Edward Davies: Money, money, money

Edward Davies It’s a well known fact that all doctors leave work at 4:30 in a gold Bentley, dispersing £50 notes to the massed peasants. They unwind in the evening by sipping a glass of 1961 Dom Perignon in their bath of ass’ milk in the East Wing of their gated mansion, whilst watching private performances by the Royal Shakespeare Comany.

If this does not ring true then you are simply letting the side down, and you might want to watch tonight’s Panorama to get the real picture of what your colleagues are up to.

Because if you can stay awake for the latest round of doctor-bashing you’ll learn such highlights as 6,478 people in the NHS earn more than the Prime Minister and 540 break through £200,000. The top ten GPs each earn over £300,000 – and the highest paid works for Hillingdon PCT and takes home almost half a million pounds.

Shocked? No, I thought not.

Most doctors accept they are well paid (although that is a fairly recent phenomenon, it must be said), and a small minority at the top might even confess to being overpaid. So why do doctors not share the media’s outrage at the systemic abuse of my be-taxed pounds (harumph)?

It is not because they are insular, arrogant, money-grabbing bastards,… probably…, but because they understand why doctors earn what they do and exactly what they are being paid for.

For example I know nothing of the £300,000+ GPs mentioned above, but you can be fairly sure that most are as much businessman as GP, running more than one practice in the area, perhaps a pharmacy, employing a number of staff from a number of professions. In any other sector, if we could not find a single businessman earning £500,000 a year, you’d wonder what they were all doing so wrong.

And not only that, but doctors are pretty intelligent, well qualified people. One consultant physician “earning more than the Prime Minister” (now the international standard measure of public outrage) spoke to BMJ Careers last year about his income (£175,000). He accepts that his pay is “more than I ever expected it would be,” but makes a compelling case for it: he has three degrees, a doctorate, an FRCP and is an honorary professor. He published six peer reviewed papers, 12 abstracts, and six other articles last year alone, and in May 2008 the fourth edition of his international textbook was published. He’s worked for various committees, charities, and academic institutions and is a world expert in his field. Oh, and he makes people better. With forty years experience in one organisation (the NHS of course) there’s a pretty good argument he’s earned his income. A CV like that in another sector could triple it.

So why do the papers and public get so vexed by the whole doctors’ salary thing? It is not because they are insular, arrogant, money-grabbing bastards,… probably…, but they simply don’t get it. And you can hardly blame them. Even the most complex clinical diagnosis is like Playschool next to the complexities of GP pension arrangements. One doctor’s Fellowship of the Royal College of Physicians (FRCP) is another man’s Federal Rules of Civil Procedure. Knowing your “programmed activities” from your “dynamising factor” takes a career to get your head round.

Frankly, there is little point in making the public “get it.”

Like the bankers and footballers before them, doctors probably just need to accept that high pay comes with negative headlines, and head to the country residence in the Aston Martin to recuperate for the weekend.

Edward Davies is editor, BMJ Careers

Competing interest: The author should ‘fess up to potentially benefitting from the high consultant salaries should his old man snuff it.