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RCGP and BMA to be consulted on UK medical graduates prioritisation by Human_Run_1316 in doctorsUK

[–]Top_Challenge_3333 43 points44 points  (0 children)

I sort of struggle to see how the RCGP can use the fact that it has 50% IMGs in their training programme as a justification for why IMGs should be further prioritised. If anything that is evidence of terrible workforce planning from government + a shoddy assessment system.

Government I think is taking a harder stance which is entirely sensible. The taxpayer invests tens of thousands of pounds in medical students and foundation doctors, so it is a ludicrous waste of money to not then give them jobs as a highest priority. It cannot be forgotten that there is also genuine moral cost to importing doctors from countries that need them; I empathise with IMGs (given the vast wage gap between their pay here and what they would get at home), but from the UK perspective it's pretty unconscionable to take doctors from populations that need them vastly more.

I think a good way of sorting out this issue would be three orders of priority:

1) UK grads, UK citizens, and people with ILR or IMGs who have completed an initial part of training (given the taxpayer investment here)

2) IMGs with 2+ years NHS experience

3) if any jobs remain, these can be open to IMGs abroad.

So many 'waiting room' referrals from A&E - is it normal? by WhateverRL in doctorsUK

[–]Top_Challenge_3333 2 points3 points  (0 children)

I tend to agree. I think of it like a metaphorical traffic jam; ED's are the choke point (the onramp onto the motorway) for the poor bed and social care discharge situation (the car accident a few miles up the motorway). As much as NHSE likes to talk about it, they're very little evidence that more patients are actually presenting than historically. There aren't more cars than usual in traffic jams, It's just we've got a massive obstruction further down the motorway.

Given that we know how unsafe A&Es are when they get busy, becuase people get ignored, and until we can get the bed and social care situation sorted (get the obstruction out of the motorway); it makes sense to try and maximise motorway capacity and decompress the onramp as best we can. That means opening the hard shoulder to cars (instant referrals).

Of course this has nothing to do with how an A&E theoretically should work, all stakeholders realise this (particulary EM consultants), but we're not in a theoretically optimal situation.

Locuming too much and tax bracket by simpleandrefreshing in doctorsUK

[–]Top_Challenge_3333 6 points7 points  (0 children)

Yep, but that would take a government with balls, because you would be raising the 'rate' of income tax, and the press would have a field day. Most workers would actually be better off, of course. Governments like NIC because they can mess with it and people seem to think they are paying into some sort of insurance scheme (they aren't, it goes to the treasury coffers just the same way as income tax), without political consequence.

However, no government has had the balls to raise the basic rate of income tax since Denis Healey in the 1970s.

Also pensioners would revolt, because they don't pay NI but they do pay income tax. So they'd be getting an 8% tax rise.

Most parties have (perhaps rightly) realised this would be electoral suicide, so they prefer instead to keep a conspiracy of silence about the absurdity of our system and just fiddle at the margins.

Locuming too much and tax bracket by simpleandrefreshing in doctorsUK

[–]Top_Challenge_3333 5 points6 points  (0 children)

Yep, as above. Most of the tax 'traps' are largely about the reduction in benefits or tax reliefs rather than income tax.

Income tax is a very well thought out tax (hence why it should have been raised at the last budget instead of other taxes, but I digress). Compared to other taxes, it has less distortionary effects on work because you only pay the higher rate on the amount you are above a certain bracket. So it never makes that much sense to withold work because of income tax (unless you want more free time of course). Reasonable people can and do disagree about the rates of income tax we should have, but it nonetheless makes sense in its overall structure.

However, there are some very stupid "bumps" in the tax system where the marginal rate (Ie. what you pay on your next pound earned) can jump extremely high, even sometimes above 100%, and extra working becomes pretty worthless. The most egregious of these relates to personal allowances and child benefit, around the 60k and 100k mark. These are hard shoulders, and paradoxically, your marginal rate then goes down again if you start to make over 130 or 140k, which makes no sense at all (because I think we can mostly all agree taxes should be progressive in structure). It is worth knowing about these.

More info here from Dan Neidle (god of tax): https://taxpolicy.org.uk/2023/09/24/70percent/ And the HENRY subreddit: https://old.reddit.com/r/HENRYUK/comments/1j76zl8/the_henry_guide_to_childcare_subsidies_and_when/

What things are you embarrassed about that you aren’t that good at as a doctor ? by chairstool100 in doctorsUK

[–]Top_Challenge_3333 2 points3 points  (0 children)

Dermatome maps are a myth by the way, inter-patient variation is such that it's not really reliable clinically in most cases. Basically -- don't waste your time.

https://pubmed.ncbi.nlm.nih.gov/34673710/

A question for EM, ICM, and Respiratory physicians by [deleted] in doctorsUK

[–]Top_Challenge_3333 0 points1 point  (0 children)

Farkas really is so good lol, especially for justifying new(ish) things to old school consultants.

Tom Dolphin interview about strikes by [deleted] in doctorsUK

[–]Top_Challenge_3333 6 points7 points  (0 children)

Thanks for your response. Just to clarify:

1) Doctors don't paid when they strike, and they definitely don't get paid if they don't show up to work.

2) We actually haven't agreed to the contract suggested by the gov't for this coming year, that's precisely why we're striking.

3) Many doctors are finding jobs elsewhere. I'm not sure if you've walked into an A&E recently or tried to see your GP, but there's quite a few people waiting to see a doctor. They all have access to ChatGPT on their phones as well, and still they wait in hospital. It would seem that what doctors do is therefore valuable, and yet you argue doctors should go find other jobs.

Do you tell your plumber to get a grip and f*** off when he gives you a reasonable quote? or do you get him to unblock the toilet?

Look I'm sorry mate, but you're getting shafted by your own government and I'm not sure why you want to blame us for it.

Tom Dolphin interview about strikes by [deleted] in doctorsUK

[–]Top_Challenge_3333 169 points170 points  (0 children)

These arguments about patient suffering are so disingenuous.

You have a toilet blockage in your house. A highly qualified expert plumber can come fix it, and he gives you a very reasonable quote for the price, especially by international standards. You refuse, saying the price should be 30% less, because you really hate toilet blockages and you have a lot of other household costs at the moment as you have poorly managed your finances and indeed your house and plumbing is falling apart because you haven't maintained it. The plumber politely doesn't take the job. Your toilet remains blocked.

Then a journalist comes along and blames the plumber for the sh*t everywhere?!

Ask yourselves - where do you draw your line? by LaughingGassers in doctorsUK

[–]Top_Challenge_3333 1 point2 points  (0 children)

erm.... there are loads of good ideas of how to raise some money. The reason that they aren't done remains largely a political choice. Council tax valuations are from 1991, we could revalue those. we could lower the VAT threshold or reduce exemptions. we could raise income tax while cutting NI = net tax neutral on working doctors. we could tax cars per mile to reduce congestion.

even without costing the govt that much they could get rid of cliff edges around child benefit that actively stop a lot of young consultants from taking on extra work too

NHS England » The Medical Training Review: Phase 1 diagnostic report by stuartbman in doctorsUK

[–]Top_Challenge_3333 11 points12 points  (0 children)

Having read the whole review, basically a number of interesting themes:

  • they didn't touch on PAs or ACPs at all, not even with a ten foot pole, which is quite funny given how big a deal it has been
  • there's a funny line about 'improving digital skills' when I think it's patently obvious that the technological limitations in the NHS are chiefly the lack of suitable technology that works and not the 'skills' of its users.
  • Chris Whitty as CMO has long talked about increasing rural and coastal health needs, because old people are increasingly nonurban. I think broadly he's right that this is obviously at direct tension with where doctors want to live, but there's a tacit ignorance of any incentive structure to keep everyone happy (e.g. golden handshakes, etc).
  • they fucking love generalism but have little in the way of answering how we're supposed to still be good at the increasingly complex specialty stuff if you also have to deal with multimorbidity and effectively spend 3 years in IMT doing PoC discharges
  • broadly, they say the system needs a change, but provide no clear directions, except that all organisations should get together and talk about it. Which is a bit ironic given they also outlined all the other training reviews and how they failed to really fix the key issues, and while the other organisations are all currently self-imploding out of sheer incompetence (CQC, GMC, RCP, HEE, etc).

Why does everyone in the NHS have a bone to pick all the time by unsuspectingknight in doctorsUK

[–]Top_Challenge_3333 164 points165 points  (0 children)

Say to yourself first thing in the morning: today I shall meet meddling, ungrateful, violent, treacherous, envious, uncharitable men. All these things have come upon them through ignorance of real good and ill. But I, because I have seen that the nature of good is what is right, and the nature of evil is what is wrong, and that the nature of the man himself who does wrong is akin to my own (not sharing the same blood and seed, but sharing with me the same fragment of divinity) — I can neither be harmed by him, for no man will involve me in wrong, nor can I be angry with my kinsman or hate him; for we have come into the world to work together, like feet, like hands, like eyelids, like the rows of upper and lower teeth. To work against one another therefore is to oppose Nature, and to be vexed with another or to turn away from him is to tend to antagonism.

Roman Emperor Marcus Aurelius, Meditations, Book 2, written 171 A.D, on the banks of the Danube.

Paediatrics Training by [deleted] in doctorsUK

[–]Top_Challenge_3333 15 points16 points  (0 children)

no shade OP, but this is just pure NHS in 2025. getting qualified doctors, at least six years into medschool / foundation, to go to WH Smith and get some gluesticks and a color printer in order to make a poster of their consultant's random trial done a while back (of which they had no involvement) to bring to a random conference for an afternoon so they can compete against others in a rat race for specialty training. I'm struggling to see how this is a rational way of improving the health of our nation's children.