Just what should we do about Tim Worstall and his misinformed article on doctors’s pay? In these pages Tim accuses doctors — of which I am one — of not really understanding economics. Perhaps he’s right. But in order to make economic points about my profession, you might assume you’d need to know a little bit about doctors first.
Tim’s argument rests on an incorrect assumption that a huge chunk of doctors are unqualified. He begins:
Just what should we do about these resident doctors and their impertinent pay demands? First off, go back to calling them medical students.
Resident doctors have never been called medical students, who are in their first five years of medical training and still based at university. They pay tuition fees, have student loans and are not paid a wage. They leave university with higher student debt because they have spent longer at university than most people, and so have more years of student finance and tuition fees. Possibly he could see this stage as similar to barristers paying their masters for pupillage, which he notes doesn’t happen any more in the legal profession.
I can see why Tim might be struggling. Without doing a basic Google search you might be forgiven for thinking that “Resident Doctors” was just a rebrand by the BMA in 2024 to boost the pay demand of what used to be called “Junior Doctors” (note, Tim, not “medical students”!), But the term “Junior Doctors” was widely recognised as one of the most unhelpful terms in doctor identification because it led to people like Tim thinking we were unqualified. I graduated from medical school eight years ago and have worked in many different NHS jobs as a doctor, often doing shifts where I have been the most senior person on a ward. Because of career breaks to have children I’ve not yet reached consultant level. This does not make me a “doctor in training”.
If public opinion is the terrain you want to deploy on, then let’s play
It’s not just Tim who’s at fault. Less forgivably, former Tory Health Secretary Victoria Atkins was criticised back in 2023 for describing junior doctors as “doctors in training”. Whatever you think of us and our “impertinent pay demands”, it’s simply an untrue statement, akin to describing all journalists as “writers in training“ because they are not the editor of their paper.
What he’s really talking about — Resident Doctors — can mean anyone from their first year after medical school (foundation year 1 or FY1) up to acting consultants who are highly qualified medics finishing off their training, and doing the equivalent work to a consultant. And they are highly prized. Hospitals need more generally skilled, less experienced doctors to run the day to day workings of the wards. This helps them to gain experience that allows them to develop into more specialised doctors, but we also need lots of them as they are. Far from a failure of the NHS to “bother to train all the (sic) potential doctors it has”, you can’t have a hospital full of expensive consultants. Surely someone keen to keep costs down would recognise that? I wouldn’t want a doctor fresh out of medical school to perform my heart surgery, but neither would it be a desirable outcome for a brain surgeon to fill in my routine blood test request forms every week.
I suspect his understanding of Resident Doctors being under “supervision” is that of a consultant standing over an FY1 as they examine a patient. This doesn’t happen. Registrars and consultants are far too busy with their own work to be wasting time watching their juniors doing the jobs they have been training 5+ years to do. Instead, like every other profession, doctors work on a referral basis. Even an FY1, the first year of residency, has lots of responsibility and they only call on their “supervision” when required. On a night shift they might take a history from a patient who has been found lying for hours after a fall, prescribe some intravenous fluids, request an X-ray and then send the pictures to the registrar on call who has the experience to know what operation would be needed and how soon. The registrar will then decide to leave the patient in the hands of the FY1 until the next morning or come in and review the patient themselves.
Aside from his category errors, the thing that amused me the most about Worstall’s article was that, despite an appeal to cold-hard economics as to why we shouldn’t be paid the top 10 per cent of the income curve, he switches argument entirely and declares that the public would never stand for it. Yes Tim, I’m sure the Great British Public — famously indifferent to #OurNHS — would prefer hedgies and stockbrokers to be paid the best out of all of us. I’d be the first to criticise the BMA’s constant pay demands, but if public opinion is the terrain you want to deploy on, then let’s play. Perhaps we should both submit our pay packets to the approval of a YouGov poll? I promise to accept the results.
