The Ethics of Crossing The Picket Line: Solidarity vs. Self

Who wins when autonomy clashes with collective action?

The logic of strike action is simple: The more workers who stop working, the higher the cost to the employer. As costs increases, so does workers’ leverage to demand better pay and conditions from their employer. This leverage, however, depends on unity. Trade union ethics therefore suggests that during an industrial dispute, you should not act in a way that reduces the cost on the employer - including crossing the picket line.

The picket line is both a physical and symbolic boundary. It is where striking workers gather outside of the workplace to demonstrate their withdrawal of labour. Trade unions will tell you that crossing the picket line is to benefit from gains others are risking to achieve, while weakening the very tool meant to secure them. On social media, this logic is often taken to extremes, with calls to ostracise “scabs” and make their working lives difficult.

Black and White Fallacy

Nothing in ethics operates as black or white. There are always exceptions and nuances. For example, in recent strikes, some doctors returned to work when trusts flagged critical safety concerns. This was a move supported by discussions between the BMA and local leadership. So we can see when patient risk escalates, the ethical calculations shift.

Not every act of strikebreaking is driven by self-interest either. There are morally legitimate reasons for a doctor to continue working during a strike. A senior clinician in a uniquely specialised role, whose absence would endanger immediate patient safety; a resident doctor on a precarious visa with no financial buffer; a single parent whose income loss risks financial stability…

These are not abstract hypotheticals but real-world contingencies that complicate the ethics of a scenario and mature thinking demands we resist the temptation to condemn all deviation as betrayal.

But still the broader principle stands: if the benefits of improved working conditions are to be shared collectively, shouldn’t the burdens be shared too.

My Choice, My Decision

“It’s my choice and I want to work - end of”. Some invoke liberal ideals to justify breaking ranks. In many Western cultures, autonomy and individualism often trumps all. Psychologist Jonathan Haidt’s research on WEIRD societies (Western, Educated, Industrialised, Rich, Democratic) highlights this: when asked to complete the sentence “I am…”, WEIRD respondents focused on the individual ("I am happy", “I am content” etc), while non-WEIRD respondents emphasised their relationships - to people, to society, to their country or even workplace ("I am a father" or “I am an employee of Fujitsu”).

This reflects a difference in cultural orientation: in individualist societies, moral decisions are shaped by personal identity, autonomy and conscience. But in collective actions like strikes, this lens can obscure our obligations to colleagues and the system we serve. The distinction is crucial for understanding global ethical frameworks. It helps explain why many non-Western nations enforced strict penalties for breaking lockdown rules during the pandemic—prioritising the collective above all. By contrast, even during a public health crisis, the UK had to weigh collective safety against the preservation of individual liberty.

The irony is that our profession is governed by principles that explicitly invoke collective responsibility, to teams, to the system and to the public.

So, does a person’s right to autonomy extend to actively undermining a democratically mandated collective action from which they derive benefit?

Most trade unions operate on the principle of majority consent — not unanimity. Once a strike is lawfully voted for, the decision is binding in its implications, even if one personally disagrees. This is similar to how parliamentary democracy works: MPs may not agree with the party on everything, but they are signed up to support it. But of course not all doctors have chosen to become members of the BMA, and this argument can not be extended to them.

So yes, you have a right to act independently, but that does not entail the right to undermine others’ efforts without scrutiny. You may wish to live in a world where ethical immunity means you can both opt out of solidarity and expect insulation from critique. We are not too sure. What’s more, we hope that even those in the On-Call community who (legitimately) choose not to strike recognise the value of open, principled debate. That, after all, is precisely why On-Call News exists.

“Mum, Dad — What Should I Study at University?”

A timeless dinner table debate and what a question it is… There are countless considerations, but let’s not pretend earning potential is not a significant part of the picture.

How does resident doctor pay stack up against other professions? Well thanks to the DDRB report we have some numbers from the 2023-24 data: FY1 doctors sit at the 53rd income percentile nationally on median pay. FY2s move up to the 68th, core trainees jump to the 84th, and registrars lie in the 90th.

Longitudinal educational outcomes (LEO) data suggests that in 2021-22, median earnings for those with a medicine or dentistry degree one year after graduation was higher than the upper quartile earning for any other subject. Median earnings for medics and dentists 10 years down the line beat the median for any other subject studied except economics.

Life is filled with anecdotes — the cousin who did Law and now earns six figures, the neighbour’s son who made it big in tech. But anecdotes are selective by nature; they highlight exceptional outcomes. What they obscure is the Law graduate who didn’t land the big law firm job or the entrepreneur who’s startup never left the garage. Data will always remind us of what we don’t see - the silent majority, and grounds our opinions in reality.

Is the BMA Fiddling The Figures?

Are claims that the BMA exaggerates pay erosion justified…

Is the BMA fiddling the figures for personal gain? Numerous media outlets think so. They believe the BMA has cherry picked benchmarks and used biased inflation metrics to deliver a headline pay-cut figure that will push its narrative forward.

The main headline is correct. Over the period 2008-2023 doctors real terms income did fall by around 28%. After the last pay settlement, the BMA mentioned that we are still 22% away from 2008 levels. Critics contend that choosing 2008 (just before the global financial crisis and a prolonged period of squeezing public sector finances) conveniently amplifies the perceived loss.

Could another date have been chosen? Sure. Would it have produced smaller numbers? Probably. But arbitrary does not mean meaningless. Yes, the use of 2008 maximises the sense of loss using the financial crisis. Most professions have also not seen their pay keep up with 2008 levels, but that does not necessarily make it invalid. 2008 represented a genuine turning point in public sector pay. Where the public sector was made to pay for the excessive risk taking of private sector financial organisations.

RPI, CPI, CPIH, IFS, ONS…

Perhaps the most charged dispute is the choice of inflation measure. The BMA uses Retail Price Index (RPI) as it’s measure. Critics, backed by ONS (Office of National Statistics) and IFS (Institute for Fiscal Studies), call RPI an unreliable measure that exaggerates inflation, favouring CPIH, which results in a more modest real‑terms pay drop of 11–16% since 2010.

So what’s the difference between CPIH (Consumer Prices Index including owner occupiers’ housing costs) and RPI? The main area of contention is about housing. CPIH includes council tax, actual rents paid, routine home maintenance, and home insurance. Crucially, it estimates owner-occupiers’ housing costs using rental equivalence: what homeowners would pay to rent a similar property. It excludes mortgage interest payments and house prices, on the grounds that these reflect financial markets rather than real-world consumption, and would introduce unnecessary volatility.

Okay here we go - people pay mortgages so why not include mortgage interest in the calculation? Well here’s the economic rationale:

People claim that mortgage interest is not a ‘consumption’ cost. Mortgage interest isn’t the price of housing, it’s the cost of borrowing. The actual price of housing is reflected in CPIH. Inflation measures are meant to track the cost of a fixed basket of goods and services, not the cost of financing them. Mortgage rates are clearly influenced by monetary policy (think interest rates).

Think about it, when the Bank of England tries to CONTROL inflation they RAISE interest rates, RPI records this as inflation getting even higher, even though the purpose of the rate rise was to LOWER inflation. Economists say this makes no economical sense - imagine if your car’s speedometer went up every time you tried to brake.

Another reason economists consider RPI flawed comes down to the maths. RPI uses the Carli formula to average price changes, whereas CPIH uses the Jevons formula (We know that went in one ear and out the other). The Carli method tends to overstate inflation because it assumes consumers don’t change their habits when prices rise — if beef becomes too expensive, many will buy chicken instead, but Carli doesn’t account for that. As a result, RPI inflates inflation, reflecting outdated assumptions about spending behaviour. It fails the ONS’s own statistical standards as an inflation measure.

Economically Flawed, But Still Relevant!

So It may be a bad measure of inflation, but a useful proxy for ‘financial burden’. These are actual mortgage interest payments that leave your bank account every month for example.

Some may say legitimately: If RPI is so flawed, why does the government use it when calculating how much interest I pay on my student loan?

Economists, and independent institutions like the ONS and the IFS, don’t defend RPI's use for student loans either. In fact, the House of Lords Economic Affairs Committee and House of Commons Treasury Select Committee have repeatedly criticised the use of RPI in this exact context, calling it a stealth tax on graduates.

So this is not an argument that justifies using RPI — it’s an argument that it shouldn’t be used inconsistently. So don’t take it out on economists, take it out on the politicians and student loan companies.

“When the last records were taken in 2021/22, the three hospital trusts who made the most on staff car parking charges were: South Tyneside and Sunderland NHS Foundation Trust (£865,409); Somerset NHS Foundation Trust (£758,412); and Imperial College Healthcare NHS Trust (£666,233) - Congratulations to all nominees”

“In a parallel universe, out of hours pay begins at 5pm (and not 9pm) and exam and royal college fees are handled by our employer”

“Doctors switching trusts in the upcoming months face form-filling rituals better suited to 1995. When will AI merge all records between trusts in seconds?”

“Picks up ECG… If it looks like it would hurt to sit on, it’s hyperkalaemia”

What’s on your mind? Email us!

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

Ever fancied pretending to be a doctor? Zholia Alemi faked her qualifications and worked as an NHS psychiatrist for the best part of 20 years. We have a solid candidate for the lead of Catch Me If You Can 2 if it ever gets made. Unfortunately, like Frank Abagnale, her run ended with prison time and a £400,000 bill.

Have we lost control of social media health misinformation? This weeks edition of health lunacy, reported in The Times, is about Barbara O’Neill, an Australian ‘Naturopath’, who shared a video explaining how an ‘all natural retreat’ cured a patient’s cancer diagnosis.

Health Secretary Wes Streeting unveiled proposals allowing successful GPs to manage local hospitals and hospital trusts to oversee GP services. This model aims to dissolve the traditional acute/community divide and ease the record 7.39 million waiting list. (The Times)

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The Great Consultant Car Park Debate

In most professions, those CEO’s and managers at the top often enjoy a few perks—fancy offices, priority access, or even a designated Lavazza coffee machine. These rewards signal respect and acknowledge years of dedication.

In the NHS, the Consultant Car Park debate is typically framed in terms of utility. We are told that Consultants must be reachable at all hours, and proximity to the hospital is practical. Yet this ‘functional’ logic can be extended to on-call registrars or even, post-night shift staff.

What’s often overlooked, however, is the consultant car park as a symbolic gesture. In other fields, privileges for senior roles are accepted markers of respect. In medicine, such gestures are frequently rejected as hierarchical or elitist. But perhaps being a consultant is an elite job… Years of rigorous training, clinical acumen, and high-stakes responsibility. Their decisions underpin hospital function. A reserved parking space, then, is perhaps not merely a perk, it’s a recognition of what consultants offer to the NHS.

To what extent do we want to push this workplace experiment of stripping all non-payment-related perks from our most senior doctors? We’ll leave that decision up to you.