Comment by jphoward | Hacker News Reader

Comment by jphoward | Hacker News Reader

Medical training (both med school, and early career) in the UK is in a fascinating situation at the moment. The term "morale is at an all time low" doesn't begin to cover the (justified) anger I see in them at the moment. Independent government bodies admit inflation-adjusted junior doctor wages since 2004 have gone down by 30%. Last week, some doctors got 4.5% pay rises, which were met with incredulity given inflation is at 9%, the tremendous efforts during Covid etc., but juniors don't even get that - they get 2%.

To put it into context, a junior doctor in the UK makes £29,384, and they will leave university with close to 6 figure debt, with 7.3% interest rates.

But it's not even just that. Over the last few years, the UK has embraced the roles of non-medically trained physician associates (PA), which in the USA have been a success by relieving medically trained doctors from the more protocolisable jobs, so they can focus on the more difficult. However, a PA earns £39,766.76 - far more than the juniors with none of the responsibility. I won't go into details on the issues about how juniors have to maintain annual portfolios, change hospitals every year etc. etc., because the Royal Colleges say it's necessary to become a good doctor, whereas PAs don't need to do any of it.

So when juniors in the UK see this, that they could have gone to University for 2 years rather than 5, with lower entrance requirements, and end up in a far better financial situation in a shorter time, many of them just don't want to be a doctor anymore.

I can say, without a doubt, that junior doctors will strike in the UK within the next 2 years. I am no longer one, but I completely get where they are coming from, and support them.

> However, a PA earns £39,766.76 - far more than the juniors with none of the responsibility

"far more than the juniors" is quite misleading: junior doctors only make less than £40k during the two Foundation Years immediately after graduating; they make more than that as soon as they start their Core and Specialty training [1] (and this is ignoring any supplemental Banding payments).

Once they've completed specialty training and transitioned from being a Junior Doctor to a Consultant (which, admittedly, takes several years, and involves considerable responsibility) they're on a minimum of £84k [2] (not counting any extras like Clinical Excellence Award payments, which can go up to £77k). If they become a GP instead of a consultant, pay is more complicated, as GPs have traditionally been Partners in a practice, though an increasing proportion are Salaried employees instead.

[1]: https://www.bma.org.uk/pay-and-contracts/pay/junior-doctors-...

[2]: https://www.bma.org.uk/pay-and-contracts/pay/consultants-pay...

>Over the last few years, the UK has embraced the roles of non-medically trained physician associates (PA), which in the USA have been a success by relieving medically trained doctors from the more protocolisable jobs, so they can focus on the more difficult. However, a PA earns £39,766.76 - far more than the juniors with none of the responsibility.

I've heard that PAs in the UK are essentially the equivalent of junior doctors (what we Americans call residents), except permanently.

> non-medically trained physician associates (PA)

This is not always true. I'm not sure what the requirements are, but my wife is a PA and she basically went through the first year of medical school and did several hospital rotations (similar to what students do in the last 2 years of medical school in the US, as I understand it).

To say they're not medically trained seems like an overstatement.

50% of healthcare resources are used in the final 5 years of life. As Western populations age, expect healthcare to be increasingly squeezed.

Australia seems to have the best approach - everyone has access to basic services, but those who can afford to pay for Private Insurance get access to better hospitals, more comprehensive diagnostics and treatment, and much shorter waiting times.

That.... seems like the worst approach?

You're right.

Private Health care is a joke, it enables you to skip the queue if you're willing to pay for private health care but you won't find me using them.

I elected to cancel my private health care this year, it means in terms of tax I'm slightly worse off by a couple of hundred dollars (AUD) or so. But it means it goes to the Government rather than a private healthcare fund that seeks to make a profit.

If I do need elective surgery in the future though, it's likely far away as a healthy 34 year old. I'll pay for it in cash which likely would only be double my out of pocket expenses for an elective surgery anyway.

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