Crunching the data: are resident doctors in England badly paid? | Doctors

Doctors resident in England voted to strike for five days from July 25, reviving one of the most bitter industrial conflicts in the NHS.

At the heart of the line is PAY: the British Medical Association (BMA) says that resident doctors (formerly known under the name of Junior) have seen their real profits fall by more than a quarter for 2008. The government affirms that union demands are unaffordable and that they have already received generous increases in recent years.

Are the strikes therefore a “useless and unreasonable” decision, in the words of the Secretary of Health, Wes Streting? Or a necessary step on the way to restore the doctor’s remuneration?

The resident doctor’s salary is still below the 2010 levels

After the 2007-08 global financial crisis, Pay stagnated at all levels in Great Britain. But resident doctors had worse than most. The average worker in the private sector now earns 7.5% more than in August 2010, taking into account inflation (including housing costs and advice tax increases). However, the salary of resident doctors fell by 10.2% in March this year.

An average salary increase of 5.4% was awarded for this year, which will begin to appear on wage terminals next month. But even with this uprising, remuneration will always be lower than the levels of 2010.

Resident doctors are fully qualified in medicine but still take third cycle training. Their path begins with the foundation training, before switching to basic training in a large field, then training in a specific specialty of medicine, for example surgery.

They are not the only NHS workers to have seen their salary reduction in real terms. Recent compensation increases for residents mean that consultants and nurses have experienced proportionally greater cuts than certain training levels – although different levels of training have seen different reductions in their real reality over the years.

Two inflation measures, two realities

The BMA said that the real terms paid for resident doctors have dropped by almost 21% in the past 17 years – but their calculations have used inflation measure called RPI. The RPI is considered an obsolete measure of inflation and statisticians avoid using it. The government prefers a more recent measure called CPI (the above graphics use a similar measure – CPIH – which takes into account prices, as well as tax and advice tax costs).

RPI is generally higher than the IPC – giving unions a greater salary reduction figure than government estimates. However, the government cannot take the moral ground here – it still uses RPI for several official calculations, especially when calculating interest on student loans that most resident doctors will reimburse each month.

The graph below shows how the use of different inflation measures, as well as different comparison dates, can benefit from each side in the negotiations.

How does the doctors’s salary compare international?

It is impossible to compare the salary of resident doctors to other countries, because various health systems involve various training programs. Pensions and other professional advantages also differ between countries. There are limited data comparing the remuneration of specialist doctors – which includes consultants – but some countries like the United States and Australia are lacking data for salaried professionals.

The organization of economic cooperation and development has embarked on the comparison of the doctor’s specialized remuneration through countries – with the year 2020 being the last estimates that included England. The figure shows that England is near the top of the peloton (after taking into account the cost of things in different countries), but several countries including Germany and Ireland have paid more.

The figures align with separate OECD data showing that the NHS has a relatively high rate of doctors moving abroad, with at least one doctor trained in the United Kingdom practicing abroad in the last five years. The BMA chair, Tom Dolphin, said that wage increases would help reduce this figure.

What countries do these doctors trained in the United Kingdom be? The figures from the General Medical Council noted that Australia was the most common destination for doctors who let practicing outside the United Kingdom in 2023, followed by New Zealand, Ireland and Canada. However, the NHS is good to recruit abroad to replace leaving – 42% of doctors from the English NHS had primary medical qualification from another country in 2023.