Transcript

How much should doctors be paid? | BMJ Interviews Economist Richard Murphy

From The BMJ · Episode page · Watch on YouTube

· 36 min · 6,537 words · 55 timestamped sections

This is the full, timestamped transcript of "How much should doctors be paid? | BMJ Interviews Economist Richard Murphy", an episode of The BMJ published January 23, 2026 (36 min, about 6,537 words). It mentions 13 people, works and ideas, including NHS, Donald C. Murphy, neoliberal capitalism, Cameron Abassi, BMA.

What this episode is about

The interview explores the ongoing pay dispute between junior doctors in the UK and the government, highlighting the decline in real wages for resident doctors amidst rising costs of living. Economist Richard Murphy argues that structural economic issues, driven by late-stage neoliberal capitalism, are exacerbating the challenges faced by healthcare professionals, raising questions about the adequacy of doctors' compensation and the broader implications for the National Health Service and public health policy.

Key takeaways

  • Junior doctors face an affordability crisis; years of studying shouldn't lead to chronic financial stress.
  • Under-valuing medical professionals raises the question: are we designing a society that breeds illness instead of health?
  • The stark contrast between medical training costs and pay highlights a key flaw in our economic priorities.
  • In the battle of inflation indices, doctors’ needs get sidelined; the right measure could change the game.
  • Caring deeply for patients shouldn't come with a sleepless night stress premium; it’s time for fair compensation.

Who speaks in this episode?

What is discussed, and when

  1. – 5:00: Cameron Abassi, Donald C. Murphy, BMA, neoliberal capitalism
  2. – 10:00: neoliberal capitalism, CPI, CPIH
  3. – 15:00: Donald C. Murphy
  4. – 25:00: neoliberal capitalism, Tim Spectre
  5. – 30:00: neoliberal capitalism, GDP, Green New Deal
  6. – 35:00: neoliberal capitalism

Notable quotes from "How much should doctors be paid? | BMJ Interviews Economist Richard Murphy"

  • Time. In real terms, their pay has fallen. And at the same time, their costs have risen dramatically. We live in a society which is actually designed to extract people's income…
    about neoliberal capitalism · at
  • Pay as well as the broader implications for the health service and government health policy. Here to talk through these issues is economics activist and co-author of the Green…
    about Donald C. Murphy · at
  • But that's what doctors live with, which very few people understand. The pay rate for that stress is just abysmal. So, I do think doctors have a very good basis for a pay claim just on pure economic factors, but also because.
    about NHS · at
  • Now CPIH which is the one that the Office for National Statistics always refer to in their monthly bulletins is very much closer to RPI than is CPI because it does take into consideration.
    about CPIH · at
  • Yeah. One of the manifestations of that is the number of young people out the proportion of young people out of work post pandemic in the UK through ill health which is out of sync and a.
    about OECD · at
  • Know that politicians aren't counting that and this is what really matters and I think we're seeing that. I watched a program recently with Tim Spectre on the television about…
    about Tim Spectre · at
  • I actually did co-author the original Green New Deal report which has become well a slogan, a meme if you like around the world. Within two months of us publishing it in 2008, somebody called.
    about Green New Deal · at
  • Economics with its focus upon GDP can't do that. GDP is a lousy measure. Robert Kennedy before he was shot in 1968 and I remember that event happening talked about GDP and said it measures everything in life except those things.
    about GDP · at

Who and what is mentioned in this episode?

People

  • Donald C. Murphy — Person · Main guest · 2 mentions · first at
    Interviewee providing an economic and political-economy perspective on UK resident doctors’ pay, inflation measures, NHS affordability, and structural drivers of ill health.
  • Cameron Abassi — Person · Host / interviewer · 2 mentions · first at
    BMJ editor-in-chief who frames the episode around the UK resident doctors’ pay dispute and guides the discussion with questions on inflation indices, affordability, and NHS funding.
    Hello and welcome to another interview from the BMJ. I'm Cameron Abassi, editorinchief.
  • Tim Spectre — Person · Referenced expert (media figure) · 1 mention · first at
    Cited by Richard Murphy as an example of public-facing discussion about diet and prevention; used to support the argument that upstream interventions could reduce NHS demand.

Books & papers

  • Green New Deal — Book · Referenced work · 2 mentions · first at
    Mentioned as a work co-authored by Richard Murphy, providing context to his economic perspectives.

Companies & orgs

  • NHS — Company · Business focus · 4 mentions
    Central topic of discussion regarding pay disputes and structural issues within the UK healthcare system.
  • BMA — Company · Business focus · 1 mention · first at
    The British Medical Association is central to the discussion as the organization representing the striking doctors.
    Pure economic factors, but also because of the job they do, which very few people really understand. Richard, one of the points of dispute is the measure inflation of inflation…
  • OECD — Company · Referenced expert · 2 mentions
    Mentioned in comparison to the UK's economic and health outcomes, providing an international context.

Concepts & topics

  • neoliberal capitalism — Concept · Key argument · 10 mentions · first at
    Critiqued as the underlying economic system causing structural problems in healthcare and society.
  • GDP — Concept · Key argument · 1 mention · first at
    Discussed as a flawed measure of well-being and prosperity, especially in the context of healthcare and economic policy.
  • RPI — Concept · Key argument · 4 mentions
    Discussed as a more accurate measure of inflation for doctors' pay claims compared to CPI.
    RPI stands for the retail price index and fundamentally it is about the prices that we pay for the consumer goods that we buy. CPI is consumer price index and takes into consideration a broader range.
  • CPI — Concept · Key argument · 1 mention · first at
    Critiqued as an inadequate measure of inflation for assessing doctors' pay and living costs.
    And fundamentally it is about the prices that we pay for the consumer goods that we buy. CPI is consumer price index and takes into consideration a broader range of goods but…
  • CPIH — Concept · Key argument · 1 mention · first at
    Presented as a compromise measure of inflation that includes housing costs, more reflective of living expenses.

Places & events

  • UK — Place · Setting · 4 mentions
    The primary location where the discussed healthcare and economic issues are occurring.
    In light of the ongoing dispute between the government and resident doctors as well as winter pressure on the National Health Service in the UK, we thought we'd ask a money expert about whether.

Full transcript with timestamps

Junior doctors, resident doctors have had a basis for a pay claim for a long time. In real terms, their pay has fallen. And at the same time, their costs have risen dramatically. We live in a society which is actually designed to extract people's income from them and redistribute it. That is the way in which late era neoliberal capitalism works. Can you actually live on this in a reasonable fashion and be able to support yourself and maybe a family? And it's not an unreasonable goal for a doctor to have a family. Why shouldn't they have one? All of these are structural problems which are being dumped on the NHS to solve without the politicians ever asking the question, why are we running an economy which is actually making people sick.

Hello and welcome to another interview from the BMJ. I'm Cameron Abassi, editorinchief. In light of the ongoing dispute between the government and resident doctors as well as winter pressure on the National Health Service in the UK, we thought we'd ask a money expert about whether resident doctors have a credible case on pay as well as the broader implications for the health service and government health policy. Here to talk through these issues is economics activist and co-author of the Green New Deal, Richard Murphy. I'm delighted to welcome Richard Murphy to the podcast today. Richard, welcome.

Hello. Thank you for inviting me. Yeah, good to see you. Um, I wanted to talk to you and let let's dive straight in. Um, in your career as an expert on tax, the economy, um, I noticed you making um, some pretty strong statements about the doctor strike and the state of the NHS. Um, and I wondered, uh, it'd be good to hear your view on on the merits of the strike and the merits of the not not the fact that whether doctor should strike or not, but on the merits of the pay claim that doctors have at the moment.

Let me put my cards on the table because I always like to be transparent. You can't campaign for transparency and then not be. So, I am married to a retired GP. I have had some interest in this subject for a long time as a consequence. So look, I do have un some understanding of what I'm talking about here. Junior doctors, resident doctors have had a basis for a pay claim for a long time. In real terms, their pay has fallen and at the same time their costs have risen dramatically. I mean, we're talking since 2010 fundamentally, but the costs have risen dramatically because of the burden of student debt which has risen over that period, which is RPI indexed. We have seen the increase in the cost of living in that period which has been real and which isn't wholly reflected I think in the cost of living indices whichever one you use CPI RPI because of the increase in house prices and most doctors will

aspire to own their own property we've seen of late interest in in increase in interest rates which again has not been reflected in the true cost of living like so much else and so doctors have suffered what is now called an affordability crisis. However much they're being paid, they can't actually afford to maintain a standard of living which you can reasonably expect to have after doing 5 years of a degree, a 100,000 of student debt quite possibly and two years at least of post-graduate training and then after that going into further training courses which you will partly have to fund yourself. Take all that into account and the pay that resident doctors are getting from the NHS is in fact pretty poor. Look at other potential outcomes that doctors could rationally take if they were the rational human beings that economists assume exists but don't actually in practice as we all know. The fact is

that there is competition for people with skills and doctors are frankly not doing very well on the basis of the pay claims they've got given in addition and I know a little bit about this the fact that many doctors go home and don't sleep at night because they're worried about the outcome in the morning. My wife always used to joke about the fact that when she phoned a patient in the morning to find out how they were, what she was really doing was saying, "Are you still alive?" Um, not how are you? Um, but that's what doctors live with, which very few people understand. The pay rate for that stress is just abysmal. So, I do think doctors have a very good basis for a pay claim just on pure economic factors, but also because of the job they do, which very few people really understand. Um Richard, one of the points of dispute is the measure inflation of inflation that the BMA uses. The BMA chooses something

called RPI um to measure inflation cost of living. Is that an appropriate measure um in to calculate um inflation and cost of living or should you use a different measure to be more accurate? RPI stands for the retail price index and fundamentally it is about the prices that we pay for the consumer goods that we buy. CPI is consumer price index and takes into consideration a broader range of goods but curiously excludes something which is absolutely fundamental which is housing costs that creates a third measure which actually is the one that the office for national statistics prefers which is CPIH.

Now CPIH which is the one that the Office for National Statistics always refer to in their monthly bulletins uh is very much closer to RPI than is CPI because it does take into consideration this real cost of living called the cost of maintaining a household which CPI doesn't whereas RPI broadly does. So we have an argument here about indices. Now you can always argue about indices and you can always come up with different measures. Let's be clear.

I'm an accountant. What would you like 2 plus 2 to be? The accountant's answer is what would you like it to be? Now, so at that level, we're arguing about semantics about numbers. But at the same time, we're talking about something which is really fundamental. Is CPI the consumer price index a good measure of outcomes or is the real cost of living reflected in either CPIH or in RPI a better indication because that is what actually people feel in their pockets

and this difference is really important because it in fact explains why so many people don't believe the government's inflation figures particularly those who are on lower pay which in these terms given their costs of living many doctors are in their training periods of work because this is where affordability actually becomes the key word and it's curious that this is now on the political agenda in the states everywhere. Affordability is about below what my income is, can I after tax and having to meet the essential costs of living, rent, utilities, council tax, and so on, actually have any money left over to live on? And the evidence is that CPI produces a distorted view of this and that's why RPI is relevant because it shows that the stress on real earnings is much greater than CPI indicates. So doctors are suffering an affordability crisis however we look at it and CPI does not reflect that RPI

does. So the BMA is right to focus on RPI or if they wanted to compromise CPIH but reject CPI in my opinion.

Okay. Um just to put some some more numbers on that which is that in March 2024 we published an article that we commissioned from the office um for health economics and we asked them this specific question you what how much has doctors paid dropped by um and what about the costs that they've incurred or how much of the costs increased over the same period and they looked at 2008 to 2023 and they calculated that on average pay dropped by 25% across across um doctors at different stages in their career. Uh and we did break down by by which stage it was all you know there was a there was a variation around that uh particular um mean and then um they calculated also that their necessary costs and if you want more information look back at this article had gone up by 54%. So that really does support what you've just said.

Yeah that's exactly what I'm saying. You cannot now appraise a pay claim on the basis of the headline pay alone is the point I'm making. We live in a society which is actually designed to extract people's income from them and redistribute it. That is the way in which late era neoliberal capitalism works. We live in a society that is fundamentally structured about the extraction of rents. Now rents are literally rents and their interest and interest rates are artificially high in the UK compared to most other countries around the world in the same economic situation. But we also see rents being extracted through utilities where for example electricity and gas are incredibly expensive now compared with what they were at the start of your comparison period because offge gem who regulates electricity prices has maximized the rate of return to companies and therefore penalize consumers. And we see the same with

regard to water where of course we now know that water bills have gone up by 25% this year and so on. My point is that the pay claim cannot take into consideration just the headline figure. It has to look at affordability. Can you actually live on this in a reasonable fashion and be able to support yourself and maybe a family? And it's not an unreasonable goal for a doctor to have a family. Why shouldn't they have one? So, you know, God knows how you fit it into the, you know, the shift system and everything else, but let's assume you can. This is something you should be able to do.

Yeah. At the very least, a reasonable standard of living. I mean, the other arguments that I've had put to me um against the doctor's uh demands in terms of pay. Number one is that if you pay doctors another 20% or however much you agree to pay them, then that will create a sort of domino effect. you'll get nurses demanding more and then this will create a crisis in public in the public sector and and secondly there's always the issue of um the NHS becoming unaffordable. What's your view on those particular arguments?

Well, one thing I find very funny about those who put forward this argument that we shouldn't be paying doctors a competitive rate of pay is that the people who are probably saying that are the strongest proponents of the power of market forces. Uh doctors have a market power here. they can walk away if they wish. We know there are alternative career options available, not necessarily in the UK, but we do know that people are looking elsewhere and taking those options. So, the market does come into play here and yet the people who are saying that doctors should not be driven by the market system when considering what reward they should get say otherwise. We know that nurses are in a competitive market situation because frankly, we do have shortages of nurses. Far too many young people who graduate and become nurses now are not staying in that profession as well precisely because it is so

difficult. The hours are so antisocial and the pay is not very good. So we actually are applying a completely false standard. One is the market says that the market can't afford the NHS because the market can't afford to support government and yet we can't have the health care system which actually makes the market operate. Let's be clear which is more in fundamental here chicken or egg. Um, I actually used the metaphor of a cappuccino once and I called uh the cup the state the um black coffee the espresso uh was the government and the frothy white milk was the private sector with the Sunday Times color supplement which explained frothy things in life being the chocolate on the top. Now the point here is that without the espresso you haven't got a coffee at all. The state has to be there. It's absolutely fundamental. There is no business in the UK and I've run businesses in the UK that can operate without a healthy

workforce. Therefore, if you don't pay sufficient to have doctors to deliver the healthy workforce, the market will literally collapse because the people who are necessary to staff it aren't available. So, the fact is that these people are looking at everything wrong. They're assuming that paying people in the public sector is a drain and there's a total lack of productivity. their continual argument about the NHS is totally unproductive and yet they don't actually use the right criterion which is that without that workforce in the NHS they couldn't be productive at all they couldn't literally function.

So my argument is they've got all their market economics wrongly they don't understand that the market is the whole of the country not just the little bit they operate in. So, so, so I I get that one in terms of um how you value particular, you know, workers and and a particular workforce. What about the other argument though that the NHS, I mean, as we know, there's more and more being devoted uh to the health service in terms of the um our national spend um and that it's unaffordable. I think this is what you hear constantly from politicians.

Well, I think that there's a problem here, and I discuss this quite often on my funding the future blog about the fact that we actually are not looking at the right issues with regard to the NHS. Why do we have an unaffordable NHS? It's because we actually aren't tackling the problem of ultrarocessed food. And therefore, we have far more people requiring consultations with regard to being diabetic, with regard to being obese, with regard to having cardiovascular illnesses and all the other things that follow from literally eating too much ultrarocessed food. We aren't dealing with the fact that dementia appears to be related to that as well. Now we aren't dealing with the fact that society is not managing neurode divergence very well and in fact tolerating it and rather than suppressing it and therefore we have young people who are outside the economy and making a demand on the NHS as a

result because the workplace is not willing to accept their difference as being acceptable within it. All of these are structural problems which are being dumped on the NHS to solve without the politicians ever asking the question, why are we running an economy which is actually making people sick because that's what it is. Or why are we running a health service which is defining people as sick when in fact they're totally normal. We just haven't adjusted the economy to accommodate them. Because neoliberalism wants to put us into little boxes. Remember the whole logic of neoliberal economics is that there is homoeconomicus.

And in fact, if you get to macroeconomics, there is assumed to be a single homogeneous human being who does all our consumption. We are all the same in macroeconomics. And the very fact is that none of us are alike. And that divergence isn't recognized as normal. The politicians aren't asking the right questions about why demand in the NHS is arising then. So they don't need to start with why are doctors so overworked, stressed, and burned out, and why are there so many appointments being demanded. they need to start with.

Why is our economy literally making people sick? That's the right place to start.

Yeah. One of the manifestations of that is the number of young people out the proportion of young people out of work uh post pandemic in in the UK through ill health which is out of sync uh and a very different pattern to the to other OECD countries where there was a rise elsewhere but the the level the proportions have dropped down again whereas we have a persistent problem with young people in particular being out of work through ill health and we know of was that that is a um a bad prognostic marker for their future um and for for their health in the future in particular.

Yes, it is. I mean the data at the moment is that the overall rate of unemployment at the time we're recording is officially around 5.1% I think but amongst that young people group the sort of 18 to 24s or so those who are considered to be the neats um it's running at around uh 9.5 to 10% I mean it's a bit hard to tell precisely but around that figure so double near enough the mainstream headline rate and why is that happening it's Not because these people are totally alienated. It's not because they're useless. It is because quite simply the market is not providing them with jobs. And again, we have to go back and look at this question about why is the economy be economy being structured in such a way that we aren't being willing to employ these young people. I mean, I will use an example from one of the disciplines with which I'm involved and which I know well. Um, my last job was as a professor of

accounting. It was pretty much the same as my job as professor of political economy. But I I mean that's the just the way I do the two subjects. I mean change of job title the same role. But my point is that in the pure accounting those who are teaching literally how to do the professional skills those people who are graduating graduating from that discipline are having a massive problem getting jobs because the economy has decided it doesn't need accountants anymore. AI is going to do everything.

And that's true of many young people now facing demands on them which are unreasonable because they are for example told well you need skills to get into this job but I can't get any skills because I can't get a job. Well therefore you can't have a job and you have no work experience. Well no of course I haven't. This is a starter job but then you need to have work experience. So we have a bias towards those who can actually first of all literally get into the system because their parents know how to manipulate it.

And that is obvious bias. And secondly, we have an absurd situation where we've created an economy which doesn't want young people because the bias to is towards having skills which employers aren't willing to train people to have. Actually, one of the crises that the NHS has because the NHS also doesn't want to train people to have the skills they um need. They would rather import doctors from overseas than actually train people who are here who've been through our medical system who want a training job and can't get it. So we see the same problem in the medical profession. If I can be honest, it's just a variation on a theme. There is a paradox. We have young people alienated by a system which has low productivity because they could provide the high productivity that the government wants but won't be employed because they don't fit the employer systems. We have to literally look at it

and ask those deeper questions to understand why we have a healthare crisis in the UK. It isn't simple. These people haven't opted out for a reason. They've they've been rejected and that's the problem. and I'm afraid medicalization of their condition is not helping them.

Okay. Um I mean you brought up some rather big areas there which around neurody divergence over medicalization. We haven't really got time to to get into those today but but your central point around um the upstream um effects the upstream interventions that can prevent ill health. uh let's put it this way are the ones that aren't being uh prioritized in the way that they that they should be. Um that is something of course that we care very much about at the BMJ. And but when you're when you're in the political arena, it's hard for you to prioritize those in the same way as it as it is to prioritize waiting lists and things that can be done today and have an impact tomorrow that will get you reelected. I think this is one of the central problems with our political system in that um the investments in the long-term benefits that you might acrewue through prevention etc um don't pay you a

political dividend. Oh I think that uh counting the right things would pay significant political dividends. Uh we are counting the wrong things. We're counting waiting lists and waiting lists are important but they aren't as important as actually caring about people. They do indicate that politicians don't care and the change in waiting list is used as a proxy for caring. But the truth is that actually that isn't the message that people are getting. They still get the message there's if there's you know a few 20 few hundred,000 off the waiting list.

They'll say so what? It's still incredibly long. It's still over a year. It doesn't matter. It's immaterial in accounting jargon terms. These measures are insignificant. The problem that people have is that they feel that the medical system no longer cares for them and they don't care about the medical outcomes they're getting. People know they're not as well and they know that politicians aren't counting that and this is what really matters and I think we're seeing that. I watched a program recently with Tim Spectre on the television about diet and it's staggering how poor people's diets are and how simple re-education could make a difference and reduce demand and he did some test and showed that. Now I don't believe in everything that Tim Spectre says and I I don't believe that every one of his prescript prescriptions is right. But the point is asking that question does show people that you care

but the government isn't doing that. If they actually understood that the government was on their side against the causes of ill health and people can work this out. They do know that pollution is having an impact upon them. They do know that climate change is having an impact upon them. They do know that employers who don't care is having an impact upon them. They do know that zero hours contracts have an impact upon them. Then people will begin to understand that health care is a much bigger issue. They know and I think the BMJ would agree with this that actually at the end of the day it is care and not medical interventions that finally produce positive outcomes and care is a much bigger inter issue than issuing a prescription. It's a much broader and more complex issue and that's what's missing from the algebra that the government is using here. I I think I' I'd certainly agree with you in the fact

that the the demand side is neglected and what is prioritized is more and more interventions, more and more hospital care. Um and part of the reason for that is of course that's where the money is. uh Richard and and governments are thinking more about companies making profits and that then being reflected um in economic growth and GDP than they are uh in terms of population health outcomes. Would you agree with that?

Oh, I'd entirely agree with that. In fact, let's be honest, the way in which the NHS is now managed is to increase the value of GDP. It's a growth generator in the sense that very few medical interventions are actually designed to cure anything. Most of them are about managing chronic illness and long-term maintenance of the condition. We can solve obesity. We can solve most diabetes by saying let's stop eating ultrarocessed food. That is a very simple intervention but it is one that requires political courage. We don't have politicians who've got that political courage because taking that courageous step would reduce GDP nominally and all they're interested in is the mechanics of growth and not well-being. So we get this desperately utilitarian approach towards the measurement of well-being through GDP which doesn't consider distribution doesn't consider actual well-being rather than pure counting and it's the

economists gone mad coupled to the accountant gone mad and the result is a lack of care.

Yeah. I mean one of the um phrases you keep mentioning is neoliberal capitalism. Uh you don't seem very enamored with it. Could you explain for a medical audience or a general audience why you're not enamored with it and what's the alternative?

Let's be clear when I talk about neoliberal capitalism, I'm not outing myself as a Marxist because, by the way, I'm not. I'm not even act outing myself as a socialist because I'm not sure on that either. I'm actually do believe in the power of markets, but neoliberal capitalism isn't about market power. It's about market domination and rent extraction. Market domination means that we end up with a few companies dominating the marketplace as we see in pharma for example who where they will actually try to extract the maximum amount amount of rent from the market.

Now a rent could be identified as a statin. Get somebody on a statin for 35 years and you have a continuing income stream extracted from the state to benefit the pharmaceutical company with little potential benefit to the person who actually takes it. I am advised by my doctor friends and I've read the papers on this as well, quite a number of them to be honest. So this is a perfect example of neoliberal capitalism. If we actually were worried about having effective markets where we needed people to participate, we wouldn't be treating with a statin. We'd be asking what are the causes of the health condition which the LDL is indicating to be a problem with regard to this situation giving rise to the prescription of a statin. Now that would be the right question not let's follow the algorithm. But when we look at neoliberal capitalism its job is to capture markets and control them and that is the problem with it. So it funds

all the research. It dominates the creation of the algorithms which are used for prescribing. It does of course provide the prescription drugs that are delivered and it suppresses information about alternatives deliberately which is why I say they should be talked about. And neoliberal capitalism also seeks to capture the political process as we have seen through substantial political donations to all our major leading political parties so that they don't question the system itself. So the perpetuation of this extraction of rents continues. Rent here is an economic term. It does not just mean payment of rent on a property. It could be excessive interest rates. It can be capture of income streams from the government. It can be high pay for executives in companies who haven't earned it. All of these are examples of rents. That's what neoliberal capitalism does. And of course, there's a cost and

that is inequality in society. And we all know from the evidence that has been produced over many years that inequality is a major driver of ill health.

Yeah. So, um, if that's something that you're opposed to, um, but you're in favor of markets, what is the alternative?

Oh, I I'm really old-fashioned here. I really want a mixed economy. I don't see any problem with a mixed economy. I want markets to do what they can deliver. I do not want the state to boo my beer because I really think the outcome would be pretty dire. I don't particularly want the state to make my car because I'm old enough to remember the Austin Allegro and it was an appalling car. It was the first one I ever drove after my driving test. Never again. I don't want the state to do things that others can do better. But I do want to have a state that is able to deliver. And in particular, I want a state that will stand up to the power of neoliberal capitalism. In other words, what I call a courageous state, which will say, you are actually undertaking market exploitation at cost of the people of the country that we as politicians are trying to deliver. I suspect I'm talking about a an overall

reduction in GDP, but an increase in well-being because of better distribution. I'm clearly in favor of actually seeing redistribution from excess wealth towards those who would benefit as a consequence. That would, by the way, increase GDP because actually reallocating wealth from the wealthiest to those with low incomes always increases GDP because the wealthy save their money and the poorest spend it. Therefore, you will increase GDP which is a measure of income for the state as a whole by reallocating income to the poorest. So, I do think an active state in that sense is vital. But I'm not ever going to say we do not need markets because we do, but we need markets that are free in the sense that economists talk about them whereby they actually are genuinely competitive and right now we haven't got those. We've got control and not free markets.

I mean, one of the things you mentioned there was about um a reduction potentially in GDP. Actually, that's one of the themes of a piece that we're publishing around now uh when we're looking at the climate emergency. And there's an argument in it which says that we should not be prioritizing economic growth. In fact, we might tolerate degrowth and we should be prioritizing um you know the measure of prosperity should not be GDP growth. It should be health. Uh and health is a is also essentially care which is something you've mentioned before. Now, that's some that's um a logic that we also advocate for at the BMJ that we should be prioritizing health and well-being outcomes um above everything else and it's something that's supported by evidence from WH and we know there are some well-being economies. But do we know that that kind of approach a is realistic? I mean, are we just being idealistic um in calling for this? And

B, are there examples of it having worked anywhere? Is it realistic? Do you want a future is my question? I mean, as simple as that. Actually, it probably doesn't worry me anymore. I'm 67. I'm going to I'm going to be dead before the full impacts of climate change matter. But I've got sons who are in their early 20s. Am I being realistic in wanting a future for them? Unless we deal with this, they are not going to have that future. And no, nor are many of the people listening to this podcast going to have that future. We've known about the costs of economic growth for years. In fact, before we started recording, I showed you the first ever book that I bought on economics, which was a book called The Costs of Economic Growth written in 1967. And I've been a Green virtually ever since 1973 when I read that book. Green in a small G, not a capital G. I'm not a member of the Green Party.

I actually did co-author the original Green New Deal report which has become well a slogan, a meme if you like around the world. Within two months of us publishing it in 2008, somebody called Barack Obama was using it to help him become president of the USA in terms of transmission idea. Pretty dramatic. The fact is that we cannot sustain growth at the level we have by consuming the world's resources at the rate we do because we are over consuming material consumption. But there's a cost to that over consumption. And this is the point.

We only count things that are valued in money where there has been an exchange. That is a failure to count the things that matter. This doesn't allow for our emotional well-being. It doesn't matter for our intellectual well-being. It doesn't matter for our spiritual well-being if you wish. And I don't mean that as religious. I mean it about purpose. And because we are over consuming material items, our capacity to even consider those things is reduced. as it is by this neoliberal capitalism system which I don't like which actually forces us to work too many hours as many doctors will know to their cost and to their long-term peril even because doctors die young because they're overworked a fact. So what we need to do is look at how we are looking at an issue of temporality here literally time. We are over consuming now by borrowing from the future. That is the only way in which we can come up

with a measure of GDP growth by literally consuming what rightfully belongs to generations to come. Therefore we have to actually reduce that level of consumption and change our focus. This is again asking about what is important. As I said with regard to other issues we've discussed already. The issue that is important is outcome, our well-being, not the level of consumption we have on the way. And we also need to put this in the context of that wealth issue that I've already mentioned. If we look at who consumes excessively, we can go back to the work of economists over a century ago, Thorston Vin, um, a Norwegian economist working in the US by the time he wrote his thesis, which was that conspicuous consumption by the wealthy is the most destructive form of consumption there is. And now we can see that because something like 50% of all excess consumption contributing to climate change emissions comes from a

tiny proportion of the world's wealthiest people. And that consumption is largely conspicuous. They're simply to say I've got bragging rights over you. So we need to reappraise what it is that we're consuming and how and why and where and when. And that means that we need to look at the quality of life issues in a very different way. Economics with its focus upon GDP can't do that. GDP is a lousy measure. Robert Kennedy before he was shot in 1968 and I remember that event happening um talked about GDP and said it measures everything in life except those things that are valuable and that's the measure that we actually need to recall. If that was his sole legacy and it wasn't but he said that it's absolutely critical we recall just about his last speech because that's what he said.

Richard, thank you. Just one final question then for you. If you were and to summarize, if you were to write a prescription for the NHS coming from an economic economics background, what would it be? Oh, I would look at it from a macro perspective, not from a micro perspective. Micro perspective is looking at waiting lists, looking at number of prescriptions, looking at numbers of people. But I'm actually asking about causes. Macroeconomics looks about how the system works. And if we add in political economy and I was a professor of political economy, we look at how power relationships impact outcomes. And we need to do those two things. One, look at the macro level.

Why is the demand for health care services rising so much? Why are the number of GPO appointments per head of population roughly double now than what they were at the turn of the century? I think my figures are broadly right there. Um, and why have we got this excess demand and what is the power relationship that has delivered it? And the excess demand has come from the production of toxic subjects toxic substances fundamentally excess alcohol consumption, excess ultrarocessed food consumption, excess drug consumption even because of course we know that actually prescription drugs do have side effects and long-term consequences and we're seeing that particularly in the states but it also happens here. So we need to look at all those issues and ask those questions about that. But then we need to ask who is causing this and what are the power relationshipships that are delivering it and that is because of the

failure of competition policy and regulation inside the UK and worldwide markets for pharmaceuticals where they hold governments to ransom and basically say if you don't do what we want we'll pull out of Cambridge or wherever it might be and we'll go somewhere else. That toxic relationship has to also be addressed because drugs aren't the the solution to every one of our problems anyway. But we need to look at the impact of this. And if we got that right, we would solve the micro problem of waiting lists and illness. Because illness is the is ilth, the opposite of wealth. And I love that term ilth. Ilth is the opposite of wealth. We're either well or we're ill according to this rather bipolar system that we're looking at in terms of economics because that's how economics looks at things good or bad. It's very simplistic. Well, if wealth is what they try to measure, they should be begin to measure il which is a

recognized term by the way and il is the thing we should be tackling. Richard, thank you very much for sharing your ideas with us today. We're very grateful to you. Thank you.

Thank you. You can keep informed about latest developments on bmj.com. As part of our coverage, uh Rebecca Kums, the BMJ's uh head of journalism, spoke with Dr. Jack Fletcher about the industrial action taken by resident doctors. He is the chair of the BMA resident doctor's committee. You can find that full interview on our YouTube channel. Thank you and join us again next time.

Questions about this episode

Who speaks in "How much should doctors be paid? | BMJ Interviews Economist Richard Murphy"?

Cameron Abassi (Host), Richard Murphy (Guest).

What is "How much should doctors be paid? | BMJ Interviews Economist Richard Murphy" about?

The interview explores the ongoing pay dispute between junior doctors in the UK and the government, highlighting the decline in real wages for resident doctors amidst rising costs of living. Economist Richard Murphy argues that structural economic issues, driven by late-stage neoliberal capitalism, are exacerbating the challenges faced by healthcare professionals, raising questions about the…

What is mentioned in this The BMJ episode?

13 people, works and ideas are mentioned, including NHS, Donald C. Murphy, neoliberal capitalism, Cameron Abassi, BMA, UK. Each one on this page links to its own page with every episode that mentions it.

How long is "How much should doctors be paid? | BMJ Interviews Economist Richard Murphy"?

The episode runs 36 min; the transcript is about 6,537 words in 55 timestamped sections.

More from The BMJ

About this transcript: the episode's spoken words as captioned on YouTube, split into timestamped sections. Reclip.Me locates every person, work and idea in the text, keeps the time it is first named, and quotes the words around it verbatim. Last updated January 24, 2026.