Comment by fnordpiglet | Hacker News Reader

Comment by fnordpiglet | Hacker News Reader

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Except this sort of funding has multiplicative effects. Funding for a single doctor helps only that doctor and their patients. Funding for this sort of work helps all doctors and all patients. When austerity cannibalizes your force multiplying efforts, that’s truly the end.

Edit:

For context the thing you linked says UK medical residents (in US language) make $36k/year, and the median household income is also $36k/y[0] .

In the US the average non specialist income is $60k[1], and the median household income is $69k[2]

This tells me things aren’t out of whack.

They also say 40% of residents in the UK want a different job. But residencies are temporary. In a few years they will have a new job - a full doctor.

I’m not saying there’s not a crisis, but that sheet doesn’t explain to me what the crisis actually is. They seem to be doing on par with US residents.

0 https://www.ons.gov.uk/peoplepopulationandcommunity/personal...

1 https://mededits.com/residency-admissions/residency-salary/

2 https://www.deptofnumbers.com/income/us/

What's the difference in pay between a "full doctor" as you put it consultant (UK) or attending (US)?

UK a consultant earns £100k pretax and pays approximately 30% net tax rate and 60% marginal rate.

What about US?

Apparently family medicine in the US brings in 130% more than the equivalent in the UK (GP which makes up half of all UK doctors).

https://revisingrubies.com/us-vs-uk-doctors-salary/

That's truly astounding.

https://www.salary.com/research/salary/benchmark/physician-i...

$230k, which when indexed by median household income, is comparable to the UK at 100k (I assume you used dollars? If not that’s $126k).

Edit: I’m not making any tax statements because taxes are unavoidable and applied to everyone in the nation, so are part of the indexing. That said US taxes sound comparable or more in some areas (taxes in NYC for instance can exceed 50%)

> taxes in NYC for instance can exceed 50%

Is that a marginal rate or total tax burden?

Total, it’s a combination of federal, state, and city income tax plus social security etc.

> UK a consultant earns £100k pretax and pays approximately 30% net tax rate and 60% marginal rate.

According to https://www.moneysavingexpert.com/tax-calculator/ , someone in the UK who earns £100k takes home £67,049:

>Earn £100,000 in 2023/24 and you'll take home £67,049. This means £5,587 in your pocket a month. Over the year you'll pay £27,432 income tax and £5,519 in national insurance.

Consultants also get a guaranteed pension funded by the net-contributing taxpayers.

However the median household income is half the US. You can’t compare nominal values.

My brother has lived in all three of the US, UK and Australia, doing non-professional jobs (construction, agriculture, gardening, cellar hand in the wine industry).

He didn't last long in London – he was working as an unskilled labourer in the construction industry, the pay was terrible, and the basic necessities of life were so expensive, he could hardly afford to eat. He'd worked similar jobs in Australia and got paid a lot more, and found life more bearable.

Some countries pay high because everything is expensive. Some countries pay low because everything is cheap. The UK seems to be a place where people get paid low because everything is expensive.

Absolutely true. But saying UK doctors are underpaid because they’re paid half of a US doctor while ignoring everyone is paid half of a US person for everything is disingenuous. Everyone in the UK is inexplicably underpaid, and everything is expensive.

What was your brothers take on the US?

> What was your brothers take on the US?

He lived in a small town in Oregon with his first wife. While they weren’t paid a lot, life wasn’t expensive either. I think he would have stayed except the marriage didn’t work out. Obviously that isn’t an entirely fair comparison to London, but I still think the pay-to-expenses ratio would be more favourable in small-town US than small-town UK

Yeah skilled labor in construction fields in the US can be very well paid, and there’s a massive demand and short supply.

OECD numbers show that UK medical pay is internationally competitive when compared to average national income.

Summary: https://i.imgur.com/DGT0d0d.png

From: https://www.oecd.org/health/recent-trends-in-international-m...

> UK a consultant earns £100k pretax

While it depends on the specialty, in Australia it is not uncommon for consultants to be on AUD 300-400K (= 150-200K GBP, 200-250K USD). I don't understand why salaries in the UK are so low, even for highly educated professionals.

My grandfather was a GP. He hated the NHS so much, he left the UK and never went back. Pay was likely a factor, but he also viewed the NHS as a denial of his professional freedom. While Australia eventually adopted something akin to the NHS (Medicare), I don't think he objected so much to that, since it involved less government control over the how of his job.

The highest marginal tax rate in the UK is 45% [1] and you only pay that on income above 125 140 GBP.

Where did your 60% come from?

[1] https://www.gov.uk/income-tax-rates

National Insurance is a tax, additionally after 100k you start losing your personal allowance.

The net effect is an effective tax rate much higher than the nominal rate.

You lose other benefits to but they aren't factored in as depend on if you have kids or not etc.

It varies quite widely by location because the income often reflects the number of patients and what source their income is from (Medicare, private insurance, uninsured). The med school debt for family medicine doctors can be quite daunting to pay off

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