Wednesday, April 6, 2016

What Happens To Doctors When The Government Stops Playing Nice

As medical students prepare to exit the comfortable familiarity of medical school and start their residency training, they may have heard all the horror stories that are about to befall them in just a few months. Lack of sleep, difficult patient care environments, and no personal time. But at least our residents don't have to face what our colleagues across the pond are having to endure, a protest against their very own government.

The medical residents in England, or junior doctors as they are called, are about to start a nationwide strike over the government's new employment contracts that are being offered. Actually, offered is too mild a word. More like coerced. The much vaunted National Health Service said they made their final best offer back in February which was then promptly rejected by the British Medical Association.

How bad is the contract? Junior doctors in England are similar to the residents here in the States. They are in training from three to nine years depending on their specialty. Their base salary starts around £23,000, or about $32,500. This can rise to over £30,000 if the resident works more nights and weekends, or what the British euphemistically call "unsociable hours". This is where the new government contract really stings.

The NHS's proposal will increase the base pay for regular hours, but decrease the amount paid for unsociable hours. Their hope is that decreasing the salaries of the doctors who work on the weekends will allow more money for more of them to work during those periods. This way more patient care can be accomplished 24/7 and patients don't have to wait for the following Monday to get their treatment. There is also the belief that patient care suffers during the weekend, with a 10-15% increased mortality compared to a weekday. By having more staff available during the weekend, some of this may be mitigated.

As you can imagine, this hasn't go over well with the BMA and the junior doctors. They counter that weekend patients tend to be sicker to begin with. There is no evidence that having more physicians available on weekends will change the statistics. Plus it is an insult to anybody who has to work unsociable hours to have to take a similar pay as somebody who works normal business hours on weekdays. So more nights and weekend shifts with less compensation? No dice, says the BMA. Therefore the strike is on.

As usual, the government is shaming the doctors, portraying them as heartless for even caring about money. They say that 5,000 operations have to be postponed because of the protest. A total of 24,500 procedures have been postponed as this is the fourth strike since the contract impasse. The BMA counters that instead of cutting the salaries of the junior doctors who have to work weekends, the government should just cough up the money to pay more people to work those dreaded hours. But since the NHS is already constantly running a deficit, that is unlikely to occur.

This is what happens when there is a single payer system and the government controls every aspect of healthcare. There is a monopoly on the payer side of the business and little to no recourse for anybody who is dependent on it to negotiate a reasonable agreement. Beware what you ask for during this election year.

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