Want to go extra large with that?

A good doctor is hard to find

I have a confession to make. I probably should have shared it with you sooner but...well we seemed to be getting along so well and I didn't want to spoil it - but it is something I think you should know. You see, my wife is a...GP. Oh dear, please stop booing. I know it must be a shock to many of you. How can I maintain any sense of integrity when I share a house with someone who brazenly treats the sick in exchange for money?

Surely no other profession has seen such a sharp turnaround in its public image. After all we never really expected anything but a clutching self-interest from the City - but doctors and GPs, in particular, were like secular saints. We expected so much more. They did not merely do a job - it was a vocation to assist the sick and listen to the mildly whingey. From Scotland's Dr Findlay to Eastenders' Dr Legg, GP's were seen as a force for good and a reassuring presence in the trials of our lives.

Gillian McKeith

Thanks to Dr Shipman that perception was severely damaged and the subsequent GP contract settlement and ensuing publicity fuelled by the Blair government, sank them further in the public mind. If you are a regular listener to Radio 2,4 or 5 you can not help but notice that they are subject to a drip-fed vilification. Only Gillian McKeith and Nick Clegg are now held in equally low esteem. Meanwhile, my wife and I toil on with the guilt of her vast wealth, compromised values and the aching question always in the back my mind, 'why didn't she do something worthwhile - like professional football?'

According to The Observer, since 1980, average GP income has risen from £12,480 to £78,366, a 627% increase. This is comparable to the 526% rise that police officers have received over the same period and 583% that nurses have received. In the private sector a bank clerk has seen a only a 409% increase in pay. So it would appear that the critics are right to attack the flabby and overpaid public sector. That is until you note that the average CEO of a FTSE 100 company has gone up from £85,000 to £4.9 million representing an astonishing 5700% increase. Does the performance of companies warrant such a rise? At the same time only £1 in every £100 taken by the 'fat cats' goes to public sector employees.

London 2010

Professor Dorling has noted in his book, 'Injustice: Why Social Inequality persists?' that  top one percent of this country now earn 18% of the country's income. In 1980 it was 4%. The last 30 years has seen the distribution of income return to what it was in 1918! Our levels of inequality are very close to those of the USA. Is that the model of society we wish to follow? During the boom a doctor's salary was 0.20% of the rewards received by top bankers. The very top surgeons could only hope to earn 0.5% of these City salary and bonuses. Even accounting for a public sector ethos, sense of duty or vocational calling is it right that some of our brightest and best should lag so far behind the private sector?

Will Hutton

Will Hutton, who is currently writing a report for the government on how to achieve fair pay in the public sector, noted in The Observer yesterday that 'there is already a dangerous talent gap below the current leadership across the public sector' as young people are drawn to the bright lights and possible rewards in the private sector. Talent is slipping away and with it - the long-term hopes of improving those services.

I have already addressed aspects of this issue in two previous posts* so I won't recap those arguments accept to say that even free market organisations now recognise that extreme income inequality is damaging to societies and to prospects for growth. Self -interest can be served by the vast majority of the population narrowing that gap. It is in this context that policy-makers, such as Will Hutton, are discussing the possibility of introducing a 'living wage' (£7.85 per hour) and / or capping the maximum full-time pay ratio to 20:1 in the public sector.

Many would argue that the relative rewards don't matter. After all, we have all grown much richer. The problem is that the public sector is in competition for the 'brightest and the best'. It is a market place and our doctors and top public servants had a choice about what career to pursue. I spent most of my 20s hanging out at a medical school in London. Compared to myself and the other rather uninspiring vocational students at City University, I was impressed by many of the qualities I saw.

As well as the usual medical school antics, these were highly motivated and extremely bright people. More importantly, almost all of the medics I knew had skills and interests which demonstrated how easily they could have followed other walks of life. Given the 'relatively' low wages, decreasing autonomy and constant criticism how much longer will our brightest young people see such public service as an attractive offer?

The leg bone's connected to the ...

Both Hutton and Dorling agree that it is essential to address the level of rewards in the private sector if any progress is to be made. Dorling suggests that one mechanism would be for the public sector to create ethical contracts and not employ any private sector company that does not pay a living wage or breaks the 20:1 pay ratio. By reducing excessive CEO pay the 'brain surgeon' is relatively better rewarded without any further costs. The alternative is a continual surge in top public salaries - which we can't afford - or else we accept that people just won't want to do the job. The controversial GP pay rise was a response to a massive shortage of GPs across the country. The pay increase solved the problem.

I think we will always have young people who will train as doctors. I just hope that it doesn't become their reserve option when the job at McDonalds falls through. Do want to go extra large with that coronary heart disease sir?

*http://canthingsonlygetbetter.blogspot.com/2010/11/this-blog-might-change-your-life.html

http://canthingsonlygetbetter.blogspot.com/2010/11/are-they-us-or-are-they-them.html