So, Let’s Talk About Money (Since No One Else Will)

David Wandless
Oct 6
4 min read

Money’s one of those weird things in medicine — it’s everywhere and nowhere. Whispered in coffee rooms, resented in tabloids, and dragged across every conversation as if we’re all lighting cigars with £50 notes while being carried around in Palanquin by overworked receptionists.

Let me say this clearly:

I make a six-figure salary as a GP partner. And I’m fine with that.

I’ve grafted nearly 15 years to get here. I pay a hell of a lot in tax. I take huge, constant risks all the time. I manage staff. I deal with shit no other profession would tolerate for the money I take home.

But if you think that means I’m loaded, or that every doctor is coasting on some gravy train, then you do not understand what wealth in medicine looks like — or what it costs.

The Doctor-as-Status-Object Illusion

That aura of status? It’s faded.

We’re treated like customer service reps with stethoscopes. The “social contract” — lower pay for higher respect and autonomy — has been shredded and repurposed into policy PDFs no one reads.

Doctors are losing professional perks, respect, and protection, while still holding the system’s core together. Many are now openly questioning whether the trade-off is worth it.

We’re Not Paid for the Work We Do

General practice is funded at around £150 per patient per year. That’s meant to cover unlimited care — from multimorbidity to palliative crises.

I have patients who make 300+ contacts a year.

Do the maths: that’s 30p per contact. We’re not underworked. We’re subsidised.

Oh, But You’re a Business!

Technically, yes.

We’re “independent contractors.” But in reality? We’re a public utility without protection.

We can’t say no. We can’t raise prices. We carry risk without control — and when it breaks, the partner GPs are the ones holding the bag.

Many GPs are blocked from retiring because of the trap of not collapsing the cost of the practice on colleagues, or worse playing “last-man-standing” having the last to get out foot the entire bill of making all staff redundant.

It has, and will, financially ruined people through no fault of their own.

Consultants Don’t Have It Better

A consultant in the NHS tops out around £130k, years after debt, training, and exams. Sounds good but with the weight of responsibility, not to mention the ever brutal on-calls and the fact that junior grades are so increasingly buried that more and more work is tricking north it’s less rosy in Secondary care than it once was

And Junior doctors? Many are on wages that can’t cover rent, childcare, and career costs — all while managing clinical risk and burnout.

The system expects sacrifice. What it offers back is eroding fast. The balance is shifting and young eyes are noticing and either leaving or not committing to the practice in droves.

Private Practice? Yeah, That’s Coming

When you treat doctors like commodities, they’ll leave for systems that offer control, time, and dignity. Not because they’re greedy — because they’re not stupid.

Public sector work is becoming increasingly DIY in nature; with all training, equipment, transportation, parking, childcare, HR, Payroll, even catering being devolved to individuals to sort.

Basically, everything that top-level experts at the same level in other fields take for granted is only available to those savvy enough to find it - or more likely willing and able to source it themselves.

Also, we need to keep ourselves up to date in a constantly changing world with neither the structure nor the clear direction on how best to do it. That, and while we’re on topic, no paid leave to do it and a demand for at least 50 hours a year of it or you lose your job.

Oh, and having to pay £500 a year just for the privilege of being a doctor (thanks GMC)

Partners vs Salaried: A Broken System

In GP in particular, having this cut deal that partnerships did 90% of the work for 10% of the budget still worked out well for both parties.

But that paradigm is shifting, fast.

The financial gap between partner and salaried GP roles is shrinking. In some areas, salaried GPs earn the same or more — without all the HR headaches or risk of running a practice.

So why be a partner? Good question.

Maybe you want to build something better - in theory.

But good luck doing that when the foundation’s crumbling and the blueprint keeps changing every time a politician cheats on his wife.

So, Yes, We Talk About Money

Because if we don’t, the public assumes we’re all fine. That doctors don’t need better funding, because we’re overpaid already.

We’re not. We’re really not.

We’re exhausted. We’re running on burnout. And if things don’t change, we won’t just talk about money.

We’ll talk about leaving. We’re already doing that too.

Because no-one would blame anyone for leaving a shitty job with bad management and an unlimited workload with all the risk and rapidly diminishing rewards.

And if I really look into my cynical, black and hazy crystal ball on this one - it’s not going to improve. No strikes, no exodus, no random blogs from no-name dickheads like me will change the coming truth;