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Source: (consider it) Thread: New Junior Doctors' Contract
Alan Cresswell

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# 31

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You start by seeking to slow the loss of doctors out of the system, which means not shafting them so that they decide that working in the US, Canada or NZ looks - or quiting medicine altogehter - very attractive

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Karl: Liberal Backslider
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# 76

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I can't help thinking that the thought of 90hr weeks must be a significant deterrent from entering the profession - it'd certainly have deterred me!

There must be people who drop out during this period as well, having discovered they are just mere mortals and actually need sleep.

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betjemaniac
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# 17618

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quote:
Originally posted by Alan Cresswell:
You start by seeking to slow the loss of doctors out of the system, which means not shafting them so that they decide that working in the US, Canada or NZ looks - or quiting medicine altogehter - very attractive

Fine, but given the shortage manning levels, that pretty much only leaves you with the money lever to pull because you can't do anything about the hours. What happens (as with naval engineering currently) when they turn round and say it's not the money, its the hours?

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Sioni Sais
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# 5713

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quote:
Originally posted by betjemaniac:


Essentially, "we've got a problem with not enough pay and too many hours which we'll solve with this contract. On the other hand, that's going to need investment and expansion of the training pipeline." They just didn't do anything after "on the other hand" and we've had 17 years of governments of both stripes looking away sheepishly.

17 years.

Er, no. We have a problem with governments of many decades (I take it back to the oil crisis of 1973/74) baring their arses to corporate business interests to do whatever they want. Unfortunately it isn't the ministers and senior civil servants that suffer but the ordinary public, including the military, the police and the rest of us.

And thanks now to the globalisation of trade, business now has so much power that its interests totally outweigh and are completely at odds, with those who elect governments.

You know what I mean Betjemaniac: if BAE systems didn't want to build the bomb magnets, we wouldn't be building them.

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Alan Cresswell

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# 31

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Well, start with a commitment to reduce hours, with an achievable timetable. And, stick with it so that doctors see progress. As a first order approximation there is probably an assessment of hours per patient, therefore multiply this by number of patients and divide by number of doctors = average hours per doctor*. Every year there's a fresh intact of new doctors graduating from university, keep that above the number of doctors leaving and you drive down the number of hours on average. Simples.

 

* OK, I know that if there is more time doctors will spend more time with each patient, so only a first order approximation.

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alienfromzog

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# 5327

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I just want to say, that pay and conditions for the military really does need addressing.

quote:
Originally posted by mr cheesy:
But if we're really saying that highly paid staff should retain their perks (and remember that junior doctors already have higher than average pay before they've fully finished their training), then I say no, sorry.

Higher than average pay?

Really?

Average earnings in 2014 were reported as £26,500. Now, I know that doctors are not the only group who do antisocial hours, that would be ridiculous. But Our income for a 37 hour week is £22k in the first year rising based on experience to £40k for me now 10 years down the line. Yes we are all still in training but it's junior doctors who do most of the (medical) work in the NHS.

Yes we do earn above that but the point is, we earn it. It's pay for hours above and beyond a normal working week and at antisocial times. The following is based on my job up until April of this year. I have moved trusts and where I work at the moment is a complete disaster in terms of the rota - and so it is not representative.

I worked 8-5 Monday to Friday, with a rota'd day off after on-calls. So our on-call would be from 5pm to 8am. Or we would do 24 hours (8am to 8am) on a Friday or Saturday or Sunday. Monday-Thursday 8-5 on-call would be covered by the 'on-service registrar' for that week. And during this week we wouldn't do any overnight on-calls. This was on a 1 in 7 rota.

This kind of rota is not unusual in paediatric surgery and most of us like it. It provides good continuity of care and is usually not too onerous. An average on-call evening would start from 5 when we take hand over from the colleague on during the day. (We would have done a normal day so often clinic or theatre that day). We would see emergency admission, operate and do a ward-round in the evening. Most week days evenings would require some operating - sometimes operating on my own, sometimes assisting the consultant. It was fairly standard to finish operating around 11-midnight and then do a round and see any new admissions / unwell patients. Then we would try to sleep from One-ish. It would be unusual not to get 2-3 calls before 8am but on about half of the nights I would not need to get out of bed before 7 as it would be just specialist advice that was needed. Conversely I have had nights where I've operated all through the night.

This kind of work pattern is fine - as long as you don't have a fixed commitment the next day.

We would do a Friday/Sunday in the same weekend or just the 24hours Saturday. Hence with 7 of us, I would work part of 1 in three-and-a-half weekends.

If you work out the hours, my basic pay of £40k was for 4x9 hours (with the rest day after on-calls). So 36 hours a week with paid holiday. That's £21.37 /hour. (My pay slip actually said slightly less than this but I won't bother you with the technicalities).

Out of hours: Well, there are 168 hours in a week. From 8-5 Monday to Friday (i.e. 45 hours) would be the normal working hours. Every other hour of a week (123) needs to be covered by us on a one-in-seven basis. This is of course without paid leave, as we have to cover these hours. We have to swap our on-calls and weekends to take holidays. 123 divided by 7 is 17.57 - so in addition to the 36 hours we did we would do a further 17.57 hours on average. These hours would pay at 20k for year as this job had a 50% banding. That works out at £21.89 / hour. That's the same when managing to get sleep (about 4 hours on an average on-call shift) as when operating on a 500g neonate at 3 in the morning. Oh and yes I got paid the same working on Christmas day.

I am not claiming that Doctors are badly paid but the idea that it's massively generous is deeply misleading.

I disagree with the statement above about the current contract - it is actually pretty good. The key to it was that the really bad rotas were made very expensive for the hospitals (There are 80% and 100% bandings in the New Deal). These upper bandings have almost all disappeared and that was what they were for. Before this, junior docs were paid decreasing amounts for extra hours 2/3rds or 1/3rd pay. This meant that when hosptials were short of doctors it was cheapest to make the ones you had work more and more to cover. The New Deal reversed that such that hospitals had to employ enough or it was very expensive. THIS is why it matters. THIS is what worries me about the new contract proposals. THIS is what led to doctors working 90-120 hours ON AVERAGE.

I've done 90-100 hour weeks (and that's time working without breaks) but that's hugely different from doing it week-in/week-out.

For the record the NHS employs 150,273 doctors. [source]
According to this source the mean income for ALL doctors is £70,646.00. I don't know off hand how that breaks down to levels and I don't know what proportion of the 150,000 are consultants/GPs/Juniors/Staff Grades without looking. However this means we can see the total cost of doctors to the NHS is somewhere around £10.5Bn. That's quite a lot of money but it is in the context of a total NHS budget of £116.574Bn. So the cost of doctors' salaries is 9% of the NHS budget. Nurses cost a lot more than us simply because there's a lot more of them.

So even if the government squeezes doctors massively, they not talking about saving big money at all in the context of the overall NHS budget.

But you may not care about any of that. You may feel that doctors should just shut up and put up with it. Fair enough - but my point is that because of how many doctors will leave, because of how this will make the longer hours much more common again, this will be bad for patients. So it is in everyone's interest to speak up.

AFZ

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mr cheesy
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# 3330

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quote:
Originally posted by alienfromzog:
I just want to say, that pay and conditions for the military really does need addressing.

quote:
Originally posted by mr cheesy:
[qb] But if we're really saying that highly paid staff should retain their perks (and remember that junior doctors already have higher than average pay before they've fully finished their training), then I say no, sorry.

Higher than average pay?

Really?

Average earnings in 2014 were reported as £26,500. Now, I know that doctors are not the only group who do antisocial hours, that would be ridiculous. But Our income for a 37 hour week is £22k in the first year rising based on experience to £40k for me now 10 years down the line. Yes we are all still in training but it's junior doctors who do most of the (medical) work in the NHS.


You might want to consider how much other professions get paid. That's the nature of an "average" and there are a large number of graduates getting paid a lot less than that after similar lengths of training.

quote:
Yes we do earn above that but the point is, we earn it. It's pay for hours above and beyond a normal working week and at antisocial times. The following is based on my job up until April of this year. I have moved trusts and where I work at the moment is a complete disaster in terms of the rota - and so it is not representative.
You earn it by trying to do complex medical procedures on minimum amounts of sleep. Excuse me as a taxpayer for thinking that's a pretty unhealthy state of affairs.

I don't give a shit how hard-done-by you feel, you are still fuckloads better off than the vast majority of public sector workers - when was the last time you went out to support your public sector colleagues struggling on minimum wages? Or is there something unique about doctors that means the rest of us have to support you in your privilege?

quote:
I worked 8-5 Monday to Friday, with a rota'd day off after on-calls. So our on-call would be from 5pm to 8am. Or we would do 24 hours (8am to 8am) on a Friday or Saturday or Sunday. Monday-Thursday 8-5 on-call would be covered by the 'on-service registrar' for that week. And during this week we wouldn't do any overnight on-calls. This was on a 1 in 7 rota.
Well you shouldn't, because that's fucking stupid. And obviously dangerous.

quote:
This kind of rota is not unusual in paediatric surgery and most of us like it. It provides good continuity of care and is usually not too onerous. An average on-call evening would start from 5 when we take hand over from the colleague on during the day. (We would have done a normal day so often clinic or theatre that day). We would see emergency admission, operate and do a ward-round in the evening. Most week days evenings would require some operating - sometimes operating on my own, sometimes assisting the consultant. It was fairly standard to finish operating around 11-midnight and then do a round and see any new admissions / unwell patients. Then we would try to sleep from One-ish. It would be unusual not to get 2-3 calls before 8am but on about half of the nights I would not need to get out of bed before 7 as it would be just specialist advice that was needed. Conversely I have had nights where I've operated all through the night.
Are you seriously trying to defend this or gain sympathy? That's fucking stupid.

quote:
This kind of work pattern is fine - as long as you don't have a fixed commitment the next day.
Nope, it really isn't. You should go see a doctor and let them tell you about unhealthy working practices.

quote:
We would do a Friday/Sunday in the same weekend or just the 24hours Saturday. Hence with 7 of us, I would work part of 1 in three-and-a-half weekends.
Yeah, and bloody marvellous it is too.

quote:
If you work out the hours, my basic pay of £40k was for 4x9 hours (with the rest day after on-calls). So 36 hours a week with paid holiday. That's £21.37 /hour. (My pay slip actually said slightly less than this but I won't bother you with the technicalities).
Of which how many hours were impaired by a lack of sleep? I'm not sure you're getting the point that I'm not impressed by the length of hours you work.

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the famous rachel
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# 1258

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quote:
Originally posted by betjemaniac:


Essentially, "we've got a problem with not enough pay and too many hours which we'll solve with this contract. On the other hand, that's going to need investment and expansion of the training pipeline." They just didn't do anything after "on the other hand" and we've had 17 years of governments of both stripes looking away sheepishly.

Not quite true... there was actually a fairly substantial effort to increase the numbers of doctors in training in the late nineties/early 2000s. See this link for example.

Best wishes,

Rachel.

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Alan Cresswell

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# 31

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But, I thought the point AFZ was making is that current hours are not ideal, but they are a lot better than were often worked before the current contract was introduced. And, the new contract being forced on doctors is a step backwards as it will result in a return to even longer hours.

What we should be looking at is steps that will reduce the hours doctors work to something more reasonable. But, part of the job is that there will always need to be doctors working anti-social hours. But, how to get to the point where the very long hours aren't a regular part of the job? When it comes down to it, that can only mean more doctors. A team of 7 will have to work the sort of hours described. A team of 9 or 10 will have flexibility to, say, let one of them have a day off before coming in for the night shift. Or, to work a more regular night shift (so, 2 of them work almost exclusively at nights, giving the rest of the team more regular day time job hours)

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Soror Magna
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The nerve of people, getting sick outside office hours.

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Sioni Sais
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# 5713

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quote:
Originally posted by mr cheesy:
<snipped a whole heap of jealousy>

Howabout just agreeing that we're all getting shat on instead of helping the government and their chums in their attempt to divide and rule?

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betjemaniac
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quote:
Originally posted by Sioni Sais:
Er, no. We have a problem with governments of many decades (I take it back to the oil crisis of 1973/74) baring their arses to corporate business interests to do whatever they want.

Indeed, although in fairness I thought long and hard about taking it back to when Mr Attlee set the thing up in the first place and baulked at ending private work and including dentists. I just decided there was too much wriggle room with that contention, and it would gloss over the existence of the occasional good person in both governing parties since the 1940s who did try to stick their finger in the dyke.

Bring back Lancelot Spratt.

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alienfromzog

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# 5327

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Mr Cheesy,

That's completely inconsistent. You think I work too many hours that's fine - but the reason the contract is constructed this way is to control that. Are you saying we shouldn't be paid for working when we're tired. You should REALLY be against this new contract.

As to your other point, I have been very vocal in support of others (My DWP thread is a good example) but even if not, as others have noted divide and rule is the strategy. Moreover, as Alan observed trade union law makes collective action across disciplines difficult.

AFZ

[ 28. September 2015, 13:05: Message edited by: alienfromzog ]

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mr cheesy
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# 3330

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quote:
Originally posted by alienfromzog:
Mr Cheesy,

That's completely inconsistent. You think I work too many hours that's fine - but the reason the contract is constructed this way is to control that. Are you saying we shouldn't be paid for working when we're tired. You should REALLY be against this new contract.

Wrong, you shouldn't be working that number of hours, period. If you had a proper trade union rather than a cabal of senior medics, you'd have been campaigning for a 37 hour week like everyone else years ago.

quote:

As to your other point, I have been very vocal in support of others (My DWP thread is a good example) but even if not, as others have noted divide and rule is the strategy. Moreover, as Alan observed trade union law makes collective action across disciplines difficult.

AFZ

I'm not talking about you individually, I'm talking about doctors in the NHS as a whole who seem to keep trying to wheel out this argument when there are many in public service, and even many in the NHS who are in a far worse situation.

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mr cheesy
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# 3330

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quote:
Originally posted by Sioni Sais:
quote:
Originally posted by mr cheesy:
<snipped a whole heap of jealousy>

Howabout just agreeing that we're all getting shat on instead of helping the government and their chums in their attempt to divide and rule?
Fuck off and die, prick-face.

How about protecting the interests of the most exploited rather than participating in tactics that seek to defend the indefensible.

Grow a fucking backbone: nobody should be working this number of hours, be they a lorry driver or a doctor. It is insane.

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Alan Cresswell

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# 31

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quote:
Originally posted by mr cheesy:
nobody should be working this number of hours, be they a lorry driver or a doctor. It is insane.

Can we clarify what hours? Is it the 90+ hour week, which the current contract largely eliminated? Is it the 24h on call shifts? Or the on call nights following a normal working day? Or, anything over 37 hours per week?

And, how do you judge what is an insane number of hours?

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Doc Tor
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quote:
Originally posted by mr cheesy:
Fuck off and die, prick-face.

Oh dear. I'm sure you can do better than that.

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Get your arse to Mars

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Erroneous Monk
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quote:
Originally posted by mr cheesy:


Or is there something unique about doctors that means the rest of us have to support you in your privilege?


Yes. Yes there is. And you couldn't do it. You cockwomble.

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Sioni Sais
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quote:
Originally posted by Doc Tor:
quote:
Originally posted by mr cheesy:
Fuck off and die, prick-face.

Oh dear. I'm sure you can do better than that.
I think we've seen many times that he can't. Pointless petulance is about as much as he can muster. Like Bibliophile with no brain power.

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Belle Ringer
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# 13379

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Two separate issues here: safety and money.

Lots of research says missing sleep rather quickly puts you in the cognitive condition equivalent to being too drink to drive. Judgment is impaired, as well as memory. Do we want cognitively impaired people making decisions about our urgent health needs? Or operating on our bodies?

Safety for us, not pay for doctors, is the issue to scream about if you want to catch the attention of the public and get them motivated to protest the current situation to the legislators.

Business bosses have never cared about safety for workers, they view workers as easily replaceable faceless cogs, to be used up and thrown away. That's why laws have to be passed about occupational safety, and why those laws are resented and often ignored by business - safety for workers reduces profits for bosses.

Money as the focus of the argument will alienate anyone who earn less, even if they work fewer hours for that less, because what is seen is the stated income, period. Most people "see" one thing at a time. "You earn more than I do, you have nothing to fuss about."

Focus on the risk to their safety, you'll get attention. When I need help I don't care if my doctor earns 10,000 or 500,000, I do care that s/he is alert & aware & focused on my need and NOT at risk of micro-sleeps while cutting me open on the operating table!

Safety is your issue if you want action.

Unfortunately, the medical community created the expectation of inhumanly long hours by forcing residents to work multiple 24 hour shifts. Some hospitals are slightly reducing that expectation because it leads to so many mistakes (and some deaths) but changing the image of a doctor's reasonable length work week that they themselves created will not be easy.

Money - global forces are determined to lower incomes for us all so the big boys can have more. I don't know what will change that.

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alienfromzog

Ship's Alien
# 5327

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OK.

Just to cover a couple of things.

The New Deal (current contract) has 3 bands and then sub-bands.

They are:
3 - 100% premium
2A - 80%
2B - 50%
1A - 50%
1B - 40%
1C - 20%

Now, some jobs - like Dermatology - have no out-of-hours work and are hence unbanded. The key point about this was that when it was first brought in there were lots of jobs which were banded 3 and cost the hospitals lots of money and hence there was a big driver to bring down the cost by making the rotas 'compliant.' For years now Band 3 jobs have virtually disappeared.* As have 2A and hence most junior docs are on a 40 or 50% banding.

The New Deal recognises two types of shifts. 'Full' and 'partial.' A Full shifts means one where you are working the whole time apart from natural breaks. Full shifts are not allowed to be more than 13 hours and there must be 11 hours between shifts.

This was simply to stop the ridiculous situation of doctors working from 9am Friday to 5pm Monday with no proper breaks.

24 hour partial shifts are allowed as long as there is reliable rest time.

The point of all this is that it worked. Whilst I have worked 90 hour weeks, it's only one in 6, one in 12 or whatever. A week of 7 night shifts of 13 hours for example. It's a bit of a crap life as all you do is sleep, eat and work. But the point is this is only one in whatever, instead of every week as happened before 1998.

The scary thing about the new contract is that by redefining 'unsocial hours' all these protections will disappear.

And really, is it unreasonable to be upset not by not having more money but by being forced to do more work - in a way that is less conducive to any kind of work/life balance for less money?

Now, some specialties - like acute medicine - should never do shifts longer than 13 hours. There work is very intense and that's what was so unsafe pre-New Deal. Similarly, some surgical specialties are busy and hence these shifts is the way to go.

Doing what we do, where the intensity is much less, I would argue that the benefits of continuity of care outweigh the downsides. The 1/7 type pattern I described works. The key thing is that we don't do non-urgent stuff out of hours. When tired, doing surgery is not a problem. Decision-making is what suffers, and in emergencies there are very few decisions - it's clear-cut and you get it done. If you look at the literature, continuity of care is just as important as clinician fatigue and these two have to be balanced against each other. And more to the point when talking about money - we earn it by working a lot of hours. It's not a fair comparison to say that a academic earns £30k and a doctor £60k on a like-for-like basis, because it probably isn't.

The fear about the new contract is that it will make us work more hours and more unsocial hours - as there will be no financial penalty for the hospitals to do this and it will also compromise continuity of care. This is why junior doctors are so upset.

Now, to come back to the money, which professionals are you thinking of who are paid less? Who have the same responsibilities? The same training? Remember, that average pay is not of professionals or even graduates it's the national average. And to reiterate if you think that doctors are already working too long hours then you should be really vociferously against this contract as it will make things far worse. Furthermore there is a practical angle to the money side of things: I would never claim to be hard up and you'll see I never have but I have to pay for all my courses and exams (which aren't optional). I have to get to and from work, often at anti-social times and hence a reliable car is not a luxury. I have to move often with work. Now, I would do medicine, whatever the pay as I love my job too much. But seriously, if I wasn't paid well, all of the things I've mentioned above would be just a little bit more difficult and onerous and so if you're talking about motivation and morale, these things matter. One of the things that makes my life much easier is being able to afford take-aways/resturants. When I was a child we never did either as my parents couldn't afford to. I know that many low paid people are in the same position. But in my 10 years of practise after many a hard day, the last thing I wanted to face was cooking - so the lack of financial stress meaning that (unlike when I was a student) I could just eat out or get takeaway has been a (metaphorical) life-saver.

So whilst it may be fair to characterise some doctors as greedy... it's not anywhere near that simple. We all make massive sacrifices to do what we do, we are lucky that we don't have to make big financial ones at the moment. Do you really think that add to the list financial sacrifice is a good idea? YMMV, of course.

AFZ

*Band 3 jobs have almost completely disappeared. The job I'm doing at the moment (not in England) is banded 3 because the rota is such a mess. I would much rather be back where I worked before and have less money.

--------------------
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[Sen. D.P.Moynihan]

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Arethosemyfeet
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quote:
Originally posted by ExclamationMark:
I calculate that I'm pretty close to being minimum waged based on my stipend and hours worked each month. You'd get no more out of me if you paid me £30 per hour -- I've chosen to do this work, I've gone into it eyes wide, open knowing the pay deal and conditions.

I can't actually come to terms with those who equate higher productivity and/to quality for higher pay. Perhaps its some kind of warped protestant work ethic but I give whatever I can to whatever I can. The pay etc doesn't come into it - and that's boasting or being some kind of martyr, it's just the way I am. And yes, I have worked and been paid in very different terms, the equivalent of hundreds of pounds a day: I gave no less nor no more then.

There is a difference between a stipend paid by a charity in lieu of salary for work done out of service and selling one's labour on a piecework basis to a commercial entity. In the latter case the rate of pay should absolutely reflect the time spent. If it were making jewellery or cakes then you wouldn't expect the same quality from a £5 piece as a £20 or £200 piece, because by paying more you are hiring a longer period of labour.

I might well spend hours making things to sell to raise funds for school or church, or preparing a church service or practicing music, without any financial reward, because I do them as a gift, an act of service. In my day job I blur the line a little, because I'm salaried and take the time necessary to do my job. When I'm being paid by the script, I have to treat it as a commercial relationship, otherwise I get exploited.

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Dafyd
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quote:
Originally posted by mr cheesy:
Grow a fucking backbone: nobody should be working this number of hours, be they a lorry driver or a doctor. It is insane.

The problem here is that nobody should be cared for by more than one doctor, because information inevitably gets lost no matter how good the handover procedure, and good handover procedures take time.

So something has to give somewhere.

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we remain, thanks to original sin, much in love with talking about, rather than with, one another. Rowan Williams

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ExclamationMark
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quote:
Originally posted by Arethosemyfeet:
If it were making jewellery or cakes then you wouldn't expect the same quality from a £5 piece as a £20 or £200 piece, because by paying more you are hiring a longer period of labour.

When I'm being paid by the script, I have to treat it as a commercial relationship, otherwise I get exploited.

I agree. But I do my best whether it's a £5 piece or a £200 commission. I don't see it as £5 and an excuse to skimp on anything. The post implied something quite different.
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Golden Key
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And, in my experience, boring work is less boring if I try to do a really good job. YMMV.

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Blessed Gator, pray for us!
--"Oh bat bladders, do you have to bring common sense into this?"--Dragon, "Jane & the Dragon"
--"I'm not giving up--and neither should you." --SNL

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Sioni Sais
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quote:
Originally posted by ExclamationMark:
quote:
Originally posted by Arethosemyfeet:
If it were making jewellery or cakes then you wouldn't expect the same quality from a £5 piece as a £20 or £200 piece, because by paying more you are hiring a longer period of labour.

When I'm being paid by the script, I have to treat it as a commercial relationship, otherwise I get exploited.

I agree. But I do my best whether it's a £5 piece or a £200 commission. I don't see it as £5 and an excuse to skimp on anything. The post implied something quite different.
If one gets a say in the price of commissioned work, that is entirely reasonable, but junior doctors and wage-slaves in general don't get the option that, for example, Mrs Sioni gets when she makes a wedding cake.

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"He isn't Doctor Who, he's The Doctor"

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Leorning Cniht
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quote:
Originally posted by ExclamationMark:
quote:
Originally posted by Arethosemyfeet:
If it were making jewellery or cakes then you wouldn't expect the same quality from a £5 piece as a £20 or £200 piece, because by paying more you are hiring a longer period of labour..

I agree. But I do my best whether it's a £5 piece or a £200 commission. I don't see it as £5 and an excuse to skimp on anything.
If I was making jewellery for £5, it couldn't be my best work, because I wouldn't be able to afford to take the time necessary to do the best job I can for five quid.

But that's not what we're talking about - we're talking about someone who is paid by the hour, not by the piece. Suppose you take a job as a security guard, to keep an eye on some commercial premises during off-hours. Would you be more diligent for an extra 50% in your pay packet?

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ExclamationMark
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quote:
Originally posted by Leorning Cniht:
Would you be more diligent for an extra 50% in your pay packet?

No.
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Sioni Sais
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quote:
Originally posted by ExclamationMark:
quote:
Originally posted by Leorning Cniht:
Would you be more diligent for an extra 50% in your pay packet?

No.
OK, but why impose you own high standards on others who are facing a real cut in pay?

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"He isn't Doctor Who, he's The Doctor"

(Paul Sinha, BBC)

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Leorning Cniht
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(I agree with EM here - I would be being the best security guard I can, whatever I got paid.

If I wasn't getting paid much, however, then I wouldn't stay as the best security guard I can for long - I'd go and get another job.)

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alienfromzog

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quote:
Originally posted by Leorning Cniht:
(I agree with EM here - I would be being the best security guard I can, whatever I got paid.

If I wasn't getting paid much, however, then I wouldn't stay as the best security guard I can for long - I'd go and get another job.)

This is the point.

There are two things here, firstly the significant worsening of conditions is the main issue for junior doctors and secondarily the pay cut.

More hours and more antisocial hours will be worse for patients and have significant effects for work/life balance. This is bad for doctors and ultimately that is ultimately bad for patients as more tired doctors are not as effective.

The money thing - what I was driving at above, and I'm not sure how well I communicated it is that doctors are not badly paid but have lots of other pressures and adding to that a financial pressure is both unfair and unwise. It is not that doctors don't (and won't) do their best for patients, it that the more the outside stresses are, the harder it is to remain so committed.

Junior doctors are indeed cash-rich but significantly time-poor. The most challenging of lives, the most stressful are those who are both cash-poor and time-poor. I would argue - in fact I have argued - that this government has been ruthless in targeting these people. This government loves to talk about 'tough decisions' to which I say BOLLOCKS. Without exception they have gone after the soft targets again and again. I am not saying that doctors are hard-up but if you are time-poor then adding to that money pressures is a significant stress. We have shared the burden of falling wages in real terms along with everyone else.

These new contract proposals will make docs even more time-poor. Doctors are well paid, but when you take into account the costs of exams and course, large student loans and that we have to move constantly, it's not as good as it seems. If you slap a 10-30% pay-cut on that then you are introducing significant stresses. You are measurably making the quality of life worse for doctors.

The effects of this will be felt by patients, in that the last thing most people want is a more-stressed doctor.

It is easy to characterise docs are greedy but I don't think that fair. My colleagues, for the most part are very dedicated and hard-working and make big life and family sacrifices; asking them to make more sacrifices not only unfair, it is unwise.

You are talking about a group of dedicated, hard-working, driven and talented people who really care about their work. But as burnout becomes increasingly an issue, how many do you think will leave? And that's the crux of the matter and will have massive knock-on effects for patients.

Of course, some doctors are driven by money, but it's very much the minority as if you go into medicine for the money, you're stupid. Because there are far easier ways to make money.

AFZ

--------------------
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[Sen. D.P.Moynihan]

An Alien's View of Earth - my blog (or vanity exercise...)

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ExclamationMark
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quote:
Originally posted by alienfromzog:
[QB/] The money thing - what I was driving at above, and I'm not sure how well I communicated it is that doctors are not badly paid but have lots of other pressures and adding to that a financial pressure is both unfair and unwise. It is not that doctors don't (and won't) do their best for patients, it that the more the outside stresses are, the harder it is to remain so committed.

Junior doctors are indeed cash-rich but significantly time-poor. The most challenging of lives, the most stressful are those who are both cash-poor and time-poor. I would argue - in fact I have argued - that this government has been ruthless in targeting these people.

I am not against what you say and I recognise the need for rewards linked to responsibility.

What I do find hard to stomach is that Doctors seem to think they are a special case. You aren't alone in this: in fact, you're well down the list in terms of people who are cash poor and time poor. Lots of people - in far greater numbers - have been going through this for years.

GP's must have seen this at first hand, so why now the bleating as it arrives on their own doorstep? I haven't seen GP's or Doctors (Junior or otherwise) campaigning for the living wage nor have I seen them calling for changes to the herd like existence of workers in call centres. They seem unnaturally focused on themselves through the medium of the closed shop of the BMA.

Take direct action, stand with UNITE on low wage issues and then only then, will I believe you (Doctors) mean business.

[ 01. October 2015, 10:20: Message edited by: ExclamationMark ]

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ExclamationMark
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quote:
Originally posted by Sioni Sais:
quote:
Originally posted by ExclamationMark:
quote:
Originally posted by Leorning Cniht:
Would you be more diligent for an extra 50% in your pay packet?

No.
OK, but why impose you own high standards on others who are facing a real cut in pay?
They are not high standards at all. It is a way of living that is not related to circumstances.

I admit that it isn't easy to accept a lower wage for doing harder work. I've been there: 20 years ago I went from a salary package of well over £70K to virtually zero - and worked rather harder and longer for less or nothing. It wasn't the first time that had happened: what i annoyed? A bit. Did I work any less hard? Nope and I'm no hero.

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alienfromzog

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quote:
Originally posted by ExclamationMark:
What I do find hard to stomach is that Doctors seem to think they are a special case. You aren't alone in this: in fact, you're well down the list in terms of people who are cash poor and time poor. Lots of people - in far greater numbers - have been going through this for years.

There's special cases and special cases. What's specifically new about this is that we've already been squeezed in the same way as the rest of the public sector: More for less, less staff, less resources, real terms pay cuts. AND now, on top of all that, there is this.

AFZ

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Everyone is entitled to his own opinion, but not his own facts.
[Sen. D.P.Moynihan]

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quetzalcoatl
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It's also another Tory attack on another group of workers. If people start arguing that 'I've got it just as tough as you, and I just buckle down and work', the Tories have won. Race to the bottom is their forte.

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no path

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Soror Magna
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Still whining?


Still whining.

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"You come with me to room 1013 over at the hospital, I'll show you America. Terminal, crazy and mean." -- Tony Kushner, "Angels in America"

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quetzalcoatl
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Still defending people against the Tories.

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no path

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Palimpsest
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In the US where things are more privatized and random there has long been a tradition of having junior medical staff work insanely long hours. It was considered part of the initiation.

It's changing a bit. People who have been mistreated by Doctors who haven't slept in a couple days have started to sue hospitals and win large malpractice awards from the hospital. That has a way of encouraging the Hospitals to figure out how to deal with the problem, but it's a slow process.

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alienfromzog

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Some more whining

AFZ

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Everyone is entitled to his own opinion, but not his own facts.
[Sen. D.P.Moynihan]

An Alien's View of Earth - my blog (or vanity exercise...)

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Sioni Sais
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quote:
Originally posted by Palimpsest:
In the US where things are more privatized and random there has long been a tradition of having junior medical staff work insanely long hours. It was considered part of the initiation.

It's changing a bit. People who have been mistreated by Doctors who haven't slept in a couple days have started to sue hospitals and win large malpractice awards from the hospital. That has a way of encouraging the Hospitals to figure out how to deal with the problem, but it's a slow process.

That's strange. I thought that there was always plenty of money to spare for legal fees and damages (that's what liability insurance is for after all) but bugger all to spend on the things that might prevent these cases.

Shame some people might have to die before the UK government realises how weak its case is.

--------------------
"He isn't Doctor Who, he's The Doctor"

(Paul Sinha, BBC)

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Jane R
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They already have. You do know what a major incident is, don't you?
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Boogie

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I want my doctors well rested and well paid, as I do the airline pilot who sits up front when I fly.

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Garden. Room. Walk

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no prophet's flag is set so...

Proceed to see sea
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quote:
Originally posted by alienfromzog:
Some more whining

AFZ

That's special pleading. Many people who are not physicians work long hours and are taken from their children and families to do so, are paid much less than even the contract you're complaining about, and have very little recourse. People in such situations could have, I suppose, have tried harder, finished school, gotten a professional qualification, had the parents with the money to keep them at home and fund their education etc. I get that because physicians look after our health that they are highlighted as somehow special (notwithstanding the inclusion of airline pilots by Boogie).

I am looking at Canada right now - and I don't think other countries are much different - where well-educated people with Master's degrees can't get more than temporary, term to term, sessional lecturer positions for $32K/yr (£16K), without benefits, without holidays/vacation. Where parents work 9-5 in retail, and then again until midnight at a second job serving in a restaurant.

The situation with the junior physicians is compelling because they are able to articulate their case, not because it is a special case. One of my children is working contract to contract in a job formerly held by a permanent civil servant. She'll never have that contract, and always be $5/hour behind in pay of the remnant permanent staff. The only way out is to do something else, and I expect her to start a business instead of resigning herself to that. -- so at least you have a contract at all as a physician. I'm not saying you should stop complaining, but just understand that your situation is the same for everyone.

I think the Zeitgeist (spirit of the times) is to realize that no-one anywhere is owed employment by anyone, that no employer, gov't or private, has any obligation to anyone, that costs and profit are the only indicators of value, and the privatisation is where everything has been going for some 35 or 40 years, long enough that few of us understand progressivism, social democracy, and that in many situations things are done much better by government, and by people employed by government directly than by private corporations.

Will your NHS districts become corporations or at least spin off corporations for some things? Run like businesses, contracting for various services? Like I am seeing lab services (blood, Xray etc) and day surgeries (mainly scoped orthopaedic surgery for hips, knees and shoulders) being contracted out to private companies as it is in many places in Canada?

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Soror Magna
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The new trend here is walk-in clinics. I've seen ads in newspapers that will guarantee a new MD an annual salary of $400,000, without ever having to be on call or see patients in the hospital or set up their own practice. They just sit in a comfy office from 9 to 5 writing prescriptions for beta-blockers and antidepressants for patients they will never see again. Anything more complicated than that gets referred to a specialist. At the same time, doctors in rural areas DO have to work on call and work in the hospital and cover for each other, and the only way to get doctors to practice in small towns is by bribing them with a couple hundred thousand dollars over and above their billing income.

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"You come with me to room 1013 over at the hospital, I'll show you America. Terminal, crazy and mean." -- Tony Kushner, "Angels in America"

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alienfromzog

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quote:
Originally posted by no prophet's flag is set so...:
That's special pleading. Many people who are not physicians work long hours and are taken from their children and families to do so, are paid much less than even the contract you're complaining about, and have very little recourse.

To me, that's just bollocks.

We are in danger of talking past each other. I inevitably have a biased perspective. I am happy to concede that but bias does not necessarily mean wrong. I work very hard to understand and mitigate my own bias. Conversely, working as a junior doctor means I understand what it's like. It's not like other jobs; it is incredibly intense sometimes. There's nothing quite like the fear of being faced with a sick patient for the first time and everyone looking at you to fix it. The more you do it, the easier it gets. There's nothing like the first time you operate without the boss in the room. You do it the same way as when you were being watched but still. And a busy shift, really is non-stop busy for 12 hours.

There are two key things here:
Firstly, all of the squeezing of the public sector has happened to us to. We've had year-on-year pay cuts in real terms as well as being asked, constantly to do more for less. It's not a case of 'well everyone else has had to put up with it.' Not that that's a good argument anyway but.... Secondly the context of what happened with junior doctors hours 20 years ago. The reason why we're so concerned about this contract is that we've been here before in the mid 90s. And it was unsafe. Patients died. This is first and foremost a safety issue.

AFZ

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Everyone is entitled to his own opinion, but not his own facts.
[Sen. D.P.Moynihan]

An Alien's View of Earth - my blog (or vanity exercise...)

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cliffdweller
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I'm an American, so don't have a dog in this fight. But I might suggest it would be helpful to separate the issue of pay from the issue of hours.

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"Here is the world. Beautiful and terrible things will happen. Don't be afraid." -Frederick Buechner

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Leorning Cniht
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quote:
Originally posted by alienfromzog:
Conversely, working as a junior doctor means I understand what it's like. It's not like other jobs; it is incredibly intense sometimes.

To be able to honestly make that statement, you need to have experience not only of your own job as a junior doctor, but of all the other jobs as well. Nobody can have that.

It might be true that junior doctors work much harder than anyone else, and it might be true that their job is more stressful than anyone else's. It seems unlikely to me, but it's not impossible.

Something that's real, rather than willy-waving about how someone's job is easier / harder / more important / whatever than someone else's is to look at the recruitment and retention of doctors. If all the promising F2s are going elsewhere, the pay's too low.

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alienfromzog

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Yes and no.

It's a fair criticism that I cannot know what all other jobs are like; I've done all sorts of things on a part time basis but that's not the same, I know. Although I think there is an objective qualitative difference in what we do which I've tried to describe. FWIW I have huge respect for all sorts of roles that I could not do. And I have and always will speak up for others too. Lots of people do difficult jobs. It's just that most of the critics seem to speak from a place of ignorance. Based on what they say, it feels like they know not of what they speak. In much the same way as people disparage teachers for only working 9-3 with long holidays. It's really not like that.

The thing is though, your argument about low pay and retention rates I don't think works because it relies on the assumption that people are only motivated by money. Which isn't true of - well - anyone. If you look at nurses as a group, if it was about money, most of them would have left long ago. Because they are dedicated to what they do for reasons other than financial remuneration, it's really easy to underpay them.

However the pay cut is of secondary importance. it is bad for morale and feels like a slap in the face to hard working people but what's really got us exercised is the the structure of the contract. WE DO NOT WANT TO GO BACK TO THE HORRORS OF THE MID-NINETIES.

AFZ

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Leorning Cniht
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quote:
Originally posted by alienfromzog:

The thing is though, your argument about low pay and retention rates I don't think works because it relies on the assumption that people are only motivated by money. Which isn't true of - well - anyone.

Well, sure. Doctors, nurses, teachers, priests, academics, artists of all kinds, musicians and so on - nobody doing any of these jobs is solely motivated by money. You could probably add more to this list.

My argument works just fine. If good people who are motivated to do the work, and love the work, are nevertheless leaving to do something else, the pay is clearly too low. (I'd expect to see the effect on recruitment first, because potential new recruits have less invested in the career.)

quote:
Because they are dedicated to what they do for reasons other than financial remuneration, it's really easy to underpay them.
Which is true for anyone who loves their job - anyone in that big long list at the top of this comment, for example.

And you're right - the "market rate" for people who believe that job X is a good thing and worth doing is lower than the market rate for people who just see it as a job, and are looking for whatever career will maximize their income.

I think you're trying to claim underpayment with respect to money-motivated people, by pointing at money-motivated people who you think have equivalent responsibility, equivalent education and training and so on, and saying "we should get that". Which is another reasonable way of looking at how much "should" be paid for your job, but tends to lead you down the path of "my job's harder than yours" willy-waving.

I'm not passing judgement one way of the other on the pay issue, but "these new conditions will cause unsafe working practices" makes a much better pitch than "doctors need more money".

[ 04. October 2015, 22:51: Message edited by: Leorning Cniht ]

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It isn't the money that is driving the poor retention rates in teaching. it's the poor conditions. That article says 4 in 10 teachers quit within a year of qualifying, more leaving before qualifying and a much higher number considering leaving. The reasons given are workload and the continual monitoring.

There's also a slow down in recruitment by 14% and a 10% wastage rate in teachers across the profession.

The government managed to downgrade teachers a few years back as education has always been a lower hanging fruit than the health service.

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