Striking Doctors Deliver A Festive Reality Check to the Government

With turnout up and rejection clear, the government’s hope of ‘strike fatigue’ was wishful thinking

The BMA has dealt the government an unwanted Christmas present in the form of the latest results of its online ballot of resident doctors. The headlines should focus not only on the rejection of the government’s offer and the continuation of industrial action, but also on what the raw numbers suggest.

According to official statements, 35,107 BMA resident doctor members voted, with 53,726 eligible voters on the ballot list, giving a voter turnout of 65.34% amongst eligible members. This figure refers to resident doctor members of the BMA who were eligible to participate, not all UK resident doctors.

Whilst official figures can vary depending on the source, according to the NHS’ 10 point plan published earlier this year, roughly 75,000 resident doctors are working in the UK, which means that 39% of all UK resident doctors voted against the government’s deal (29,215 out of 75,000).

A Strong Message

Even so, this is a significant turnout compared with many political ballots. For example, in the 2019 general election, the UK’s overall turnout was around 67%, with major parties receiving 30-plus per cent of the popular vote each.

But whilst the appeal of comparing such votes may be obvious, the comparison is not as politically sound as we may think. The first-past-the-post electoral system, multi-party voting dynamics, protest abstention and a sense of an inevitable Labour victory all differ from a binary referendum-style strike ballot. What we generally expect in politics is that referendums draw larger turnouts, especially when the question can be seen to be of huge personal relevance.

If we compare the BMA result with other recent union strike ballots, we see variation in turnout and support figures. For example, in 2022, the National Union of Rail, Maritime and Transport Workers (RMT) ballot on industrial action saw around a 71% turnout and 89% support for strike action, illustrating that high participation and strong majorities can occur in other sectors as well.

Looking To Jan 6th

These numbers remain significant, and the BMA will welcome a clear reaffirmation of member support for continued industrial action. The result spells continued frustration for Health Secretary Wes Streeting and the government, who were hoping that “strike fatigue” after more than a year of intermittent strikes might make it harder for the BMA to secure a fresh mandate. The current strike mandate is set to end on January 6, 2026, and the BMA is already preparing to reballot members to extend the mandate further.

The government will have been hoping that the vote to extend the mandate would be on shaky ground, given the last vote drew a voter turnout of only 55%, just higher than the 50% turnout needed for an eligible vote. But for all their hopes, this vote seems to have blown all of that speculation out of the water.

What’s the reason for this? Hard to pinpoint. Could it be the dialling up of the government’s harsh rhetoric on doctors? Perhaps, but one thing is for certain: the dispute between the government and the BMA shows little sign of resolution in the near term, and this stand will likely continue well into 2026.

When Becoming a Psychiatrist Is Just One Exam Away… Literally

How many UK doctors and medical students are familiar with the route by which doctors enter CT1 psychiatry training and become consultant psychiatrists of the future? Well, first you need to sit the MSRA exam and then… [checks notes]…that is it.

Yes, if you manage to score highly enough on the MSRA exam, you are offered a position based purely on your score. The speciality in which communication skills are arguably most paramount lacks an interview altogether.

You know our role at On-Call is to try our best to deliver alternative, and sometimes contrarian, viewpoints that you may not have considered, but this one presents an almighty challenge. What this process has created is an artificially inflated competition ratio and a serious question about whether the right candidates are being appointed to psychiatry posts.

The RCPsych has suggested that MSRA success is a good predictor of success in the MRCPsych examinations. Even if we accept the conclusions of the paper this claim is often based on, to reduce the skillset of a good future psychiatrist solely to one exam is incredibly shortsighted.

What about commitment to the speciality, which is often demonstrated through a robust portfolio built over many years? What about excellent communication skills that could be assessed through interviews? And what about resilience, multidisciplinary teamwork, professionalism, or empathy?

The cynics reading on will have their own explanations for the RCPsych’s direction, such as fiscal savings or logistical ease. The RCPsych has released statements referencing the unprecedented competition ratios, and, of course, accommodating these applications in interview centres would be resource-heavy.

However, does the Royal College realise that part of this inflation is secondary to the scatter gun application approach that has been able to proliferate alongside the surge in applications from overseas?

Psychiatry patients deserve doctors who are committed to the speciality and selected in the best possible way, with no corners cut to save a couple of pound notes.

Resisting the ‘Taskification’ of Medicine – Why the Generalist Must Live On

Medicine is more than protocols and compilation of isolated tasks

Sit down, we need to talk about how medicine is evolving. In 2025, medicine has increasingly become ‘taskified’, in short - broken down into discrete interventions delivered by a growing array of professional roles. So, today we ask: What is left of the idea that medicine is a complex mixture of science and art, rather than merely a set of protocols and compilation of tasks?

Medicine cannot be allowed to turn into a factory line. As ICU consultant Dr Matt Morgan has pointed out, there are circumstances in which a production line approach can be efficient and appropriate. For example, the majority of patients undergoing cataract surgery do not require an exhaustive exploration of their life history and medical background to achieve a good outcome.

Yes, there are exceptions, and cataracts can occasionally signal underlying systemic disease, but these are not the norm. Yes, we know cataracts as part of the Myotonic dystrophy triad for those of you waving your MSRA notes around.

The problem is that simple pathology is increasingly rare. As populations age, comorbidities accumulate, and health needs overlap. Patients are no longer single problems to be solved in isolation. They are complex networks of interacting organ systems, medical histories, medications and social circumstances. We can attempt to taskify medicine as much as we like, but the need for clinicians who can integrate information across multiple domains does not disappear.

Algorithmic ‘Ease’

Consider the patient with diabetes, COPD, and early dementia who presents with a chest infection. A task-based model of care may focus narrowly on the lungs: There’s a fever, cough and oxygen requirement, so let’s prescribe some antibiotics. This type of thinking is incredibly easy to ‘protocolise’.

But what this patient truly needs is recognition of the broader context: the interaction between comorbidities, the effects and side effects of existing medications, the risk of delirium, and the impact of acute illness on mobility and independence. Without this wider perspective, the patient may survive the acute infection yet deteriorate in quieter, more insidious ways.

The medical workforce, therefore, cannot be built solely around task completion. It must be staffed by doctors with a deep, well-grounded understanding of human biology and illness in context. Far from being obsolete, the generalist clinician with a broad knowledge base is needed now more than ever.

“As a Consultant Surgeon, I sometimes miss going into Zen mode and cracking on with a case by myself and at my own pace. I think this is one of the main things I enjoy about the private sector, whilst accepting that my role in the NHS is also for training and teaching.”

“As a GP, I am at breaking point for the amount of discussions where patients expect me to sort out their difficult and in many cases, unfortunately, life circumstances… in ten minutes, I should add.”

“I need to remind myself every day that it is human nature to always want more and that I will never feel entirely satisfied (aside from the odd fleeting moments of gratitude).”

“Every paediatrician is well aware of the classic borderline unresponsive and sick child who begins running around and having the time of their life the moment they make it into hospital. I am used to reassuring the embarrassed parents by now.”

What’s on your mind? Email us!

Some things to review when you’re off the ward…

Here is a great article from the Association of Anaesthetists of Great Britain and Ireland answering whether the MSRA should be how the UK decides the anaesthetist of the future.

83% of BMA members voted to reject the government’s deal and continue industrial action on a background of a whopping 65% turnout.

For those interested in public opinion, this is the latest YouGov poll, suggesting that 58% of the general public oppose the resident doctors’ strike, with 33% in favour.

Weekly Poll

Last week’s poll:

Are you in favour of this next round of resident doctor strike action?

…and whilst you’re here, can we please take a quick history from you?

Something you’d like to know in our next poll? Let us know!

Can You Shave a Zero or Two Off My Loan, Please, Wes?

The idea of student loan forgiveness for NHS doctors has been raised repeatedly, and when proposed, it is often tied to years worked in the NHS. Alternative ideas would be to reduce the rate at which interest accrues on the loan.

We know that the amount that we pay reflects our income, with repayments made at 9% of income above a threshold. This has led many to call student loans a ‘graduate tax’. Crucially, a graduate’s monthly payment is independent of the total value of their debt, which means that any student loan reform would not put money in the pockets of resident doctors for many years (unless 100% of the loan was written off today), unlike the increases in current pay advocated for by the BMA.

Equally, this policy would only benefit students with an outstanding English student loan, and with a growing proportion of resident doctors now having done their medical school years abroad, this policy would act as a pay-enhancing reform that only targets UK graduates.

Think about when doctors will repay their loans, however. Let’s say Dr Al Bumin gets his £90,000 loan reduced to £45,000 through the kindness of Wes Streeting’s heart in return for doing five years of mandatory NHS service. This would make no difference to Dr Al Bumin’s student loan payments until that £45,000 is paid off.

So by the time our hypothetical doctor begins to benefit from this student loan forgiveness, he is likely a Consultant and already remunerated well. Surely we can agree that a fiscally wise system in any walk of life would put money into the pockets of our graduates when they need that money the most.