As doctors in England enter their 13th month of industrial action, an independent analysis of their pay confirms that the real terms value of their salaries has declined by a quarter in the 15 years since their pay was frozen.
The analysis - conducted for The BMJ by the Office of Health Economics (OHE), an independent health economics research organization - found that across all grades doctors' salaries declined in real terms by 25% on average, between September 2008 and September 2023, compared with 10% across all work sectors.
This mirrors analysis by the British Medical Association (BMA), which says doctors require a 35% pay rise to correct the 26% pay erosion since 2008.
Freelance journalist, Adele Waters, reports that this fall, combined with a substantial rise in the cost of living in the UK over the same period, is disproportionately affecting doctors' purchasing power, especially among junior doctors.
For example, newly qualified (F1) doctors have to spend 24% more of their salaries than they did in 2008 for the same essential goods and services (food, drink, transport, energy and housing), while for consultants this figure is 7%.
House prices have also risen in real terms, making home ownership out of reach for many doctors, especially in cities such as London and Manchester, where house prices have risen by 31% and 21% respectively.
One F1 doctor told The BMJ he can't afford breakfast or to join a gym, while another said "if I wasn't living with my partner, I would struggle financially."
An F2 oncology doctor in London says his pay is "rubbish" and if it wasn't a job that he enjoyed and spent so much time working towards, "I would probably be doing something else."
The BMJ also spoke to a former ophthalmology trainee who made the difficult decision to quit medicine last year after worrying about affording a gas bill. "I loved medicine but I hated the pay and the way doctors were treated," he said.
"Both the private and public sectors experienced a fall in pay in real terms after the financial crash in 2008," says BMA junior doctors committee co-chair Vivek Trivedi in response to the findings. "But in the private sector, which makes up 80% of the UK workforce, we saw pay levels rebound relatively quickly, while the public sector bore the brunt of austerity.
"And within the public sector, doctors have taken a specifically harder hit - so the level of pay erosion has been even stronger."
Fellow co-chair Robert Laurenson argues that doctors are disadvantaged financially throughout their postgraduate training due to the frequent demands to relocate. "Pay erosion is compounded by the geographical instability of our careers, rotating every four, six to 12 months," he tells The BMJ.
"That lends itself to not being able to benefit from things like fixed tariffs from energy companies, from being able to commit to something as significant as a mortgage if you can afford it, and you're constantly at the whim of the rental market."
While the Doctors' Association UK (DAUK) is not putting a figure on the salary increases doctors need, it aligns with the BMA on the need to value doctors properly. "Our pay should reflect levels of training and expertise that doctors have, as well as the levels of responsibility that we carry. It's as simple as that. And our pay should keep pace with inflation," says its co-chair Helen Fernandes.
NHS England did not respond to The BMJ's request for comment.
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