Intended for healthcare professionals


Pay restoration for junior doctors is a rallying point for wider discontent

BMJ 2022; 379 doi: (Published 08 December 2022) Cite this as: BMJ 2022;379:o2966
  1. Alexander Lee, junior doctor and council member on the BMA East of England Regional Council
  1. UK

Junior doctors have been undervalued and overworked for years. It’s now coming to a head, writes Alexander Lee

Junior doctors are to be balloted for industrial action on 9 January 2023. Pay restoration is the focus of their demands, with a message that is easy to understand and sympathise with. Junior doctors today are earning at least 25% less in real terms than they would have in 2008/09.1 This group has experienced a steady erosion of their pay for the past 14 years so why has the movement for pay restoration come to a head now?

Doctors at this stage of their training face many longstanding challenges in their working conditions, which have gradually worsened over the past decade. A non-exhaustive list includes: having to move between jobs every few months, a normalised working week of 48 hours where 37 hours is considered “part time,” the length and competitiveness of training programmes, and the difficulties in planning more than a few months ahead and securing leave for family time or important life events. On top of this, junior doctors face a growing day-to-day workload and patients with more complex conditions and multimorbidities.

More recently, the events and aftermath of the covid-19 pandemic was undoubtedly a considerable driver in pushing discontent towards a tipping point. Notwithstanding the physical effects the pandemic had on junior doctors, a 2021 BMA survey found that 42% of junior doctors had been left feeling depressed, anxious, and burnt out, with 60% reporting higher levels of fatigue than normal.2

The government was happy to shower plaudits on healthcare staff and “clap for our careers” during the worst days of the pandemic, but has failed to back up this support in any meaningful way. Their continuation with a 2% pay increment in 2022/23 as part of junior doctors’ multi-year pay deal feels grossly unfair after doctors’ hard work during the pandemic.3 Pay erosion is a measurable, relatable experience felt by all doctors and is a clear rallying point for some of doctors’ broader feelings of being undervalued, overworked, and underappreciated.

Unsurprisingly, the government’s 2% pay award has been poorly received, particularly in the middle of a cost of living crisis and with inflation running up to 10% in recent months. Junior doctors, myself included, have mobilised through the grassroots Doctors Vote movement that has campaigned for pay restoration. The movement has gained influence throughout the BMA by winning critical seats in a number of elections—showing the strength of junior doctors’ feelings on this topic.

Notably, junior doctors are not the only profession feeling short changed—discontent has been seen throughout the public sector, with other workers taking industrial action. Criminal barristers received a pay rise of 15% in June 2022 after they took strike action and initially called for a 25% pay award.4 The train strikes are currently ongoing at the time of writing. Our nursing colleagues have voted to strike for the first time in the 106 year history of the Royal College of Nursing, and ambulance staff will also be taking industrial action at the end of December.

Few would suggest that pay restoration is the silver bullet for all of the challenges junior doctors face. We need sustainable long term strategies that consider not just the struggles of junior doctors but the very future of the NHS. Workforce planning, the funding of health and social care, creating a healthcare infrastructure for the 21st century, and spending on public health will be crucial to these conversations. Yet until such a time as these strategies come into fruition, immediate pay restoration is a necessary part of the wider solution and represents a crucial step towards reversing the chronic undermining of our profession.


  • Competing interests: AL is a cohort director with the Healthcare Leadership Academy, council member on the BMA East of England Regional Council, and local negotiating committee member with East and North Hertfordshire NHS Trust.

  • Provenance and peer review: commissioned; not externally peer reviewed.