, against the context of planned, and now cancelled GP strike action.
The news item claimed that average GP's salary was £100K with many earning a bonus in excess of £30K.
From my current perspective, based on the workings of my on GP's practice, my GP starts seeing patients at 0930, I assume he starts work at 900 to review details of incoming patients, spending around 10 - 15 minutes with each patient. The last available appointment is 1730 and assuming he spends half and hour to an hour dealing with admin, his working day is Mon - Fri 0900 - 1830.
From observing those in the waiting room when I am have been waiting on my appointment, the majority are there with minor ailments, I don't believe my GP is regularly making life or death interventions.
So when compared with the pressures and gravity of decisions which are taken in a heartbeat by A&E doctors, who work long hours, and deal with much more unpleasant situations than my GP, it seems to me that GP's wages are disproportionately large for the work they engage in; I also find the GP's working in my local practice are no more than in their late 20's or early 30's, so I would be surprised if they can be deemed to be highly experienced in their chosen field.
Surely the services provided by GP's could be delivered more cheaply and competitively by outsourcing GP services as a managed service, with relevant service levels, performance indicators and targets?
I don't mean this thread to be in any way disrespectful towards GP's or those in the medical profession, but as their salaries are paid from public funds, and the health service seems to be creaking and competing for funds in various areas, I think members of the public are entitled to question whether the salary is proportionate for the function they carry out.
Where does being a GP sit within the medical hierarchy, 15 years ago, I recall all the doctors at my practice were much older, late 50's and beyond; I assumed GP's were at the highly experienced end of the medical spectrum, as I said, it now seems the average age of the GP's in my practice is late 20's or early 30's, so perhaps the GP's from 15 years ago were slowing up and in the autumn of their careers and seeking an easier life than the demands of A&E or dealing with more acutely ill patients?
Apologies for the long post, this is something which has caught my attention, I would be interested to hear the views and perspectives of others.
The news item claimed that average GP's salary was £100K with many earning a bonus in excess of £30K.
From my current perspective, based on the workings of my on GP's practice, my GP starts seeing patients at 0930, I assume he starts work at 900 to review details of incoming patients, spending around 10 - 15 minutes with each patient. The last available appointment is 1730 and assuming he spends half and hour to an hour dealing with admin, his working day is Mon - Fri 0900 - 1830.
From observing those in the waiting room when I am have been waiting on my appointment, the majority are there with minor ailments, I don't believe my GP is regularly making life or death interventions.
So when compared with the pressures and gravity of decisions which are taken in a heartbeat by A&E doctors, who work long hours, and deal with much more unpleasant situations than my GP, it seems to me that GP's wages are disproportionately large for the work they engage in; I also find the GP's working in my local practice are no more than in their late 20's or early 30's, so I would be surprised if they can be deemed to be highly experienced in their chosen field.
Surely the services provided by GP's could be delivered more cheaply and competitively by outsourcing GP services as a managed service, with relevant service levels, performance indicators and targets?
I don't mean this thread to be in any way disrespectful towards GP's or those in the medical profession, but as their salaries are paid from public funds, and the health service seems to be creaking and competing for funds in various areas, I think members of the public are entitled to question whether the salary is proportionate for the function they carry out.
Where does being a GP sit within the medical hierarchy, 15 years ago, I recall all the doctors at my practice were much older, late 50's and beyond; I assumed GP's were at the highly experienced end of the medical spectrum, as I said, it now seems the average age of the GP's in my practice is late 20's or early 30's, so perhaps the GP's from 15 years ago were slowing up and in the autumn of their careers and seeking an easier life than the demands of A&E or dealing with more acutely ill patients?
Apologies for the long post, this is something which has caught my attention, I would be interested to hear the views and perspectives of others.
20 June 2012, 10:11 PM
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The BMA are an extremely powerful sectional interest who have opposed and obstructed health care in this country since the creation of the NHS. As Aneurin Bevan said he (referring to the Doctors) "stuffed their mouths with gold" to get them onboard when the NHS was created.
This BMA is a kind of union which enables Doctors to charge a form of economic rent over and above the market rate.
I acknowledge that they are skilled professionals but I don't agree with collective bargaining to exploit the employer who is in this instance us the taxpayer.
This BMA is a kind of union which enables Doctors to charge a form of economic rent over and above the market rate.
I acknowledge that they are skilled professionals but I don't agree with collective bargaining to exploit the employer who is in this instance us the taxpayer.
20 June 2012, 10:28 PM
#5
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Heard an article discussed on Radio 4 on my way home from work, against the context of planned, and now cancelled GP strike action.
The news item claimed that average GP's salary was £100K with many earning a bonus in excess of £30K.
From my current perspective, based on the workings of my on GP's practice, my GP starts seeing patients at 0930, I assume he starts work at 900 to review details of incoming patients, spending around 10 - 15 minutes with each patient. The last available appointment is 1730 and assuming he spends half and hour to an hour dealing with admin, his working day is Mon - Fri 0900 - 1830.
From observing those in the waiting room when I am have been waiting on my appointment, the majority are there with minor ailments, I don't believe my GP is regularly making life or death interventions.
So when compared with the pressures and gravity of decisions which are taken in a heartbeat by A&E doctors, who work long hours, and deal with much more unpleasant situations than my GP, it seems to me that GP's wages are disproportionately large for the work they engage in; I also find the GP's working in my local practice are no more than in their late 20's or early 30's, so I would be surprised if they can be deemed to be highly experienced in their chosen field.
Surely the services provided by GP's could be delivered more cheaply and competitively by outsourcing GP services as a managed service, with relevant service levels, performance indicators and targets?
I don't mean this thread to be in any way disrespectful towards GP's or those in the medical profession, but as their salaries are paid from public funds, and the health service seems to be creaking and competing for funds in various areas, I think members of the public are entitled to question whether the salary is proportionate for the function they carry out.
Where does being a GP sit within the medical hierarchy, 15 years ago, I recall all the doctors at my practice were much older, late 50's and beyond; I assumed GP's were at the highly experienced end of the medical spectrum, as I said, it now seems the average age of the GP's in my practice is late 20's or early 30's, so perhaps the GP's from 15 years ago were slowing up and in the autumn of their careers and seeking an easier life than the demands of A&E or dealing with more acutely ill patients?
Apologies for the long post, this is something which has caught my attention, I would be interested to hear the views and perspectives of others.
The news item claimed that average GP's salary was £100K with many earning a bonus in excess of £30K.
From my current perspective, based on the workings of my on GP's practice, my GP starts seeing patients at 0930, I assume he starts work at 900 to review details of incoming patients, spending around 10 - 15 minutes with each patient. The last available appointment is 1730 and assuming he spends half and hour to an hour dealing with admin, his working day is Mon - Fri 0900 - 1830.
From observing those in the waiting room when I am have been waiting on my appointment, the majority are there with minor ailments, I don't believe my GP is regularly making life or death interventions.
So when compared with the pressures and gravity of decisions which are taken in a heartbeat by A&E doctors, who work long hours, and deal with much more unpleasant situations than my GP, it seems to me that GP's wages are disproportionately large for the work they engage in; I also find the GP's working in my local practice are no more than in their late 20's or early 30's, so I would be surprised if they can be deemed to be highly experienced in their chosen field.
Surely the services provided by GP's could be delivered more cheaply and competitively by outsourcing GP services as a managed service, with relevant service levels, performance indicators and targets?
I don't mean this thread to be in any way disrespectful towards GP's or those in the medical profession, but as their salaries are paid from public funds, and the health service seems to be creaking and competing for funds in various areas, I think members of the public are entitled to question whether the salary is proportionate for the function they carry out.
Where does being a GP sit within the medical hierarchy, 15 years ago, I recall all the doctors at my practice were much older, late 50's and beyond; I assumed GP's were at the highly experienced end of the medical spectrum, as I said, it now seems the average age of the GP's in my practice is late 20's or early 30's, so perhaps the GP's from 15 years ago were slowing up and in the autumn of their careers and seeking an easier life than the demands of A&E or dealing with more acutely ill patients?
Apologies for the long post, this is something which has caught my attention, I would be interested to hear the views and perspectives of others.
It is an interesting question. On the whole GPs earn more than hospital consultants from the NHS, but then consultants more than make that up from private practice but have to graft really hard for that.
This does seem odd as in many ways the job of a hospital consultant is more demanding, stressful etc than a GP but to be fair general practice has its own set of unique challenges which I wouldn't want.
The bottom line is though what do you feel is a fair wage for a GP? Does £100k really sound too much to you? Do you feel they should be paid less than say a bank manager, a commercial pilot etc?
As for a free market without the BMA resulting in 'cheaper' doctors I'm not so sure. If every senior doctor in the country woke up tomorrow and refused to work for the NHS by my reckoning they would then charge more to provide the same service.
If you look at what doctors earn in the private sector per hour/case it is at least three times as much as in the NHS. If you look at countries where there is no real NHS type set up ie USA the doctors earn a lot more.
Actually if you look at lots of developed countries the doctors there are paid more ie USA, Australia, Canada, Middle East (as compared to average incomes/standard of living etc)
There are those countries that pay less ie Italy, Spain etc but that's why a lot of their best doctors leave.
Last edited by Dingdongler; 20 June 2012 at 10:37 PM.
20 June 2012, 10:34 PM
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It is an interesting question. On the whole GPs earn more than hospital consultants from the NHS, but then consultants more than make that up from private practice but have to graft really hard for that.
This does seem odd as in many ways the job of a hospital consultant is more demanding, stressful etc than a GP but to be fair general practice has its own set of unique challenges which I wouldn't want.
The bottom line is though what do you feel is a fair wage for a GP? Does £100k really sound too much to you? Do you feel they should be paid less than say a bank manager, a commercial pilot etc?
This does seem odd as in many ways the job of a hospital consultant is more demanding, stressful etc than a GP but to be fair general practice has its own set of unique challenges which I wouldn't want.
The bottom line is though what do you feel is a fair wage for a GP? Does £100k really sound too much to you? Do you feel they should be paid less than say a bank manager, a commercial pilot etc?
For example if I hurt my knee what is the point in seeing a GP so they can fill in forms to send me to a consultant? I could just be seen by a nurse. Of course with GP's no longer needed as gatekeepers we wouldn't need so many GP's which is the BMA's objection (veiled of course).
20 June 2012, 10:37 PM
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i think all NHS staff earn their money, nurses should be treated better and rewarded more.
I know a heart consultant/surgeon and know for a fact that he earns less than a GP in his own clinic which does seem strange -no dissrespect to GP's at all. So maybe you are right in what you say, it should be biased to the frontline.
However, the sights that they have to see, deal and treat aswell as the stress and i guess abuse - to me - suggests that they should earn good money.
They have trained hard for what they do and i guess proved that they are the cream of the crop and should be rewarded for it.
I know a heart consultant/surgeon and know for a fact that he earns less than a GP in his own clinic which does seem strange -no dissrespect to GP's at all. So maybe you are right in what you say, it should be biased to the frontline.
However, the sights that they have to see, deal and treat aswell as the stress and i guess abuse - to me - suggests that they should earn good money.
They have trained hard for what they do and i guess proved that they are the cream of the crop and should be rewarded for it.
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20 June 2012, 10:43 PM
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20 June 2012, 10:47 PM
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In our practice you may observe that I start seeing patients at 0915, but often before then I have visited a patient at home and done about 15 telephone consultations. On another day I may be consulting you at 0730 or 1930 because of extended hours initiatives. On days I am not on call (about half of them) I start seeing routinely booked patients at 0840.
GPs as part of their training have usually done A&E, and some continue to do sessions in A&E. Except in very rural areas, GPs are not usually the first response to an out of hospital cardiac arrest, or a heart attack (all of these should have a 999 call and we can sometimes respond as well) where a paramedic response with an ambulance that is equipped to cut through traffic and carries more equipment can allow rapid transportation to hospital is most effective. I dispute the claim that GPs are not regularly making life or death interventions though, spend a day with me and look at the decisions I have to make based on incomplete information and you would I guarantee reconsider. Whilst performing 90-95% of of NHS contacts without onward referral (a lot of the skill is selecting the right patients to refer and to whom), without GPs I think we'd be spending more of our GDP on healthcare when you compare price and outcomes with other countries. Secondary care would be swamped, inappropriately. Secondary care are now too specialised to replace GPs and would require retraining.
The news item claiming £100k + £30k is overall about double what many GPs actually earn, before tax. Like lawyers and accountants, not all GPs are partners. Not all have seniority allowances, many don't have significant private practice, and most don't have dispensaries, own nursing homes or multiple practices, or have other business interests, or manage other services, all of which can bring in extra income.
As I have said already, our surgery is not striking. I heard that only 22% of surgeries are planning to strike.
In terms of outsourcing GP services, I'd welcome it, I'm not scared of the free market at all. Unless a service was a loss leader I think that it would be difficult to compete on price. I do think there is a role for other health care professionals to replace some routine GP work, but this has happened a lot with the use of nurses, but often because of the time they need to make the same decisions and the backup/support required it isn't any cheaper.
GPs as part of their training have usually done A&E, and some continue to do sessions in A&E. Except in very rural areas, GPs are not usually the first response to an out of hospital cardiac arrest, or a heart attack (all of these should have a 999 call and we can sometimes respond as well) where a paramedic response with an ambulance that is equipped to cut through traffic and carries more equipment can allow rapid transportation to hospital is most effective. I dispute the claim that GPs are not regularly making life or death interventions though, spend a day with me and look at the decisions I have to make based on incomplete information and you would I guarantee reconsider. Whilst performing 90-95% of of NHS contacts without onward referral (a lot of the skill is selecting the right patients to refer and to whom), without GPs I think we'd be spending more of our GDP on healthcare when you compare price and outcomes with other countries. Secondary care would be swamped, inappropriately. Secondary care are now too specialised to replace GPs and would require retraining.
The news item claiming £100k + £30k is overall about double what many GPs actually earn, before tax. Like lawyers and accountants, not all GPs are partners. Not all have seniority allowances, many don't have significant private practice, and most don't have dispensaries, own nursing homes or multiple practices, or have other business interests, or manage other services, all of which can bring in extra income.
As I have said already, our surgery is not striking. I heard that only 22% of surgeries are planning to strike.
In terms of outsourcing GP services, I'd welcome it, I'm not scared of the free market at all. Unless a service was a loss leader I think that it would be difficult to compete on price. I do think there is a role for other health care professionals to replace some routine GP work, but this has happened a lot with the use of nurses, but often because of the time they need to make the same decisions and the backup/support required it isn't any cheaper.
20 June 2012, 10:52 PM
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At what price do you value life? Gps are self employed were they pay in excess of 30k to become a partner in a surgery, there wages then from a budget provided from the government,
10 years time there will be no nhs service it will all be private, and doctors/ gps etc will earn a lot more as well!
everyone should give the nhs a break! Stop
Complaining about wages etc and be thank ful it exists!
Would you fan c paying 5-10 k from your pocket for an operation? But that's what it wil come too unfortunately!
I take my hat off to any nhs worker! Hours cut yes but still putting the same hours in then before but getting payed for less hours, and every referal a gp makes costs the practise money! So by referring you to see a consultant is showing there looking out for the patients interest over financial gain!
10 years time there will be no nhs service it will all be private, and doctors/ gps etc will earn a lot more as well!
everyone should give the nhs a break! Stop
Complaining about wages etc and be thank ful it exists!
Would you fan c paying 5-10 k from your pocket for an operation? But that's what it wil come too unfortunately!
I take my hat off to any nhs worker! Hours cut yes but still putting the same hours in then before but getting payed for less hours, and every referal a gp makes costs the practise money! So by referring you to see a consultant is showing there looking out for the patients interest over financial gain!
20 June 2012, 11:01 PM
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I'm not sure it sits too well with me. I'm ok with private healthcare if I am paying for it directly but otherwise would feel like a commodity to be exploited.
Incidentally our local practice moved to a new location...all purpose built but with a pharmacy built into the same building.
It's changed the way I feel towards the practice now as I feel again like a commodity to be exploited. I don't want to see a GP who pushes me pills he/she profits from.
Needless to say I never get my prescriptions filled there but go to Tesco instead.
It's only Naproxen anyway.
Incidentally our local practice moved to a new location...all purpose built but with a pharmacy built into the same building.
It's changed the way I feel towards the practice now as I feel again like a commodity to be exploited. I don't want to see a GP who pushes me pills he/she profits from.
Needless to say I never get my prescriptions filled there but go to Tesco instead.
It's only Naproxen anyway.
20 June 2012, 11:04 PM
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I will give you a typical scenario that happens about daily and you can consider the difficulties:
Patient calls you in the middle of a surgery asking for a visit (if you are a small practice, you may be the only doctor on), from the phone description you make the decision (not the patient, many visit requests are inappropriate and for convenience or due to lack of self-reliance) whether to visit them now or at the end of the surgery in a few hours. They are "not right", vomiting. You have to consider (before you see them), their past history, medication, age, risk factors and the problem to try to decide whether they are having a stomach bug, anxiety attack, or acute glaucoma (people forget that one as a cause of vomiting), myocardial infarction (they sometimes just look vaguely unwell with no chest pain whilst half their heart has little circulation and they could die from an arrythmia if you misdiagnose), pneumonia (they don't always cough), diabetic ketoacidosis (you don't know they are diabetic because they haven't been diagnosed yet) or peptic ulceration (with brown vomit - much of it is brown, you need to decide if blood or not). Some of these will not merit you making all your other patients who have pre-booked about 45 minutes late once you've driven to the visit, assessed them, returned. Some will be at considerable risk of death or serious deterioration if you wait 2 hours. If you visit them you have to assess them often in poor circumstances with dogs and children to fight off and all the special vagueness that patients reserve for these awkward occasions, especially if they are in the early stage of something serious. You then need to make the right call based on this incomplete information and decide what to do.
Compare this to jobs I've done messing about with cars. There is no emergency, no life and death to the vast majority of it, it needs quiet and careful analysis, skill and a logical brain with innovation and experience. But there is little peril to it, the systems being worked with are all man made and documented in some way. There is a predictability to intervention-response. There is very little human overlay to it. You can test-measure-repeat.
Ultimately, the challenge of being a GP is why I continue doing that rather than working on cars. The pay was similar, the mental ability required is similar, but the challenge of being a doctor is far greater than many other jobs which is why we only let people do it after they jump through many difficult hoops and keep jumping through them.
Patient calls you in the middle of a surgery asking for a visit (if you are a small practice, you may be the only doctor on), from the phone description you make the decision (not the patient, many visit requests are inappropriate and for convenience or due to lack of self-reliance) whether to visit them now or at the end of the surgery in a few hours. They are "not right", vomiting. You have to consider (before you see them), their past history, medication, age, risk factors and the problem to try to decide whether they are having a stomach bug, anxiety attack, or acute glaucoma (people forget that one as a cause of vomiting), myocardial infarction (they sometimes just look vaguely unwell with no chest pain whilst half their heart has little circulation and they could die from an arrythmia if you misdiagnose), pneumonia (they don't always cough), diabetic ketoacidosis (you don't know they are diabetic because they haven't been diagnosed yet) or peptic ulceration (with brown vomit - much of it is brown, you need to decide if blood or not). Some of these will not merit you making all your other patients who have pre-booked about 45 minutes late once you've driven to the visit, assessed them, returned. Some will be at considerable risk of death or serious deterioration if you wait 2 hours. If you visit them you have to assess them often in poor circumstances with dogs and children to fight off and all the special vagueness that patients reserve for these awkward occasions, especially if they are in the early stage of something serious. You then need to make the right call based on this incomplete information and decide what to do.
Compare this to jobs I've done messing about with cars. There is no emergency, no life and death to the vast majority of it, it needs quiet and careful analysis, skill and a logical brain with innovation and experience. But there is little peril to it, the systems being worked with are all man made and documented in some way. There is a predictability to intervention-response. There is very little human overlay to it. You can test-measure-repeat.
Ultimately, the challenge of being a GP is why I continue doing that rather than working on cars. The pay was similar, the mental ability required is similar, but the challenge of being a doctor is far greater than many other jobs which is why we only let people do it after they jump through many difficult hoops and keep jumping through them.
20 June 2012, 11:12 PM
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Ultimately, the challenge of being a GP is why I continue doing that rather than working on cars. The pay was similar, the mental ability required is similar, but the challenge of being a doctor is far greater than many other jobs which is why we only let people do it after they jump through many difficult hoops and keep jumping through them.
Sure its a safeguard against charlatans but it also fossilizes knowledge but that is more a philosophical point.
20 June 2012, 11:12 PM
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Maybe it isn't relevant, but just the word "naproxen" triggers so many thoughts in my little GP brain that if you were a health care professional but not a GP you might not appreciate, but will be glad I'm considering. Many specialists, nurses or physios that recommend it just don't get the bigger picture. Using these people to replace GPs won't work.
20 June 2012, 11:15 PM
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Maybe it isn't relevant, but just the word "naproxen" triggers so many thoughts in my little GP brain that if you were a health care professional but not a GP you might not appreciate, but will be glad I'm considering. Many specialists, nurses or physios that recommend it just don't get the bigger picture. Using these people to replace GPs won't work.
No I'm not a diazepam addict or anything.
20 June 2012, 11:28 PM
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NSAIDs require special consideration, perhaps less so in the relatively young and fit, but add a few comorbidities and polypharmacy to the equation and it rapidly gets more complex than many realise. Many of the posters on Scoobynet don't fall into these groups as they are much younger than our main users, their interactions with their GPs are simple, often for self limiting illnesses that they didn't really need a doctor for in the first place.
It doesn't take long as a GP to realise that there are no real general physicians any more, expect perhaps care of the eldery/geriatrics. Quite sick patients need a lot of work and don't pigeon hole easily. Specialists are also under pressure to discharge patients from their follow up too.
Many may not realise that type 2 diabetes, a very complex area with vast potential for complications is now usually managed entirely in general practice.
It doesn't take long as a GP to realise that there are no real general physicians any more, expect perhaps care of the eldery/geriatrics. Quite sick patients need a lot of work and don't pigeon hole easily. Specialists are also under pressure to discharge patients from their follow up too.
Many may not realise that type 2 diabetes, a very complex area with vast potential for complications is now usually managed entirely in general practice.
20 June 2012, 11:30 PM
#19
I will give you a typical scenario that happens about daily and you can consider the difficulties:
Patient calls you in the middle of a surgery asking for a visit (if you are a small practice, you may be the only doctor on), from the phone description you make the decision (not the patient, many visit requests are inappropriate and for convenience or due to lack of self-reliance) whether to visit them now or at the end of the surgery in a few hours. They are "not right", vomiting. You have to consider (before you see them), their past history, medication, age, risk factors and the problem to try to decide whether they are having a stomach bug, anxiety attack, or acute glaucoma (people forget that one as a cause of vomiting), myocardial infarction (they sometimes just look vaguely unwell with no chest pain whilst half their heart has little circulation and they could die from an arrythmia if you misdiagnose), pneumonia (they don't always cough), diabetic ketoacidosis (you don't know they are diabetic because they haven't been diagnosed yet) or peptic ulceration (with brown vomit - much of it is brown, you need to decide if blood or not). Some of these will not merit you making all your other patients who have pre-booked about 45 minutes late once you've driven to the visit, assessed them, returned. Some will be at considerable risk of death or serious deterioration if you wait 2 hours. If you visit them you have to assess them often in poor circumstances with dogs and children to fight off and all the special vagueness that patients reserve for these awkward occasions, especially if they are in the early stage of something serious. You then need to make the right call based on this incomplete information and decide what to do.
Compare this to jobs I've done messing about with cars. There is no emergency, no life and death to the vast majority of it, it needs quiet and careful analysis, skill and a logical brain with innovation and experience. But there is little peril to it, the systems being worked with are all man made and documented in some way. There is a predictability to intervention-response. There is very little human overlay to it. You can test-measure-repeat.
Ultimately, the challenge of being a GP is why I continue doing that rather than working on cars. The pay was similar, the mental ability required is similar, but the challenge of being a doctor is far greater than many other jobs which is why we only let people do it after they jump through many difficult hoops and keep jumping through them.
Patient calls you in the middle of a surgery asking for a visit (if you are a small practice, you may be the only doctor on), from the phone description you make the decision (not the patient, many visit requests are inappropriate and for convenience or due to lack of self-reliance) whether to visit them now or at the end of the surgery in a few hours. They are "not right", vomiting. You have to consider (before you see them), their past history, medication, age, risk factors and the problem to try to decide whether they are having a stomach bug, anxiety attack, or acute glaucoma (people forget that one as a cause of vomiting), myocardial infarction (they sometimes just look vaguely unwell with no chest pain whilst half their heart has little circulation and they could die from an arrythmia if you misdiagnose), pneumonia (they don't always cough), diabetic ketoacidosis (you don't know they are diabetic because they haven't been diagnosed yet) or peptic ulceration (with brown vomit - much of it is brown, you need to decide if blood or not). Some of these will not merit you making all your other patients who have pre-booked about 45 minutes late once you've driven to the visit, assessed them, returned. Some will be at considerable risk of death or serious deterioration if you wait 2 hours. If you visit them you have to assess them often in poor circumstances with dogs and children to fight off and all the special vagueness that patients reserve for these awkward occasions, especially if they are in the early stage of something serious. You then need to make the right call based on this incomplete information and decide what to do.
Compare this to jobs I've done messing about with cars. There is no emergency, no life and death to the vast majority of it, it needs quiet and careful analysis, skill and a logical brain with innovation and experience. But there is little peril to it, the systems being worked with are all man made and documented in some way. There is a predictability to intervention-response. There is very little human overlay to it. You can test-measure-repeat.
Ultimately, the challenge of being a GP is why I continue doing that rather than working on cars. The pay was similar, the mental ability required is similar, but the challenge of being a doctor is far greater than many other jobs which is why we only let people do it after they jump through many difficult hoops and keep jumping through them.
However you do seem more forward thinking than many GP's including my own; in the last few years my role has changed dramatically in that I now do all the chronic disease management, most of the QOF work, ie, a lot of routine work previously done by GP's, but I am considerably cheaper
Incidentally, I have never met a subaru-driving GP before (nor even a subaru driving nurse); perhaps that is where I am going wrong
20 June 2012, 11:37 PM
#21
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There's not a single doctor at the surgery which I'm registered, to who is under 40. One doctor who is about to retire gave me injections as a baby, 30 years ago.
One of the other doctors, probably in his 60's, actually books his holidays but still goes in to surgery while he should be off.
I'm not fussed about how much they get paid. I have to pay council tax, I don't use the majority of the things the council wastes money on, so the doctors who actually do something useful may as well be paid.
One of the other doctors, probably in his 60's, actually books his holidays but still goes in to surgery while he should be off.
I'm not fussed about how much they get paid. I have to pay council tax, I don't use the majority of the things the council wastes money on, so the doctors who actually do something useful may as well be paid.
21 June 2012, 12:24 AM
#22
This may not be all that serious in the grand scheme of things, but I just wish someone had listened sooner. Thankfully, my seizures were fairly far apart, and none resulted in serious injury, but for someone else, they may not be so lucky?? I do understand that GPs have to make decisions based on what they think, but for me, I felt ignored and dismissed and it seems I was right to feel that way.
Do I think GPs don't deserve a good wage? No. I think a lot comes down to experience and like with any profession, there will be good and bad, right and wrong decisions and purely what we as patients want sometimes conflicting with what we get. I think they do a difficult job, and most likely get more decisions right with a lot of responsibility on their shoulders. It's not a job I would envy. For all my significant experiences haven't been great from my point of view, I can't tar all GPs with the same brush.
21 June 2012, 12:50 AM
#23
In comparison with other medical 'gradings', I think surgeons, anaesthetists, A&E doctors all deal more frequently with the delicate balance between life and death. I would assume perhaps wrongly, that the national average for these roles would be less than £100K. Exactly two years ago today, I watched as specialists in a high dependency neo-natal unit routinely performed miracles, and promoted life with confidence where the odds seemed heavily loaded against them. I have no idea what they earned, but I suspect it will be less than £100K.
In my view there are only 3 fields of employment where higher education is absolutely essential; law, engineering and medicine. I wouldn't be shocked or surprised if a good solicitor, barrister or engineer earned £100K for their services. I think it is the public funding aspect coupled with my own perception of having had some poor service from my own GP which has prejudiced my view a little on GP's earnings.
21 June 2012, 01:15 AM
#24
Quite sick patients need a lot of work and don't pigeon hole easily. Specialists are also under pressure to discharge patients from their follow up too.
Many may not realise that type 2 diabetes, a very complex area with vast potential for complications is now usually managed entirely in general practice.
Many may not realise that type 2 diabetes, a very complex area with vast potential for complications is now usually managed entirely in general practice.
In an average day, how many patients would you encounter who really had no requirement to see a doctor? Are there circumstances where you could or ever have told a patient they could not have or did not require an appointment?
Should there be more reliance on chemists / apothecary services to treat trivial ailments so the GP's role moves to a 'secondary' level of care and more time can be dedicated to the more complex issues which you describe?
Doing some rough calculations in my head based on the reported figure of £100K, working 220 days per year, 8 hours per day, ten minutes of a GP's time would cost a little under £10.
I had a puncture repaired on my wife's car last week, this took around 10 minutes to repair and cost me £12.
Is it worth paying a tenner to find out if I will live or die from my latest ailment??? - maybe £100K pa is not such a crazy sum of money after all!!!!
21 June 2012, 08:04 AM
#25
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I cant give an objective viewpoint on this, there are probably some people who would hold the view that I am paid an excessive amount for the job which I do. There are possibly some people who would argue that my job is not particularly skilled or specialised, and just as many again who would really like to do what I do for a living, or think that my job is a walk in the park.
In comparison with other medical 'gradings', I think surgeons, anaesthetists, A&E doctors all deal more frequently with the delicate balance between life and death. I would assume perhaps wrongly, that the national average for these roles would be less than £100K. Exactly two years ago today, I watched as specialists in a high dependency neo-natal unit routinely performed miracles, and promoted life with confidence where the odds seemed heavily loaded against them. I have no idea what they earned, but I suspect it will be less than £100K.
In my view there are only 3 fields of employment where higher education is absolutely essential; law, engineering and medicine. I wouldn't be shocked or surprised if a good solicitor, barrister or engineer earned £100K for their services. I think it is the public funding aspect coupled with my own perception of having had some poor service from my own GP which has prejudiced my view a little on GP's earnings.
In comparison with other medical 'gradings', I think surgeons, anaesthetists, A&E doctors all deal more frequently with the delicate balance between life and death. I would assume perhaps wrongly, that the national average for these roles would be less than £100K. Exactly two years ago today, I watched as specialists in a high dependency neo-natal unit routinely performed miracles, and promoted life with confidence where the odds seemed heavily loaded against them. I have no idea what they earned, but I suspect it will be less than £100K.
In my view there are only 3 fields of employment where higher education is absolutely essential; law, engineering and medicine. I wouldn't be shocked or surprised if a good solicitor, barrister or engineer earned £100K for their services. I think it is the public funding aspect coupled with my own perception of having had some poor service from my own GP which has prejudiced my view a little on GP's earnings.
It is a difficult one I agree. All consultants of the same seniority doing the same amount of work will earn the same in the NHS, it is a founding principle.
It's the way we make sure that we have talented people in all specialist areas.
The GP question is also interesting. I work in one of the acute hospital specialities so from the outside you might say my job is more stressful than being a GP.
However the difference is that I practice just one particular field, in this field I am (well) paid to be an expert. I need to know everything, be up to date with everything and there will be hell to pay if I get it wrong.
However a GP will get bombarded with all sorts and varieties of medical conditions. Show me a rash, a red eye, a diabetic foot, a schizophrenic, a breast lump etc etc and I wouldn't have a clue.
Decisions they make that may seem on the surface to be easy are far from that.
As an example think about all those people who go to their GP because they have a headache. Now which one just has stress, which one has a cervical spine problem, which one has a tooth problem, which poor bugger has a lethal brain tumour. Something that seems as simple as a headache could have all manner of causes
As I said GPs have their own unique challenges which I don't envy.
Some services can be taken over by nurses and done more cheaply and these have already been done. However they do not have medical training and so if you over step the mark with this it won't be cheaper but MORE expensive as they won't feel sure on the decisions and so refer everything back to the doctor anyway. So you've now paid twice for the same service.
I don't feel GPs have blocked reform, their work practices have changed a lot and now they manage a lot of the chronic stuff that years ago would have blocked hospital beds/appts.
If you've had sub standard service from your GP than I can see why you are questioning the high levels of pay. Like any job there are good and bad, it's a shame you might have encountered the latter
21 June 2012, 08:58 AM
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I have often thought looking around the patient waiting area at my local GP's that many of these people don't appear too ill.
In an average day, how many patients would you encounter who really had no requirement to see a doctor? Are there circumstances where you could or ever have told a patient they could not have or did not require an appointment?
In an average day, how many patients would you encounter who really had no requirement to see a doctor? Are there circumstances where you could or ever have told a patient they could not have or did not require an appointment?
The real issue is that she has never gotten over the death of her husband seven years ago. Every eight weeks she goes to the GP and he reassures her that she is okay, they have a chat for five or ten minutes, and off she goes.
She is very 'old school' in that whatever the GP says it must be true so it's no use anyone else trying to tell her she is fine. I'm quite sure that without the GP's kindness and patience towards her she would have topped herself by now. The guy probably sees her name on his appointment list and thinks 'Here we go again' but he's never shown that towards her.
I could tell you tales of horror GPs but still think, mostly, they are worth every penny.
21 June 2012, 09:00 AM
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I'm sure most of the stats quoted in the papers are well off the mark but even so I don't begrudge GP's earning a high salary given 1) the length of training and 2) the obvious challenges of the role.
I'm more concerned that other health care workers are so poorly paid! If we cut the amount of administrative (and managerial) waste we would be able up salaries.
I'm more concerned that other health care workers are so poorly paid! If we cut the amount of administrative (and managerial) waste we would be able up salaries.
21 June 2012, 09:12 AM
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In an average day, how many patients would you encounter who really had no requirement to see a doctor? Are there circumstances where you could or ever have told a patient they could not have or did not require an appointment?
Should there be more reliance on chemists / apothecary services to treat trivial ailments so the GP's role moves to a 'secondary' level of care and more time can be dedicated to the more complex issues which you describe?
Doing some rough calculations in my head based on the reported figure of £100K, working 220 days per year, 8 hours per day, ten minutes of a GP's time would cost a little under £10.
Posting at 0910 because I am on annual leave, doing DIY, not because on strike! Our practice is open as usual.
Surgeons, anaesthetists and neonatologists are all highly valuable when you need them, but 90-95% of healthcare (by quantity not cost) is in primary not secondary care.
In terms of life and death decisions, a night on call when I was doing hospital medicine and the more senior doctors were based at home was very stressful, being told 18 months out of medical school that you are running the cardiac arrest team is one thing, but having the support of great anaesthetists on the team was fantastic, and after the initial shock you can settle into the well worn protocols which make a lot of it as automatic as it has to be at 3am. Now there is a drive to bring more middle and even senior grade staff on site, and rightly so. However, despite the present lower frequency of resuscitation situations and not taking the very sickest patients from the whole area as kindly selected by their GPs, the job I do now is more skilled and demanding as it requires decision making in the earlier stages of illness which are potentially serious but not developed enough to draw on secondary care support. Keeping patients out of hospital by better management of their chronic diseases is another skill, and that is one where nurses have a particular role as they can run regular follow up to protocols.
Last edited by john banks; 21 June 2012 at 09:14 AM.
21 June 2012, 11:20 AM
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I am fortunate im having a very good GP who is quite young, in his 30's I imagine, who is always very helpful when I have a problem and whose knowledge is quite astounding.
He has always given me the right answers so far, in fact Mrs Leslie embarrassed me by asking him how he knew so much at his age! He certainly proves that the doctor does not have to be in his dotage to be able to be very good at his job.
It is ridiculous to say that you don't believe that a particular doctor is not likely to have made very many life or death decisions! In the first place, how would anyone know the details of his dealings with other people's problems. The real point anyway, is he good enough to be able to see a serious future problem when it presents itself and is he reliable enough to take the necessary action?
I think that in general, doctors work pretty hard for their money and are also in a most responsible job so they deserve what they get.
See how you feel the first time one of them saves your life!
Les
He has always given me the right answers so far, in fact Mrs Leslie embarrassed me by asking him how he knew so much at his age! He certainly proves that the doctor does not have to be in his dotage to be able to be very good at his job.
It is ridiculous to say that you don't believe that a particular doctor is not likely to have made very many life or death decisions! In the first place, how would anyone know the details of his dealings with other people's problems. The real point anyway, is he good enough to be able to see a serious future problem when it presents itself and is he reliable enough to take the necessary action?
I think that in general, doctors work pretty hard for their money and are also in a most responsible job so they deserve what they get.
See how you feel the first time one of them saves your life!
Les
