I get asked this

[dc]

Every so often, someone will ask me if I don't want to go back to my old job, if I don't miss it. Leaving aside that that isn't an option anyway, since I simply don't have the physical stamina to even consider doing a fraction of what I used to (I can put in a lot of effort for a defined, limited period, as with a con or something like that: not as a continuing, open-ended commitment)...

Of course I miss it. On the one hand, it was a fascinating job, and on the other you got to help people directly, occasionally even saving their lives. Even if I could do it now, though, I wouldn't. Here is an account of some of the reasons why. I could see it was going that way fifteen years ago.

Comments

[tanngrisnir.livejournal.com]

It would take too long to go into all the details of why things are the way they are (shorthand: Bloody Thatcher!), but there are not enough porters. Volunteers in NHS hospitals only do things like run canteens for visitors, not actual hospital work.

NHS doctors are underpaid. Not necessarily the consultants (although the consultants I have known largely work much harder for their money than you would suspect from some newspaper stories), but the other ranks. The total take-home pay might not be too bad, but that is largely because of the number of hours worked. I think it has improved a little, but when I was working, it was certainly possible for a junior doctor to be getting less per hour than a student nurse. (And nothing like as much as a plumber would make!) The level of remuneration in the UK is not at all comparable with that in the USA. But not many people I knew were in it for the money.

Why there isn't a move to the USA...? Hmm. Quite a lot of people in Britain simply wouldn't want to move to the USA in the first place. Also, certainly when I was working, many doctors simply would not want to go to the sort of healthcare system the US has, where the health care you get depends on what you as an individual can afford (or your employer can give you). Of course, we have had a succession of governments who seem to want to turn the NHS into precisely that. :o(

[weofodthignen]

Yes of course, the elephant in the room is that in the US you can quite easily die, be maimed, or be rendered destitute--or blight your family financially--by being unwise enough to get sick. Even with some employer-provided health insurance. And wages in the US are severely depressed by the health insurance burden, not to mention the out-of-pocket costs of all but the rarest health plans. About the only non-wealthy people with reasonably good healthcare in the US are the elderly on teh nationwide programme for them, Medicare, and they're doing their best to make that unaffordable too--for one thing because the costs of ever-increasing numbers of retirees accessing more and more outrageously expensive treatments are dragging down the entire economy.

I am a fervent exponent of nationalised health care, always have been. I think everyone who grew up with it is.

But there are tons of clinics for the poor in the US--because of the shameful need. And research hospitals that the system throws money at. And while I'm well aware that most Brits don't like the idea of living in the US--least of all under the current régime--a lot of us do come over every year, just not in medicine for some reason.

I think all decent doctors work long hours, and I don't think they've found a way for residents not to work crippling hours while learning how to practice. While recognizing that, and the strain it puts on a person, and the much higher ceiling on wages in the US, in my experience actual disposable income at different income levels tends to feel much the same in the two countries. The tax structures are different, and the necessities one has to (or feels one has to) pay for are different, but it feels much the same in terms of financial comfort or strain. And people who can afford not just two cars but a non-employed spouse or alternatively paid daycare tend to forget others can't . . . you know? Physicians tend to be at that level of comfort in both countries, whereas university professors, for instance, notoriously do not.

However, making less than a nursing student is clearly just economically strange, much though I respect nurses and much though I am aware of the market forces bringing them closer and closer to wage parity with some kinds of physicians.

In the US, more and more of the patient contact is with an RN or a physician assistant. Legal authority to prescribe is the only real barrier to their entirely replacing physicians in some settings. Conversely, a lot of the Florence Nightingale stuff in the hospitals is done by various grades of Nurse's Aides and even volunteer "candystripers." I'm getting the impression the British system has refused to go that route? It makes the dynamics very different--paradoxically, I think it contributes to the mystique of the physician, since the doctors have a tremendous interest in guarding their superior status. But it also means cost pressures lead to some decisions being made alone by a nurse that should have been made as a team--notably the gatekeeper medical insurance decisions.

The problems here stem from the morally indefensible profit-driven system. Your problems seem to stem from wilful misdirection of resources.

M

[tanngrisnir.livejournal.com]

...just not in medicine for some reason

One reason there could well be the very high level of litigation in the USA.

I know a lot of people do go to the USA, but I was just pointing out it is not universally seen as overwhelmingly desirable. There are lots of reasons for that, some of them just that it's a foreign country.

actual disposable income at different income levels tends to feel much the same in the two countries. The tax structures are different, and the necessities one has to (or feels one has to) pay for are different, but it feels much the same in terms of financial comfort or strain. And people who can afford not just two cars but a non-employed spouse or alternatively paid daycare tend to forget others can't . . . you know? Physicians tend to be at that level of comfort in both countries

Except at the top of the tree, that really isn't the case in the UK. I can think of hardly any doctor I knew in the UK whose spouse was not also working, because they needed to both be working to have a reasonable standard of living. Also, I have worked with US doctors, too, and they did have more disposable income and were used to it.

There is some truth in the long hours statement, although there isa difference between long and crippling. Also, long hours in the 1950s and 60s was one thing; long hours in the 2000s is something else, it is much more demanding.