by Lynda Goetz
There are still plenty of ‘old schoolers’ who believe that both doctors and vets, like clergymen, are following a vocation. Apart from the fact that this was never invariably true and people chose these careers for varying reasons, including the challenge, the desire for knowledge etc., it is certainly not always the case these days. It is also, perhaps sadly, no longer in line with the way the modern world works. British citizens may have stood on doorsteps and banged saucepans and clapped for “our National Health Service”, or had their kids draw NHS rainbows to display in windows during the pandemic, but when it really comes down to it, they simply want, and expect, doctors to attend to their medical needs NOW, “free at the point of delivery”. They would also really like an NHS equivalent to deal with their increasing number of pets, a service preferably also free at the point of delivery.
What they do not expect is for doctors to go on strike or for vets to charge “through the nose” for their services. One elderly lady of my acquaintance, whose father was a family doctor, commented on the subject of the present strikes: “My father must be turning in his grave. In his day you went into medicine to help people”. There is clearly still an element of that in the choice of human or veterinary medicine as a career: the feeling that you are a useful member of society; that your job is not simply a money-making exercise. However, it is also a job which requires a lot of study and carries with it a lot of responsibility. In exchange for which, it is not unreasonable to expect decent recompense and a certain amount of respect, in the old-fashioned sense.
Whilst it is true that once you get to the status of consultant there is reasonable recompense, there is a great deal less respect in this age of Dr Google; and the pay, in comparison with what it was a decade or so ago, is considerably reduced. Until you reach that consultant level, not only is the financial reward distinctly less in real terms than it was, but the lack of respect plus uncongenial and demanding working conditions are all issues for many struggling junior doctors*. They are required to pay £433 a year for membership of the doctors’ ruling body, the General Medical Council (GMC), and, like the consultants, are held to account by that organisation for mistakes called out by the public, which may or may not be justifiably laid at their door (take the Bawa-Garba case). They are required, in order to progress through the system once they have qualified initially, to choose a speciality. It takes three years of further training to become a General Practitioner, and eight years in something like anaesthetics. There are a series of compulsory exams to be taken (at a cost of at least £800 a time and alongside long working days) to complete the training before one can then start looking for a post as consultant. I say “complete” but one always has to keep up to date with latest research, techniques and medications by means of Continuing Professional Development (CPD). For a medical professional (or vet) the learning never ends.
For most members of the UK public this is all of little or no interest. All they want to know is that when they are sick, or require surgery, a doctor or series of doctors will be on hand to treat them at the earliest opportunity. The quasi-religious status of the NHS in Britain is somewhat bizarre and not replicated in any other countries, but it has resulted sometimes in an equally strange lack of respect for those who work in it, perhaps because of the feeling that it “belongs” to us and that we are entitled to make demands of the services it offers because “we have all paid for it”. Now that it is clearly a very broken service, the feelings of dissatisfaction on all sides are increasing rapidly.
Veterinary services, on the other hand, have never been free at the point of delivery. However, veterinary medicine too is currently a cause of dissatisfaction, both for vets themselves and for the public. No longer a profession which operates in the rather cosy way it used to when the vet author of the James Herriot books was recording his series of charming anecdotes about life as a rural vet, it is at present the subject of an inquiry by the Competition and Markets Authority (CMA) as the costs of services have risen exponentially in recent years. For the public these rising costs are seen as simply the result of greed on the part of vets (as evidenced by such articles as “Exploitative vets make me mad”). What most are unaware of is the fact that the vets themselves are not even particularly well-paid, especially when one considers the hours they have to work. Since 1999 when Tony Blair’s Labour government opened up the world of veterinary services to competition, it has been possible for companies and private equity groups (PE) to own veterinary practices. It is this which has changed the nature of veterinary practice entirely. The speed of change has been particularly rapid in the last five to ten years.
In 2021 there were approximately 25,000 vets, either self-employed or employed, in the UK. This is up from around 14,000 in 2013, but because of the increasing ‘feminisation’ of the profession many of these work part-time. As of 2018 there were 4,058 veterinary enterprises, according to Statista, but an increasing number of these are corporate or PE-owned. Anyone at all interested in gaining a bit more understanding of the profession and the way it sees itself should read the 2019 Survey of the Veterinary Profession produced for the Royal College of Veterinary surgeons (RCVS), the ruling body of the profession. 40% of respondents to that survey worked for “a practice that is part of a corporate group or a joint venture with a corporate group” and there are “high levels of concern about the changing structures in veterinary practice ownership”. Interestingly, the RCVS has control over the vets themselves, but no control over the corporates which are increasingly dominating the profession. This has led to a “very commercialised 'profession' which seems to be more interested in commercial gain of large conglomerates rather than to care for our patients and clients”, in the words of one respondent to the survey.
Unfortunately, as the number of first-time pet owners in the country increases and their only experiences of veterinary practice are these commercialised conglomerates (largely dedicated to the treatment of domestic pets, mainly cats and dogs), so the standing of the actual professionals, the veterinary surgeons themselves who remain the face of the ‘industry’, will decline. Those who go into the profession do so for very similar reasons to those who go in for human medicine. Like doctors they work extremely hard and have to pass rigorous exams and conform to exacting standards and ongoing CPD. They certainly do not go into it for profit. Unlike NHS doctors, vets are not recipients of state-provided pensions, and the average salary of a veterinary surgeon is between £35,000 and £46,000 depending on which statistics you use. This is hardly rich remuneration for years of training and a work schedule which usually includes weekends and nights.
It is possible, by dint of taking further exams (while still working) to obtain specialisations and earn up to £70,000 or £90,000, but this requires a great deal of dedication and almost certainly a further reduction in the poor work-life balance, which is already a major complaint of those in practice. The chances of perhaps one day becoming a partner have receded as the corporates gobble up more and more practices. In the meantime, it is a serious concern to vets that ‘‘The profession appears to be moving away from a caring and clinically-reasoned profession towards a non-caring, profit-based service industry where profit and not medicine is driving treatment approach.”
The veterinary surgeons are faced daily with disgruntled and angry clients who seem not to understand that x-rays, blood tests, scans, medications and consultations cost money, so used are they to the NHS system. They also misinterpret the question “Are you insured?” which is not asked so that they can be charged more, but so that the vets do not carry out tests which the client does not have the wherewithal to pay. However, should these costs be as high as they are currently? The CMA inquiry will hopefully determine the truth of the matter. In the meantime, it would almost certainly be of enormous help to both the public and to vets if the RCVS were to include in its role the education of the public and if, instead of being so ready to jump in to action client complaints, it was to step in a little more frequently on behalf of the vets – particularly in their relationship with the conglomerates now determining the direction of the profession.
As for the direction of the NHS and the discontent of the doctors and the public, the GMC would not appear to be in any position to improve either of these. The size of the behemoth and the years of state involvement make this a different beast altogether. Many are beginning to feel that reform along the lines of most European health services, or the Australian model, all of which rely on a mixture of state and private insurance, could be a better way forward. Interestingly, the British Medical Association (BMA), the doctors’ union, which could be the subject of a whole article on its own, is not interested in reform of the NHS. It appears simply to want more money thrown at it – oh and possibly to replace the current government with a Labour one. The demand for a 35% pay increase is largely viewed by both politicians and public as completely unrealistic and greedy, although the amount which has been spent on using consultants to cover absent juniors could, it is said, have paid for the increase demanded.
Without doctors there can be no NHS; the flood of departures to places like Australia once graduates have completed their two-year post-qualification requirement must be a cause for concern. A system which is capable of treating the health requirements of our ever-expanding population without bankrupting the country, whilst also treating the doctors with the respect and reward they expect and deserve is going to be an ongoing conundrum for whichever government is in power after the next election. A cross-party agreement on this subject would almost certainly be in the interests of all.
*For anyone not familiar with so much absurd British terminology, a 'junior doctor' is a qualified medical practitioner who has yet to finish their specialist training. There are many who have been junior doctors for twenty years. At last, this year the BMA voted to stop using this term. 'Postgraduate doctors' has been suggested instead. Unfortunately, neither the media nor the politicians seem to have noticed.