In a recent small-sample poll, nearly three-quarters of UK-based physicians on Sermo said pay during their training years in the UK was unfair:
- 44% called it very unfair
- Another 29% said it was somewhat unfair
- Only 14% described it as at least somewhat fair
That headline figure raises some important questions. Why do so many doctors feel their junior doctors’ salary is unfair in the UK? Is the issue the size of the paycheck, or the way doctors feel their work is valued? And how does this tie into the choices physicians are making about striking, staying or leaving?
In this article, we’ll explore those questions using a combination of Sermo physician community data, member voices and supporting pay figures from the BMA (British Medical Association) and UCL (University College London).
Resident doctor salary in the UK: fairness or failure?
On paper, the pay scale for resident doctors looks like a steady climb: from £38,800 (〜$49,000) in FY1 (Foundation Year 1), to £44,400 (〜$56,000) in FY2 (Foundation Year 2), then into the £52,600–£73,900 (〜$67,000–$94,000) range for specialty training. UCL also shows premia for shortage specialties and a London weighting of around £5,000 (〜$6,300).
But doctors on Sermo believe reality doesn’t feel like that neat progression. One member put it bluntly: “Pay is very low and not risen since 2008. We must strike for full pay restoration.”
The numbers explain why. The BMA estimates junior doctors’ pay has dropped by more than 25% in real terms since 2008/09 once inflation is factored in. Inflation itself is running at 3.8% as of August 2025, with food up 5.1%, rents across the UK up 5.7%, and the average London rent now £2,252 (〜$2,840) a month. For an FY1 earning £38,800 (〜$49,000), that’s over £26,000 (〜$32,800) gone on rent before necessary living expenses such as household bills and commuting
The result is a pay structure that looks stable on paper but feels unfair in practice. Sermo members highlight that frustration. As one UK GP said, “Pay should increase.” Another resident added, “This issue needs to be sorted as soon as possible.”
What they’re pointing to goes over and above simply salary. It’s the sense that costs have outpaced earnings and the value of the role has slipped compared to other professions that require similar training. As one pediatric resident put it, “While no one practices medicine simply for economic gain, it is important to be paid enough to feel like adequate value is placed on one’s knowledge and skills, and that the time and effort put into one’s work receives equitable remuneration.”
So when three-quarters of polled doctors in the UK describe their pay as unfair, they’re describing a disconnect between how hard they have to train and work and the value put on those very skill sets.
Is pay pushing resident UK doctors on strike?
With pay widely seen as unfair, it’s no surprise that 47% of physicians on Sermo said they have participated in strike action, and another 36% seriously considered it. That leaves just 16% who never entertained the idea.
Doctor strikes in the UK aren’t entered into lightly. One Sermo member and UK resident put it clearly: “The decision to participate in industrial action is very difficult due to the high level of empathy one feels for patients and their families. It is seen as the last resort when everything else has failed to yield acceptable results.”
This captures the tension that runs through several of the comments from UK-based community members on Sermo. Doctors are pulled between their duty to patients and their duty to themselves. They don’t want to be out on picket lines, but they also don’t want to see their profession steadily devalued.
Some members recalled earlier strike waves where others carried the burden. A GP said, “I was ready to participate in a strike, but SAS doctors did not need to strike when Consultants and resident doctors took industrial action a few years ago.” Those previous walkouts, including the 2016 junior doctor strikes over new contract terms, made headlines but ended with only partial concessions, leaving many feeling that the core issues of pay erosion and working conditions were never fully resolved. That history feeds into how solidarity is understood today and is built into a growing frustration that conversation alone is proven not to shift anything, that strikes across healthcare might be inevitable.
Ultimately, there’s an urgency here that makes this moment different from historical strike action. Now there’s a palpable sense that it’s less about temporary gains and more about trying to protect the future of the profession.
Expectations versus reality in medical careers
The poll on Sermo also asked doctors how clear expectations were when they first entered the profession. Only 12% said very clear, with most describing the picture as somewhat clear (26%) or neutral (23%), and nearly 40% called it unclear.
One GP traced this back to the Modernising Medical Careers (MMC) reform in 2005: “Our path as trainees was clear until someone tried to ‘reform,’ introducing the Modernising Medical Career initiative, which was a disaster for my career.” The MMC program was designed to streamline postgraduate medical training by replacing the old Senior House Officer system with a new, more structured route from foundation training to specialist registration. In practice, it reduced flexibility, shortened rotations and introduced the controversial Medical Training Application Service (MTAS), an online matching system that collapsed in 2007 after widespread errors and protests. Many doctors felt the process was rushed and opaque, and that it limited career choice while prioritising bureaucracy over merit. Eventually, Tooke’s independent inquiry concluded that MMC’s flawed implementation had undermined confidence in the fairness and clarity of training pathways.
The lack of clarity has other consequences. With uncertainty around NHS career progression, many UK doctors are exploring additional opportunities such as private work or paid surveys as a flexible way to supplement their income while continuing to grow their careers. Communities like Sermo give physicians a space to do both: to share advice and experiences with peers and access survey earning opportunities that value their expertise.
A resident in internal medicine summed up the wider frustration: “The whole NHS system needs to be changed, especially non-clinical staff like managers.” For many, the problem isn’t just pay but the structural imbalances that make progression inside the NHS unpredictable and can even lead to burnout. Yet, even within that uncertainty, doctors are finding ways to stay connected, supported, and proactive about their professional future.
Who should lead the UK’s public health future?
If pay and career progression feel shaky, the next question is who doctors actually trust to lead change. The Sermo poll shows no clear frontrunner. 36% of surveyed doctors chose professional medical associations, 33% pointed to government and health departments and 22% went with NHS leadership.
The comments help explain the divide. A nephrologist wrote: “The NHS has been put in a very difficult position currently and urgent and brave political decisions are required.” That’s a call for the government to step up. But others pushed in the opposite direction. A GP argued: “Stakeholders best positioned to lead…are not necessarily leaders at the pinnacle of their careers, who are actually far removed from the day to day running of their respective fields.”
What’s really being debated here is: who makes a legitimate leader? Should an overhaul of the UK’s health service be led by:
- The politicians with a democratic mandate?
- The national institutions that run healthcare?
- The frontline doctors who work within the system every day?
None of these options hold support from the majority of Sermo members. The only point that comes close to agreement is that whoever takes the lead should listen to the doctors on the frontline delivering the care.
What can be learned from global healthcare models?
When Sermo asked doctors which countries the UK should learn from to restructure its healthcare system, two answers got the most votes: 31% said Australia and New Zealand, while 30% felt the UK should build its own model.
When looking toward Australia and New Zealand, many UK doctors point not just to abstract benefits but to system designs that deliver them. Their training and public hospital systems tend to use contract-based remuneration tied directly to hours or shifts, and often allow doctors to balance public and private work more flexibly. For instance, in Australia, unsocial hours attract much higher pay (e.g. a doctor in Queensland might get 187% of base salary for a Sunday shift) and pay is linked directly to specific shifts rather than an averaged formula. A 2023 BMJ feature also finds that many UK doctors who move cite higher salaries and more control over hours as key attractions.
In terms of other models from across the world, Denmark is often pointed to as a great example. “A system similar to Denmark’s would be good,” one Sermo member said. The Danish model is built on a decentralised structure, where healthcare is organised and funded mainly at the regional and municipal levels, rather than controlled centrally. General practitioners act as gatekeepers, and most are independent contractors rather than salaried employees, which gives them greater professional autonomy. A 2024 WHO–European Observatory review described how this setup gives GPs and local authorities genuine responsibility for planning and delivering care, ensuring decisions are made closer to patients. The same report highlighted Denmark’s focus on “professional flexibility” and the way this system protects time for clinical work over administration.
The Danish idea has been borrowed by the NHS Confederation, which has proposed plans for a UK system that uses devolved decision-making and longer funding cycles. However, not many physicians on Sermo argue that simply copying another country is the answer. One preventive medicine physician believes that “The UK should look at models across the world to develop its own model further.”
So, looking to other countries may be useful, but most Sermo members believe external ideas won’t solve things outright. As one GP reminded us: “The UK was leading, not even 10 years ago. But the NHS and the government need to be honest.” What doctors want most is simply to create a system that feels fair and sustainable at home.
Key takeaway
When it comes to resident pay, UK doctors feel stuck in a system that hasn’t kept its promises, and it’s driving them ever closer to strike action. As one oncology trainee put it: “This issue needs to be sorted as soon as possible.” That urgency runs through every poll result and community member comment on Sermo.
When only 12% of polled physicians remember clear expectations at the start of their careers, and most now say their pay is unfair, it points to a trust problem deeper than wages.
What resident doctors are asking for is fairness and leadership that actually listens to the frontline. Without that, the NHS risks losing staff alongside the confidence of the very people who keep it going.
Join the conversation on Sermo
How do you see the future of residency pay and strikes in the UK? Do you think reform should come from government, professional bodies, or the frontline itself?
Share your views and hear from other physicians facing the same challenges.
