Alistair Ludley

Enough is enough: a life of debt

Pay & Contracts
Ben Ireland

As the BMA campaign for pay restoration gathers pace, The Doctor has spoken to a range of junior doctors about why they are considering industrial action ahead of a ballot expected in early January. In the third of a series of interviews, Ben Ireland speaks to foundation year 2 Alistair Ludley

In his foundation year 1, on £14.09 an hour, Alistair Ludley accumulated £1,044 of interest on his near £90,000 student loan debts – more than his annual repayment of £903.

‘I’m not sure I’ll ever pay this off,’ he says. ‘It’s an inflated graduate tax for being a doctor in the NHS.’

Now an F2 at University Hospitals Sussex NHS Foundation Trust, Dr Ludley (pictured above) was the first in his family to go to university and chose medicine for a ‘stable, engaging, complex, fun career which was fairly remunerated’.

‘I was always told “you’ll never be a millionaire, but you should be comfortable”,’ he says. ‘Historically, medicine has been a career that was paid fairly, in keeping with the levels of responsibility and educational attainment you need to achieve.’

Some think doctors are paid well, but I don’t feel like they take into account the hours we work

Dr Ludley

The reality, however, is that he has had to rely on a landlord giving him an NHS discount to live in Brighton, where rents are ‘similar to London, without adjusted London salary weighting’. This, after studying in London, paying ‘sky-high rent’ with maintenance grants that ‘barely scratch the surface’.

Now earning a base rate of £16 an hour, he’s due to embark on a role with a 48-hour average week, including some 70-hour on-call weeks, at the boundary of the legal maximum. Owing to contract terms, he points out that ‘on bank holidays, sometimes the lowest-paid person in the hospital could be the F1’.

‘Some think doctors are paid well, but I don’t feel like they take into account the hours we work, and the levels of responsibility we take on,’ he says. ‘Even considering the enhancements for any out-of-hours work we do, the hourly rate is ridiculously low for what you are being asked to do and for the impact on your life and detriment to your own health.’

Busy Hospital Corridor Crop
Hard work: Juniors can see up to 150 patients a night

In one job, he was one of two doctors looking after all the medical adult patients in the hospital overnight. ‘You could be talking 100-150 patients per doctor per night,’ he recalls.

‘When I was on my surgical rotation, we could have up to 120 inpatients at any moment. There was one F1 doctor looking after those patients overnight, though you might have a registrar on site.

‘The major problem is that our greatly eroded salary is now not reflective of the level of responsibility that is demanded of us. In contrast, those with a similar level of training and debt, such as junior doctors in Australia, are paid fairly at a higher rate.’

No furlough

Dr Ludley volunteered at Charing Cross during the first wave of COVID, unpaid, as a final year medical student, along with many others. Given that, the 2 per cent pay offer from the Government’s pay review body felt like ‘a kick in the teeth, especially given the devolved nations gave NHS staff bonuses and NHS England did absolutely nothing’.

He adds: ‘There was no furlough for anyone clinical, our pay has already been eroded by at least 26 per cent since 2008, inflation is hitting silly numbers, and they still stand firm at 2 per cent. It’s a joke.

‘I, like my colleagues, have devoted my life to pursuing medicine. I diligently worked through secondary school, stressed through multiple competitive application processes, took multiple exams and interviews, studied for at least five years, and took on £90,000 of debt, all to work for an exhausted, under-staffed and under-appreciated monopoly employer, at £14 an hour.’

Juniors Generic Corridor
Dr Ludley questions if medicine was the right decision

Comparing his situation to graduates from the same university who studied other STEM subjects, such as physics and geology, he says many are ‘on double or triple our salary’.

This is despite other degrees being shorter, graduates taking on less debt and responsibilities, and not having to pay for multiple membership exams or compulsory GMC fees.

‘You are paying through the nose just to be a doctor, and it’s not optional,’ he says, noting the ‘brain drain’ he’s witnessed with colleagues and friends moving to places such as Australia, New Zealand and Canada.

That is not just owing to the levels of pay, but to working conditions and better autonomy over your own work-life balance.

It’s not just the poor remuneration, there’s not enough staff to do the job, with England deficient to the tune of 46,000 full-time doctors

Dr Ludley

Dr Ludley has had opportunities for further post-graduate training in medical education hindered because of nightshifts and having no one to swap with. And a holiday next year is not guaranteed despite giving 12 months’ notice.

While he’s hopeful it will go ahead, he notes: ‘If you’re putting thousands of pounds into a holiday deposit, you could lose that.’

Working one in three weekends makes organising plans with friends ‘much more difficult’ and ‘if your friends are doctors, you must align the stars’.

‘It’s not just the poor remuneration, there’s not enough staff to do the job, with England deficient to the tune of 46,000 full-time doctors. You work three or four 12.5-hour shifts in a row, without time for a break, and you’re burnt out by the last shift.

'If you ever need to take a sick day, this leaves your already short-staffed colleagues even more short. They understandably may become so over-worked they need to take a sick day themselves. And the cycle viciously repeats itself.

‘It will never end until you properly staff things. And proper staffing doesn’t begin until you entice people into the profession with fair pay.’