Industrial action within the NHS has ignited widespread interest in the earnings of doctors in the UK. This article delves into the complex topic of doctor pay, providing a fresh perspective grounded in data and addressing key questions surrounding medics’ earnings in England. We examine the evolution of doctor salaries over time, compare them to the broader UK labor market, and benchmark them against international counterparts.
It’s crucial to approach discussions about pay with caution, as it’s inherently sensitive and multifaceted. Presenting earnings data involves numerous methodologies and assumptions, each with limitations. The insights shared here are intended to contribute to a nuanced understanding of this intricate issue, not to offer a definitive or exhaustive analysis. Our aim is to inject objective, evidence-based information into a highly debated subject, rather than to prescribe a “fair” level of compensation.
Understanding the Recent Doctor Pay Settlements
A recent pay agreement, announced in July and covering the financial year up to March 2024, outlined a 6% pay increase for consultants. Doctors in training are set to receive a £1,250 uplift in addition to this percentage rise, resulting in an average total increase of 8.8%.
Consequently, the basic NHS salary range for consultants now falls between £93,666 and £126,281. Accounting for additional earnings from on-call duties, medical awards, geographical allowances, and extra work, average full-time NHS consultant earnings are projected to be around £143,100.
Junior doctors’ basic pay now ranges from £32,397 to £63,162. Average total full-time earnings are estimated at approximately £41,300 for doctors in their first year post-qualification, rising to £71,300 for specialty registrars nearing the completion of their training, as detailed in Table 1.
The Historical Trend of Doctor Salaries in the UK
Previous analyses have illustrated the shifts in average salaries for doctors in training, consultants, and other NHS staff groups. It was estimated that by March 2023, consultant and junior doctor salaries had decreased by approximately 14-15% in real terms compared to levels 12 years prior, adjusted for inflation. These initial estimates have proven to be remarkably accurate reflections of the actual trends.
By utilizing more comprehensive data on actual pay settlements, we can extend our historical perspective and account for changes in seniority and experience within different grades, factors that might influence earlier analyses. This approach also presents challenges, as records of implemented pay deals are somewhat inconsistent, and some agreements were phased in throughout the year.
Nevertheless, the overall trend clearly reveals alternating periods of sustained real-terms pay increases and subsequent periods of real-terms decreases. This fluctuation is problematic, as doctors, like many individuals, tend to be loss-averse, experiencing the negative impact of real-terms pay cuts more intensely than the positive effects of real-terms increases. While the minimum basic starting salary for consultants in 2022/23 (around £88,000) was lower in inflation-adjusted terms than it was a decade earlier (£96,000 in 2012/13 prices), it mirrors the level of two decades prior (£88,000 in 2002/03) and surpasses that of three decades ago (£75,000 in 1992/93). It is important to note that this data reflects underlying pay frameworks, not individual pay packets, which will increase with career progression and years of service, as shown in Figure 4.
The historical trend emphasizes the significance of choosing a baseline when examining changes over time. While junior doctor and consultant pay scales have declined in real terms over the past decade, a longer-term view reveals a more favorable picture relative to inflation. The chart also underscores the challenges that arise when the employment landscape evolves. Historically, junior doctors and consultants received similar pay settlements. However, the four-year deal for junior doctors, averaging 2% annually, was agreed upon before the pressures of the pandemic and the surge in inflation, quickly rendering it a less attractive agreement.
While this analytical method has its merits, it is limited to pay settlements and doesn’t capture the impact of other contractual changes. Notably, in the financial year 2003/04, coinciding with the introduction of a new contract, total earnings per full-time equivalent consultant reportedly increased by 12% in real terms, with basic salaries rising by approximately 25%. A survey from that period indicated that consultants who transitioned to the new contract experienced an average annual pay increase of £12,454. Although two decades ago, this example illustrates a challenging scenario where government-led pay increases, initially perceived as unaffordable, are subsequently followed by periods of below-inflation pay deals to recoup costs. More recently, pension tax modifications are set to benefit consultants financially, but like other broader changes, these are not reflected in analyses of basic pay increases.
Various changes to junior doctors’ NHS employment terms and conditions also need to be considered when comparing pay over time. For example, the phased implementation of the European Working Time Directive reduced maximum weekly working hours from 56 to 48 in the five years leading up to 2009, impacting hourly equivalent wages during this period. While the 2016 contract aimed to maintain average earnings, it altered the balance between basic and additional pay and rates. More recently, the broader terms of the 2019 multi-year pay settlement included an additional pay increment level, meaning the total investment for 2020/21 was effectively 3%, rather than the headline 2%. This nuance is not reflected in the chart above, which is limited to pay uplifts.
Doctor Salaries Compared to the Wider UK Economy
Examining doctor pay in relation to salaries across the broader UK economy offers valuable context. While comprehensive data is only available up to 2021/22, and direct comparisons are complex, the data reveals insightful trends. In 2021/22, the average NHS earnings for doctors in their first year of practice exceeded the median UK wage, placing them above the majority of workers but below the mean wage. Specialty registrars’ average NHS earnings surpassed those of nearly 90% of the wider workforce, while consultant earnings positioned them between the 98th and 99th percentiles. This relative pay standing for consultants has remained consistent over the past decade, but junior doctors have experienced a decline in their percentile ranking over time.
GP partner earnings, derived from practice profits rather than a national pay framework, are even higher relative to broader labor market earnings. However, it’s important to note that GP partner earnings increased by 17% in the last year included in the data, likely partly attributable to additional payments made during the pandemic. Some of this pandemic-related funding may not be sustained. Furthermore, these figures are sensitive to assumptions used to convert GP earnings per head (£142,000 for a partner) to full-time equivalent earnings. GP partners at the time were contracted to work 87% of a full-time contract on average. It is not guaranteed that increasing contracted hours would proportionally increase take-home pay.
These analyses are limited to NHS earnings, excluding potential income from work outside the health service. Data on wider earnings sources are limited. A previous, albeit dated, survey found that only one in eight NHS employers had accurate information on consultants’ private practice work. However, older research indicated that private practice accounted for, on average, nearly a third of consultants’ total earnings, varying significantly by specialty. This level may have changed since. Wider labor market earnings data are limited to employees and do not include profits earned by business owners, who constitute a significant portion of high earners. The chart also doesn’t factor in the financial value of pensions, with NHS schemes being particularly generous.
Medical school admission is highly competitive, often requiring substantial student debt, and the training and work are demanding. Therefore, expecting doctors to be among the highest earners is reasonable. Ideally, comparisons would be made with professions with similar demands and training, but data limitations restrict this. However, previous research on the impact of a medical degree on lifetime earnings suggests a favorable outcome, even considering factors like prior academic achievement.
International Comparison of Consultant Salaries
Given media reports about clinicians seeking opportunities abroad, comparing doctor salaries internationally is relevant. The BBC specifically requested this analysis. Limitations exist, including a lack of readily available data on junior doctors and variations in employment terms and conditions, including pensions and working hours. Available earnings data for ‘specialists’ (covering consultants) are inconsistent, with some countries, like England, only providing data for salaried doctors, while data for others, such as the USA and Australia, are only available for self-employed doctors, who typically earn more.
Various methods exist for international earnings comparisons, including adjusting for exchange rates, purchasing power parity, or average earnings within each country. Despite the inherent caution required in international comparisons, England appears to rank below countries like Germany but above others like France in specialist doctor salaries, regardless of the chosen measure.
Pay variations also exist within the UK. While comprehensive data on hospital doctors’ overall earnings (including non-basic pay) is limited to England, basic salary comparisons are possible. Junior doctors in Scotland, Wales, and Northern Ireland, with similar contract terms, experience incremental pay increases with each training year. In England, where the junior doctor contract diverged in 2016, pay rises are larger but less frequent. For example, a doctor entering their sixth year of specialty training in England earns £63,152 annually, while their Northern Irish equivalent earns £50,903 (potentially rising to £60,260 depending on training program length).
For consultants, pay increase sizes vary based on years of service. After four years as a consultant, basic pay increases by 2.9% in England, Scotland, and Northern Ireland, and by 5.7% in Wales. However, basic pay plateaus earlier in Wales for the most experienced consultants compared to other UK nations. These comparisons must be interpreted cautiously. Non-basic pay accounts for approximately 25% of consultant earnings in England, so variations in additional earnings allocation could significantly impact actual take-home pay.
Moving Beyond the Pay Impasse
While pay is central to current industrial disputes and a tangible measure of valuing doctors’ contributions, policymakers must proactively address broader factors affecting staff retention and wellbeing. Work-life balance, quality of care delivery, and professional autonomy are all known to be crucial. The pressures of the pandemic and efforts to reduce elective care backlogs have left staff feeling undervalued and exhausted, highlighting the need to improve wider working conditions.
No single metric can definitively determine a “fair” pay deal. However, a lack of independent analysis has led to debates based on flawed figures. Often, true inflation levels are misrepresented, basic pay is confused with total pay, and starting pay is presented as average pay. Affordability arguments frequently overlook the fact that some additional pay returns to the public purse through taxes. Given the potential impact of strikes on doctors, colleagues, patients, and the public, a more informed discussion is essential. This, along with necessary reforms to the official pay review process, could help resolve the current impasse.
