In this series of posts, I answer questions from medical students and doctors interested in getting into Occupational Medicine. If you have any questions you’d like me to answer, please feel free to put them in the comments below.
Q. In the same way that consultants can boost their private income in certain specialties, is there much or any room for salary growth beyond advertised salaries role for occupational medicine? Also, is there a significant pay rise in a strategic non patient facing position, and is there a significant bottleneck of competition at these points as you would be interviewing against non medics?
A: Most of the doctors training you in medical school will spend much of their working time in the NHS. Additional income for these doctors is often an 'add-on' to NHS practice - be that private practice, medicolegal work, teaching/presenting, journalism, or other activities.
For an NHS occupational medicine doctor, the options are similar to those for other specialties - there is certainly private work out there. Many occupational physicians work as contractors, either working directly for the company they are advising, or for an OH provider company.
Someone with the Diploma in Occupational Medicine (DOccMed) may be able to get £600-£900+ per day, a consultant may be able to earn £1200+ per day or more. While this sounds like a lot, bear in mind that when contracting, people have to pay their own medical indemnity, professional fees, taxes and national insurance, and they don't get workplace benefits like a pension, maternity pay or sick pay. The total deductions can be considerable, although many costs can be offset on your tax return.
Where OH is different from other clinical specialties is that a significant proportion of OH work in the UK is fully outside the NHS. This means that doctors are not subject to nationally agreed pay scales and are much more able to negotiate salary, terms and conditions. Doctors working outside the NHS in OH would usually expect higher salaries, workplace benefits like private health care, potentially an annual bonus and sometimes other benefits like a company car (many OH jobs require some travel). They would also expect to have GMC, medical indemnity, professional memberships, appraisal fees and CPD costs covered by their employer, which can amount to several thousand pounds per year.
On the flipside though, annual leave and pensions provisions are often (but not always) better in the NHS when compared with industry jobs. Job security in the NHS is often greater than in industry - economic factors can lead to redundancies in industry which are possible but rarer in the public sector. And sick pay is often significantly different in the public and private sectors - in the NHS workers are eventually entitled to 6 months' full pay and 6 months' half pay. Parental/adoption leave terms in the public sector are also often better than in the private sector - though not always.
The work can also be quite different - there may be more opportunity for research in the NHS, and to work in a large in-house integrated OH department. In-house OH does exist in industry, but it is not as common as it once was. This may be changing though as organisations realise there can be significant benefits to having in-house expertise
Someone with DipOccMed working full time with an OH provider company might expect to earn £70-90k, though with experience this can be more. Someone working a day a week in OH and the rest of their time in GP may be able to start at that sort of level (pro rata) but may not have the salary-growth potential given their reduced time specialising in OH.
A consultant in OH would expect to start on over £100k in industry. Consultants may be on £120-140k+ when they are employed in patient-facing roles with clinical leadership duties (regional lead, training director etc) which attract additional pay.
It is certainly an option for OH physicians to set up themselves as independent practitioners providing services directly to companies. Estimating earnings is very difficult because there's so much variation in overheads, but an hour-long appointment for an OH management referral with a consultant OHP may be charged at £200-450. The price someone who has a lower-level qualification is likely to be less.
The most lucrative career option is probably to set up a successful OH company, grow it and sell it. However, this requires a very particular set of skills, would require taking on a considerable amount of risk and needs an enormous amount of energy over a prolonged period of time. We're talking potential returns in the millions, but I must stress the ability to do this is extremely rare. Anyone this entrepreneurial would probably be able to make this sort of money if they started their career working almost anywhere - you'd need the right mix of ability, temperament, drive and (as always in building a business) a certain amount of luck. Being a senior clinician in a business that’s already established may bring the opportunity of an equity stake, which can also be lucrative if the business grows, is bought out or gets listed on the stock exchange.
There is significant opportunity for salary growth in more strategic/leadership roles in large companies. The COVID pandemic has highlighted for many organisations the need for in-house health expertise, which applies the organisation's culture and business practices to the wider health and wellbeing landscape. A senior consultant in a national role may have compensation worth £140-200k or more. People in an international regional role (e.g. covering Europe, Middle East and Africa) or global leadership roles may be on significantly more, commensurate with experience, skills and responsibilities. Salaries can grow substantially when one is on an executive career track, although they vary hugely depending on the sector and the company. Packages for executive roles may include stock options, larger bonuses or profit shares, or other benefits.
In terms of competition - there is always fierce competition for high-level jobs. Whether competitors are medics or not, what matters is the applicant's understanding of the business, ability to navigate varied stakeholders, maintain professional integrity, comply with legal and regulatory requirements, their experience and track record in managing complex health systems and more besides. Being a doctor will generally stand applicants for health roles in very good stead. Anyone looking at this sort of role would be advised to add as many strings to their bow as possible to ensure they had a broad and relevant experience in corporate health management.
Many thanks to Mohammed Blaaza, medical student at UCL, for the question.