This year has seen some of the most radical industrial action taken by junior doctors in NHS history, fuelled by the fight for full pay restoration of doctor salaries. The strikes are ongoing and are currently set to continue through 2024. Given that this topic has complex ethical considerations, it is important to be well-informed in case you are asked to discuss junior doctor strikes at your medical school interviews.
Why Are Junior Doctors Striking In the UK?
Contrary to some public/media opinion, junior doctors are not striking simply for ‘more money’. The BMA is requesting full pay restoration of junior doctor salaries.
While inflation in the UK has made life more expensive, junior doctor salaries have remained static, meaning that while their pay has not been cut, their salary is not worth as much.
In order for junior doctors to receive full pay restoration they will need to receive a pay increase of 35%. Health Secretary Steven Barclay is currently radically opposed to such an increase, stating that the amount of money is just not available to be spent.
The negotiations between the British Medical Association (BMA) and Steven Barclay have been halted due to the inability to come to an agreement.
Do Junior Doctors Get Paid When On Strike?
The straightforward answer to this question is: no, junior doctors do not get paid when on strike. However, it is unlikely that the industrial action will affect the pensions of the striking doctors.
The BMA encourages doctors to plan ahead and save money in order to cope with the financial strain of the industrial action. The BMA has begun to develop a “strike fund”; a scheme to provide financial aid to doctors during the strikes.
However, this scheme is still in its infancy and can only offer £50 per strike day only to doctors facing significant financial hardship.
When Are Junior Doctors Striking?
The junior doctor strikes began this year (2023) and, following a recent announcement from the BMA, are due to continue into 2024. We have had 19 days of junior doctor strike action so far this year. Currently, the next strike dates are as follows:
- 20-21-22 December
- 3-4-5-6-7-8 January
Both periods of industrial action involve a “full walkout”, meaning that as well as doctors not attending their scheduled shifts, there will also be no emergency cover. The January strike period of 216 hours is the longest strike in NHS history.
How Do The BMA Junior Doctor Strikes Affect Patient Care?
There are two ways in which you can view the effects of the strikes on patient care.
- Fewer doctors present in A&E, meaning longer emergency wait times which can endanger patient safety.
- Cancellation of clinic appointments and theatre lists due to understaffing.
- Fewer doctors on the wards, meaning increased stress levels and possible errors (such as medication errors).
- Deterioration of the doctor-patient relationship.
- An increase in doctor salary will mean doctors are less stressed and overwhelmed, leading to better patient care.
- Improved working conditions will reduce emotional and physical pressure on medical professionals, leading to better patient outcomes.
Key Ethical Issues Related to Junior Doctor Strikes
Ethical arguments against the strikes:
- Doctors should follow the ethical principle of non-maleficence (do no harm), which is not followed when understaffing is a result of strike action.
- Strike action affects the doctor-patient relationship as well as public perception of the profession.
- Beneficence, or “doing good”, is not honoured by strike action as it is not morally good to delay a patient’s treatments/procedures when this is avoidable.
- Strike action has cost the NHS over £1bn since the start of the year, which is money that could have been used for medical equipment.
- The strikes are putting extra stress/pressure on the other members of the multidisciplinary team.
Ethical arguments in favour of the strikes:
- Doctors are human beings, and while they do a vocational job, this doesn’t mean they should accept poor working conditions.
- Better pay and working conditions will improve the quality of life of doctors, making them better clinicians.
- The literature shows that the mortality of patients either remains at the same level or decreases during strike action.
- While some would argue that full walkouts are negligent, industrial action must be impactful to be effective.
- UK doctors are leaving the NHS to work abroad for better conditions. If we continue to lose doctors at this rate, the understaffing crisis will get significantly worse meaning a much lower quality of care for patients.
Key Economic Issues Related to Junior Doctor Strikes
The industrial action of the past year has cost the NHS over £1.5bn. The main reason for this is that the NHS is paying consultants to cover the shifts of junior doctors on strike days, which costs significantly more than paying the junior doctors to do their own jobs.
There is a huge variation in opinion on industrial action between the public, doctors, other healthcare workers and politicians, so it is important to discuss the topic in a sensitive and logical way.
Here are some tips on how to go about talking about the BMA junior doctor strikes in your interviews:
- Remember that it is likely going to be a doctor who is your interviewer, so being highly critical of doctors who strike may come across as too strong and offensive.
- If you are asked directly if you agree with the strikes, you must give a definite answer. If you are asked to discuss the ethics of the strikes, you can give both sides of the argument without forming a final opinion.
- Refer to ‘pay restoration’ rather than doctors ‘wanting more money’- there is a difference between these two motives!
- Reference the literature/data on this subject to impress your examiner.
- Contrast this set of doctor strikes with previous strikes, particularly related to the Junior Doctor contract.
During your interview, you may also be expected to answer ethics-based interview questions or personal insight interview questions.