UK doctors are walking out for the thirteenth time since March 2023. The government points to a 30% pay increase and says “we’ve done our part.” The BMA says “it’s not enough.”
Both sides are trapped in a binary conversation about money when the real crisis is time.
I work in healthcare technology. I’ve watched this pattern repeat across systems, countries, and decades. The strikes, the negotiations, the impasse. Everyone’s talking about compensation while doctors drown in administrative work that has nothing to do with patient care.
Here’s what nobody’s quantifying: if we gave each striking doctor back 2-3 hours per day by eliminating documentation burden, would we even be having this conversation?
The Invisible Crisis Nobody’s Measuring
A junior doctor starts their shift at 7 AM. First patient at 7:30. Fifteen minutes of actual medicine, then 25-40 minutes documenting that encounter.
Not just clinical notes. They’re navigating multiple screens in antiquated EMR systems, copying and pasting from previous notes, manually entering billing codes, cross-referencing drug interactions, trying to remember exact phrasing that won’t trigger a claim denial.
By mid-morning, they’re already 90 minutes behind.
They see eight patients before lunch but only document four of them. So they skip lunch, sitting in a break room typing frantically, trying to remember details from patients they saw three hours ago. The accuracy suffers. The detail suffers.
Their ability to think clinically suffers because they’re in “documentation mode” instead of “diagnostic mode.”
The data backs this up. US physicians now spend 49% of their day in the EHR, with only 27% spent caring for patients. That’s not a small inefficiency. That’s a fundamental inversion of what healthcare should be.
Then there’s the hidden work. Inbox management between patients. Messages from nurses, lab results, specialist coordination. Every interaction creates a paper trail they’re legally obligated to maintain.
By 5 PM when their shift officially ends, they’ve got another 2-3 hours of “pajama time.” Finishing notes at home, after hours, unpaid.
This is the invisible labor burning them out. They trained to diagnose, to treat, to connect with patients. Instead they’re glorified data entry clerks who occasionally get to practice medicine.
The Cognitive Cost That’s Killing Patients
We’re treating this like a labor dispute when it’s actually a patient safety crisis in disguise.
When a doctor constantly switches between diagnostic mode and documentation mode, they experience what cognitive scientists call “attention residue.” Part of their brain is still thinking about how to phrase the last note while trying to listen to the next patient’s symptoms.
When clinicians are cognitively overloaded by administrative tasks, diagnostic errors increase. They miss subtle clinical cues because they’re mentally rehearsing documentation requirements. They order unnecessary tests as defensive measures because they’re thinking about liability and coding requirements instead of clinical necessity.
The quality of patient interaction deteriorates because the doctor is partially present. One eye on the patient, one eye on the clock, knowing they’ve got 30 minutes of typing waiting for them.
Every hour spent on documentation is an hour not spent on critical thinking. Medicine requires pattern recognition, differential diagnosis, catching the thing that doesn’t fit. That requires mental space and cognitive bandwidth.
When you’re exhausted from administrative burden, you don’t have that bandwidth.
The strike conversation is framed as “doctors want more money” versus “the system can’t afford it.” The real question should be: how many diagnostic errors are we accepting as collateral damage of an inefficient system?
How many patients receive suboptimal care because their doctor is cognitively depleted from documentation overload?
That’s not a labor issue. That’s a public health crisis.
Why Technology Isn’t Even At The Table
There’s a political calculus happening that’s completely divorced from problem-solving.
Technology solutions don’t make good headlines and they don’t win negotiations. When the government offers a 30% pay increase, they get to say “look, we’re investing in the NHS.” It’s visible, quantifiable, plays well publicly.
When doctors reject it, the government can point to that number and say “we tried, they’re being unreasonable.”
Implementing AI-powered documentation systems, workflow automation, EMR integration requires admitting the system is fundamentally broken. That’s a much harder conversation because it implicates decades of policy decisions, procurement failures, and bureaucratic inertia.
From the government’s perspective, technology investment is risky. It requires upfront capital, implementation time, change management. No guarantee of immediate political payoff.
A pay increase is clean. You write a check, you move on.
Technology is messy. Multi-year implementations, training, integration challenges. If it fails, you own that failure publicly.
From the doctors’ perspective, there’s also skepticism. They’ve been promised technological solutions before and gotten clunky EMR systems that made their lives worse. So when someone says “technology can help,” their immediate reaction is “yeah, like the last system that added three hours to my day.”
Both sides are locked in a transactional negotiation when what’s needed is a transformational conversation.
Technology isn’t at the table because admitting it should be there means admitting that money alone won’t fix this. That’s politically inconvenient for everyone involved.
The Difference Between Old Promises And New Solutions
The EMR systems that burned doctors weren’t designed to reduce their burden. They were designed to satisfy billing requirements, regulatory compliance, and hospital administration needs.
The doctor was an afterthought.
Those systems added work because they were fundamentally built for the wrong stakeholder.
Modern AI documentation tools are built with clinical workflow as the starting point. Systems that listen to natural patient-doctor conversation and generate documentation in real-time. Not systems that force doctors to navigate seventeen dropdown menus to record a blood pressure reading.
The litmus test: does the technology make the doctor faster or does it make the billing department happier?
Old EMRs made billing departments happy. Modern AI solutions make doctors faster.
There’s a fundamental difference in design philosophy.
The other piece is the hybrid approach. AI plus human quality assurance. Pure speech-to-text fails because medical terminology is complex and context matters. A system that transcribes “patient denies chest pain” when the doctor said “patient describes chest pain” isn’t just inaccurate. It’s dangerous.
Combining AI recognition with expert medical transcriptionist review delivers speed and accuracy.
The proof has to be in measurable outcomes. Actual time saved, actual reduction in after-hours documentation, actual improvement in claim acceptance rates. The technology has to work in the messiness of actual clinical practice, with interruptions, with noisy environments, with the reality of how medicine actually happens.
The Permanente Medical Group found that generative AI scribes saved physicians an estimated 15,791 hours of documentation time over one year. That’s 1,794 eight-hour workdays returned to clinicians.
The Ethical Minefield Nobody Wants To Walk Into
If the NHS implemented this technology tomorrow and gave every striking doctor back 2-3 hours per day, does that let the government off the hook for the pay issue?
Yes, there’s absolutely a risk that technology becomes a substitution strategy instead of a complementary solution.
If you give doctors back 3 hours a day through automation, the government could argue “great, now you can see more patients with the same staffing levels.” Technology becomes a productivity extraction tool, not a quality-of-life improvement.
That’s not solving burnout. That’s optimizing exploitation.
But the pay issue and the efficiency issue are separate problems that happen to overlap. Doctors deserve fair compensation for their expertise and training. Full stop.
They also deserve to spend their paid time actually practicing medicine instead of fighting with administrative systems.
Those are both legitimate grievances. Solving one doesn’t erase the other.
The real question is: what’s the actual goal? If the goal is “doctors should be fairly compensated for their work,” then pay restoration matters. If the goal is “doctors should be able to practice medicine effectively without burning out,” then technology matters.
If the goal is “patients should receive safe, high-quality care,” then both matter.
Where this gets tricky is implementation intent. Technology deployed with the mindset of “now we can squeeze more productivity out of fewer people” is destructive. Technology deployed with the mindset of “let’s eliminate waste so clinicians can focus on what they’re trained to do” is transformative.
The tool is neutral. The intent behind it isn’t.
What Responsible Implementation Actually Looks Like
Time saved goes back to the clinician first, not to the system’s productivity targets.
That has to be contractually embedded in the implementation. If we automate away 2 hours of documentation, those 2 hours belong to the doctor to decide how to use them. Maybe they see one or two more patients because they choose to. Maybe they spend more time with complex cases. Maybe they leave on time for once.
But it’s their time, not the administration’s time to reallocate.
Pilot this with the doctors who are most burned out. The junior doctors, the ones working in understaffed departments, the ones doing “pajama time” documentation at home. Let them be the test case.
Measure what matters to them: hours saved, after-hours work eliminated, cognitive load reduced. Not what matters to administrators like patient throughput or revenue cycle improvements.
Those might be byproducts, but they can’t be the primary metrics.
If doctors don’t feel the relief, the implementation has failed, regardless of what the spreadsheets say.
Total transparency on how the technology works and what it’s doing with their data. Doctors need to trust that the AI isn’t making clinical decisions, it’s making documentation faster. They need to see the human QA layer. They need to know that if the system makes an error, there’s accountability.
No black box algorithms that they’re expected to trust blindly.
The implementation has to include a commitment that technology savings won’t be used to justify staffing cuts or to avoid addressing the pay issue. Put it in writing: “We’re implementing this to improve clinician well-being, and we commit that efficiency gains will not result in reduced staffing levels or be used as justification to limit compensation discussions.”
Without that commitment, you’re proving that technology is just a cost-cutting exercise dressed up as innovation.
Involve the doctors in the design and rollout. Not as token consultants, but as actual decision-makers. What workflows need customization? What specialties need specific templates? Where are the pain points that the technology needs to address first?
The EMR systems failed because they were imposed on doctors. This has to be co-created with them.
Lessons From US Healthcare’s Mixed Results
I’ve seen practices where it worked exactly as intended. A urology group that implemented AI documentation and actually used the time savings to reduce physician burnout. They measured it: 1-3 hours saved per clinician per day, and they protected that time.
Doctors left at reasonable hours, spent more face-time with patients. The practice saw both improved physician satisfaction and better patient outcomes.
But I’ve also seen the darker version. Large hospital systems that implemented automation and immediately increased patient quotas. “Great, you’re saving 90 minutes on documentation, now you can see three more patients per shift.”
The technology worked perfectly from a technical standpoint, but it made burnout worse because it became a productivity weapon. Doctors felt like they’d been tricked. Promised relief, delivered more work.
What determined the difference: leadership intent and physician involvement in governance.
The practices that succeeded treated doctors as stakeholders in the implementation. They set the rules together: time saved stays with the clinician, productivity targets don’t automatically increase, regular check-ins to ensure the technology is serving its intended purpose.
The implementations that failed were top-down mandates where administrators saw efficiency gains as an opportunity to cut costs or increase throughput.
Technology is an amplifier of existing culture. If your culture is “extract maximum productivity from limited resources,” technology will amplify that extraction. If your culture is “support clinicians so they can deliver better care,” technology will amplify that support.
You can’t use technology to fix a toxic organizational culture. You’ll just automate the toxicity.
Survey data shows that 46% of physicians believe decreasing administrative burden would be the most effective intervention in reducing burnout. That outranks all other factors as the primary driver of physician burnout.
The Real Resistance Nobody Wants To Admit
Fixing the documentation problem exposes how badly leadership has failed for the past two decades.
If you implement AI documentation and suddenly doctors have 2-3 extra hours per day, the immediate question becomes: “Why did we tolerate them wasting that time for years?”
That’s an uncomfortable admission for everyone who’s been in charge.
There’s also a perverse incentive structure. Hospital administrators and government health officials have built entire careers around “managing scarcity.” Doing more with less, optimizing constrained resources, heroic efficiency measures.
If technology actually solves the efficiency problem, it undermines the narrative that the system is doing the best it can with limited resources. It reveals that we’ve been asking clinicians to compensate for systemic dysfunction through personal sacrifice.
Financially, there’s resistance because technology requires upfront investment with benefits that accrue to clinicians, not to balance sheets. A pay increase is a line item you can point to. Technology investment is harder to sell politically because the ROI is measured in clinician well-being and patient safety, not immediate cost savings.
But here’s what nobody wants to say out loud: there’s also a power dynamic at play.
The current system, as broken as it is, gives administrators control. Documentation requirements, productivity metrics, scheduling systems are all mechanisms of institutional control over clinical autonomy.
Technology that gives time back to doctors also gives autonomy back to doctors. Some administrators don’t want that. They want compliant, overworked clinicians who don’t have the bandwidth to question administrative decisions.
The final piece is accountability avoidance. As long as the crisis is framed as “not enough money” versus “unreasonable doctors,” both sides can avoid responsibility for the systemic failures.
The government can blame budget constraints, doctors can blame undervaluation, and nobody has to admit that the infrastructure itself is fundamentally broken.
Technology forces that admission. Admissions require accountability, which requires change, which requires political courage that’s currently absent.
A Message To The Doctors Walking Out Next Week
You’re right to be angry, and you’re right to walk out.
But you’re fighting the wrong battle.
The government wants you to believe this is about whether you’re worth the money. You’re worth far more than they’re offering. But even if they doubled your salary tomorrow, you’d still be drowning in documentation at midnight. You’d still be cognitively depleted. You’d still be leaving medicine within five years because the job you’re actually doing isn’t the job you trained for.
The real fight is about time restoration, not just pay restoration.
It’s about demanding a system that treats your clinical expertise as valuable enough not to waste on administrative tasks that technology could handle.
When you walk out, you’re making a statement about your value. That’s important. But make sure you’re also demanding structural change, not just financial compensation.
Don’t let them buy you off with a pay increase that leaves the broken system intact.
Demand the technology implementation. Demand the workflow redesign. Demand the protection of clinical time.
You have more leverage than you realize. The system can’t function without you, and that gives you the power to demand better pay and a better system.
Your burnout isn’t a personal failing. It’s a system design flaw.
Systems can be redesigned if there’s enough pressure to do so. Strike, make noise, but make sure you’re demanding transformation, not just transaction.
You deserve both the compensation and the conditions that let you actually practice medicine.
Don’t settle for one without the other.
The doctors walking out next week aren’t just fighting for themselves. They’re exposing a fundamental dishonesty in how we talk about healthcare sustainability.
We act like it’s a resource problem when it’s actually a design problem.
Until leadership on both sides is willing to have that harder conversation, we’ll keep cycling through these crises. Throwing money at symptoms while the disease progresses.
These doctors and their patients deserve better than a system optimized for institutional convenience rather than clinical excellence.
