Doctors across England walked out today in the first of three planned strikes over pay and working hours, causing hospital services to be severely disrupted.
The strike by 38,000 junior doctors (qualified doctors that are not consultants or general practitioners) is the first of its kind in 40 years and means thousands of appointments and non-emergency operations have been cancelled.
Emergency cover is being provided, similar to a Christmas Day service, but the last of the three planned 24-hour strikes, on February 10, will involve a complete withdrawal of labor.
There are more than 55,000 junior doctors in the UK, around a third of all medical staff. Doctors who belong to the trade union British Medical Association (BMA) have been in a long-running dispute with the government over planned changes to their contracts, which would mean an extension of their standard working hours to include evenings and Saturdays.
At the moment, any hours worked between 7pm and 7am, or at any time over the weekend, are classed as antisocial and are consequently paid more. The UK health secretary, Jeremy Hunt, wants to change this to make basic hours (and pay) last from 7am to 10pm, and 7am to 7pm on Saturdays.
Hunt has offered an 11 percent basic pay rise but doctors say this is offset by a much larger reduction in the pay for antisocial hours.
The contractual changes are part of a government drive (and key manifesto pledge) to create a "seven-day National Health Service (NHS)," where the services and doctors available on a weekend fully match those available on weekdays.
The BMA says it fully agrees this is what should happen, but what is needed to make it a reality is more money and staff, citing a dire shortage of doctors and a funding shortfall in the NHS of 30 billion pounds ($43 bn) that is predicted by 2020.
The BMA also says safeguards to prevent overwork are being removed in the proposed new contracts in a way that is fundamentally unsafe and will put patients' lives at risk.
It is also concerned about changes they say penalize people who take time out or who work part-time, which it states will disproportionately affect women.
BMA junior doctors committee chair Johann Malawana said of the strike: "Junior doctors feel they have been left with no option but to take this action. We have been clear throughout this process that we want to negotiate a contract that is safe and fair, and delivers for junior doctors, patients, and the NHS as whole.
"This remains our goal and our door is open to talks, but the government must address our concerns around safe working patterns and ensure the contract recognizes the long, intense, and unsocial hours which junior doctors do."
A BBC poll assessing the public mood on the strike found 66 percent of respondents supported it, while 16 percent opposed it.
Junior doctors in England and Wales have a starting salary of about 23,000 pounds ($33,000), which rises to 30,000 within four years, while doctors in specialist training get a starting salary between around 30,000 pounds and 47,000, rising to 69,325. However, thanks to anti-social working hours pay the average junior doctor earns about 40,000 rising to 56,000 in the later stages.
Once qualified as consultants or GPs, doctors can expect to earn from about 55,000 pounds to more than 100,000.
In the US, the average pay for doctors is $195,000 for a primary care physician and $284,000 for a specialist, according to last year's annual Medscape Physician Compensation Report.
Follow Miriam Wells on Twitter: @missmbc