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The dispute between resident doctors and the Department of Health and Social Care has reached a point of deadlock, with more strikes happening in the run up to Christmas. Although pay restoration has dominated public discussion, the drivers of the discontent are structural: deteriorating working conditions, limited career progression, insufficient training capacity, and longstanding failures in workforce planning.1 The NHS’s operational difficulties cannot be attributed solely to industrial action—system pressures predate the current dispute, and this framing obscures deeper structural problems. Without tackling doctors’ fundamental concerns, the present dispute is unlikely to resolve, and similar crises will recur.