Resident doctors deserve a stable and equitable future in the NHS

One of the most pressing and unifying of these issues in the profession today is pay, which has seen a severe decline in real terms since 2008.123 Multiple pay restoration campaigns led by the British Medical Association (BMA) and associated industrial action by resident, consultant, and specialty and associate specialist doctors have begun to reverse this trend. “While moving in the right direction, deficits in real terms pay of 23%, 26%, 25% in the 2024/25 tax year remain from 2008/9 levels for each respective group.”123 Despite this, momentum for further action remains strong, particularly following this year’s average recommended pay award of 5.4% from the Review Body on Doctors’ and Dentists’ Remuneration, which has prompted a new pay dispute with the government. Resident doctors are once again balloting for industrial action.

The erosion of doctors’ pay has coincided with a substantial rise in the cost of living, resulting in a marked decrease in purchasing power, particularly for those on lower pay scales. A recent analysis found that doctors in their first foundation year now spend 24% more of their salary on essential goods and services than in 2008, leaving them with less disposable income.4 Compounding this, the overall tax burden has continued to rise and is now at its highest level in 70 years, meaning a greater proportion of doctors’ income is lost to taxation.5 Additionally, the state pension age has steadily been increasing, meaning that today’s doctors will need to work longer than those in previous generations.

Student loans are another key source of financial pressure contributing to intergenerational inequality. Before the introduction of Plan 2 loans in 2012, newly qualified doctors left university with much lower levels of debt. By contrast, many now owe over £100 000 (€117 000; $136 000) on graduation, with repayments effectively acting as an additional 9% tax on earnings above the repayment threshold. This adds yet another layer to the growing burden on doctors, reducing their take home pay. For many, the interest accruing on these loans exceeds the value of their repayments, meaning that the total debt continues to grow unless they earn substantially more or make early repayments. Faced with this, doctors are often forced to choose between paying down their loans early, at the cost of other milestones such as home ownership.

While pay remains a pressing issue, concerns around employment are now taking precedence. For resident doctors, unemployment is once again becoming a pressing concern, drawing comparisons to the so-called lost tribe of senior house officers crisis in the early 2000s.6 A recent BMA Scotland survey found that seven of 10 resident doctors are worried about potential unemployment from August 2025 onwards.7 Like many of my colleagues, a key part of our decision to enter medical school was the expectation of stable training and employment opportunities. Yet, on completing the foundation programme, many of us now face frozen career progression and a real risk of unemployment. These concerns extend further along the training pathway, with senior registrars encountering a shortage of consultant and general practitioner (GP) posts. The BMA has warned that up to 1000 GP trainees could be left without jobs this year,8 which is a clear failure of workforce planning.

An alarming level of intergenerational inequality in the NHS that has been developing over many years. Senior doctors must take a stand and support their junior colleagues with the ongoing campaign for full pay restoration. Alongside pay, other potential avenues could relieve the financial burden on doctors, one of which would be reducing the mandatory costs required to progress, such as specialty specific examinations and portfolio fees. More consideration is needed in the financial impact of student loans, with potential opportunities to introduce fee waivers for set years of NHS service. Workforce planning is broken and must be overhauled. Doctors are valuable assets to society, and we must ensure that they can expect stable employment and career progression. The social contract is broken, and now it must be rebuilt and protected. We cannot allow our profession to crumble because of neglect. Unwavering solidarity across generations of doctors is vital, not just to restore our profession, but also to secure its future for those doctors coming through after us.