This is the first article in a series on pay and considerations when employing a medic. They have been written for both medics and employing companies to improve on the understanding of the profession in the expedition field. The next article, ‘Employing an Expedition Medic’, will be published soon.
Introduction
Adventure Medic has long been aware of the battle for remuneration for expedition medicine work and the challenges of securing fair pay.
There are an ever-increasing number of commercial providers organising trips to exotic destinations and requesting an accompanying medic. This is in part due to changing societal expectations and insurance requirements, alongside the general growth of adventure tourism.
We are healthcare professionals with extensive training and experience, taking professional risk. However, remuneration for expedition medics varies greatly with no guidance or standard set by a professional body. It is important that both medics and expedition providers understand each other’s perspectives as we carve a way towards fair remuneration.
This article will set out why pay is a complex issue, and how to advocate and negotiate for remuneration for our work. This is the first in our Masterclass series on ‘Pay in the Expedition Medicine Community’.
Current Factors Affecting Expedition Pay
At present, there is no standard for expedition medic pay. Financial arrangements can range from voluntary to a competitive salary. Most companies will offer reimbursement for expenses, although sometimes with exceptions (e.g. indemnity or flights) leaving a medical professional at a financial loss. A daily wage in addition to expenses is, however, becoming increasingly common amongst more professional and ethical companies. Below is a diagram demonstrating the range of pay:
Sometimes financial arrangements are unclear from the outset. If pay is available, it may be hourly, daily or a flat rate. In addition, significant pre-expedition tasks such as screening or building a medical kit may or may not be included in paid time.
Recommendations for specific pay come with difficulties. They must be viewed as fair and also fit within the culture and context of the expedition community. Where a cheaper medic is available, providers may choose them without factoring in aspects such as experience or trip remoteness, both key factors highlighted in the Faculty of Prehospital Care framework. Often, this is simply because, to those outside healthcare, a medic is a medic. We need to play our part as a community in educating providers, an standing together for fair pay.
Cultural Attitudes to Pay Amongst Medics
It is important to consider the ecosystem in which we operate. It encompasses everything from aspiring medics to experienced expedition sages on one side, and new and established commercial companies on the other. The narratives, relationships and economic contexts in which these providers and medics sit will affect any drive for changes to pay.
Some medics may feel that the opportunity to travel is a sufficient price for their services. Others may believe they will lose a ‘foot in the door’ to the expedition world if they advocate for pay. Many believe that due to the desirable nature of expedition work, companies often have no shortage of interested parties to fill roles, and so hold the court on pay. Few consider the risks to their future livelihood, should a legal claim be brought against them.
There is a risk that in not offering remuneration, providers attract only the most junior or inexperienced medics who are looking for their first opportunity to start their expedition medicine careers.
Even with experience, we may still be tempted into unpaid roles for scarce opportunities, or in support of research data collection or charity fundraising. In such situations sometimes all staff are voluntary. However, if there is an intermediary company hiring the medic and supporting a separate charity with expedition logistics, then this company is often commercial. We should not assume that because we are unpaid, everyone else is unpaid: “what is the day rate for the expedition leader?” is often a very revealing question.
Cultural Attitudes to Pay Amongst Providers and Companies
Many expedition companies have narrow margins, and an anxiety that paying the medic will drive costs up, raising prices, and putting off clients. The pandemic and economic instability have amplified this concern.
It would be unfair to tar all providers with the same brush. Some will pay their medics in line with the pay of other leaders, acknowledging the hard work, legal risk and responsibility. However, others will use the financial argument above to justify leaving the medic out of pocket (indemnity or insurance, flights or food and accommodation). Still others will extol their desire to pay medics but call it unaffordable. Some assume that the medic is being paid for a day job elsewhere to fund their costs of living.
What is Fair Pay?
In the last year, this discussion has gained momentum and provoked a range of opinions in the expedition community. We all appreciate that commercial expedition companies must break even and have struggled with losses during the pandemic. Equally, a skilled medic working on the trip should be fairly compensated for their work commitments, and professional risk.
Comparisons are sometimes drawn between pay for medics and other leaders, such as guides, in the same expedition team. This is a starting point, and a reference point as to what may be ‘fair’ in that particular context. Pay will vary between expedition leaders, assistant leaders, local ground handlers and others. Nonetheless, we believe the approach to remuneration for skill and experience, work and risks, should be transparent and fair across all staff involved in making an expedition a success. For example, if the medic is covering two roles (leader and medic), we believe they should be fairly remunerated for carrying the extra burden of responsibility.
By example, we have put together the table below, based on trips that the Adventure Medic team and others have worked on:
| Type of trip | Example | Typical current pay | Adventure Medic suggestion |
| Commercial expedition | Ship’s doctor | Variable | £300-600/day + expenses* |
| Charity expedition | Trekking Kilimanjaro | Nothing or out of pocket – stipend with expenses | Comparable with western guide + expenses* |
| ‘High value’ or desirable trip | Antarctic cruise | Nothing or out of pocket | Comparable with western guide + expenses |
| Film and TV | Wildlife documentary | £300-600/day + expenses | £300-600+/day + expenses* |
| Funded research expedition | High-altitude data collection funded by grants | Variable | £300-500/day + expenses* (should be included in grant applications) |
| Sporting event | Ultramarathon | Nothing to gratuity of £1000 | £300-500/day + expenses* |
| Trip > 3 months | Remote research | Equivalent + of your public service salary (eg NHS) for level of seniority | Equivalent + of your normal public service salary for level of seniority |
| Expedition medicine teaching | Multiple UK/EU providers | Expenses to £300/day | £200-500/day depending on if course assisting or directing and level of seniority + expenses |
| Extreme / ‘highrisk’ expedition | Technical skills required (e.g., crevasse skills) High-profile clients Remote (e.g. polar) | Variable | £300-600/day+ expenses* OR comparable to with western guide + expenses |
*Expenses should be all expenses including indemnity. Travel days should also receive 50-100% of the day rate.
Legalities of Paid Work
Medics may receive payment for expedition work alongside a wage for another job provided the trip was conducted during off and annual leave days. If using contracted study leave or educational development time, they cannot be paid for the same day of work by both their regular employer and an expedition company. The situation is more complex where a mixture of day “types” is used, in this case the medic can be paid for only those that are off or annual leave days. In other words, we can’t “double dip”.
Negotiating Pay
Negotiating for fair pay is complex and nuanced. This should not put us off asking the question however. Steps and tips for negotiating:
- Begin by discussing the trip, including the clients, leaders, itinerary, risks and goals.
- Be explicit in your experience, and the services you will provide, pre-, during and post-expedition to support these clients in their goals. This is a good opportunity to discuss other potentially contentious issues, including the care of local staff.
- Clarify the current offer. Does it match the table above? Is indemnity covered? Is the kit provided? Are food and accommodation included including on travel days? Is travel covered from your front door to the destination? Are there any hidden expenses? Be explicit in your questioning.
- Ask whether other team members are remunerated in the same way – if not, gently ask the provider to explain the differences in their approach.
- Take a step back, and think whether the remuneration is right for you – are you happy to do this trip? In your annual leave, and on the terms given? You can always walk away, and there will always be other trips – no matter how it seems. Further information on Assessing an Expedition Opportunity is available here.
Below is a written example of how you might advocate for your work:
“I am grateful for the opportunity to join your expedition and to work with your clients. I would like to clarify remuneration, and the reimbursement of costs.
In the [X] years I have worked in healthcare, I have gained additional skills including [X] and achieved formal qualifications in [X]. This puts me in a strong position to offer medical support to your team and I’m looking forward to doing so.
Having an experienced medic is reassuring to clients and attracts bookings. It reduces cognitive bandwidth for the expedition leader, and clients appreciate the additional moral, as well as medical, support from a medic. Some companies find that having a medic reduces their insurance costs. Please also bear in mind that, in acting as medic, we take on significant medico-legal risk. If issues occur, they have the potential to impact our entire career.
I will of course do my utmost to safeguard against this and to protect your company and your clients. I will assist with pre-expedition screening and medical kit prep. I will be on-call throughout the trip for clients’ medical and psychological needs. Post-expedition I will produce a report, and arrange handover to clients’ regular medical practitioners, where necessary.
In return for the skills and experience I bring, and for giving up my annual leave to work on your expedition, I hope your company will reimburse my costs and consider remuneration for this work. For a similar expedition, I would typically look for a day rate of x / day, plus expenses.
I look forward to hearing from you so we can agree on a contract for this work, and I can begin supporting your expedition.”
Protecting Ourselves
We must protect ourselves from expeditions that exploit us. If the enjoyment, remuneration and energy required do not outweigh the cost and sacrifices, is the trip worth it? If a provider does not value our time, energy and skills then we should see this as a red flag and strive to protect ourselves. This holds particularly true for those under significant strain in their “day jobs”, where the additional stresses of a challenging expedition may increase burnout risk and pressures at home.
Some situations develop insidiously, with hidden costs gradually revealed through the trip. We should not shy away from advocating for ourselves and feeding back to the provider about our treatment and our worth. Always do so with an open and empathetic mind – the provider may simply need the opportunity to adapt and adjust.
Sadly, there is no formal governing body to report mistreatment. However, the expedition community is small and news travels fast. Opportunities with providers who support and remunerate their medics fairly will become highly sought after. Equally, there will always be other opportunities. By turning a blind eye to exploitation, we help neither ourselves nor those who follow in our footsteps.
Caveats
This article features information gathered from the experiences and opinions of medics within the expedition community. Adventure Medic acknowledges that the situation is dynamic and expedition medics and providers are striving to improve standards across the industry. This includes pay for medics.
Reference:
- Updated Guidance for Medical Provision for Wilderness Medicine. Faculty of Pre-Hospital Care. Royal College of Physicians and Surgeons of Edinburgh. 2nd Edition. 2023.
