by John Knox
I don’t mean to be unkind, but we could probably take £20,000 a year out of doctors’ salaries without it having much effect. In Scotland, that would save the NHS around £200m a year which could be used to meet other rising costs or even employ more doctors.
According to the OECD, Britain has fewer doctors per thousand people than any other European country. It also pays its doctors more than any other European country. On average, GPs earn around £80,000 a year. Senior consultants in our hospitals may earn as much as £110,000. Partners in a GP practice may earn up to £103,000 – but that includes the costs of running the practice. Salaried GPs, employed directly by the NHS, earn anything between £53,000 and £81,000.
These numbers defy economic logic. How can the UK have so few doctors and at the same time pay them so much ? In a normal market you would expect high wages to attract a large number of workers, the supply would then exceed demand and the wage rate would fall. But of course we are not dealing with a normal market. Medicine, very largely, is a state-controlled business and the powers that be – politicians and the professional bodies – determine the salaries paid and the numbers of doctors.
There are always plenty of applicants for the UK’s 32 medical schools (5 of them in Scotland) – 16 applicants for every place at the last count. And the number of specialised training places, after basic qualification, is again restricted. The system is so tightly controlled that it has left Britain, and Scotland, with a chronic shortage of doctors – so much so that a third of our doctors are from overseas – 10 per cent qualified elsewhere in Europe and 28 per cent qualified outside Europe, mainly in Asia and Africa.
It seems to me that it would make more sense to loosen the stranglehold on entry to the profession and pay those in it a little less in order to balance the books. Individual doctors would then be under less time-pressure and we might then see a fall in the number of complaints against doctors which the General Medical Council says have risen 23 per cent in the last year.
Now you might say doctors have a very responsible job, they are all clever men and women, they have worked long and hard through university and training, they have not been paid high wages while junior doctors, so they are entitled to a substantial salary. Indeed it’s a sign that society places a high value on their work and that they are among the most respected professions. All this is true. All I am saying is that £80,000 a year is excessive and unnecessary.
It is a throw-back to the old days when old boys dominated the profession and were able to restrict membership of their club in order to keep their rewards artificially high. It was also a wage designed to provide for two people, doctors’ wives often serving as unpaid receptionists and secretaries. Nowadays woman make up half the profession and a lot live in a two-income households.
A salary of £80,000 or more is also unfair when compared to other professions. Experienced nurses are paid around £30,000, teachers £40,000 and the average wage is around £26,000. Not much wonder there was considerable public anger when doctors took industrial action in June over their generous pension arrangements….an average annual pension of £68,000 a year. They had lost touch with the fact that the whole country is having to take a 10 per cent cut in our living standards as a result of the bankers’ recession.
So what can the Scottish government do about it all ? Well it can start moving towards a doctor’s salary of £60,000. Next time the contracts with our 5,000 GPs come up for renewal, that lower salary should be the basis for working out the practice payments. Health Boards – who employ the other 5,000 doctors directly in their hospitals – could advertise all new doctors’ posts at the reduced rate.
Of course there would be outrage from the leaders of the medical profession but I think that would soon die away – as it did over the introduction of the NHS in the first place. And, in any case, the change would have to be introduced slowly to allow the universities time to train more doctors. But I don’t believe it would lead to any great exodus from the profession. Medicine is, after all, a vocation and £60,000 a year is a comfortable living.