How much doctors get paid for their work is a taboo subject and is not something people enjoy discussing. Maybe it has something to do with the nature of our work... nobody wants to be reminded that doctors are being paid to save lives - but this does not take away from the fact that the core reason many people enter the healthcare profession is to save lives regardless (in case you haven't noticed, the pay is pretty average but the rewarding nature of the job definitely isn't).
In this blog post, I'm going to lay it all down on the table and present what I found on pay scales, pay slip breakdowns and ways that doctors tend to accumulate extra funds. Please be aware that there is no 'one salary fits all' - each doctor's pay will inevitably be slightly different due to a number of factors which I will attempt to explain in this post.
FOUNDATION (JUNIOR) DOCTORS:
A Foundation doctor (Junior, FY1 or FY2, previously known as a house officer) is the name for UK doctors undertaking the Foundation Programme – the 2-year, postgraduate medical training programme which forms the bridge between medical school and specialist/general practice training.
Being a Foundation Doctor is compulsory for all newly qualified medical practitioners in the UK (from 2005 onwards). The Foundation Doctor post has replaced the old names of the same role: 'pre-registration house officer' (F1) and 'senior house officer' (F2).
As a junior doctor, you’ll earn a basic salary of £28,243 to £32,691 (from 1 April 2020) - BEFORE TAX.
PLEASE NOTE: as the new junior doctor contract is being implemented in England, pay scales are now very different in England compared to Wales, Scotland, and Northern Ireland.
You are likely to be paid closer to the top end of this bracket if:
You work in London: you receive the London Allowance which is approx. £2000-3000 extra a year
You work additional rostered hours: Any additional contracted hours over 40 hrs (up to a maximum of 48 in total, or 56 for doctors who have opted out of the Working Time Regulations)
Your work more night shifts: Any antisocial hours (any hours between 9pm and 7am) are paid at an enhanced rate of 37% on top of your hourly basic pay.
You work on weekends: A weekend allowance is set as a percentage of your basic salary for working 1 in 8, or more frequent, weekends. This is usually between 3% and 10% on top of your basic pay.
Your on-call availability allowance: An allowance of 8% of your basic salary to compensate for your availability while on-call, regardless of frequency.
Your flexible pay premia: In England, the 2016 junior doctor contract introduced a new range of flexible pay premia (FPPs) which are intended to encourage recruitment in certain specialties. These currently include: General Practice, Psychiatry, Emergency Medicine, Histopathology, academia and Oral & Maxillo-Facial Surgery. These payments are taxable, non-pensionable and made annually until you complete your clinical training. An individual can receive more than one FPP at a time, wherever they meet the criteria, though not the same premium twice. These FPP are paid pro-rata for less than full-time (LTFT) trainees. If you take maternity or other family leave whilst receiving FPP, maternity pay will be calculated including the pay premium. The list of premia and an outline of the eligibility criteria can be found in the pay circular pdf documents on the BMA site here
Working locum: Working locum shifts is essentially filling in gaps in the rota on your days off from your full-time NHS job. The pay for locum shifts varies but will all be an added bonus to what you already make in your NHS job. As a F2 doctor or 1st year specialist trainee, you can expect £35 – £50 per hour for these shifts!
NOW LET'S FACTOR IN TAX TO SEE WHAT A JUNIOR DOCTOR'S TAKE HOME PAY WOULD BE:
Generally if you are employed in a fixed term contract with an NHS trust, your income tax, National Insurance (NI) and NHS Pension (if you don’t opt out it) will automatically be deducted from your pay. Your student loan will also be deducted as you earn more than the current UK threshold, which is £26,575 a year, £2,214 a month, or £511 a week. You will be paid the rest. This is called PAYE (pay as you earn).
For more information on understanding taxes visit the gov website here (get to grips with this NOW before you become a doctor because ... it's a necessary life skill): https://www.gov.uk/topic/personal-tax/income-tax
After these deductions are made, the average junior doctor is left with approximately £2500/month which is more like £30,000/year. This can be higher or lower depending on whether you work in London, what tax you may or may not be exempt from, what you opt-in and opt out of etc. And is, of course, always subject to change!
Sources/further info:
GENERAL PRACTICE REGISTRAR (3 year training):
The same factors as mentioned previously are used for your pay as you progress onto GP registrar or Specialist Training.
When you are a designated GP registrar (i.e. after your Foundation years, you have chosen to train in General Practice and have secured a post), your average salary will be approximately £49,000 (BEFORE TAX).
Here is a breakdown of why:
Your basic pay will be approx. £38,693 (This does not change between your 1st and 2nd year of training but in your final year, it will increase to £49,036)
Your flexible pay premia: This is around £8,789 extra for the current year pro rata (e.g. if you do 6 months in a GP practice you get half this amount). This allowance is NOT payable when in hospital posts as part of your GP rotation. This is because General Practice counts as one of the undersubscribed specialties for the flexible pay premia to encourage recruitment (mentioned above).
If you are training in London, there is an additional London weighting allowance of £2,162 per year.
Working locum: This can boost your yearly take-home salary even more as you work extra shifts alongside your full-time role. Rates can be £50 – £100 per hour for speciality registrars including GP registrars!
AFTER TAX, your take-home pay will be between £3000-3500/month = £36-42,000 a year
Sources/further info:
This is a helpful recent video by a doctor in June 2020 describing the different pays
Helpful blog post on GP trainee rates here
SPECIALIST TRAINING
If you’re a doctor starting your specialist training in specialties other than General Practice in 2020, your basic salary will also be £38,693 to £49,036 (BEFORE TAX).
At the bottom end, some ST1 / ST2 posts with 40 hours per week, no on-call commitments, no weekend or night working will have basic pay only of £38,693 (e.g. some public health posts).
At the top end, a busy post in Emergency Medicine with 1 in 3 weekends, an average of 47 hours per week worked, and with lots of regular night shifts will most likely give you total annual earnings of > £50,000.
I will not go into every specialty but as mentioned above, Psychiatry (all grades), emergency medicine (ST4+), Histopathology, and oral and maxilla-facial surgery (OMFS) are specialties that receive a flexible pay premia. General Practice trainees get paid the most BY FAR.
Flexible pay premia additional pays (FPP):
Psychiatry: Extra £3503/year
Emergency Medicine (ST4 and above only): depends on the length of training but can be between an additional £2628 to £7006/year
Histopathology (ST1 and above): Extra £4204/year
OFMS (ST3 and above): depends on the length of training but can be between an additional £2628 to £7006/year
FPP is also paid to those who return to clinical training after successfully undertaking a pre-agreed period of approved academic research, and, in some circumstances, to those who take time out of training to undertake other recognised activities that may be of benefit to the wider NHS.
Academia (Upon return to training following successful completion of higher degree): Extra £4204/year
For a pdf of these values, you can download it here
Since specialist training programmes are on average 5-7 years, your pay will increase each year you accumulate experience. Towards the end, your basic pay will be closer to £50,000 - which shows that the increase per year is NOT much at all.
However, you must factor in that you will have to pay to take extra exams during your training. These can be found here. Each exam costs about £500 each. I will be doing a blog post on taking examinations as a doctor soon.
DOCTORS TRAINING LESS THAN FULL-TIME
The breakdown of the pay for trainees working less than full time is as follows:
Basic pay (and the value of any applicable flexible pay premia) will be calculated pro-rata to their agreed amount of full-time work
On-call availability allowance will be calculated pro-rata, based on the proportion of the full-time commitment to the rota
Antisocial hours enhancements will be paid according to the working pattern detailed in your rota
Weekend allowance will be paid pro-rata based on the proportion of full-time commitment to the weekend rota. For example, if the LTFT doctor contributes to 60% of the weekend rota, they will receive 60% of the extra allowance.
CONSULTANTS
There is a huge jump once you're a consultant, with a starting salary of £79,860 (BEFORE TAX)
After completing 14-18 years as a consultant, you will be sitting on £100,000 a year (BEFORE TAX) - this is really closer to £66,000 after-tax...
BMA info on Consultant pay grades can be found here
SALARIED GPS (FULLY QUALIFIED)
There is a lot of confusion surrounding working as a fully qualified GP and owning your own practice. There is NO pay scale for salaried GPs. This is another major attraction of the profession. Not only is training 3 years long, but you are earning more than a doctor who has been in specialist training for 8 years!
In England, fully qualified GP salaries range from £60,455 to £91, 229. The minimum annual salary for a full-time salaried GP working 37.5 hours or nine sessions per week in England is £60,455 for 2020-21 (plus London weighting). However, this is closer to £45-50,000 after tax.
There is also no official upper limit to what GPs can earn. GPs must ensure their salary reflects their level of responsibility, experience, and qualifications, especially if they own their own practice.
LOCUM WORK
'Locum shifts' seem like where the money is AT but they can take a big toll on your physical and mental health alongside your full-time job as a doctor! These are extra shifts within the scope of your role that you can take on to accumulate some extra money. These can be done in the NHS or for private health companies/services.
You will get paid at a much higher rate for these shifts because they are in need of someone to fill in gaps in the rota. These can range from £50-100/hr depending on your level of training, with locum consultants in some cases being able to rake in almost £150/hr (e.g. emergency medicine consultant working during anti-social hours). Rates vary as the facility/service looking for the locum doctor will set the price.
This is a nice pdf that provides information on what locum work is and if it is suited to you: download here
Search 'locum' on the BMA for any further info
I hope this blog post provided some clarity on what UK doctors get paid but does not put you off from wanting to work as one. It is actually tax that is one of the main culprits for the fairly low take-home pay.
Nevertheless, it's good to get this information out there now so we can be aware of the budgeting that is needed and the chance to work extra shifts when the time comes. If you're a doctor reading this, let me know your thoughts and if you have any comments below! I recommend Ali Abdaal's YouTube video on what he earns and. the BMJ's Complete Guide To NHS Pay For Doctors.
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