[slackline]

There are quite a lot of papers in neuropsychological journals that demonstrate a significant reduction in cognitive function after the age of 60, although I don't know of any that specifically look at doctors and errors.  There have been a couple of papers from the states that show stress increases errors doctors make, I seem to recall an increase of 14% or so.

I'm not doubting that cognitive function declines after the age of 60 but its not the 'end-point' of interest here, but for this particular case does that decline in cognitive function, which is a proxy, translate to a significant increase in deaths and/or mis-diagnoses?

Just as my wife and I were told that her taking chlomofene citrate would increase her FSH/LH levels.  This may be true, but she was more interested in whether she was more likely to actually get pregnant.  Based on a review this appears not to be the case in her situation, despite the increased hormone levels taking chlomofene citrate conferred, and contradicts what the doctor told us when I asked him this specific question.

Anyway, once again I'm going    and no doubt sound pedantic so will shut the fuck up.

[GCW]

It's a fair enough point, but I think you'll be disappointed by the lack of randomised controlled trials looking at errors made by doctors at various ages.  There would be so many issues doing that study I think it'd be virtually impossible.  What is an error?  Would people report them?  etc etc

All I can say is that I know a lot of people that are getting burnt out and jaded in their 50s.

[rich d]

I work in the private sector and it's like getting bummed by a goat at burbage bridge on a sunday morning. But I support the doctors, from what I understand their contribution pot is positive after being re agreed 4 years ago.
Yes doctors are well paid, but then they're well qualified and have a pretty responsible job.
I don't think we should use jealousy that another sector were being treated properly as a reason to not support the doctors, it should have the reverse effect where the terrible state of private sector pensions and the issues further down the line should be dealt with and discussed.
I have a new rule, if the politicians are doing it to others then they should have it done to themselves, it would be interesting to see what cuts etc happen then.

[GCW]

But I support the doctors, from what I understand their contribution pot is positive after being re agreed 4 years ago.

It's £2 billion in surplus.

[slackline]

It's a fair enough point, but I think you'll be disappointed by the lack of randomised controlled trials looking at errors made by doctors at various ages.  There would be so many issues doing that study I think it'd be virtually impossible.  What is an error?  Would people report them?  etc etc

I don't think an RCT here would be appropriate, epidemiological observational study based on exisiting (routinely recorded?) data would be more suited and I fully appreciated before even questioning the evidence that getting accurate data would be problematic.  But its not impossible, and evidence, accepting its limitations, is best grounds for making a case.

  That really is all I'll say on the matter.

[Offwidth]

The fact is that it will always be seen by the majority of the population as a "strike" over "money". Given doctors relatively generous salaries ... it's always going to be a hard sell to drum up much popular support whatever the Daily Scaremonger reports.

I think as a group you appear to have attracted less venom than teachers.

I wonder what the daily scaremonger readership actually want.. is it some kind of fantasy world where they get as much as everyone else despite doing nothing significant to deserve it. We live in a society that I quite like... those who are bright and work hard in their studies and their training can achieve a reasonable salary in a caring profession. Equally they can earn a shit load more in an investment bank with much less education and training. Those less fortunate in society who dont have the ability or luck to get a well paid job seem to me to get better support from the liberal public sector softies than the hard nosed bankers. When governments start to steal shit without any proper justification or comeback we are facing social breakdown.

Oddly some people I know with views very much on the right were far more vicious in their attacks on the doctors than teachers. I suspect very high paid professionals out of a free market demanding respect are seen as much more of a political threat.

[IanP]

The current scheme is that you can retire on a full pension at 60 if you have made full contributions (25 years full time)- this used to be included voluntary contributions, but this has effectively gone now.

Are you sure you mean 25 years is full contributions!

It gets a bit complicated, but to keep it simple:

Very little to do with pensions is simple!

In the standard old style scheme if you work until 60 with full contributions the pension will be around £37,000 pre tax.  If you retire 5 years early, without extra contributions, it will be about £29,000.  If you retire 10 years eary it will be £23,000 ish.

This varies depending on if you want lump sum payments etc etc though, but as a general guide it's about right.  I can only presume the new deal will mean you get less, but 8 years later.

Which sorts of defines part of the issue - if we don't know what the new figures will be how do we know how good your case is.  BTW working to 60 and getting a £37k pension based on a £80k salary (plus I assume lump sum as standard NHS pension scheme) is very attractive by almost any measure other than maybe special cases like armed services etc (and MPs though that's probably a different discussion).

[Offwidth]

BTW working to 60 and getting a £37k pension based on a £80k salary (plus I assume lump sum as standard NHS pension scheme) is very attractive by almost any measure other than maybe special cases like armed services etc (and MPs though that's probably a different discussion).

It needs to be attractive, to encourage enough of our brightest and best to be doctors, carrying all that debt and lost time in training and education. The real question is, is it affordable given the payments made? We are not talking about risky investment schemes increasingly skimmed by dodgy financiers we are talking about a virtual fund backed by the government. Will the government get enough money from these changes to pay for the future pension costs? Everything I've seen says they are deliberately taking more than they need, partly to get more cash now and partly to make it easier for private sector providers to buy out sections of the service (by reducing pension liabilities).

[GCW]

No, I meant 30.  D'oh.  I'm still in the 1995 section and the 2008 revisions wouldn't have affected me.

We know the effect of the 2008 section- less money, 5 year later retirement.  The proposed changes' figures are out there.  For me personally in the 1995 scheme I would have contributed £250,000 over my working life to get the amounts we have discussed.  In the proposed plan I will contribute £514,000 and get 9.4% less.  I could have potentially retired at 55 on a full pension, but now I need to work until 67 to get it.

[Offwidth]

I think you need to be careful about saying "full pension" at 55. By that you presumably mean the accrued pension from your number of years worked based on a final salary calculation and without any actuarial reduction. Were there not diferences in the lump sum before and after as well (Im not as familiar with your schemes)?

[GCW]

I only say "full pension" as this is the maximum you get, working longer doesn't increase it but working less reduces it.

Yes, the proposed lump sums drop too.  That gets far more complex though.

[IanP]

It needs to be attractive, to encourage enough of our brightest and best to be doctors, carrying all that debt and lost time in training and education. The real question is, is it affordable given the payments made? We are not talking about risky investment schemes increasingly skimmed by dodgy financiers we are talking about a virtual fund backed by the government. Will the government get enough money from these changes to pay for the future pension costs? Everything I've seen says they are deliberately taking more than they need, partly to get more cash now and partly to make it easier for private sector providers to buy out sections of the service (by reducing pension liabilities).

Doctors are very well paid - the Guardian highest paid jobs 2011 has medical practiioners second behind heads of major organisations and ahead of senior goverment officals airline pilots, dentists etc.   I'm not saying that they don't deserve to be well paid but I think any idea that a less good pension scheme will significantly impact the number of very able people who choose medicine as a career is wide of the mark .

Link http://www.guardian.co.uk/money/2011/nov/25/highest-paid-jobs-uk-2011

I don't think the comparison with bankers (in the financial markets sense rather than bank managers) is really useful - of course there is a group of very highly paid (overpaid?) people working in this area but it's not really a career in the same way medicine is and I'm sure requires very different skills.  It's easy for a clever person to say I could have made a fortune in banking but I don't think it's quite as easy as that (and hopefully lots of people would have more principles as well!).

[Offwidth]

That must be a detail I missed and seems odd to me. Most of these schemes have a payout of n/x times calculated 'final salary'; with n number of years worked and x the fraction of salary accrued per year; plus a lump sum on a similar calculation (but x will be smaller). If you work past the standard minimum retirement age (60 for me) you still increase n. As an example, if I was a year older (and not just caught in the transition zone) and worked to 68 I'll have got 46/80ths plus a lump sum based on the a similar fraction.

That's another divide-and-rule trick in the government plans: by the changes not affecting those less than 10 years from the standard scheme retirement age, those near retirement (who are much more likely to vote on an industrial action ballots) are less likely to vote yes on behalf of their younger colleagues.

[Probes]

Im reading this discussion with interest. GCW is that right what you said? Under the old scheme, if at 60 you retire, you've contributed £250k, and retire on £37k a year + lump. Im guessing on average youll make it to a ripe age of 80.. that £500k coming out of the fund! Wow.

Personally I think its a cheap shot to have a go in this way at doctors.

But there is a great deal of rebalance needed between public and private sector. It does need addressing. In the private sector myself as are my parents and we have been royally fucked right over, my parents especially!  My old man retired last year... his retirement now involves working 3 days a week and working weekends for me to keep food on the table.

[Offwidth]

I think any idea that a less good pension scheme will significantly impact the number of very able people who choose medicine as a career is wide of the mark .

I don't think the comparison with bankers is really useful ... I'm sure requires very different skills.  It's easy for a clever person to say I could have made a fortune in banking but I don't think it's quite as easy as that (and hopefully lots of people would have more principles as well!).

Well I beg to differ, as a bright working class comp kid I considered medicine when I was choosing A levels and S levels in 1978; all facing a grant and a likely good future but I followed my heart into applied physics. No way would I have even looked at medicine now with the pension changes and the debts I'd build in my studies. The future of medicine if we are not careful is very upper middle class topped up with foreign imports.

As for banking not being an option: we place about 5-10% of our computing and technology students in various merchant banks in their sandwich year: they just take the brightest students and train them up; paying twice the average placement salaries and three times the average graduate starting salaries if they stay on after their final year. Even our graduates scrambling for jobs after Lehman's went down didn't take to long to get something else. Its a very viable option.

Plus you avoided my key point: are the pensions now more than affordable? This is important because if they are (as the doctors argue on cold facts) then the government are placing a stealth tax on being a doctor. If we pay money into something supposedly safe we dont expect it to get nearly halved. If society feels doctors are paid too much, reduce their salary not steal their savings.

[Lund]

I work in the private sector and it's like getting bummed by a goat at burbage bridge on a sunday morning. But I support the doctors, from what I understand their contribution pot is positive after being re agreed 4 years ago.
Yes doctors are well paid, but then they're well qualified and have a pretty responsible job.
I don't think we should use jealousy that another sector were being treated properly as a reason to not support the doctors, it should have the reverse effect where the terrible state of private sector pensions and the issues further down the line should be dealt with and discussed.
I have a new rule, if the politicians are doing it to others then they should have it done to themselves, it would be interesting to see what cuts etc happen then.

http://www.bbc.co.uk/news/uk-politics-13962454

'MPs should face "exactly the same changes" to their pensions as those imposed on public sector workers, David Cameron has said.'

[slackline]

Should != will

[Lund]

Im reading this discussion with interest. GCW is that right what you said? Under the old scheme, if at 60 you retire, you've contributed £250k, and retire on £37k a year + lump. Im guessing on average youll make it to a ripe age of 80.. that £500k coming out of the fund! Wow.

Not sure I get your maths: if you claim  your pension for 20 years, at 37K thats 740K.  Is that what you mean?  The fund needs to triple your money to break even.

80 is a big high.  Life expectancy today is that, but that's for today's babies.  Assuming that penicillin doesn't stop working that is.  If it was 75: then it would be 15 years, and 550K; if it's 10 years (work to 65), then we're getting close.

This is why you have to work longer.  The maths doesn't work otherwise.

Now, if you grow the population by three, and they are still paying into the pension schemes, then it would work then.  Clearly that won't work either.

 

[Lund]

Should != will

There's not much discussion possible in the face of that statement.  Government bashing is all to easy and unproductive don't you think?

[GCW]

You are assuming I earn 80k- I don't earn anywhere near that, which is why the figures seem odd. I'm a salaried GP, so my full time equivalent wage is 63k, although at present I'm part time.

[andy_e]

Surely you should be using this strike time to write your blog?

[rich d]

I'll stop government bashing when the "should" becomes "has". I seem to recall that the MPs pension isn't based on the four or five years they spend doing the job (assuming they're only in for one term). So true parity with other public sector workers would be good. Does anyone know if the MP canteens and bars are still tax payer subsidised?

[Probes]

Thats what i was getting at, 750k is high possibility as a normal take from the fund, so thats one heck of a cock eyed pension scheme to start with. Every put in 250 and get 750 back. Thats not  maths. No matter how you think it will cope over time with increasing numbers paying in etc. Most doctors appear to be clipping bolts in spain with the young broad back at the chalette housing keeping at 55, so id thought it common to claim 20 years pension is normal.

Sorry just amazed it was actually set up like this originally.

[slackline]

Should != will

There's not much discussion possible in the face of that statement.  Government bashing is all to easy and unproductive don't you think?

Well they don't do themselves any favours now do they?

Cameron on Jimmy Carr: "morally wrong". Cameron on Philip Green: "I'm not going to comment on individual's tax affairs"

Something of a contradiction there Mr Cameron wouldn't you say?

Cameron family fortune made in tax havens

Politicians are self-serving, self-interested individuals, they say whatever soundbites they think will placate the populace.   Rather than saying MPs "should face 'exactly the same changes'" why don't they lead by example, cut their pensions, take the salary cut, declare all their sources of income etc. etc. before imposing the same on others and then quietly forgetting to impose the changes on themselves?

As usual I'm 

[IanP]

Well I beg to differ, as a bright working class comp kid I considered medicine when I was choosing A levels and S levels in 1978; all facing a grant and a likely good future but I followed my heart into applied physics. No way would I have even looked at medicine now with the pension changes and the debts I'd build in my studies. The future of medicine if we are not careful is very upper middle class topped up with foreign imports.

I don't know what you do / earn but given a median salary of £82k for a medical practioner, did you make the right decision?  (assuming of course that money is your only criteria.

As for banking not being an option: we place about 5-10% of our computing and technology students in various merchant banks in their sandwich year: they just take the brightest students and train them up; paying twice the average placement salaries and three times the average graduate starting salaries if they stay on after their final year. Even our graduates scrambling for jobs after Lehman's went down didn't take to long to get something else. Its a very viable option.

You've got more direct experience than me but these bankers don't appear on the guardian article linked earlier and according to http://news.bbc.co.uk/1/hi/8151355.stm, £61k gets you into the topo 5% of earners and 118k into the top 1% so there's not that many such jobs about.  Once we're looking at the top 1-2% we're definitely talking about the rich and any arguments about how tough things are for them have to be taken in context.

Plus you avoided my key point: are the pensions now more than affordable? This is important because if they are (as the doctors argue on cold facts) then the government are placing a stealth tax on being a doctor. If we pay money into something supposedly safe we dont expect it to get nearly halved. If society feels doctors are paid too much, reduce their salary not steal their savings.

Wasn't directly avoiding it just talking about different things.  First point, in general savings aren't been stolen - any earned benefits are retained only benefits for future years are impacted.  On the affordability side I'm not completely clear on how the NHS pension scheme is funded or the full details of the new proposal (it's suprisingly difficult to find out and nobody seems to contribute such details to threads like this) but as general rule of thumb I think db schemes such as this cost in the order of 25% of salary so it's fairly easy to see that significant employee contirbutions will still be required.  As I said earlier, without any real figures it's very difficult to come to proper conclusions, but I'm willing to hazard a guess that I'd jump at a chance to join a scheme like the doctors have even after its changes.