NHS consultants: Overworked or overpaid?
The sums are eye-watering. Consultants in a quarter of trusts are making six-figure sums each year from overtime alone.
In one case, the total is in excess of £200,000 and in another it is £375,000. That is over and above their basic salary, which is just shy of £90,000 for the average consultant. These are amounts many people could only ever dream about.
Make no mistake, there is disquiet in the health service about these payments.
Hospital managers recognise they are not the best use of money. But they feel they have been left with little choice.
They are under pressure to hit waiting time targets, cope with rising demand and deal with the consequences of over-run emergency departments (which leads to other treatments being postponed).
Among the medical workforce there is unease too. These high-cost payments are not claimed by all. The BBC investigation suggests no more than half of doctors get them.
Those doing routine work are the most likely to benefit, while those doing urgent and emergency work are more likely to be working extra shifts for normal pay.
And, of course, it goes without saying that doctors up and down the country are working extra hours for no pay. It is not a profession that clocks on and off.
Consultants earning the biggest sums are undoubtedly putting in the hours. Sometimes 20 to 30 hours of overtime a week, if not more. But that in itself raises questions about safety.
The sums do not make financial sense either. For every doctor getting £100,000 in overtime, hospitals are spending enough to pay for an extra consultant - or four nurses.
So what can be done? Ministers argue changing the contract will help. Consultants have an opt-out which means they do not have to do non-emergency work at weekends. Get rid of that, the theory goes, and the cost of overtime will drop.
It is certainly true the contract has helped consultants negotiate higher rates for overtime in the first place.
But it is the rising demand in the NHS that seems to be the most important factor in why the overall cost is going up.
Some places have got round this. People will highlight the example of Wrightington, Wigan and Leigh NHS Foundation Trust featured by the BBC today.
The trust has managed to stop paying premium rates for overtime by getting doctors and nurses to work differently. No change to the contract was needed.
But that is a high-performing trust which doctors want to work for and where management and the medical workforce have been able to work together constructively.
Rock and a hard place
Perhaps the best way to look at it is to ask, what would happen if hospitals stopped paying the premium overtime rates?
One hospital manager I spoke to said the answer to that is easy. Consultants would be more likely to say no to overtime.
Hospitals could then turn to locums (but there is pressure to keep spending on those down) or farm work out to the private sector (where the consultants who have stopped doing overtime may well be working and where costs may be even higher).
The other option is to let patients wait longer, but that's not particularly palatable either.
The laws of supply and demand mean the NHS is caught between a rock and a hard place.