JUNIOR doctors in England are threatening to strike, in response to a new contract the government is trying to impose from August 2016. It is easy to see why. At the moment, any doctor working from 7pm to 7am on weekdays, or any time at the weekend, is considered to keep “antisocial” hours. They are rewarded with a higher rate of pay. Under the proposals, “social” hours are being extended, to include any time before 10pm, Monday to Saturday. The change would wallop junior doctors, for whom pay outside their basic hours makes up one-third of their overall packet. NHS Employers, an industry body, has not provided many data, and the changes will affect doctors differently, but some could see a 20-40% pay cut. This would reinforce a secular decline in “real”, or inflation-adjusted, pay (see chart).

Like workers in any public service, doctors always say that morale has never been lower. But this time many are threatening to vote with their feet and practise overseas. Normally the General Medical Council, which regulates the profession, gets 20-25 requests a day for certificates of professional status, which make it easier to work abroad. From September 16th-18th it received a staggering 1,644 requests.

A small number of doctors went on a 24-hour strike in 2012. Many were in senior positions and continued to perform essential tasks. A study by Imperial College London found that the strike led to no increase in in-hospital deaths on the day. But it is trickier for junior doctors to pick and choose, since they are more likely to be dealing with emergency situations. One junior doctor says going on strike was previously “unthinkable”. No longer.