As veterinary professionals, it’s a natural comparison to look at the working life of doctors and dentists. We often labour under the impression that the human medics benefit from higher salaries and more defined career options. There can be a hint of envy as we look at our medical colleagues if we find ourselves financially stretched or stagnating in our careers. However, a recent government review on remuneration of the medical professions reveals truisms remarkably similar to our own experiences and mirrored challenges to those facing the veterinary profession. Can we benefit from parallel solutions?
With guaranteed jobs on graduation and public perception of being valued and held in high regard, it’s still an attractive prospect to be a vet, doctor or dentist, although there has been a recent decline in the number of applicants across the three professions. With parallel challenges with recruitment and retention we need to focus on creating good workplaces to safeguard the future of these professional workforces.
Starting salaries for new graduates are certainly respectable and very comparable for the three professions. The 2018 Society of Practising Veterinary Surgeons Salary Survey showed the average salary for new graduate vets was £32,175. Foundation trainee salary for dentists is a comparable £31,992, while the foundation doctor year 1 (FY1) salary is lower at £27,146.
The small salary advantage vets see as new graduates soon reverses. The median annual salary for a full-time salaried general medical practitioner (GMP) was £63,493 in 2016. Compare this to the results of the SPVS Salary Survey 2018, with a median salary of £47,800 (excluding additional benefits) and the difference in salary progression is stark. The British Dental Association (BDA) stated that there had been a deterioration in dentists’ pay since 2008, from a median FTE net of £67,880 to £60,200 in 2016 for performer-only dentists (equivalent to a salaried assistant vet). An interesting comment is the idea that pay progression should be linked to performance and competence in the role. Performance related pay is a controversial area in the veterinary sector, beyond the scope of this article. We know that pay is an important hygiene factor, but the relationship is not linear and beyond a certain point higher pay does not continue to boost motivation. However, the knowledge that as a vet we’re paid on average 20 to 25 percent less than our doctor and dentist colleagues may be demotivating.
The move towards larger medical practices and corporatisation in the dental and veterinary professions is also increasing. In dentistry, large pan-European groups are forming, with the recent acquisition of one of the largest UK dental groups by a Swiss firm. NHS England stated that 85.7 percent of dentists in England were now performer-only (ie hold no share of NHS contracts or facilities), compared with 62.4 percent between 2006 and 2007, and similarly general practitioners are increasingly opting for salaried GMP roles. In the Doctors and Dentists Remuneration Report the reasons for the shift towards lower-paid performer-only or salaried roles are not clear, but were thought to relate to the desire for work–life balance, flexibility and fewer responsibilities. Work–life balance and flexibility are also common themes for the veterinary profession.
Interestingly, while dentists earned more on average as young graduates, career progression did not always materialise as expected. The BDA’s view was that dentists were almost at the tipping point where the balance between pay and workload would push them to leave. If a number left or retired and Brexit had an impact, there could be a crisis. Again, many similarities with the veterinary profession…
There are signs of a clear trend in the medical workforce towards salaried employment and away from the partnership model. All generations are showing an increased desire for flexibility and a better work–life balance, and this appears to be translating into salaried employment, locum work and part-time working patterns (sound familiar?). Interestingly, the RCVS Survey of the Profession in 2014 found that although women are more likely to work part-time than men (26 percent compared with 11 percent), the biggest growth in part-time working in the last four years was from men (5 percent in 2010 to 11 percent in 2014). Reports from all the professions have noted that employers and planners will need to react to the different work preferences in order to recruit and retain and ensure the effective delivery of healthcare/veterinary care.
This leads us on to the gender pay gap which is prevalent in all three professions. These are often accounted for by structural factors such as fewer working hours or more junior roles (which in themselves can often have a discriminatory basis), versus a more obvious discriminatory gap where equal work is not rewarded with equal pay. The independent report from the Review Body on Doctors and Dentists Remuneration noted that the prevalence of women as performer-only dentists (ie not partners) or salaried GMPs may entail a correspondingly lower income for these individuals. We have heard similar things in the veterinary profession.
Here’s where others may learn from vets. The BVA’s gender discrimination report based on an experimental study highlights obvious discrimination and indicates attitudes as key in addressing the issue. Maybe doctors and dentists can also learn from the BVA report to help them shape a thriving, motivated and sustainable workforce for the future.
In May 2016, the King’s Fund published research on the pressures in general medical practice, which found that increasing demands including a heavier workload and increasing complexity and intensity of work had led to a feeling of crisis. It added that the NHS was finding it difficult to recruit and retain GMPs who wanted full-time, patient-facing work. On the positive side, peer support was reportedly increasing. With the advent of similar veterinary peer support networks including veterinary social media groups focused on everything from career support, parenting and chronic illness, this is a clear, unmeasured trend for our profession.
Changes are afoot for doctors to increase retention of the groups where the pipeline has the biggest leaks. The NHS GP Retention Scheme is aimed at doctors who are seriously considering leaving or have left general practice due to personal reasons (caring responsibilities or personal illness), or requiring greater flexibility. It provides financial support for both the retained GP and the employing practice, providing working hours are limited. Crucially, it also demands CPD and educational support are provided. While the veterinary profession may lack a pot of funds, a similar scheme could reap long-term benefits.
Early retirees are the second key group, with a loss of skills and experience of doctors over 55 years of age – a similar phenomenon to the buy-out of independent vet practice partners by corporate groups, leading to career divergence or early retirement for vets. The NHS GP Career Plus pilot scheme encourages the retention of this experienced group through vaccine clinics, cover of practice holiday or sickness, mentoring and clinical coaching, and specialist clinics or home visit services to augment local practice offerings. In this modern era of innovative recruitment start-ups, a matching service for those in the twilight of their veterinary careers would be an interesting prospect.
In summary, the challenges around workforce retention and satisfaction which will impact the future shape of all three medical professions are similar. By comparing and contrasting proposed solutions we can learn from each other how best to adapt working practices to ensure continued provision of excellent care. The bottom line from the BVA study suggests that if the profession can facilitate its members feeling valued, fitting in and having role models, this is likely to have multiple benefits in terms of cultivating a cohort of vets who are strongly motivated in their careers and keen to stay within the profession.
