Top specialists can earn in excess of pounds 400,000 a year

A FEW consultants earn in excess of pounds 400,000 a year in private practice fees, the Monopolies and Mergers Commission report shows - although the average for NHS consultants before expenses was pounds 25,000.

The MMC calculates that in 1991-92 about 17,100 out of the 20,000 consultants undertook private practice; some, such as public health doctors, academics and accident and emergency specialists, had little or no chance to do so. Of those who did private work, nearly 1,800 earned less than pounds 1,000 a year. About 250 consultants had gross earnings in excess of pounds 200,000 a year, almost 50 of them earning more than pounds 400,000 in private fees. But after expenses, which in general took between 29 and 33 per cent of earnings, the numbers earning more than pounds 200,000 dropped back to about 90.

Almost 40 per cent of consultants undertaking private practice earned less than pounds 10,000 after expenses, and the top 10 per cent accounted for just under 40 per cent of the pounds 550m that hospital doctors earned from private practice.

Plastic surgeons on average earned the most - a quarter of them earning more than pounds 120,000 a year - a somewhat ironic finding given that much of plastic surgery is uninsurable and, therefore, not subject to recommended fees. Of those who undertook private practice, pathologists earned the least.

NHS consultants with full-time contracts - just over half of the total - can only earn up to 10 per cent of their NHS salary from private practice. Part-timers, who make up about one-third of NHS consultants, have no limit on the amount they can do. Maximum part-timers, who make up just over a quarter of NHS consultants, on average earned pounds 17,000 a year from their private work, after expenses. The top earning speciality after plastic surgery was orthopaedics, followed by ear, nose and throat surgery.

Apart from a doctor's speciality, the location in which a doctor works is 'critical' to the level of the doctor's earnings, according to the MMC. Outside the principal cities, there are few opportunities for private practice in the north of England, or in Scotland, Wales and Northern Ireland, the report says, and average gross earnings ranged from pounds 49,000 in the South-east ( pounds 92,000 around Harley Street) to pounds 18,000 in Northern Ireland. In each region, however, 'there were some consultants earning over pounds 100,000 gross from private practice'.

However, while consultants can earn large sums from private practice, the MMC report says most do more work for the NHS than they are actually paid for. Full- time consultants worked 53 hours a week on average for the NHS, spending a further 6 hours in private practice; maximum part-timers worked 51 hours for the NHS and 11 privately; even those with smaller part-time contracts worked 45 hours for the NHS against the 16 they spent on average doing private work.

After expenses, earnings from private work ranged from pounds 40 to about pounds 130 an hour - compared with the pounds 25 an hour a consultant with a 'C' grade merit award receives an hour from the NHS.

(Table omitted)