What Are You Really Worth?

A Logical Look at Doctors’ Value in the NHS Economy

Industrial action within the NHS on a resident and consultant doctor level has renewed public interest in how much doctors earn. Conversations about pay often turn into a battlefield of anecdotes— Statements like "my friend in finance makes X," and the like. But at On-Call, we don’t just deal in anecdotes. We like data and logic.

Pay is an uncomfortable subject, one wrapped in layers of history, ethics, and societal expectation. It wasn’t long ago that discussing doctors’ salaries was taboo, framed as distasteful in a profession driven by service - probably on par with asking someone their age or how much they weigh. But as the NHS faces recruitment crises, strikes, and an exodus of doctors abroad, we have to ask: what is a doctor actually worth?

The Theory Behind Pay…

At its core - the theory behind why some jobs command higher pay boils down to 3 key factors - scarcity, skill and leverage. Yes, economists throw these words around in their lectures, but it is central to everything and explains why you pay more for a designer handbag than a totebag at Poundland even though they perform the same function.

The first and most obvious driver of wages is scarcity. If something is rare, valuable, and in high demand, it commands a higher price. Jobs that require highly specialised knowledge, like doctors, lawyers, or nuclear physicists, should logically command higher pay. In theory, we are highly specialised workers, with skills that are scarce in the market - but here is where it gets complicated. Whilst scarcity suggests high pay, the NHS operates as a monopsony (a market condition in which there is only one buyer) because it’s virtually the only buyer of medical labour. There is no bargaining environment. If there was another provider of healthcare that was able to outcompete the NHS by offering more pay, then doctors pay jump ship - increasing wages. When a single buyer controls the labour marker, it creates disproportionate leverage for that buyer.

What about leverage? Well, the value of a job doesn’t come from how rare or skilled it is, it also comes from how much power the worker has to negotiate their pay. Take your average Wall-street Banker - they have enormous leverage, as their decisions literally move an entire economy. In our NHS however, your average junior doctor has much less (although not insignificant) negotiating power, especially now with the influx of International graduates aimed to fill rota gaps.

Is it really that bad?

A popular defence of the current pay structure is the argument that foundation year doctors earn well above the median UK salary, speciality doctors earn more than 90% of the general workforce and that consultants sit in the top 1-2% of earners.

This sounds great, but like most topics in life it gets much more complicated when you consider that comparing doctors’ salaries to the general workforce can not be done on face value. One has to compare like for like, so the correct comparison is how much would the same individual (with the same level of education and experience) earn in a different profession?

Doctors have made huge sacrifices, achieved impressive educational feats and if we account for these factors, we may be able to make a more accurate judgement.

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NHS Admin Crisis - A Job For AI?

The NHS is drowning in inefficiency. One in five patients recently received appointment letters after their appointment. A staggering 20% lost in outdated systems, wasting time and resources. When communication failures top NHS complaints (17% of all grievances), we must ask: how much patient harm is caused by administrative errors?

Why are we still spending billions on outdated processes when private-sector efficiency proves that streamlined, digital solutions work? A pilot program at Mid and South Essex NHS trust used AI software to predict and prevent missed appointments. The software analysed factors such as weather, traffic and employment data to schedule appointments that were convenient for patients. The result - 30% reduction in non-attendances over 6 months (377 missed appointments prevented and £27.5 million saved annually)

Programmes like Deep Medical, Co-founded by Dr Benyamin Deldar are using AI to reduce missed appointments and could be the answer to our NHS admin woes.

‘We Did Our Own Research‘: The New Second Opinion

Why facing scepticism with data matters more than ever

The nursing alarm has not stopped ringing by bed 12. His family is demanding to speak to a doctor. The charge nurse, clearly exhausted and desperate, pleads for your help.

You approach, only to be met with a wall of sceptical faces. Arms folded. Frowning faces, you hear:

"Doctor, how can you be so sure all these steroids are actually helping his inflamed bowel? Not to step on your toes, but we did our own research… and nutmeg...."

Science—and by extension, the scientific method—is under siege. We like to think of science as the foundation of our guidelines and medical decisions, but increasingly, it’s being challenged by a different force: ideology. Or worst still… Vibes.

The loss of public trust in science is not just frustrating; it’s dangerous. The tactic is clear: delegitimise expertise, suppress evidence, and replace data-driven reasoning with personal beliefs. Doctors may wish to ignore this creeping scepticism, but the truth is, how we engage with the public will shape the future of our profession itself. Let’s see some common objections:

"But Science Keeps Changing Its Mind!"

Yes, and that is precisely its strength. Science is not about dogma—it is about following the evidence, wherever it leads. If new, high-quality data contradicts or supersedes an old belief, good science does not cling to its past mistakes; it adapts.

That does not mean, however, that past conclusions were irrational. We make decisions based on the best available evidence at the time. You cannot retroactively dismiss well-founded reasoning just because new evidence has emerged. That’s like blaming 18th-century sailors for not using GPS.

As the psychologist Stuart Sutherland noted, "The willingness to change one’s mind in light of new evidence is a sign of rationality, not weakness."

“Why Should I Trust Expert A Over Expert B?"

Skepticism is the backbone of science—but not all opinions are created equal. Our take on quantum mechanics is not worth the same as Albert Einstein’s. And in the same way, one scientist’s contrarian view does not automatically outweigh the collective work of thousands of experts.

In science (and in life), we don’t have the time to assess every single person at face value - so we use pragmatic tools to assess expertise—peer-reviewed publications, institutional credibility, impact factors, and consensus. Of course, there will always be outliers. History has its fair share of lone geniuses who overturned conventional wisdom. But if 99% of experts agree on something, the layperson would do well to lean toward that majority rather than the 1% making bold claims on social media.

"But Here’s a Paper That Says Otherwise!"

Yes, and there are also published papers claiming to have found alien DNA in meteorites. The ability to Google a study does not make one an expert in assessing its quality. Some ‘research papers’ slip through the cracks and lack the scientific rigour we would expect of good research. It takes years of training to properly evaluate research—to distinguish well-conducted studies from flawed ones, to screen for bias, to understand statistical manipulation.

Statistician Doug Altman highlighted this: "What should we think about researchers who use the wrong techniques, use the right techniques wrongly, misinterpret their results, report their results selectively, cite the literature selectively, and draw unjustified conclusions? We should be appalled." ​

Doctors, this is our duty - to defend science and the scientific method as the best route to medical knowledge. If we fall short on this, we risk letting down our patients and ourselves.

“A reminder that you can resuscitate a shocked patient infinitely faster through a 18-gauge IV in their vein than a 14-gauge IV in the sharps container - don’t need poiseuille’s law for this one”

“GP reg knocked at my door, looking a bit pale like he needed a sit down. ‘need help with a guy… farmer. Fair to say I, too, now need a sit down”

“An end of life patient told me yesterday that before you die, the financials flash before your eyes. Every meeting, every forced laugh. As it loops, you wonder, was this worth it all along?”

What’s on your mind? Email us!

Some things to review when you’re off the ward…

Just Stop GP’s - Bristol GP sent to prison in his role in the Just Stop Oil Protests covered by the BBC

Mr Bill Gates took the headlines this week by a rather bold prediction where he predicted that AI will completely replace doctors and teachers

Check out this brilliant piece in the BMJ this week on evaluating chest pain by Professor Bellolio and colleagues

Weekly Poll

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In the UK there is an over-medicalisation of mental distress:

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GP Finally Get the Lift After Decades of Being Second Best

The 8 a.m. appointment scramble has long been a black mark on a health service that once set the global gold standard worldwide. Many patients delay care just to avoid the madness. But last month’s new GP contract from the government aims to fix this—allowing online appointment requests to clear phone lines for those who actually need them.

The government’s deal includes an extra £889 million boost—a 7.2% increase to the total budget (outpacing the NHS budget’s 5.8% growth). For the first time in a decade, GP funding isn’t second best and shrinking as a share of the NHS budget. Perhaps Lord Darzi’s warnings about primary care withering away finally hit home?

To free up GP time, the contract also slashes meaningless demands—scrapping 32 of 76 mandatory GP targets, including mandatory wellbeing meetings. The government insists box-ticking won’t heal patients and GP time needs to be freed for essential activities.

But will these changes make a real difference—or do we need more than a week to find out? GPs, we want to hear from you.

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