The argument surrounding doctors’ pay remains an ongoing battle. At the time of writing, Foundation Year 1 doctors have voted in favour of industrial action due to the lack of substantive employment or regular locum work at the end of foundation year training.
In addition, resident doctors in England held a five-day strike in July 2025 with weaning public support. Unfortunately, what many members of the public fail to understand is that doctors face their own unique set of financial burdens.
Being a doctor is a vocational career, and doctors are paid above the UK average, but the extra ‘tax’ doctors have on their income is under-appreciated. All doctors have mandatory professional fees as well as extra costs that come with professional development. On the surface, this may seem to be an issue of financial renumeration, but the real problem is much deeper. The expenses that come with being a doctor unfavourably affect people from lower socio-economic backgrounds, acting as a barrier to entry and career advancement.
I returned to ophthalmology after a 12-month career break at the height of the ‘junior’ doctor strikes in August 2023, when doctors were painted as selfish and unreasonable for demanding a pay rise that countered inflation. Even though my non-medical friends were supportive, they had no idea about the hidden fees of being a doctor. Returning to medicine from a non-medical job meant I had to restart paying these doctoring fees.
In August 2024, I had to pay just under £1000 to continue doing my job (Table 1). This sum doesn’t include the BMA membership fee, which is over £500 a year for senior resident doctors. The costs only rise year on year with increasing seniority. On top of these fees come the costs of professional development.
Career progression is locked behind expensive exams, and the additional costs of courses we take to help us pass those exams. This is without mentioning the things we do to improve as doctors: CPD courses, conferences and educational meetings. The costs of the Royal College exams have also gone up rapidly (Table 2). From 2024 to 2025, the cost of the Part 1 and Part 2 written fellowship exams increased by £45, which is a 6.9% increase – an increase above the current rate of inflation in the UK [1]. The reason behind the sharp increase is unclear considering the exams are taken online at home. Also, the pass rate of the Part 1 exam is around 40%, so many candidates will have to take this exam twice or even three times. Therefore, the £695 cost of the Part 1 exam is a mere starting point. The Part 2 Fellowship oral examination fee increased from £875 to £1195, a 36.6% rise. Someone miraculously passing all four exams on their first attempt in 2025 would need to pay £3460 for the feat.
One might respond that it is possible to apply for tax relief for all the professional fees mentioned. Although it takes time and patience to navigate HMRC’s forever-changing application rules, it is possible to get a couple of hundred pounds returned. Also, doctors are entitled to a study leave budget and relocation allowances. Not all professions have that benefit, so we should just be grateful, right?
Well, with regards to relocation allowances, even though we can claim the money back, the cost of time and stress do not add up. We would rather not relocate at all – a sentiment that’s commonly echoed amongst doctors is our lament for the lack of locational stability that comes with more traditional jobs.
As a Welsh trainee, my annual study leave budget is £600. Even though the rules have changed post-Covid, in that any extra money from the previous year gets carried forward to the next year, it is uncommon for there to be any. Take 2025’s RCOphth Annual Congress as an example: the early bird price of the four-day package for trainees was £308. Attending one of the surgical courses during the congress would be another £438. Before travel or accommodation is added on, I would have already blown through my annual study leave budget. A budget hotel for three nights will cost about £150 in Liverpool and an off-peak return train ticket from Cardiff to Liverpool will cost around £130. Adding all the costs together, £600 may cover the basic costs of Congress but I would have had to pay out of pocket for any other professional activities.
The situation is not better for nurses and allied health professionals (AHPs). Similar CPD is expected from them, but their study budget framework appears more opaque. Since 2020, a CPD fund has existed for nurses and AHPs at £333 per person, but this fund isn’t guaranteed year on year [2], and the application process seem to vary locally [3]. For postgraduate courses, study leave and funds are available but may rely on the conditions of that staff member staying with the Trust for at least two years.
"If someone from a less fortunate background also needed to support their family while trying to progress through the hierarchical medical career, they would certainly be at a disadvantage compared to their more privileged peers"
My colleagues and I were recently criticised by our manager for not taking locum shifts. Even though they said that additional shifts aren’t mandatory, we were reprimanded for not putting patient care first and making a consultant step down to cover a second on-call in one rare instance.
In stark contrast, a friend of mine who had to take the Chartered Financial Analyst exams didn’t have to pay a penny for the exams or revision materials – the financial consulting firm he worked for paid for everything. He had approximately 20 private study days to prepare for the exam, too. Those exams weren’t completely mandatory for his job role, unlike our postgraduate exams. Not to mention the annual bonuses he receives for the extra hours he clocks in. Comparing our situation in the NHS to someone working in a private consulting firm will only cause misery, but it would be nice to receive more support surrounding exams.
Beyond the long superficial groan about these professional fees, I am fully aware and thankful that we are still in a better position than the national average, and I do absolutely love aspects of my job. However, the unsavoury truth is that many doctors are leaving the UK or the profession all together because of poor financial renumeration in the NHS, contributing to the staffing crisis. In addition, these professional expenses act as a barrier of entry to the profession and career progression.
While the medical profession may be racially diverse, it certainly isn’t socioeconomically diverse. It’s no secret that the majority of successful applicants to medical school come from middle-class backgrounds [4,5]. Even though I am a first-generation Chinese immigrant, I attended an all-girls grammar school for sixth form and my parents are white-collar middle-class professionals. My mum is an accountant and my stepdad is an IT consultant. Only 4% of doctors come from working-class backgrounds, a percentage that’s certainly not representative of the national population [6]. Also, one may argue that racial diversity is contributed to by immigrant doctors from other counties, rather than diversity being represented from entry to medical school [5].
A student from a lower socioeconomical background who manages to get into medical school and successfully graduate does not have the same starting position as those from more privileged backgrounds in terms of career progression. For example, they may be an aspiring ophthalmologist trying to maximise their points through their professional portfolio and interview in the national selection process.
Points are awarded for demonstrating their commitment to ophthalmology through participation in postgraduate exams. One point is awarded for attempting the Part 1 FRCOphth exam, while three points are awarded for passing it. Two points are also awarded for passing the Refraction Certificate. If the applicant had the time to study hard and pass, they may earn themselves five points by paying £1570 in exam fees – don’t forget the additional costs of exam preparation and interview coaching courses though!
In addition, points are given for attending ophthalmology educational meetings. These meetings cost money and they may not be covered by study leave expenses. If one had the financial backing of family money, one could buy three points by spending a few grand to attend multiple international or national meetings. This is a luxury that working-class applicants simply cannot afford.
Even though I’m from a middle-class background in the UK, my family in China is a different story. A goal of mine is to be able to send money to my family in China to improve their quality of life. Unfortunately, my grandmother passed away in China in 2024 and her hospital bills cost my dad more than he could afford. Thankfully I was able to alleviate some of that financial burden with the money I had saved for them. My story can’t be unique. If someone from a less fortunate background also needed to support their family while trying to progress through the hierarchical medical career, they would certainly be at a disadvantage compared to their more privileged peers.
Everyone likes being paid more; the problem is bigger than that. We shouldn’t be nurturing a homogenous group of middle-class doctors that does not represent the diversity of the general population. Struggles that working-class patients experience may only be fully empathised with by doctors from similar backgrounds. Widening access schemes are needed beyond entry to medical school. In addition, we need to address the selection bias of more financially able doctors getting their preferred specialty training. While it may feel morally superior to boast about doing this job for the love of it, that is not a privilege we can all afford.
References
1. https://www.ons.gov.uk/economy/
inflationandpriceindices
2. https://www.nottstraininghub.nhs.uk/
cpd-funding
3. https://www.rcn.org.uk/magazines/Career/
2022/Jan/Accessing-CPD-funding
4. Steven K, Dowell J, Jackson C. et al. Fair access to medicine? Retrospective analysis of UK medical schools application data 2009-2012 using three measures of socioeconomic status. BMC Med Educ 2016;16(11).
5. Burke K. Medical schools continue to favour white, middle class candidates. BMJ 2004;328(7455):1518.
6. www.gov.uk/government/publications/
state-of-the-nation-2016
[All links last accessed October 2025]
