'Pricing Out An Entire Generation!' NHS Surgeon On Why Junior Doctors Turned To Strikes

There's a "social contract being pulled from under doctors’ feet”, according to an NHS surgeon.
Junior doctor at his desk in his office performing various tasks
MartinPrescott via Getty Images
Junior doctor at his desk in his office performing various tasks

An NHS surgeon explained why junior doctors were considering striking across three days over their pay this year in a viral video in January 2023.

The five-minute explainer had almost 200,000 views at the time, and was released after the British Medical Association’s ballot for junior doctors in England to vote on industrial action opened (on January 9).

Junior doctors across the country are striking for 72 hours from March 13 in a dispute over pay, amid ongoing worries about how rising inflation may impact their wages.

A BMA survey from the end of December 2022 of its junior doctor members also found 71% were “very worried” about the cost of living, with 28% “slightly worried”.

The NHS is already thought to be on its last legs at the moment, with nurses and ambulance drivers already striking to push the government into action, increase their pay and improve their working conditions.

And ear surgeon Joe Manjaly explained in his viral TikTok video why he would support those striking, even though it means his own workload will grow significantly.

He explained: “In the spring, I’m facing the prospect of all the junior doctors in my team going on strike for more pay.

“That means I’ll have to cancel all of my operations and cover emergencies while they’re away.

“My out-patient clinics are already being affected by nurses going on strike too.”

Manjaly then adopted the stance of those criticising the strikes: “Surely, anyone going into the NHS should know that there’s some sacrifice involved, that the early years are going to be hard, ad that ultimately you should be willing and ready to serve the public and not strike for more pay?

“Let me say this: if you have agreed with anything I just said, I would really urge you not to believe that rhetoric that I’ve just repeated.”

But he said the “massive thing which doesn’t get talked about as much as it should is the effect of raising university fees to £9,000 a year”.

Manjaly said that has had an effect on an entire generation of doctors in the medical profession who need five or six years of university education.

“That is essentially a lifetime of indirect taxation that very much keeps you in your line unless you are willing to leave altogether,” he explained.

“In the meantime, instead of wages rising to reflect that, real-terms pay has simply fallen [more and more] slowly until it’s at the point where it’s hitting nearly 30% over a 15-year period.

“That too at a time where house prices and the cost of living have gone up.

“So you’d think therefore at least doctors, exams, registration fees, indemnity, the cost of courses, portfolio fees, might all at least stay the same to mitigate the fact that wages have not risen over time – but actually all of those have gone up too.”

He added that accommodation and the changes to pensions have made it worse too.

Basic pay for a junior doctor is around £29,000, although most will receive a little more for overtime and payments for anti-social work shift.

Still, the BMA say that below inflation pay rises work out to 26.1% real-terms pay cut for junior doctors in England since 2008-9.

Manjaly explained: “Junior doctors who have committed to putting in those early hard yards are now finding themselves not breaking net zero and starting to save something, they’re still trying to break net zero into their 30s and 40s.

“And that means being in debt when you want to start a family, because your fertility doesn’t wait for your student loans to be paid.”

He added that medicine is out of hours as a profession – being childcare will be additionally expensive, “pricing out an entire generation of the workforce”.

He said: “I would not blame the junior doctors for questioning whether they couldn’t just done something else entirely, at far less sacrifice, and end up saving the same amount”.

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He also expressed fears that this meant junior doctors would turn their back on the NHS.

“Doctors don’t need resilience training. Doctors know that they are expected to work hard in their career.

“I don’t think doctors burn out from working hard, I think they burn out from the stress, the sheer stress, of expectation disappointment.”

The surgeon said that this means the “social contract is being pulled from under doctors’ feet”.

He also pointed out that anyone in their hour of need will require someone with good communication skills, emotional intelligence, someone who can understand a lot of data to come up with a health plan.

Manjaly said you need “the best” of each generation to do this job – and therefore the role itself needs to be attractive.

“If we don’t do that, then I really worry we will see what people have been predicting for many years now – and that is the slow atrophy of the very health system that supports this country.”

Junior doctors last walked out of routine and emergency care in 2016 again in a dispute over pay.

Prime minister Rishi Sunak, in the meantime, is prioritising anti-strike proposals which would ensure minimum service even on strike days – even though this is one of the proposals the short-staffed NHS has been calling for for years.

Dr Robert Laurenson, co-chair of the BMA’s junior doctors committee, also explained: “Our ask is not unreasonable.

“We are not worth a quarter less than our colleagues in 2008. And those about to graduate and join us in our profession should not have to suffer the pay cuts that have gone before us. It sounds like a lot, and it will feel like a real struggle. We are up against terrific institutional power and inertia.

“The government steps back from its responsibility on a year-by-year basis and we always come in to pick up the pieces, subsidise what our employers are asking us to do and provide the high-quality healthcare we want to give or need to receive as citizens of this country.”

According to the BBC, Laurenson and his colleague, co-chair of the BMA’s junior doctors committee, Dr Vivek Trivedi, also said: “When we are faced with such resolute ongoing silence despite all our attempts to start negotiations, then we are left with no choice but to act.”