If you continue without changing your settings, we’ll assume you’re happy to receive all cookies from the BMA website. Find out more about cookies
When you visit any web site, it may store or retrieve information on your browser, mostly in the form of cookies. This information might be about you, your preferences or your device and is mostly used to make the site work as you expect it to. The information does not usually directly identify you, but it can give you a more personalised web experience.
Because we respect your right to privacy, you can choose not to allow some types of cookies. Click on the different category headings to find out more and change our default settings. However, blocking some types of cookies may impact your experience of the site and the services we are able to offer.
These cookies are necessary for the website to function and cannot be switched off in our systems. They are usually only set in response to actions made by you which amount to a request for services, such as setting your privacy preferences, logging in or filling in forms.
You can set your browser to block or alert you about these cookies, but some parts of the site will not then work. These cookies do not store any personally identifiable information.
These cookies are required
These cookies allow us to know which pages are the most and least popular and see how visitors move around the site. All information we collect is anonymous unless you actively provide personal information to us.
If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance.
These cookies allow a website to remember choices you make (such as your user name, language or the region you're in) and tailor the website to provide enhanced features and content for you.
For example, they can be used to remember certain log-in details, changes you've made to text size, font and other parts of pages that you can customise. They may also be used to provide services you've asked for such as watching a video or commenting on a blog. These cookies may be used to ensure that all our services and communications are relevant to you. The information these cookies collect cannot track your browsing activity on other websites.
Without these cookies, a website cannot remember choices you've previously made or personalise your browsing experience meaning you would have to reset these for every visit. In addition, some functionality may not be available if this category is switched off.
Our websites sometimes integrate with other companies’ sites. For example, we integrate with social networking sites such as Twitter and Facebook, to make it easier for you to share what you have read. These sites place their own cookies on your browser as a result of us including their icons and ‘like’ or ‘share’ buttons on our sites.
This year I made the decision to change from being an orthopaedics trainee to an emergency medicine trainee. Yes, as people were quick to point out, there would be challenges and it would be no easy path, but three years into T&O and I realised I was far better suited to the diversity and urgency of the emergency department.
And then the DDRB report was published. One of its recommendations says: ‘Pay should be based on stages of training and actual progression to the next level of responsibility, evidenced by taking up a position at that level.’
Our pay is currently based on more than that. It takes into account our clinical experience and responsibility, our academic achievements and our life experience. Together these create better doctors, and our salaries reflect that.
The DDRB proposal is not so much limited as utterly unfair. Change specialty and bring the skills you learned to another one? You’ll be penalised. Step off the rota to complete clinical research that may one day save lives? You’ll be penalised. Have children? And remember this is 2015 not 1915 – you’ll be penalised.
You’ll hear lots in the coverage of the contract negotiations about ‘pay protection’ and ‘pay progression’. The terms are not immediately obvious but my own experience illustrates them well. I transferred from orthopaedics to emergency medicine – pay protection – and continue to receive the appropriate increment (‘pay progression’).
It matters because my value as a doctor is more than a number on a badge. My value as a doctor is more than a gap on a rota. The DDRB recommendations disincentivise any career path that does not fit its homogenous model.
What evidence does it have for thinking this model is best? Does it have something against children or PhDs?
The DDRB model only works if you have had a clear run from medical school to the foundation programme to specialty training. Only then does grade equate to experience.
My experience is greater than my grade would suggest. On 5 August, I’ll step into the emergency department and be able to aspirate a knee or ankle, manipulate a shoulder or wrist, and plaster a fracture pretty much anywhere. Others starting in Emergency Medicine may not have these skills and time will, very appropriately, be spent teaching them.
But the DDRB isn’t interested in my skills, experience or clinical judgement.
This will affect many of us personally but it will also have a negative impact on the profession. I once worked with a GP trainee who had changed specialty from neurosurgery. He had moved from a hugely over-subscribed specialty to one which, we know all too well, is crying out for doctors.
Under the DDRB recommendations, he would have had no acknowledgement of the five years of clinical, academic and life skills he brought to general practice, and a substantial drop in salary.
What happens to doctors put in this position? They take the salary cut, and can perhaps no longer afford their rent or mortgage. Or they stay in a specialty that, for whatever reason, doesn’t suit them and they never bring their skills to one that does. Or – and this is a very real possibility – they take those skills out of the NHS altogether and go somewhere that values them.
Ellen McCourt is an ST3 in emergency medicine in north Yorkshire
Visit the BMA website for more information and updates on junior and consultants contract