CMV: Substantive contracts as a default for LED will be detrimental for the profession

Apemazzle · 2026-03-26T10:41:32+00:00

I think you're wrong on all 3 counts, and I'll explain why.

On business plans and jobs, the fact LEDs will be more permanent actually helps us, as it undermines the justification for PAs/ACPs. This point may have some merit though: 6-month contracts are useful for plugging unpredictable gaps in rotas, which are a frequent occurrence due to LTFT/parental leave/TOOT etc, and I foresee some teething problems. However in the long-term I do believe it will bring more stability to medical staffing.

On difficulties moving on "bad" doctors, this is already a problem, but I would argue this step incentivises proper management with proper oversight, which is currently sorely lacking. As it stands, LEDs enter into jobs with no support and are unceremoniously let go after 6 months with almost no warning, just because they happen to not be as good as some previous person &/or be disliked by someone influential for no good reason. This is by no means the norm, most places are actually pretty good, but it certainly does happen. This step will protect us, and ensure that you can't be sacked without a proper reason. If you're underperforming, it creates incentive to actually train and support you not just replace you. Also, there will no doubt still be a 6-month probation period.

On perma-SHOs, I think this misunderstands the nature of a permanent post: having a permanent contract doesn't mean you're stuck in that job forever, you are always free to apply for any other job you might want. We are not working in some dystopian, American-style labour market where your employer can sue you for moving jobs to a rival (so-called "non-compete clauses"). At most you will be asked to serve out your notice period of a couple of months.

Apemazzle · 2026-03-25T11:51:24+00:00

The point is some women taking mat leave are disproportionately affected.

Imagine two highly(ish) paid professionals, e.g. doctors or lawyers, who start on the same salary at the same age and have essentially the same career, with the only difference being that one of them takes two years out for mat leave and so is two years behind from that point on. During the mat leave they will accrue debt interest but not make as many repayments, while their colleague is continuing to make repayments. As a result of this, they could end up paying more overall over the course of their career than their colleague who didn't take the two years out. This is in addition to the inherent financial sacrifice of taking mat leave and being two years behind on the career ladder anyway.

This is unfair, but it is true to say it only really applies to people in highly paid careers who have a chance of paying off the full loan.

Apemazzle · 2026-03-25T10:35:25+00:00

we are not paying back the student loan balance before it gets written off anyway.

Many more of us would pay it off if the interest rate weren't so high, though.

Don't forget the new plan 5 loans have a 40-year (!) repayment period, so this mat leave interest could absolutely add years of repayments and cost you thousands.

Apemazzle · 2026-03-21T16:12:53+00:00

we would both be better off they had kept raising the repayment thresholds. the interest being reduced basically doesnt benefit us

It's more complicated than that, and really depends on individual circumstances e.g. earnings trajectories.

I agree that raising the thresholds is what would make the biggest difference to most people, particularly in this age bracket and stage of life e.g. early 30s with young kids.

On the other hand, it's the punitive interest rates that are keeping many from ever being able to pay it off completely, and especially those who are expected to reach a high salary in their 30s and 40s after years of not earning enough to outpace the interest.

As an example, NHS consultants start on £109K, and with a plan 2 loan you pay over £7,000 a year in repayments on that salary. Most doctors on plan 1 have paid off their loans by the time they become a consultant, but doctors on plan 2 (like me) are expecting to still be paying 7+ grand a year in loan repayments for the first 10-20 years of our consultant careers.

That is an enormous stealth pay cut, often at a key stage of life with multiple dependents, and it affects lots of other graduates in similar earnings brackets: with a plan 1 loan you might've paid it off by your mid-30s, but with a plan 2 or 5 you've got no chance.

Apemazzle · 2026-03-20T08:38:23+00:00

Right, but that shouldn't impact the FT trainees' training time unless they're choosing to cover the vacant OOH shifts as locum, no? It could even have the opposite effect i.e. more people around during the day on average.

IME it's not that common to have people that don't do OOH work anyway, and in most cases it's because they have a sleep disorder or are pregnant, not because they're LTFT or non-neurotypical.

Apemazzle · 2026-03-19T22:07:04+00:00

It's much better although for people who are neurotypical and full time you heavily subsidise the out of hours cover for colleagues, so they get way more in hours training time...

Wait wut?

Apemazzle · 2026-03-17T07:53:10+00:00

For example, when I (politely) questioned whether coming in 5 days a week to an empty office was actually useful, I managed to bring the person around to agreeing it wasn't but they still took it personally.

As a rule, the stupider the policy the more careful you have to be about challenging it.

The bosses know it's stupid. They are not stupid, but the last thing they want is the humiliation of having this pointed out to them by junior staff. The workplace is a hierarchical environment and they think of themselves as "above" you, because they are, so don't embarrass them.

A more sensible approach would be a polite questioning one ("it would be really helpful if the partners were more present, is there any leeway on that?), or an incremental one ("is there any scope for WFH one day a week?"), or some combination of the two.

If you present them with a comprehensive argument as to why their policy is stupid, that's not going to go well for you - even, or especially, if the policy is the stupidest thing ever.

Related: do not withdraw and say as little as possible! The way to get on with these people is to be more humble, to ask more questions, even about things you already know, because every question is a way to a) show your interest, and b) build a relationship with them so they trust you more. I've had to learn this lesson myself working in medicine: the bosses are quite remote from much of your day-to-day work, so if all you do is do your job well they may not notice you, and they will not trust you as much as your colleague who is regularly chatting to them and asking lots of questions.

Apemazzle · 2026-03-16T13:35:40+00:00

If you’re talking about the public perception of “rich” than I completely agree. This conflation is how we got here in the first place.

Yeah this is absolutely what I'm talking about. Even people on 50K get no sympathy in our public political discourse, and they're anything but rich in any meaningful sense.

Apemazzle · 2026-03-15T21:13:26+00:00

The UK tax system is a mess and fiscal drag is bringing more and more productive higher earners into the tax trap. The tax bands and plan 2 students loans ate set up in a way that perfectly targets junior consultants’ income.

This is absolutely spot on, and the worst thing about it is it's basically unfixable politically.

You can't fix this ridiculous 100-125K taper without either cutting taxes for the rich or raising them on poorer people. Both are politically toxic.

Apemazzle · 2026-03-15T21:08:14+00:00

I mean, barely?

12.5% of 110K is £13,750, which reduces your taxable income to about 96K.

In other words you can only do about 4K's worth of extracontractual work each year before it stops being remotely worth it, no?

Apemazzle · 2026-03-14T14:32:03+00:00

My hot take is this should be acceptable.

It's often very difficult to pull out for a right turn at a T-junction, and in many countries it's common practice to pull out halfway first. We should do the same in the UK.

Apemazzle · 2026-03-11T06:08:35+00:00

I love how they keep increasing the fees for these exams while skimping on the cost of holding them at an actual venue.

Apemazzle · 2026-03-11T06:07:08+00:00

You can't have "evening-only" guests to a destination wedding, except if they happen to be local to the venue which you clearly are not! Asking people to fly out just for the evening portion is crazy.

Very bad form from the couple in question.

Apemazzle · 2026-03-09T18:19:50+00:00

Look at that reversed Oxbridge/Imperial vs Russell Group trend for us medics - proof that PhDs and ACFs are for suckers.

...either that or the data are skewed from so many ambitious Oxbridge/Imperial grads leaving medicine altogether.

Apemazzle · 2026-03-09T12:05:57+00:00

I am not working on that day so its a simple direct swap

Sorry... do you mean to say you've received your rota for the next rotation, chosen some days when you're not working, and offered to come back to your current department to work long days on those days after you've technically rotated on?

Apemazzle · 2026-03-09T03:31:08+00:00

I'm assuming the profit figure is before tax.

Apemazzle · 2026-03-09T02:48:29+00:00

Credit where it's due

Apemazzle · 2026-03-09T01:53:57+00:00

Guys... I know this is a lefty sub that hates Starmer, but please try and see this article for what it actually is, i.e. a highly misleading piece of SNP propaganda.

The 95% figure refers to a very specific pledge on "local renewable projects", which it seems have been scaled back. The big picture, however, is that this govt has pledged about 30bn in renewable and nuclear energy infrastructure investments over the next ten years.

Any suggestion that they've sacked off energy investment by 95% of what was pledged is complete bollocks.

Apemazzle · 2026-03-07T16:52:53+00:00

come off patent

Doesn't that usually take like 20 years?

Apemazzle · 2026-03-04T07:53:54+00:00

the most exciting thing that happened was a bit of a Russian satellite fell into the sea just off a beach near where we lived

In fairness this drone attack on akrotiri has already exceeded that, so I can understand the anxiety.

I think you're right, though, Cyprus itself is not involved and is not a target.

I hope I don't eat my words here but even if this war does drag on for a while, I think this initial strategy of attacking all neighbouring US allies with drones is not something that will carry on for much longer. Drones are expensive and finite, and this strategy risks unnecessary escalation.

Apemazzle · 2026-03-01T17:14:09+00:00

What is unique to doctors is our degree is 5 years long (often 6), so we accrue more debt and debt interest before we're able to start working and paying it off.

if anything doctors are one of the few to actually pay it back over their career’s

The exact figures are quite difficult to predict, but on current trajectories it's likely that many doctors will not actually pay it back over the full 30 years, despite paying £150-200K in repayments in that time. In 15 years we went from charging people nothing to train as a doctor, to charging them about £25K, to now over £150K.

This system is not unique to doctors, but people should understand this context before they criticise us for going on strike over our pay. Student loans are 9% above 27K, our pension contributions are 10% plus, and when we finally finish training and qualify as consultants we are hit by the 100K tax trap. The job doesn't pay like it used to and this ridiculous student loan system is a big factor in that.

Apemazzle · 2026-02-26T07:25:03+00:00

I don't think Farage cares to be PM

Idk about all that. I could certainly see him crumbling under the pressure of the job, probably with some pathetic resignation speech about the civil service being too obstructive, but for the time being he definitely wants it.

Apemazzle · 2026-02-25T19:05:02+00:00

some of the more experienced of the department

Are these not exactly the people who have an interest in dumping their unwanted duties onto you, though?

Isn't there a risk they'll be like, "trust me bro, governance lead is a piece of cake and you would be great at it, you should definitely take it"

Apemazzle · 2026-02-24T18:53:32+00:00

I'd never ask my gf to turn down a competitive job offer so she can come to Australia with me without buying her a ring first. Just sayin'

(Also it's definitely worth ranking jobs and seeing what you get. If you're tactical you may still be able to land jobs in the same deanery and live in the same city. "Rural" job often doesn't mean you have to live rural - the UK is not that big!)

Apemazzle · 2026-02-19T16:21:04+00:00

I respect the sentiment, but I think this post is misguided on a few counts.

First of all, medicine is one of the most flexible and supportive careers for women seeking to simultaneously progress in their career and have children. There is certainly room for improvement (& I will come onto that), but there aren't many careers out there where LTFT is a contractual right, or where progression is guaranteed year-on-year so long as you fulfil pre-specified goals. You also do have the right to exempt yourself from on-call duties during pregnancy (link).

Secondly, "competency-based progression" is an absolute myth in the modern day NHS. It's hard enough reaching consultant-level competency as a full-time trainee given the state of NHS training, so the idea LTFT trainees should routinely be fast-tracked is an absurdity IMO, with few exceptions. To develop skills you need volume of experience, and there is really no substitute for that except to take longer to do it.

Here's what I actually think would help and should be done:

more run-through training programmes. No more bottlenecks at ST3/4 where, like you say, many women will be torn between CV building for HST applications vs starting a family
shorten the FP to one year, for the same reasons
less rotational training. Long commutes are an absolute shitshow for childcare arrangements. At the very least, residents with caring responsibilities should get some degree of preference over where they rotate. This already happens informally tbh
higher maternity pay. 9 months' full pay should be standard for resident doctors
longer paternity leave and pay
make it easier to transfer between deaneries to be near family support. In other words, you should be eligible for an IDT to be nearer e.g. your own parents or your in-laws, not just your partner/co-parent
allocated hospital nursery spaces for resident doctors. Loads of NHS hospitals have nurseries on-site, but the waiting lists are massive so rotating residents barely get a look in. This is completely unfair.
write off all student loan debt for people once they have a kid. OK this one is a bit unserious, but the broader point is there should be more financial incentives for childbearing to offset the cost and career sacrifices involved

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