A medical career is special. It is a privilege. This is not due to monetary incentives or corporate benefits, but because the opportunity to alleviate suffering and strive for excellence makes for a rewarding and exciting job. However, in the words of the 19th Century Physician Dr Humphrey Rolleston, "Medicine is a noble profession but a damn bad business."
Every day thousands of well-trained, highly skilled junior doctors carry out their duties with enthusiasm, integrity and respect. This is reflected in numerous patient satisfaction surveys as well as a 2014 IPSOS MORI poll that demonstrated 90% of people trusted their doctor (by contrast, only 16% trusted politicians).
Doctors seek to serve their patients in the best way they can. In fact it is the trust and appreciation of patients that motivates them through a long nightshift or a weekend away from loved ones. However, this does not mean that the needs and aspirations of doctors differ from those of anybody else. They too have relationships and families. They too aspire to own a home, travel and spend time with their family. Whilst it is inevitable that sacrifices will be required, it is also perfectly reasonable to appropriately remunerate for missed bedtime stories, birthdays and Christmas lunches.
Maslow's "Hierarchy of Needs" proposes that the motivations that drive us as a species can be grouped into basic needs and those for growth and development. According to this model, when basic needs such as food or shelter are unfulfilled a person is unable to step up to the higher levels.
Undermining and undervaluing an individual impacts on self-esteem and precludes any chance of acquiring "self-actualisation," the ultimate stage where an individual is able to reach their full potential and develop characteristics such as concern for community and a strong moral and ethical standard - characteristics that are pre-requisites for good medical practice.
Research by Truman Bewley from Yale University showed that employers were reluctant to reduce salary because they believed this would hurt employee morale, reduce productivity and negatively impact recruitment. Ultimately they concluded that these costs outweighed any gains from salary reduction. Conversely, a study from Harvard Business School showed that raising salary above expected levels led to increased productivity, whilst studies by Shapiro and Stiglitz showed that increasing salary improved discipline and reduced labour monitoring costs.
A potential 22% pay cut would have a significant impact on a junior doctor salary, which currently stands at just over £22,000 for newly qualified doctors and approximately £50,000 for those with several years of experience. Moreover, in the era of top-up fees, medical students could now leave university with a debt burden of £70,000 over a six-year training programme.
In The Wealth of Nations, Adam Smith, wrote
"It is not from the benevolence of the butcher, the brewer, or the baker that we expect our dinner, but from their regard to their own interest. We address ourselves, not to their humanity but to their self-love, and never talk to them of our own necessities but of their advantages."
The reciprocal of Smith's statement would suggest that a pay cut with worsened working conditions could dis-incentivise doctors.
Doctors have academic fortitude and a skillset that can be applied to a variety of careers. Any further deterioration in working conditions may force doctors to seek options outside of medicine. Alternatively, some may emigrate to locations such as Canada or Australia where they can earn better remuneration and working conditions; this year almost 7,500 doctors have applied for Certificates of Good standing from the General Medical Council allowing them to work abroad.
In his blog on the Conservative Party website, Dr Hugh Byrne asserts that that if doctors migrate, "ready replacement will come from UK medical schools whose places are completely oversubscribed." Given that there are only just over 6,200 medical students qualifying every year, the impact on the workforce is likely to have a greater impact than suggested by Dr Byrne. His further assumption that the shortfall could be filled by doctors "from abroad" is also ambitious given that only 37% of the current doctor workforce are foreign-trained . The general scepticism over immigration coupled with Theresa May's concerns over loss of "community cohesion" secondary to it will hinder any attempts to increase that number.
The people of Britain deserve a well-paid, highly skilled healthcare workforce because they pay well for it. According to the Office of National Statistics, an annual income of £30,000 attracts a tax bill of £6,781, of which £1,257 is spent on healthcare. The repercussions of junior doctor pay reforms are serious and affect us all; the potential exodus that could result would undoubtedly negatively impact on the quality of healthcare.
The objection to the junior doctor pay deal on offer is not childish petulance, avariciousness or political gaming. Nor is it an attempt to align junior doctor remuneration with financial sector packages. But it IS about money and being paid a fair wage for a demanding job.
Whatever the eventual outcome of this dispute is, what is certain is that if pay and working conditions are severely compromised, doctors will naturally gravitate towards better opportunities as anyone would, and without doubt, we will all be worse off for it.