What’s Fair, Really? The Psychology, Economics, and Politics of a Doctor’s Pay Rise

In an age of scarcity, how do we approach the topic of Doctor’s pay?

Fairness sounds simple - until you are the one handing out the money.

No one knows this better than our friends at NICE, who routinely have to make impossibly tough decisions about which treatments are worth funding. Cost-effectiveness and scarcity are central to every decision.

As resident doctors potentially prepare for another wave of industrial action, we ask a difficult question: What does it mean to be fair in a publicly funded system, when everyone feels squeezed?

Get with The Times

This week, The Times reported that Labour is poised to reject NHS unions’ demands for a bigger pay rise. The government has proposed a 2.8% uplift for NHS workers to the independent pay review body - the DDRB (whose recommendation has not been publicly released), citing a stagnant UK economy, broader public sector pay constraints, and the growing share of NHS funding going toward staff, now at a record 49.24% of the NHS budget, up 8.77% from last year.

But then came the eye-opener: a live poll at the bottom of the article showed 75% of the public support the government’s offer.

People support what they perceive to be “reasonable.” But behavioural economics tells us that public perception is shaped by anchoring bias. If most public sector workers are getting 2–3%, then 2.8% for doctors feels fair—even if it represents a real-terms pay cut.

The public hears calls about doctor pay erosion and respond with a simple question: which public sector worker has seen their pay keep pace with inflation over the years gone? At the same time, more money than ever is going into an NHS many now view as underperforming, with approval ratings at record lows. Health spending has risen from 2.8% of GDP in 1955 to 8.4% today. That money didn’t appear from nowhere — much of it has come from defence, which has dropped from 7.6% to 2.2% over the same period.

On top of this, the psychology of behavioural economics and the principle of the availability heuristic part explains public perception, where one makes judgements based on what comes to mind the easiest, rather than what’s true. When asked about Doctors, many members of the public will immediately jump to imagining a consultant or a private Harley Street GP, rather than your F2 who is 3 coffee’s deep into a 12 hour on-call.

Many of the public can’t intuitively grasp the scale of doctors’ pay erosion. Whether it’s 5%, 15%, or 25% lost since 2008—it all just gets mentally filed under “more than I got.”

The Argument from Exceptionalism:

Here’s a provocative but necessary truth: not all work is created equal.

Austerity logic says: “Everyone must tighten their belts.” But that logic ignores risk, responsibility, and human capital. Doctors take on high cognitive load, emotional labour, unusual hours, and liability risk that most other professions don’t. There is a reason we pay airline pilots more than median wage workers. A 26-year-old doctor managing a crashing patient is not performing routine labour. Their decisions have immediate, irreversible consequences.

Governments talk about NHS pay like it’s a national indulgence. But underpaying doctors may not end up being fiscally conservative - it could be economically irrational…

Training a medical student alone costs around £230,000. But right now, more than 1 in 4 resident doctors are planning to leave the NHS within two years. Any company losing 25% of its highly trained staff after six years of investment would declare a state of crisis.

A Final Word

Of course, many will rightly argue there’s little fiscal or moral sense in spending hundreds of thousands to train doctors, only to watch them walk out the door. But while pay is certainly part of the equation, it is not the only—nor always the most decisive—factor driving retention. A 2022 report from The King’s Fund highlighted that workplace culture, rota design, and leadership support were more significant predictors of why doctors choose to stay or leave.

Similarly, OECD data shows that higher Doctor pay alone does not correlate with better health outcomes, workforce stability or retention of doctors. The United States, where doctors are among the highest paid globally, still struggles with high burnout and retention problems relatively. The government may see this and reasonably argue that compensation alone is a risk that may not necessarily solve the NHS’s retention crisis.

A Summer of Discontent? Resident Doctors Move Toward Strike Action

The BMA’s Resident Doctors Committee (RDC) is balloting members for strike action over pay, with voting set to open on 27 May. This follows a meeting this week between RDC co-chairs and Health Secretary Wes Streeting, who declined to commit to full pay restoration by 2027.

Should the ballot pass, doctors would hold a strike mandate from July 2025 to January 2026.

Meanwhile, other public sector unions—representing millions of teachers, nurses, and civil servants—are also gearing up. Unless the government funds above-inflation pay deals (exceeding Rachel Reeves’ tight fiscal plans), a “Summer of Discontent” is around the corner—echoing the mass public sector walkouts of winter 1979.

Labour seems to be wagering that doctors, financially drained from previous strikes, won’t have the stomach, or the savings, for another prolonged walkout. But with falling NHS waiting lists one of Keir Starmer’s proudest early achievements, some ministers fear that Doctors could have seriously impactful leverage over Whitehall. As things stand, one question will linger in Westminster: was it worth the gamble?

Tailored Thinking: How Attire Influences Outcomes in Medicine

Part 1 - The Case For Dressing Smartly In Medicine

Welcome to the first instalment of our two-part series exploring the pros and cons of dressing smartly in medicine. This week, we’re making the case for it — so grab your crispest shirt and let’s dive in.

We often hear about the “white coat effect” in medicine — where wearing a white coat influences how patients perceive their doctors. We’re all aware of how our clothing influences how others perceive us, whether it’s on a date or in the hospital. But what if we told you that what you wear also has a powerful effect on how you think, act, and perform in professional settings? Enter the concept of enclothed cognition.

Crafted by psychologists Hajo Adams and Adam Galinsky, the theory suggests that clothing does more than change how others view us; it can also influence our cognitive processes. In a 2012 study published in Social Psychological and Personality Science, participants wearing formal clothing performed significantly better in tasks that demanded creativity and organisational skills. Not only that, but their communication skills improved as well.

This extends beyond just cognitive abilities — the mental and hormonal shifts triggered by professional attire can actually increase self-esteem. Those dressed formally report feeling more confident and capable, with one study finding that participants were more likely to apply for new positions when wearing professional outfits.

A well-fitted, smart item of clothing might not just make you look more authoritative to others but could also make you feel more empowered and confident in your professional capacity. This information is crucial, particularly in the backdrop of doctors feeling more undermined than ever by other colleagues.

“Picks up phone… ‘There's a patient... she has a dog, well actually it's her partners ,but she tripped over it’ ...Excuse me? Who are you, what grade are you and what do you need from me?" Phone etiquette”

“Welcome to the world of ophthalmology, home of wacky referrals for decades - “C/o blurred vision ?eye ?which one refer optamology”. Is it a super-niche speciality that hardly gets taught in medical school, yes. Is it an ophthalmologists job to uphold the education of ophthalmology in medicine, No.”

“In the NHS, ‘Just culture’ is everywhere. We hear the prefix ‘just’ used frequently, often in a derogatory and degrading fashion - can you ‘just’ insert a cannula for me.”

“We are facing a ‘copy and paste’ epidemic when it comes to documentation. A fella I worked with who worked with in the Middle East noted that there was an electronic patient record that somehow electronically stopped people from cutting and pasting the same block of text more than twice”

What’s on your mind? Email us!

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

The NHS is proposing a new policy to screen transgender youth for autism and ADHD before granting access to gender-affirming medical care. This initiative, part of the “Children and Young People's Gender Service,” follows the Cass Review, which highlighted a notable overlap between autism and trans identities. (Them)

An official impact assessment from the UK’s Department of Health and Social Care estimates that up to 12 people per day could utilise an assisted dying service in England and Wales a decade after its introduction. (The Guardian)

In a recent episode of 24 Hours in A+E, a patient with nausea and vomiting was handed an alcohol wipe to smell — and it worked surprisingly well. Randomised controlled trials have confirmed its effectiveness, and it might even outperform ondansetron.

The King’s Fund is back with another great report — this time taking an in-depth look at how poverty affects health in the UK and the NHS. In primary care, there are fewer GPs per patient in more deprived areas, consultations are shorter, and continuity of GP care is worse.

Weekly Poll

Last week’s poll:

How often do you think commercial interests affect clinical decision-making?

Have thoughts about the role of AI in medical education?
Help shape the future of medical education through this 5 minute survey: AI in Medical Education

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

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

Helping Our Female Colleagues: The Free-Time Gap

We know many of our female colleagues have big dreams in medicine — and big workloads at home too. According to the 2024 Gender Equity Policy Institute report, women working part-time have 16% less free time than their part-time male peers, and women working full-time have 12%. The report termed this the “The Free-Time Gender Gap”

The busiest group of all? Women aged 35–44. Marriage doesn’t seem to help: married women take on far more housework than their single peers, while married men find just a few extra minutes of chores compared to single men. Even without kids, women still carry more of the unpaid work at home, even after accounting for their hours, education, or marital status.

It is key to remember that not every female doctor’s path looks the same — some want to go full tilt at their careers, some value more balance. Our job isn’t to guess — it’s to support them, so they can chase whatever version of success they choose.