What doctors earn
Authors: Jo Stephenson
Publication date: 02 Set 2009
Seven doctors at different stages in their careers talk candidly to Jo Stephenson about their income
Foundation year 1
Name: Bala Karunakaran
Job: Foundation year 1 trainee
NHS earnings: £21 190 to £31 785
Total income: £26 839
Hourly rate: £10
Bala Karunakaran is nearing the end of his first foundation year at Royal Sussex County Hospital in Brighton. For his third and final rotation he’s doing an unbanded job in acute medicine earning £21 190 a year. His first two rotations, in elderly medicine and general surgery, were banded, and included working on-call and overnight shifts, so he earned 40% more.
An unbanded job is supposed to equal about 40 hours a week. “In reality it’s never just 40 hours. You leave when the job is done,” says Dr Karunakaran. “Often people are doing two or three hours extra a day, but that’s seen as acceptable practice and part of the job. It’s very unusual to come in at 9 am and leave at 5 pm on the dot.”
At the moment he reckons he works at least 50 hours a week. His job includes taking patient histories, ordering tests, chasing up results, and diagnosing and managing patients under the supervision of senior doctors.
On his banded rotations he did one day a week on call and worked one weekend every month. His surgical rotation included a week of nights and then a week of late shifts.
“Junior doctors are respected by the public and treated with respect by other staff in the NHS but we’re at a low level,” he says. “It’s the same starting out in a law firm—the first thing you get to do is make a cup of tea. That applies very much to junior doctors—you start off doing things other people don’t want to do like paperwork but do more as you move up.
“The people asking me to do jobs have done them before. It’s a ladder you’re climbing, and when you’re at the bottom of the ladder you can’t pick and choose.”
He says it’s quite usual to work without a break or stop for lunch and because of this he feels junior doctors sometimes get a raw deal from management.
“It can be stressful, especially when you’re doing on call and have a huge list of patients to see. You just have to go all out,” he says. “You’re overworked but that is part of the training. Being able to handle stress is a requirement of being a hospital doctor. Usually I enjoy it, and I’m learning and getting more confident about making the right call.”
Nevertheless stress can take its toll. “I know at least three junior doctors who have had mental breakdowns and had to take time off,” says Dr Karunakaran, who chairs the BMA’s South Thames Regional Junior Doctors Committee. “There is a lot of support available but probably not as much support before something happens as there is after a crisis.”
It’s early days, but he is keen on hospital medicine and perhaps pursuing a surgical specialty. It’s a competitive world, however, and the way training is structured means a lot of uncertainty.
Is he paid enough? “That’s a difficult question,” he says. “The main issue is junior doctors’ salaries are going down because fewer jobs are being banded. Plus hospitals used to provide free accommodation, but that’s stopped—and that’s definitely a pay cut.
“We’re the first cohort of junior doctors to be charged for accommodation, and I’m paying £450 a month.
“I think we do feel our pay is a bit low, especially when we look at what friends our age are earning. When I tell people my basic salary, they’re shocked because they think doctors are loaded. Yet there are more and more medical students coming through and getting into serious debt.”
Specialty trainee 3
Name: Helen Johnston
Job: Specialty trainee 3 in gastroenterology
NHS earnings: £45 000
Total income: About £47 000 (including extra shifts)
Hourly rate: About £18
Helen Johnston has had a varied career to date. She’s a specialty trainee 3 (ST3) in gastroenterology at the Royal United Hospital, Bath but is about to take up a post in acute medicine at North Bristol NHS Trust’s Southmead Hospital.
Currently she earns about £45 000 a year, occasionally covering extra shifts, which pay £35 an hour.
Her working week begins with a consultant led ward round on Monday morning. She’ll then see referrals from other specialties and wards.
On Tuesday she does her own ward round with junior doctors, and in the afternoon she does an endoscopy training list.
Dr Johnston has an outpatient clinic on Wednesday and her own list, including about four new patients and six follow-ups. The afternoon is spent doing paperwork and research and development.
Thursday is another consultant led ward round and endoscopy training list. Friday is outpatients’ clinic and more paperwork and ward work. In addition, the hospital has an on-call “bleed list” so she may come in early a couple of days a week to observe urgent endoscopies.
Dr Johnston has at least three lunchtime educational meetings each week and is on the general medical on-call rota, which means she works as a general registrar on about one in eight weekends and one in 12 night shifts.
“On the gastroenterology side of things I’m busy but I’m not overworked,” she says. “On the medical registrar side it varies from being busy to being run off your feet. Medical registrar on call feels like the busiest job in the hospital. You’re reviewing junior doctors’ medical admissions and seeing anyone who comes in who’s very unwell as well as any existing inpatients who are medically unwell. You can feel pretty stretched.”
She would like to earn more. “Realistically we should be paid a bit more. I actually earned more as a senior house officer than I do now,” she says.
Dr Johnston is among those whose salaries were affected by rebanding and the introduction of the European Working Time Directive. She has more responsibility but has seen her pay drop because she does fewer hours. She is currently contracted to do a 48 hour week.
She feels ST3s are generally well treated. “We get a lot of support from our consultants,” she says. “They’re always there for help and questions. I think the junior doctors definitely respect us too.
“The best bit about being a registrar is the training, including learning new skills like how to perform endoscopies. And it’s great seeing patients on my own in outpatients.
“I do enjoy on calls. You’re seeing acutely unwell patients so it’s quite a challenge. It’s nice when you feel you have done a good job, although sometimes you wish you could split yourself in three.
“Obviously, as a consultant I’ll earn a lot more. But every year as a registrar my pay does go up in increments.”
Her goal is to be a consultant in acute medicine.
On top of her regular job, Dr Johnston has become involved in medical education. She’s studying for a diploma of medical education in her spare time and is an associate college tutor. She has helped revise and devise training for senior house officers and most recently helped put together a quarterly day-long course in acute medicine funded by the Severn Deanery.
“It’s great for my CV but also in the future I’d like to do half consultant work and half medical education work,” she says.
“As a consultant you need that variety, but I also really enjoy teaching and revising training. Now the European Working Time Directive has come in, junior doctors will get less on the job training so it’s really important that good training is delivered and relevant courses are available.
“Teaching also helps keep you refreshed as you’re constantly updating your knowledge.”
Salaried general practitioner
Name: Katie Bramall
Job: Full time salaried general practitioner
NHS earnings: £61 250
Total income: £68 850 (including out of hours locum shifts)
Hourly rate: About £34
Katie Bramall completed her general practitioner (GP) training in August 2008 and found herself thrust in to a new and competitive world.
An increasing shortage of partnerships and exponential rise in the number of salaried GPs means few can step into their dream job.
“It is very much a buyers’ market,” says Dr Bramall, who has just started a new job at a north London practice. “You need to be quite savvy. You find yourself having to negotiate and have to learn to sell yourself. It’s something most of us have never had to think about before.”
Pay, welfare benefits such as sick pay and maternity leave, working patterns, and responsibilities for salaried GPs can vary a great deal. Only General Medical Services practices are obliged to stick to the BMA’s model contract.
Salaried GPs are generally paid per session and a full time salaried GP would probably do eight to nine sessions a week. Dr Bramall does seven GP sessions earning £8750 a year for each, with medical indemnity cover reimbursed.
A four hour, 10 minute session includes appointments and all associated paperwork. “In reality it takes longer to finish all the work and calls,” says Dr Bramall. “It depends on how efficient you are, but even the best time managers struggle if it’s very busy.”
She does an eighth session as a gynaecology assistant at the Whittington Hospital and is paid £250 a month.
“I do it because I love it; not for the money,” she says. “I’m passionate about improving women’s health services, and it helps make me a better GP.” She was the informal gynaecology lead at her last job.
Dr Bramall also does occasional shifts for a GP out of hours provider. She can do four, six, or eight hour shifts and gets paid £200 to £400 a shift for evenings, weekends, overnights, and bank holidays.
“I get paid more than when I was a hospital doctor, but then I’m more experienced now and the work is much more intense and high pressured,” she says. “A GP can see 25 plus patients in the morning, 10 to 15 plus patients over the phone, write 50 prescriptions, do two or three home visits, see another 15 patients in the afternoon. You may deal directly with 60 patients on a busy day—you don’t think in those terms in a hospital.”
Often, salaried GPs do the less popular shifts and at her last job Dr Bramall did every Friday evening on call and the weekly extended hours session, with no additional pay for antisocial hours.
“Many practices are supportive of salaried GPs and offer them opportunities for development and let them take on management roles, but for some they’re a way of getting through the work,” she says.
Dr Bramall’s new practice has six partners and six salaried GPs for a list of just over 10 000. She will do one late evening shift and there may be occasional Saturday morning surgeries in the future. She received 50% extra for Saturday morning shifts.
She feels lucky in getting a decent contract, which includes an annual quality outcomes framework bonus of £1000.
“When people look at what GPs get paid, there’s a lot of negative feeling that they have a lot of money,” she says. “I think I’m fairly paid, but I work very hard for that. The problem is you can be working in one practice and earning £10 000 to £20 000 less than a salaried GP working in a practice next door.”
She would like a partnership but knows there are many who prefer the flexibility and variety that a salaried role offers. “It’s important there is a choice,” she says. “But at the moment there isn’t much choice.”
Name: Rodney Price
Job: Orthopaedic and trauma surgeon
NHS earnings: £79 000
Total income: £81 000 (including private work)
Hourly rate: About £17.90
Staff grade doctors do a large proportion of the work in the NHS but many feel undervalued. “In the context of average earnings, I’m well paid,” says Rodney Price. “But in respect of the responsibilities I have, the length of training I have done, and the work I do, it’s ludicrous.”
The father of five works 60 to 70 hours a week for Mid Yorkshire NHS Trust. His basic salary is £53 000 a year plus £26 000 for on call, and he tops this up with a small amount of non-NHS work.
He splits his time between two hospitals, working with two consultants and doing elective and trauma surgery. He has his own clinics and operating lists, helps train future consultants, and does ward rounds.
“Basically I do a lot of what a consultant does but I am supervised at arm’s length,” says Mr Price.
He works about one in six weekends and is on call on a one in eight basis
Some days are packed. For example on Monday he has an all-day operating list from 7 30 am to 5 pm at Pontefract, then goes to Wakefield to do a ward round until 7 30 pm.
Other responsibilities include serving on his local negotiating committee and on the BMA’s Staff Grade and Associate Specialist Committee.
He admits he’d like to earn more. “We earn the same money as a consultant starting out and very rapidly that moves apart. I would say that as a senior hospital clinician my pay should probably be 10-15% higher than it is at present.”
Consultants saw their pay increase by 15-25% in their new contract, while pay went up by about 30% for GPs. In contrast, staff grade doctors’ pay went up 4% on average.
Mr Price believes staff grade doctors suffered because the government felt it had been too generous with consultants and GPs. He had hoped to become an associate specialist and has applied for regrading. But as a consequence of the new contract the grade was scrapped nationally, dashing the hopes of many.
“I can be in a situation where my body screams for sleep,” says Mr Price. “I would at some stage like to come off on call. I’m 53, and I find it difficult getting out at nights. When I’ve been up to four in the morning operating, it can take me days to recover. I’d like to give that up and take on a larger management role. But we are, by many of our seniors, seen as failed doctors, and that’s a huge problem.”
Staff grade doctors’ CVs are often packed with experience and many were specialists in other countries.
“There are other senior colleagues who don’t understand where we come from, what we have been through, and who we are as clinicians,” says Mr Price.
“Most of us have come back to this country after living abroad; a lot of us are refugees or economic migrants brought here with a promise of a career. But we don’t have the contacts or the foot in the door to obtain the posts to train for specialisation. We are often pigeonholed into service posts and denied any form of personal or career development.”
Mr Price studied medicine in the Netherlands and worked there and in Germany before coming back to England in 1987 to “start all over again” as a senior house officer on a surgical rotation, moving in to orthopaedics in 1990.
Although he says he is treated with respect by most of his colleagues, staff grade doctors working elsewhere are not so fortunate.
“I’m a big bloke, a big mouth, and can put my views across,” he says. “A lot of my colleagues from other countries are not as articulate and are often bullied and trodden upon.”
Name: Keith Brent
Job: Consultant paediatrician
NHS earnings: £100 000
Total income: £100 000
Hourly rate: About £44
The stereotypical image of a consultant raking in money while frittering away time at the golf course is long out of date, says Keith Brent. “I’m not sure that was ever true, and it’s certainly not the case with my generation,” he says.
He works at Eastbourne District General Hospital, earning £100 000 a year. This includes money for on call and a level three clinical excellence award, which means about an extra £2700 a year.
He’s contracted to do a 44 hour week and is part of a team of five consultants, so he does one night in five on call and works one in five weekends.
His week usually includes three general paediatric clinics. He also sees patients on the ward, particularly shared care oncology patients, and deals with a steady flow of queries from other doctors, patients, and families.
One week in five he’s “consultant of the week” and is in each day, doing a children’s ward round each morning and afternoon, looking in on the small neonatal unit, reviewing patients throughout the day, supporting junior staff, and teaching students.
He does a specialist rheumatology clinic once a month.
In addition, Dr Brent is available to social services and police to examine children who may have been abused or neglected, one of the most difficult parts of his job.
Much time is taken up with meetings, including the hospital resuscitation committee, trauma committee, and meetings with accident and emergency about children’s care.
“Some of the time I’m paid for is also about making sure I’m up to date, so it’s about reading journals, noting practice, discussing cases with other people, going to training sessions,” adds Dr Brent.
He feels he’s paid fairly.
“I realise I get paid much more than the average person in the UK,” he says. “But if I’d gone off to work in the city I might have made a great deal more.
“Personally, I think I’m worth the money because of the level of responsibility, the amount of training I’ve done, and my experience.
“I get paid to get the easy questions right all of the time and do that quickly and keep the system going, but also to take the really difficult decisions and hopefully get them right most of the time.”
He also does a considerable amount of unpaid work including helping coordinate the Saving Londoners’ Lives scheme, which teaches schoolchildren resuscitation techniques.
He is deputy chair of the BMA’s Central Consultants and Specialists Committee, which can take up to 20 hours a week.
Dr Brent believes that getting involved in wider health policy is another way to help improve patient care, but it does mean that he has to do a lot of juggling. “Meetings usually take place 9 to 5 so I will move clinics to fit it all in,” he says.
“This often means I am writing reports or doing letters for clinics at evenings and weekends, in what would otherwise be my own time.
“I don’t think I’m horribly overworked because I’m not run off my feet, but I do have to work quickly and efficiently.”
Consultants are highly respected and valued by each other, junior staff, and management at Eastbourne, says Dr Brent. But he adds, “In some trusts there may not be such a happy relationship between consultants and management, and consultants may not feel as valued.”
In the future he’d like to take on a more managerial role and maybe do some more subspecialty work in rheumatology or oncology.
He has no set goals when it comes to pay. “I hope it will rise not just year on year but as I move up and take on more responsibility,” he says. “I would hope to get more clinical excellence awards if I work hard and deliver high quality care.”
Name: Prit Buttar
Job: Full-time GP partner
NHS earnings: £110 000
Total income: £117 000 (including private consultations)
Hourly rate: About £45 an hour
Prit Buttar is a partner in an Oxfordshire practice and for him it’s pretty much the perfect job.
“There is nothing I would rather do,” he says. “It’s a job I think I’m good at; I’m appreciated by most of my patients, well paid, and live in a nice part of the world—how can it be any better than that?”
He works about 47 hours a week at the four partner General Medical Services practice in Abingdon, which has a list of about 10 700, and also employs two salaried GPs.
His £110 000 a year NHS income includes £4000-5000 for training medical students. In addition, he earns between £5000 and £10 000 a year for private work.
“Everyone feels they’re worth at least what they’re paid and probably rather more,” he says. “The reality is I meet people from all sorts of backgrounds who aren’t nearly as happy in their work as I am, and few earn as much as I do. On balance, given my experience, the years I have given to the job, the hours I put in, the skills I have, I’m adequately paid.”
He became a GP in 1991 and feels he’s a well respected member of the community. “Even though we’re only about 50 miles from London we don’t have the list turnover you tend to get in a big city and we get to know our families over a prolonged period of time,” he says. “I feel part of the community. I’m in the supermarket and people smile and nod; it’s a nice position to be in.”
During a typical week he does morning surgery from 8 30 am to 11 30 am Monday to Friday, and four afternoons a week he does surgery from 3 40 pm to 6 pm. He works one Saturday morning in four and one evening every fortnight he works an extended hours session up to 7 30 pm.
Between morning and afternoon surgery, Dr Buttar makes phone calls, does home visits, and deals with admin and paperwork. “Phone calls usually come first, because they may influence the number of home visits,” he says. “Then it’s back to the surgery in time for the afternoon post to arrive from the hospital; each letter has to be read and, if necessary, acted on. There’s the twice daily task of dealing with repeat prescriptions that need to be re-authorised and reviewed, and teaching is fitted in somewhere too.”
As a partner, other responsibilities include dealing with practice finance and keeping a close eye on quality outcome framework targets.
“I turn in to a bully to make sure everyone’s up to date with their blood pressure checks and hassle those who are behind,” he says.
Together with another partner, Dr Buttar is also leading an expansion that should see the practice take on another partner and move in to the building next door.
Mentoring medical students who come for six-week attachments is a big part of his job. Students are with the practice three days a week and during a 10 hour day, eight hours will be spent with the student including a lot of one to one time.
“They’re only with us for 18 days so we really pack it in,” says Dr Buttar. “When we’re doing a home visit we’ll talk about managing asthma or diabetes while we’re driving.”
He also has a particular interest in palliative care, ensuring the surgery meets best practice standards and developing an enhanced service for those with life threatening illnesses.
“The idea is to have a more structured and proactive approach to their care so we’re not waiting for them to ring us when they’re in pain and feeling miserable but trying to anticipate problems,” he says.
Other responsibilities include serving on the local medical committee and the BMA’s General Practitioners Committee.
When it comes to GP pay he says the debate should focus on value for money.
“Yes, it’s a lot of money for one person to earn, but if you look at my practice’s NHS income then you’re talking about £24 every time someone comes to see us,” he says. “If you compare that to going to see a dentist or a vet then that’s fantastic value.”
He estimates his practice gets about £85 per patient per year. “That’s for unlimited access to us. Compare that to pet insurance. The cheapest I’ve found is for a hamster and it was considerably more than that. So the government pays me less per patient than it would cost to insure a hamster and for that amount of money we get through an awful lot of hamsters.”
Name: Peter Davies
Job: Consultant physician
NHS earnings: £175 000
Total income: About £180 500 (including medico-legal work, private practice, and book royalties)
Hourly rate: £48
Peter Davies is a world renowned chest physician but admits he never expected to earn as much as he does.
He’s been a consultant for more than 21 years, is lead clinician for tuberculosis in Liverpool, and has a silver award for clinical excellence.
He earns £175 000 a year working at two trusts—the Liverpool Heart and Chest NHS Trust and Aintree University Hospital Foundation Trust. On top of that he gets about £4000 for a small amount of private practice, medicolegal work, and royalties from an international textbook.
“My pay is more than I ever expected it to be, but there are physicians on more,” he says. “People on the platinum award would earn about £27 500 more.”
Professor Davies is contracted to work a 44 hour week. On top of that he’s on call at home one night and one weekend in four at the Liverpool Heart and Chest Hospital and—not at the same time—he’s on call at Aintree one in 10, going in both days at weekends. However, he says: “I haven’t had to get out of bed for a long time.”
Monday and Tuesday are his busiest days. On Monday morning he’s at the Royal Liverpool University Hospital for a multidisciplinary meeting to discuss patients with tuberculosis. He then travels to Aintree where he does a ward round and has an afternoon clinic.
On Tuesday he’s at a community based tuberculosis screening clinic. Then it’s off to the Liverpool Heart and Chest where he may do a small ward round and has another chest clinic, finishing about 6 pm.
On Wednesday morning he’s at Liverpool Heart and Chest for a two hour radiology meeting with surgeons and physicians from across Merseyside to discuss problem cases.
He oversees four registrars. The rest of his week may include supervising bronchoscopy lists, more ward rounds and seeing inpatients, teaching students, meetings about research projects, and plenty of paperwork and reading.
In addition he coordinates a specialist electronic service to give advice to doctors across the UK on drug resistant tuberculosis and works for the charity TB Alert.
“Because I earn so much I do feel it is incumbent on me to give some of that back, not just in terms of shedding a few pounds but spending time with the charity and for me that’s important,” he says.
His charity work and other roles, including chairing the tuberculosis section of the International Union Against TB and Lung Disease, include speaking at conferences and a lot of international travel.
Last year until October he was president of the Liverpool Medical Institution, and he still serves on several committees.
Professor Davies, who is an honorary professor, also devotes much time to academic and research work, reviewing scores of papers and abstracts and assessing grant applications.
He published six peer reviewed papers, 12 abstracts, and six other articles last year, and in May 2008 the fourth edition of his international textbook was published.
“One of the most satisfying aspects of my job is knowing that I can give one of the best opinions on a complicated TB case anywhere,” he said.
“The frustrations of my job come out of NHS organisation, particularly when I’m trying to coordinate an integrated TB service.
“I’m working with several primary care trusts and four acute trusts that aren’t coordinated.”
Ideally he’d like an academic appointment that would allow him to drop some of his NHS work, giving him more time to apply for funding for larger research projects.
“I earn much more than most people in most sectors, but then I have three degrees and a doctorate and am an FRCP [fellow of the Royal College of Physicians] but that’s not unusual for a consultant at a large teaching hospital,” he says. “We have more letters after our names than most bankers and lawyers, and that may be one reason we’re worth the money.”
Competing interests: None declared.
Jo Stephenson freelance journalist