Posts Tagged ‘Obstetrics’
How much do doctors get paid?
Posted on January 25th, 2009 by Rob
When during my medical school interview I was asked “Why do you want to be a doctor?” I didn’t reply “cos I wanna get paid loads of money”… but I thought it! However, if you do want to make buckets full of cash perhaps medicine isn’t the right career for you. It’s true that medicine is a well paid profession. After all you spend 4-6 years at university, amount thousands of pounds worth of debt, and generally work rubbish hours. There are better paid professions and jobs. How about accountancy or business? Your reasons for choosing a career in medicine are personal to you, however I wouldn’t imagine that money can possibly be a sole reason. I admit that you do get paid pretty well and that sweetens the deal.
The pay scale for doctors is rather complicated, but during this article I will attempt to give you an idea of what doctors get paid. Starting with my salary as a new house officer (F1):
| Month | Gross pay | Deductions | Net pay |
|---|---|---|---|
| August 2008 | ?1483.62 | ?256.70 | ?1330.60 |
| September 2008 | ?1703.41 | ?348.48 | ?1473.35 |
| October 2008 | ?4918.45 | ?1647.51 | ?3389.36 |
| November 2008 | ?1828.41 | ?603.83 | ?1343.00 |
| December 2008 | ?3810.81 | ?1316.03 | ?2613.20 |
The two things that stand out on this is table is firstly the amount you get paid varies greatly from month to month and secondly there are lots of deductions.
The reason that my gross pay varies so much is because I choose to work extra hours as a locum and also because NHS banding changes every 4 months. Most hospitals are short of all grades of doctors because the working hours have reduced so much recently, there simply aren’t the doctors to cover the new shift patterns. This means that if you are motivated by money you can give up your weekends, evening and even holidays to work. The locum rate for a house officer is ?20-30 an hour.
The deductions on a junior doctors pay include income tax (PAYE), national insurance, pension contributions, student loan re-payments, and payment for the doctors mess (?18 per month – see previous blog posting for explanation). Total deductions work out at about 30% of your gross pay.
The basic pay for junior doctors (taken from the NHS careers website):
Foundation House Officer 1 = ?21,862
Foundation House Officer 2 = ?27,116
Specialist Trainee = ?28,976 – ?44,562
GP (non partner) = ?52,462 – ?79,167
GP (partner) = ?80,000 – ?120,000
Consultant = ?73,403 – ?173,638
This is the very basic pay and does not include out of hours banding, locum pay, cremation forms (a major addition to house officers income) or private work (not for junior doctors).
If a person wishes to be cremated once dead a ‘crem form’ must be completed by two different doctors that don’t work together. It is generally the job of the house officer to complete part one of the form. Part one is filled in by a doctor that saw the patient while they were alive, during the illness that lead to their death and can state what the person died of. You must sign the form to say that they are sure that the person died of natural causes and not foul play. Part 2 is completed by the pathologist. The form takes about 20 minutes to complete (less if you knew the patient well) and you get paid ?70 per form. I have a friend who did his first F1 job in care of the elderly and he did an average of 3 forms per week – that’s an extra ?900 per month. Some people think it’s immoral to get paid for this. I even know a doctor that refused to cash the cheques! This is silly because even if you refuse payment the funeral director still charges the family and so by refusing payment you just line the pockets of the funeral director.
NHS doctors also get a salary banding that reflects the hours they work and how unsociable the hours are.
| Band | Hours per week | Unsociable hours | Amount added |
|---|---|---|---|
| 3 | >56 | any | 100% |
| 2a | 48-56 | Lots ( 1 in 3 weekends ) | 80% |
| 2b | 48-56 | Moderate ( 1 in 5 ) | 50% |
| 1a | 40-48 | Lots ( 1 in 4 ) | 50% |
| 1b | 40-48 | Moderate ( 1 in 6 ) | 40% |
| 1c | 40-48 | Some ( 1 in 8 ) | 20% |
The most common banding for a Foundation House Officer 1 is currently 2b (50%), making the average wage for a F1 ?32,793. Again this is before you do any locum shifts and it doesn’t include the cremation forms. However, fairly soon the most common banding will go down to 40% and then 20% and it won’t be long before all F1 jobs are unbanded.
Remember that during your F1 year you will do 3 four month rotations and each rotation (job) will have a different banding. My girlfriend started with a 40% banding for her first job but then her second job was unbanded resulting in a 40% pay cut. My first job (obstetrics and gynaecology) was unbanded but when I moved to my second job (surgery) I got a 40% pay rise. You will notice, however, that my actual monthly pay was more when I was doing obs and gynae. This is because during the unbanded job I had plenty of spare time to do lots of locum shifts.
3 Comments »Working hard
Posted on September 22nd, 2008 by Matt
Sorry about the short absence from both Rob and I. We’ve both been working extremely hard, certainly I’m doing a total of about 20 hours contact time at college, plus all of the homework and coursework that goes with it.
Rob is still doing his Obs & Gynae rotation at the minute, and I’d say we’ve a long way to go before the EU Working Time Directive starts to affect junior doctors. Rob tells me that this week he is on the nightshift, starting at 9pm, and finishing at 11am the following morning. He jokes, “I have about enough time to work, eat, and sleep – usually in that order!”
Not to worry, I’m off at the end of October for a week, and I will personally be overseeing some significant updates to the site, including the Interview Question Bank, Work Experience, and the difference between the teaching/assment styles. I also know Rob is planning to free up some time to make some contributions too!
Don’t forget that while we’re working away at the site, it will remain free-of-charge to our users, so do make the most of it! I can promise you that next year’s users will have to pay for their membership…
Matt is glad he isn’t a junior doctor – yet…
No Comments »Obstetrics ward week
Posted on August 16th, 2008 by Rob
Being a doctor is tiring and I?m afraid to say a little less fun than expected. My bleep never stops. I start work at 8am every morning and my bleep usually goes off before I’ve taken my coat off, adjusted my tie, and had my morning wee. It then goes off every five – ten minutes until I leave at about 7pm. I should finish at 5pm but I just don’t get all my jobs done. I feel that this might be my own fault. I haven?t found a natural flow to things. I start a to-do list each day and cross jobs off when they?re done. As people see me they quickly add as many jobs to my list as they can (midwifes, patients, SHOs and registrars). I just get started on a job and then my bleep goes and I have to apologize to the patient, go and answer my bleep, add the job to the list and then back to the patient. This was very exciting for the first few days but now it?s getting boring. I have so many forms to fill in. I?m hardly using anything that I learnt in the last 6 years ? I?m just filling in blood forms, writing the same old things in the notes, filling in TTAs (to take away (prescription)), and taking blood/putting in venflons.
In the last week I?ve made maybe three medical decisions on my own ? 1 yes this lady is constipated and needs and enema. 2 ? Her haemoglobin is low so let?s give her iron tablets. 3 ? This woman could get sick so I?ll call the registrar (times 100). The reg is always in theatre so I have to go down to theatre, and explain what?s wrong with the woman. He then tells me what to do and I go and do it.
The most fun I had was with a woman who had a caesarean section for twins. 5 days post-op the midwife bleeped me and said ? ?I?m just not happy?. This is a common midwife complaint. So I went down and had a look and her wound was oozing green horrible stuff. So I bleeped the reg ? he was in theatre. I went down and told him (I?d already taken the initiative to start antibiotics ? very brave of a young doctor as starting new drugs in any pregnant or breast feeding woman is dangerous. Anyway the reg said ? you better remove the sutures and lay it open ? very exciting ? So I went upstairs and on the ward cut open the stitches that were holding this poor woman?s tummy together. It was very smelly. I didn?t vomit (but almost). She?ll have to spend extra time in hospital and heal by secondary intention (new growth ? as oppose to primary intention where the two sides of a wounds stick back together. You can?t suture an infected wound.
On Tuesday we met my favourite member of staff so far ? Father Rodney is the cheerful, up beat Chaplin. He single handily tries to keep the moral of everyone high. It was Thursday when I first called Father Rodney. A 21 year old woman went into labour at 24 weeks gestation. 24 weeks is on the borderline of viability. The baby is alive on NICU where it has a 95% chance of dying. The neonatal doctors beat me to the room and explained the bad news to the family. I was next in. I had to explain that I was an obstetric doctor and here to look after mum only ? I know nothing about the care of babies. The baby was in a bad way but mum was also in need to care as she had lost lots of blood. The reg was (you guessed it) in theatre. He promised that he would be up as soon as he could. I needed to get IV access and start fluids to replace the blood loss, take bloods to make sure that she didn?t need a transfusion and start a drip of syntocinon. This is a drug that makes the uterus contact. She had a bit of placenta left in the uterus and it was making her bleed heavily. If the synto didn?t do its job she may have to go to theatre and that could end up in a hysterectomy which would end her chances of future pregnancies. It was all too much for her, her husband and her parents. It took me 4 attempts to get a line in ? she needed lots of fluids plus the synto drip fast. That means a very big needle ? little needles restrict the rate at which you can transfuse. However, this woman?s veins were just too small for the venflon. My flipping bleep going off every 2 minutes now ? the same midwife bleeping me until I answer. At last I remember Father Rodney. I bleeped him (almost in tears myself). After I finished the medical stuff he took over, meaning that I could answer my bleep to the stupid midwife that *urgently* needed me to fill in a form.
This was my ?ward obstetrics week?. Next week is ?gynae week?. I?m told that ?gynae week? is the hardest.
2 Comments »Gynae on-take
Posted on August 6th, 2008 by Rob
For those who are unsure Gynaecology is a surgical speciality that deals with the female pelvic organs. It is a massive field covering, infertility, contraception, menstruation, pelvic cancers (e.g. cervical cancer), sterilization, sexually transmitted diseases, incontinence, sexual health, menopause, and key hole surgery just to name a few. Most gynaecologists are also obstetricians. Obstetricians are doctors that look after pregnant women and the foetus before it?s born.
Today was my day to look after all the women on the gynaecology ward. This is any woman who has had surgery, or who was going to have surgery or who was acutely unwell with a gynaecology problem (e.g. ectopic pregnancy, painful ovarian mass). There are 10 consultant gynaecologists at my hospital and they all have patients on the gynae ward. I had to look after all their patients. They would arrive on the ward at any time with their registrar and I would have to have a list of their patients and a pile of their patient?s notes. I would then follow them around while they see their patients. They would chat to the patient then give me a list of jobs to do (e.g. write her up for x drug, or get some bloods). I would make a list of jobs from each mini-ward round and then get on with the jobs until the next consultant arrived to do her ward round. Any patient that the consultant said could go home needed several forms filling out before they could go (called TTAs (to take away)). Then if a nurse was worried about a patient I had to go and see them. If a patient felt sick was in pain or felt generally ill I had to see them. If a GP felt that his patient was ill he would call me and I would have to accept his referral. The patient would come to the ward and I would have to do a full clerking in. This was the busiest day of my life. I was supposed to go home at 5pm and I didn?t get away until 8pm. I had great fun though.
No Comments »First ‘proper’ day
Posted on August 5th, 2008 by Rob
So I arrived at 8am and the House Officer whose job I am taking over gave me a bit of a tour. I?d met her before and she we?d chatted about the job at length. At about 9am she said ?right ? I start my new job in London tomorrow morning and I have to pack and drive there today ? do you mind if I go??. So there I was in Central Delivery Suite (CDS ? Labour Ward). I?m a doctor. I?m wearing scrubs; I have a stethoscope around my neck, a name badge saying ?doctor?, and a bleep. Good lord ? What has just happened?
A midwife comes to me and says ?can you prescribe some morphine for my lady in 3, doctor?? I don?t know! Can I? I hesitate for a second. I know nothing about this woman. I?ve never seen her, never spoken to her, and I haven?t asked about her allergies. The midwife gets a bit more hurried and so I cave in and just do as requested ? my first prescription for morphine no less. I?m still expecting the police to break the door down and arrest me.
Then my bleep goes off. I pick up the phone and called the number on the display. I say ?hello you bleeped the obs house officer?. The voice replies ?It?s the reg, where are you??. I explain that I?m on CDS. ?Well I can?t do the section on my own come to maternity theatre to assist me?. So I stand up and ask the midwife ? where?s maternity theatre? The door directly in front of me!!
I spent the next three hours holding retractors, pushing here, pulling there and getting back ache. The afternoon was filled with more Caesarean sections but with a different reg. Unlike this morning the reg was chatty and asked questions, showed me things and explained what he was doing. By the last case he said do you want to try closing the skin? And my answer: ?YES PLEASE?. So on my first day I learnt and did subcuticular skin sutures.
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