Consultants are thinking of striking [link]. If we look at the [data] we can see that consultants are in the top 5% of earners as they start in the £80,000 a year ballpark. In Foundation training, doctors will earn a basic salary of £29,384 to £34,012 (top 43% => top 33% of UK wages). Doctor starting specialist training have a basic salary will be £40,257 to £53,398. (top 25% => top 13% of UK wages).

Why are they thinking about striking? Well, they’re not completely unreasonable, yet they don’t see the bigger picture. Let’s hash out why.

Consultants have experience in the system that they are working in. Most consultants should be content with being in the top 5% of UK earners. If they’re not, with some training in systems thinking and a bit of business, they should utilize their experience to build a system or product that makes the healthcare provision in their field more efficient. They would then definitely have the income of the top 2%.. maybe 1%. We are spending more and more on healthcare globally. Like food farming in the past, we need deflationary pressures applied otherwise it’s going to run out of control. However, I know we can’t just point the fingers at consultants here for not doing this. The NHS is awful at supporting autonomy and innovation.

I personally know of 3 doctors who did extra degrees in physics or computer science. They didn’t jump straight away, they hung around the NHS for a couple of years and then left out of frustration. Even though they could earn more they initially didn’t want to not utilise those years of clinical experience. Only after being blocked multiple times by people in the NHS did they leave. It was the same with us. We got blocked for roughly 2 years by the NHS when we said that we had derived a way to create realistic virtual patients using a range of statistical spreads and object orientated programming. After 2 years of being blocked by NHS bureaucrats and senior clinicians who liked to talk about innovation but were frankly coasting and didn’t like the idea of having to actually learn in depth about innovation, we shrugged our shoulders and developed our software with German universities and medical schools.

If we remove feelings and purely focus on the economics, most of the people in the top 1%-2% are paid this because of economies of scale. If a celebrity could only get 5 people a day to buy a product through endorsement, they wouldn’t even make enough to make minimum wage. Same goes for the software engineer that codes software that only affects 5 people a day, again I’d be shocked if they even get up to minimum wage. If a banker only manages the investment of 5 people a day who have average salaries, they’re not going to be living off the fees they charge. A consultant surgeon can affect the lives of 5 people a day and be in the top 5% of earners. When you look at it like this, you’ll realise that medical consultants are very highly paid per economic unit. This makes sense, having lifesaving surgery is more valuable than getting a slightly better return on my portfolio, light entertainment, or having a more convenient experience due to an app. However, what a lot of doctors don’t acknowledge which is why they will never be happy until they do realise it, is that the internet and tech in general, has enabled the other jobs to scale at an insane rate in terms of economic impact. People would have to be crazy not to acknowledge that when the world embraced paradigm shifting tech, there would be a shuffling in the world economy. Economies of scale revolutionised food production. Economies of scale is now doing the same to cognitive productivity.

Let’s do a simple example. The numbers are so extreme that I can be very liberal with my assumptions. I’m going to assume that the consultant surgeon never takes a day off except weekends, and never takes holiday.  The surgeon operates on 5 patients a day resulting in 1,200 patients a year. At £80,000 a year they get a unit cost of 66.666 per patient. Looking at this [video] by doctor YouTuber Ali Abdaal, a YouTuber example needed 500k views a month to get $47,000 a year. Scaling this to £80,000 the YouTuber would need 12600000 views a year to get £80,000 a year. They’re both earning the same, but the surgeons per economic unit output is valued 10,500 times more which is reasonable. The YouTuber is only earning the same in total because they have managed to scale their economic unit output by huge orders of magnitude.

People may question if society is better off with YouTube but in general, creating scalable solutions is a good thing. People creating deflationary pressure through innovation are being directly rewarded for it. It’s also equalising. Whilst the super-rich can afford the buy the best lawyers and doctors (paying private to jump the queue if the NHS is involved), they have less effect on the scaled products. For instance, Jeff Bezos does not have some special version of Windows or MacOS. When he goes on Google, he will have the same experience you have. If consultants want to get back into the top 1%-2%, the world economy has changed, and they must work on economies of scale. In 2012 medicine and dentistry graduates used to be the top earners in the UK. If we look now at the highest paid grads in the [link], we can see that the top earners are computer science and software engineering, then finance, then some other forms of engineering, economics, and marketing. These all have low economic units, but they scale extremely well. In the [link] we can also see the 10 lowest paying degrees are social work, Nursing, Counselling etc. These don’t scale at all, but their individual economic units are still paid more than the top earners. It’s just that modern tech has enabled math orientated grads to scale.

We can see the problems in scaling. During the economic crisis the government has gutted every other department to keep the NHS afloat:

And has had soaring debt:

and our percentage of GDP spent on healthcare just keeps increasing no matter what:

If you want your profession to really be earning the big bucks, try and work out how you can scale your economic impact. But sitting around and crying about the days before the internet is not productive as we are not going to go backwards with this technology. Also, money isn’t everything, people have different lives, and they value different things. But if you’re in the top 5% and you want to be in the top 2%-1%… then clearly money is a massive motivator for you, so spend time reading on why these shifts have occurred. The entitlement of expecting the stay in the top 1%-2% without bothering to read why the system has changed or take any extra steps to keep up with the shift in the system is just going to make you miserable.

Whilst I’m highlighting the entitlement of the doctors here, we also must acknowledge that doctors are handcuffed by the NHS and usually do not have the ability to explore innovation and economies of scale. Blindly raising wages is unsustainable. We need the NHS to enable clinicians to have autonomy over decoupling their productivity with hours worked. This will also lead to bigger differences in earnings amongst clinicians, but at least there will be an incentive to look at valuation honestly. Also training in systems level thinking, object orientated problem solving, and general information theory for such clinicians who want to raise back up to the top 1%-2% of earners is needed.

One last thing we need to highlight. Doctors state that they can get more money in the USA, Australia, and certain EU countries….. well, yeah. I myself am a software engineer. I’d get paid a lot more if I worked in the USA, Australia, and a range of EU countries. When it comes to the USA I’m talking over 3 times my salary. Different economies will pay different rates and this is across the board….. if I started working in Zimbabwe I’d earn a lot less. The UK is not the strongest economy in the world. You get paid relative to your country. It’s kind of depressing so many educated adults think this is a talking point.