Doctors are utterly wrong, and also utterly right

The Herald Scotland

01-08-2025

The rationale behind these prohibitions is very simple, which is that their striking is deemed to place at risk the lives of members of the public. The rationale for banning doctors from striking would be exactly the same. To argue, as many strikers do, that lives are not at risk when doctors absent themselves from work is to argue that they do not save lives when they walk through the door of the hospital. I do not believe that, and given their high level of education it is impossible to accept that the striking doctors believe that either. Perhaps it just makes it easier for them to sleep at night.
'First, do no harm' are the four totemic words extrapolated from the Hippocratic Oath. Hippocrates would not have approved of today's doctors' principle of 'First, go on strike'.
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The unpalatable truth is that many of England's striking medics, qualified and accomplished as they are, have all the self awareness of a toddler. The typical path to becoming a doctor lends itself to a relatively accurate stereotype. The rigorous academic requirements mean that doctors will tend to have gone to a good school, which in turn means that they will tend to live in an affluent area, which in turn means that they will tend to have grown up in relatively comfortable circumstances.
The youngest of the strikers will not have been exposed to what most of us would consider to be 'real life'. They go from school, to medical school, to the NHS, with little or no exposure to the outside world. They have no need to understand how the wealth creating private sector, which pays their salaries, works. They need not trouble themselves with the economic impact of low public sector productivity. They are unbothered by archaic systems and dismal outputs because they have never been exposed to anything else.
They are cocooned; everything is seen through the prism of the NHS. It is hardly surprising, then, that they have been so easily manipulated and exploited by their trade union, which is one of the most fiercely politicised lobbying groups in the country.
Not all pre-consultant doctors can be tarred with this brush. A thoughtful few risked ostracisation by speaking up, such as Dr Adam Boggan of the Royal London Hospital, who said: 'I was alarmed because a BMA representative had told a Sky News reporter that losing public support was a price that they were willing to pay. I am not willing to pay that price. My education was funded by the taxpayer … the relationship between the doctor and the patient is based on trust and based on confidence. If we do damage to that basic relationship, that's bad for everyone.'
You may, at this point, be thinking two things. Firstly, that I have disdain for doctors. But nothing could be further from the truth; indeed, I am so keen on doctors that I married one. The second, for the eagle-eyed, is that I said two seemingly contradictory notions can be true at once, and I have not yet mentioned the second one.
So here goes; doctors are grotesquely underpaid and should be remunerated to at least the degree they are demanding. There is little public understanding of what lies beneath the title. Unlike almost any other job, a doctor will have started making career choices at the age of 13. A school pupil, in S3, will have to choose a particular mix of subjects for their National 5 exams in order to ensure that being a doctor remains a viable career path. They'll need straight A's the following year, of course, and then again at Higher, which will generate only a conditional offer for a Scottish medical school.
A good performance in S6 will be required, along with a series of extracurricular activities to elevate themselves above all the other kids who will be sitting a further aptitude examination which will give them the right to be interviewed for medical school. If they do get in, they have six years of university, followed by two years as a Foundation doctor and a further seven or eight as a registrar, often working debilitating hours. They will, in between treating patients, be paying to sit Royal College exams to allow them to continue their careers
Ten years of flawless academic achievement followed by ten years of practice in the NHS, working for one of the most inflexible, unsympathetic and obstructive employers in the country, in a failing health system which creates even lower morale, offers a reward of something around £65,000.
For context, a train driver, with no academic qualifications and after a three-year qualifying period, will earn £55,000, before overtime and other bonuses, to which doctors are not entitled. What would you be?
There is a way around this. Public sector pay is the chaotic consequence of successive governments rewarding the trade union which causes the most trouble with the best pay settlements. We should, instead, create an independent public sector pay commission, staffed by private sector recruiters who understand how to evaluate market value based on education, difficulty, responsibility, demand and so on. They would identify a midline salary and apply a market value above or below for that job.
Doctors in England behaved appalling this week, egged on by their trade union. They have articulated their complaint with a maturity that may match their age, but does not match their status. They have further corroded public trust and, ironically, prompted the ordinary person in the street to question the NHS, again.
Fundamentally, though, their complaint is valid. Our health service is not facing an 'if you pay peanuts you get monkeys' scenario. It is facing an 'if you pay peanuts doctors will go and work somewhere else' scenario.
Andy Maciver is Founding Director of Message Matters, and co-host of the Holyrood Sources podcast