The more junior doctors have tried to justify their three-day withdrawal of labour over the past week, the more damage, or so it seems to me, they have done to their cause – whatever that cause may be. On the final day of their strike – in pursuit of a 35 per cent pay rise – reports are piling up of cancelled operations, postponed cancer treatments and more people pushed towards the private health sector.
Some of the striking doctors’ work is apparently being covered by consultants – to which I, and no doubt many others, would say: bring it on. For years, consultants have delegated far too much of their responsibility to junior doctors, including plenty of after-hours and weekend work. So if patients get to see more senior doctors, well, that would not be such a bad result, would it?
It might even set a trend, if downing tools becomes a habit for the junior doctors, as their frustration with their paymasters deepens. But you have to ask how plugged in they are to the real lives of their patients.
Budding medics pay the same tuition fees as everyone else, even though their course costs far more than many others
A young London medic complained to an interviewer that she had to spend £5.80 a day on her commute and could afford only a baked potato, the cheapest item in the staff canteen, at lunchtime. First-year junior doctors, it should be clarified, earn just less than £30,000 a year. But in many cases, within a few years, this amount can rise quickly.
With the average annual pay for full-time employees in the UK standing at around £33,000, there must be plenty of her patients, current and future, whose options are at least as constrained. Unlike her, however, they will not have the prospect of significantly increasing their starting salary within a few years.
To judge by radio phone-ins, some of the striking doctors had tee’ed up their parents to present their case to the wider public. One called to point out that his daughter’s starting salary was half that of (some?) new graduate recruits to banking or the law, though he neglected to point out (nor was he challenged to do so) the vastly superior job security, pay prospects and pensions, which are due to be given new tax breaks in Jeremy Hunt’s Budget, that awaited his offspring. Then again, if top-flight banking and the law was the league the father was playing in, an NHS starting salary was always going to be a shock. And if that was his daughter’s expectation, then you have to ask how much of an idea she has about how the rest of the population, including most of her patients, really live.
Which may highlight part of the problem. Where once upon a time teachers and doctors were seen, and saw themselves, as part of a wider professional group, where advancement, salaries and public standing were much of a muchness, this is no longer so. At some point in the last 30 years or so, rewards for certain types of bankers and lawyers sped away into a stratosphere all of their own. And, yes, this left junior doctors and teachers (though not ‘super-heads’) lagging behind, even as they retained the same expectations vis a vis their peers as before.
But that’s the free market for you. It is also, for many, far from the norm. By no means all those working in banking and the law enjoy anything like the rewards reaped by those at the top. The trouble is that it is mostly not these more modest grafters that many aspiring doctors and teachers choose to see.
The whole selection and training of doctors reinforces privilege. Today’s medical students come disproportionately from a top intellectual drawer. Acceptance on a medical course requires the highest grades in subjects – often three sciences – that not all schools can teach to the necessary level. Efforts to broaden entry to the top universities have made less headway in medicine, where a string of A*s remains the order of the day. Whether having your head in your books, or your eyes glued to a screen is the best grounding for tomorrow’s doctors, however, is a question still too seldom asked.
Once accepted, a medical student benefits from another unfairness that reinforces their privilege. Budding medics pay the same fees as everyone else, even though their course costs far more than many others, especially arts courses. Indeed, they are double beneficiaries: not only is the cost of their course effectively subsidised by those paying the same fees for much cheaper courses, but their likely future earning will be higher, in many cases a lot higher, than those of most other graduates.
The cost of medical courses is one reason why the Treasury and universities themselves baulk at increasing student numbers (as they should), preferring to make up the shortfall with ready-trained doctors from abroad. But I find it amazing that so few students or their parents have challenged the principle of equal fees for courses whose cost can be wildly different. A medical degree in these circumstances is an absolute bargain, even if training takes longer.
This is also why medics should be required to work for the NHS for a certain period, and why they should have to pay back the true cost of their training if they take a job abroad before that time is up. I realise this sounds like what happened in the former USSR, where would-be emigres to Israel had to pay back the cost of their degree before leaving. But, looking back, maybe the authorities had a point.
The length of the training is another point that could usefully be addressed. Of course, no one would want to be treated by a young medic who might have qualified after, say, a two-year crash-course. But one probable reason why the training is so long is that 18-year-olds with minimal life experience have to learn basic social skills, or some equally basic professional skills, such as how to recognise what a really sick child looks like.
The more a medical degree has become the preserve of an academic elite and the better-off, the less suited, arguably, many of those students will be to treat real live patients from very different backgrounds, and the longer and more elementary in many respects the training they need. Maybe instead of increasing the intake of 18-year-old undergraduates, colleges and hospitals could focus on developing shorter courses for more mature students, those with more life experience and those transferring from other walks of life.
In the meantime, if you are unlucky enough to find yourself in hospital on a strike day, you may still be lucky in another respect. Once you have run the gauntlet of the junior doctors chanting their demands on the picket-line, you could well find an unaccustomed number of grown-ups staffing the medical front-line inside.
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