Publisher Health

Junior doctors in England are starting their fifth round of strike action with no sign of a breakthrough in their bitter pay dispute with the government.

The doctors’ union, the BMA, made headlines earlier this year when it said pay had fallen so far behind inflation that its members would be better off serving coffee than treating patients. The government described that as misleading and said the average junior doctor earns between £20 and £30 an hour.

In reality, that term – junior doctor – covers someone fresh out of medical school right up to those with a decade or more of experience. And pay is complicated, with salaries varying massively as medics move up grades when they become more skilled and start to specialise.

BBC News asked two junior doctors, at different stages of their careers, to show us their wage slips and explain exactly how much they earn.

Dr Robert Gittings graduated from medical school in Liverpool after studying for a master’s in infectious disease biology.

Last summer, he started his first, or FY1, year as a junior doctor in London and is currently working on the infectious diseases ward as part of his rotation – where doctors get experience in different types of medicine.

“In my hospital, we have a lot of tuberculosis patients, patients with uncontrolled HIV, and we also get pneumonias and, sometimes, we get a tropical infection coming in,” he says.

Robert is paid a basic salary before tax of about £2,450 a month for a standard 40-hour week – or just over £14 an hour. Then there are additional roster hours – which are compulsory – taking his average working week to 48 hours.

Under what the government calls a “final offer”, his pay will go up in October in two ways: a straight 6% pay rise and £1,250 permanently added to annual salaries – both backdated to April.

But that falls well short of the 35% increase for which the BMA has been asking to make up for years of below-inflation rises.

For Robert, the latest pay offer would be worth roughly £250 a month before tax.

He also receives extra payments each month:

“Sometimes night shifts can be really busy,” he says. “There have been times when I’ve had to manage a patient by myself who is deteriorating, and I have to do everything for them, just with advice over text message.”

Junior doctors like Robert typically spend five or six years in medical school before starting their jobs.

He says he graduated with about £50,000 of debt including tuition fees and – in June – paid back £75 in student loans from his salary.

There are other deductions including £257 – or 9.8% of his wages – for a pension, with the NHS contributing 20.7% under the latest career average scheme, more than most private sector pensions.

In June, Robert took home a total of £2,164 after tax and deductions. That works out as a total annual salary of roughly £37,000.

He says he is now looking to take a year out to work abroad – probably in Australia. “I’m not confident the pay here is going to improve as much as I’d like it to,” he says. “I would really quite strongly consider staying [there].”

Dr Kiran Rahim qualified from medical school in 2011 and now treats sick children as a paediatric registrar – one of the most experienced junior doctor grades.

“I was at work yesterday and it was really, really busy,” she says. “I was managing A&E – so taking in all the paediatric referrals, all the sick kids who needed to be seen.

“And then managing the acute stay ward, making sure the children were getting their treatment, accessing and booking scans for them.”

Kiran has taken three years out to have children herself, and is now working part-time while she looks after her young family, meaning her training – and her time as a junior doctor – has been “elongated”.

For an average three-day week, she is paid a basic salary before tax of roughly £3,315 a month – or just under £28 an hour – which is the same rate as a full-time doctor. Like Robert, she also receives London weighting.

In July, she was paid another £292 for night shifts and £132 for working one weekend in every six or seven.

She says the “vast majority” of junior doctors at her level end up working extra unpaid hours before they can go home at the end of the day.

“I can’t just leave a sick patient because it’s unsafe, and it’s not fair on the people who are already fighting fire on the next shift,” she adds.

Kiran finished paying off her student loan this year, although she says – like other junior doctors – there are unavoidable costs which do not show up on her payslip.

She pays £433 a year to the GMC to be on the doctors’ register. There are charges to be a member of the Royal College of Paediatrics and Child Health, and she has had to pay thousands of pounds in exam fees.

Plus there is the cost of personal indemnity insurance – just under £700 a year – to protect her in case she is sued for medical negligence.

In July, Kiran took home £2,159 after tax and deductions for a 27-hour working week. That would work out as a total annual salary of roughly £69,000 if she was full-time.

“Pay is important but so are all the other things that make you want to go to work,” she says. “This is not the job I signed up to do 10 years ago and I have seen a decline in morale, in our working environment and in our working conditions.”

The government says it has accepted the latest recommendations made by an independent pay review body and its most recent offer represents an 8.8% annual pay rise for the average junior doctor in England.

“Our award balances the need to keep inflation in check while recognising the important work they do,” says Health Secretary Steve Barclay.