Junior doctors who are striking in Wales this week have a strong sense of solidarity, even stronger resolve, but frustration runs deep.

It’s not just Australia they’re competing with now, in their bid to retain colleagues: it’s England and other parts of the UK which are luring the workforce away, with the promise of better pay and conditions.

The Welsh Government’s offer of a sub-inflationary 5 per cent last August was lower than any other offer made to junior doctors anywhere in the UK. That was hurtful but also damaging, according to junior doctors braving heavy rain at the demo outside University Hospital of Wales in Cardiff yesterday.

Craig George-McDowall, a specialty trainee 2 in radiology, wonders if he should reconsider his commitment to the nation which has awarded him two degrees. He is concerned Wales is becoming ever-less appealing for those applying for specialty training. Colleagues are already requesting inter-deanery transfers to England because of pay, he said.

‘Why would they choose Wales if they could choose Scotland or England where they've had better pay offers?’ said Dr George-McDowall, whose dog, Pancake, joined the Cardiff demo. ‘And why are we worth less?’

The disparity in pay offers across the UK is worrying for Welsh patients too, said foundation year 1 Imogen Potter, a broad smile belying her frustration.

‘The Welsh nation is already more poorly funded than other nations, and the incentive to stay is now less,’ said Dr Potter. 

‘I chose to come to Wales because it was a different challenge. Previously, I was in a big tertiary hospital in England where it was all electronic: here, we are still doing paper prescribing, paper notes and, until August, paper X-ray requests. You've got populations which are really vulnerable here in Wales, and having doctors who can support those patients is key.’

Dr Potter does not take lightly the decision to strike: she worked late on Tuesday evening to try to make things easier for those covering for her during the walk-out.

Specialty trainee 2 Rachel Kerr too is concerned that retention across all sectors of the health service won’t improve until pay rises, for everyone. Junior doctors deserve full pay restoration to 2008 levels, she feels, not least in recognition of the considerable responsibilities they shoulder and the emotional toll of the work. 

‘We've got an ever-increasing workload, we've got an ageing population, and there's just less and less of us,’ said Dr Kerr. ‘When you're on call on a weekend or overnight, and there's just you and you're covering multiple wards, it’s a lot. We have people's lives in our hands.’ 

Dr Kerr came to medicine as a graduate so has a large student debt. ‘I only ever pay the interest on it,’ she said. Dr Potter added wryly: ‘I've got friends who've been able to buy houses because they worked for a year in Australia.’

In common with many at the Cardiff demo, Richard Lean, a specialty trainee 2 in radiology, cannot help but compare his salary with that of his contemporaries who chose careers other than medicine.

‘I can't think of many professions where you have this level of responsibility, the risk of litigation. There have definitely been times where I’ve felt completely unsupported, managing hundreds of patients, and it's just unsustainable, dangerous as well. My peers who have gone into other professions are earning a good living, with a good work–life balance and far less responsibility.’

Among many, there’s a sense of deep weariness with the state of the health service. Frequent honks from traffic passing the demo on Wednesday reassure them of public support for their cause. But Peter Fahey, co-chair of the BMA Welsh junior doctors committee, described morale at work as being at ‘rock bottom’.

‘More and more people are having conversations, not just about leaving for different countries, but about whether being a doctor is even worth it any more,’ said Dr Fahey. ‘It’s not even necessarily about the money but pay is the number one way in which your employer values you. Having it continually eroded shows we are not valued. 

‘My wife is a doctor as well, and we can’t even talk about it because it's just gets you down too much.’

'I don't want to strike'

Dr George-McDowall is exasperated and saddened about feeling forced to strike after the Welsh Government made a commitment to full pay restoration a year ago, then reneged on it.

‘I don't want to be here striking: I didn't want to be here the first time [in January],’ he said. ‘I wanted the Welsh Government to come to the table, and I really was hopeful, perhaps naively, there would be some movement. 

‘But I do want to be here today expressing my unhappiness with how we're being undervalued, and how we're being treated. We are worth more.’

Oba Babs-Osibodu, who is Dr Fahey’s co-chair of the BMA Wales JDC, agreed that junior doctors in Wales have ‘absolutely no choice’ but to strike until a ‘credible’ new pay offer is made. 

'I'd much rather be in work,’ said Dr Babs-Osibodu. ‘But that feeling is dwarfed by the gargantuan pay cuts that we've received and the ridiculous levels of burnout that we're seeing. And I've seen the impact that this is having on patients; chronic understaffing means we're not able to deliver the care we want to.

‘We've made our case to the Welsh Government; we've told them the strength of feeling and the fact this situation is untenable. And despite that, they've offered us just 5 per cent: in other words, a real-terms pay cut, lower than the Doctors' and Dentists' Review Body recommendation and the worst offer in the UK at this time. 

‘The Welsh Government has been respectful to us, but what we're hearing from them is excuses; we're not hearing any ideas, we're not hearing anything constructive. So, until they come to the table with a credible offer, we'll keep striking.’

The current 72-hour walk-out by junior doctors in Wales continues until 7am on Saturday 24 February, and a further strike is scheduled for 25 to 29 March.

(Images by Seren Boyd)