Analysis of consultants' NHS and private incomes in England in 2003/4

Abstract

SummaryObjective Consultants employed by the NHS in England are allowed to undertake private practice to supplement their NHS income. Until the introduction of a new contract from October 2003, those employed on full-time contracts were allowed to earn private incomes no greater than 10% of their NHS income. In this paper we investigate the magnitude and determinants of consultants' NHS and private incomes. Design Quantitative analysis of financial data.Setting A unique, anonymized, non-disclosive dataset derived from tax returns for a sample of 24,407 consultants (92.3% of the total) in England for the financial year 2003/4. Main outcome methodsThe conditional mean total, NHS and private incomes earned by age group, type of contract, specialty and region of place of work. ResultsThe mean annual total, NHS and private incomes across all consultants in 2003/4 were £110,773, £76,628 and £34,144, respectively. Incomes varied by age, type of contract, specialty and region of place of work.The ratio of mean private to NHS income for consultants employed on a full-time contract was 0.26.The mean private income across specialties ranged from £5,144 (for paediatric neurology) to £142,723 (plastic surgery). There was a positive association between mean private income and NHS waiting lists across specialties.

‘The workman is worthy of his hire’* What is an anaesthetist worth in 2010?

“…As with the Australian data, this is at the level of state-funded care; purely private practice fees would be much higher than this, and annual incomes of £300 000 are not uncommon for US anesthesiologists, although the US Bureau of Labor Statistics, basing its data on tax returns, cites the mean income of an anesthesiologist in 2008 as being the equivalent of £105,000 [6]. Interestingly, if you add the full-time NHS salary of a consultant on their sixth seniority increment [7] to the mean annual private practice earnings in the UK quoted by Stubbs et al [8], the total comes to a remarkably similar value to this. It seems that in spite of the vagaries of foreign exchange, the complexities of reimbursement systems and differing balances between state and private commitments, anaesthetists may well be equally valued, or at least similarly paid overall, in the UK and US, with Australia valuing its anaesthetists perhaps a little more highly.…”

Remuneration of medical specialists. Drivers of the differences between six European countries

“…2 Average income per year is obtained from stats.oecd.org. supplementary income, we used a study by Morris et al [4]. They use a unique, anonymized, non-disclosive dataset derived from tax returns for a sample of 24,407 consultant specialists (92.3% of the total) in England for the financial year 2003/4 and report that the ratio of mean private to mean NHS income for consultants was 0.45.…”

“…Those specialists with an income from private practice had an average annual gross income of D 181.703 in 2010. 4 Almost 32% of salaried doctors also work in a selfemployed capacity; taking a weighted average of salaried only (D 121,182) and salaried plus income form private practice (D 181,703) gives a total figure of D 140,205.…”

“…Fujisawa and Lafortune [10] concluded that variations in remuneration levels across countries may be partially explained by the use of different remuneration methods 4 Data acquired from Statistics Netherlands.…”

Restricting private-sector practice using contracts

“…It is unclear whether the violations were due simply to lax enforcement; on its face, compliance could be monitored by auditing physicians' tax returns. 13 Another option is to contractually limit the time physicians devote to private practice. Ireland prohibits public-sector physicians from devoting more than 20% of their clinical workload to private-pay patients.…”