Monday, September 21, 2009

Psychiatrist's wages

I was on the bus yesterday, and I got to thinking about what psychiatrists are paid. Personally I have thought in the past that psychiatrists are guilty of biological reductionism. To be honest I now think that if they reduce mental illness to biology, then we should reduce them to the dealing with that biology, including a subsequent considerable drop in their wages!!!

Nearly all the constructive input into my mental health, and thus any real healing I have received, has been from nursing staff, and yet they get paid a fraction of the wages of shrinks. Having pursued a BSc with a considerable biosciences component including neurobiology, I doubt that the average SHO has a better grasp of the subject than I, and certainly a £70-100k consultant's knowledge would be far less than a PhD student on a £16k stipend who might go on to earn in the region of £30-40k. No doubt they would argue that they do more than merely address neurobiology, but there's the irony; clinicians often spend all their time poo pooing (or at least completely disregarding) the statements of patients in regard to socioeconomic, psychological, and micro-political concerns, then justify their wage packets by arguing they address precisely these factors. In fact much of the real treatment for psychiatric patients is rendered by CPNs, RMNs, Care Assistants, Social Workers, 'Lay' Therapists and Workers. It times where the state has to tighten its belt, when cuts must be made, I can think of no better place to start than with psychiatrists. They would no doubt wish to be compared with other grades and consultants across the NHS, but let us not forget that very many of these have a wide skill base, often including surgical skill (and I'm not arguing for more psychosurgery before they get any ideas!!!). Its time that we turn around the description of psychiatry as biologically reductionist, and reduce both their job description (to cover what they can or will ACTUALLY do) with an associated drop in wages. Some might argue that with lower wages in the discipline talent would be drained away from psychiatry, having met much of the 'talent' I'd argue that this might be no bad thing.

After all how much should somebody be paid for holding the metaphorical keys to the meds cabinet?

If we consider that it is projected that after recovery by 2012, the average price of a house will be around £226,000. Even if we take psychiatrists as being of above average importance to society (let's say for arguments sake double the average) and that they pay a third of their wages in NI and Tax, then we are left with a standard consultant psychiatrists home being worth c£500k, with a yearly wage after tax of c£66k (and ignoring private practice or 'consultancy'). That would mean they would be able, not counting their ability to gain multiple properties, mortages and related incomes, to buy outright a half a million pound home in around 12 years with a remaining wage of c24k (after tax!!!) a year for that 12 year period.

Given that the average person's mortgage is around 25 years, and given that we have already calculated that their home would be worth twice as much, are we also meant to swallow that it would also take them half the time for pay for a house valued at double the (average) value???

I would think that considering their education, training, and position, a capped salary from the public purse for their biomedical intervention should be fairly set at c£50k?

1 comment:

Anonymous said...

Hi there,

Interesting to know all this.

I think GPs should be paid much less. I think that Clinical Psychologists should be paid the same salary as Psychiatrists. I think that psychiatrist should be paid slightly less than they get now.

I don't understand why Clinical Psychologists get paid half the salary of a Psychiatrist. They have PhDs as well. They work the same hours. They seem to be just as sophisticated and experienced. They might be better at assessing most people (most people not having severe medical mental insanity). They seem to work harder; it's easier and quicker to give pills than to find and use the right words, right body language and give enough time to help a person. There are more different ways of talking to a person than the number of different pills to prescribe for mental health and many more variables to consider than the side effects of pills.

On top of all this, Clinical Psychologists seem to make a bigger, more positive, long lasting and better quality differences to people's lives with their non-biological therapy. Pills don't help most people, they're really only for the severely medically mentally unwell who don't have particular psychosocial stressors.

Psychiatrists are more like administrators. The greet people, take notes and refer most people to other health professionals to diagnose and treat because they're not qualified to.

So I understand why you're questioning psychiatrists' salaries. On the other hand the psychiatrists I have met have impressed me and they have valuable knowledge about people which I think other doctors lack. The ones I have met do take into account socioeconomic and psychosocial problems.

I think psychiatrists realise that psychiatry is for the socially abused (often with the perpetrators at large who are considered by society to be the mentally well). And I think that psychiatrists are genuinely concerned about preventing people going on a downward spiral due to psychosocial stressors. I hope that modern psychiatry develops this attitude further so as to become more effective in preventing mental illness.

I think it is the GPs who should be earning much less. Many earn over 100k. To me they are more like basic receptionists and, to be honest, much of their work is dealing with minor illnesses. Many GPs are less sophisticated in their dealings with people than psychiatrists. But I suppose it depends on the person and I suppose there are good and bad psychiatrists just as there are good and bad GPs. I haven't come across a bad psychiatrist though. They seem to have had better training in people skills than GPs do and perhaps should have a greater role in training other doctors how to understand, sympathise with and treat people.

So, I think GPs should earn much less and Clinical Psychologists should earn the same salary as psychiatrists, who should earn less.

- GPs should be considered as more like receptionists and earn much less.
- Psychiatrists should be considered more as administrators and earn less.
- Clinical Psychologists should be recognised as doctors and called doctors who do valuable and life changing work which is just as sophisticated as psychiatry work and they should have the same length of training as psychiatrists and be paid the same as psychiatrists.