The truth about the junior doctor strikes

By Shimeon Lee, researcher

Junior doctors went on strike this week for the 11th time since March 2023, demanding a
35 per cent pay rise on top of an 8.8 per cent pay award they received in 2023-24. The British Medical Association (BMA), a trade union representing doctors, argues that this is necessary as raises in the past decade have failed to match inflation, leading to real pay declining by 26 per cent (though some say a more accurate figure would be 11 to 16 percent). 

Even so, junior doctors are still among the highest earners in their age group. Those fresh out of medical school can expect to find themselves in the top half of all earners on £37,140 a year, hitting £44,167 in their second year. While those at the end of training are close to the top 10 per cent of earners on £64,211 a year. 

As highly skilled professionals holding in-demand qualifications, it is natural that doctors earn more than the average worker. Yet at a time when the NHS is struggling to keep afloat are junior doctors’ demands fair, especially considering that their extremely valuable medical degrees have already been heavily subsidised by taxpayers?

Junior doctors receive a significant subsidy at the start of their careers in the form of capped tuition fees. Since 2017-18, tuition fees have been capped at £9,250 per year regardless of subject, with most universities charging this rate. This means that a student studying medicine pays the same as a student studying history even though the cost of delivering those degrees are very different. 

And the actual costs of a medical degree are substantial. Overseas students, whose fees are not capped, pay between 4.5 to seven times more for the same medical degree. The difference between what a medical degree actually costs and what home students pay is made up by taxpayers, with the Department for Health estimating that it costs taxpayers £230,000 to put a doctor through medical school. This includes £64,000 in loans (around a fifth of which usually goes unpaid) and £163,000 in grants that the government never gets back. The grant portion alone is more than four times the average annual earnings of a first year junior doctor.

Australia, by far the most popular destination for junior doctors seeking to leave the UK, also significantly subsidises medical degrees. However, this is not a universal cap meaning more than 10 per cent of domestic medical students pay full fees which can be upwards of £44,000 a year. Another 27 per cent only pay subsidised fees in exchange for three years of mandatory service in remote or rural regions. Then health secretary Jeremy Hunt mooted a similar idea in 2016 under which UK medical graduates would have to serve a mandatory four year term in the NHS. 

While taxpayers may have an interest in subsidising the training of doctors to ensure an adequate supply to meet our healthcare needs, it should be recognised that junior doctors also benefit significantly through acquiring a valuable medical degree, which continues to pay off even if they subsequently choose to leave the public sector or work in another country as four in ten and one in three junior doctors respectively say they plan to do. 

The Institute for Fiscal Studies estimates that a medical degree has a post-tax median net lifetime return of £341,000 for women and £493,000 for men, five and seven times the median net lifetime return of a degree in general. Folding to the BMA’s demands would add to this, propelling junior doctors fresh out of medical school to close to the top 20 per cent of all income earners.

The BMA’s own estimate puts the cost of such a raise at at least £1.03 billion. That means £1 billion less for other parts of the NHS, like cancer treatments or hospital equipment. Concerns that junior doctors have about issues like understaffing become even harder to justify when they make such extreme demands on pay. Indeed, NHS capital budgets have already been raided by around £900 million to fund the cost of strikes and pay growth in 2023-24, including £115 million from the “40 new hospitals” programme. For the same cost as a 35 per cent pay rise for junior doctors (£1 billion), we could instead increase medical school places by 52 per cent, meaning 5000 additional doctors every year. Surely that’s a greater priority for an understaffed health service? 


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