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By Marie-Louise Connolly
BBC News NI health correspondent
Junior doctors in Northern Ireland are to be balloted about strike action for the first time.
The ballot will run for six weeks and could result in a 24-hour walk out.
A newly qualified doctor in Northern Ireland earns £26,000 per year; in England the starting rate is over £33,000, and in Scotland it is £32,000.
The Republic of Ireland's pay grades operate differently, but junior doctors are paid a higher rate than their colleagues in Northern Ireland.
In England, junior doctors started six days of strike action at 07:00 GMT on Wednesday in their dispute over pay.
Northern Ireland's Department of Health has said there is "no scope for a pay offer to be tabled for this year".
Dr Steven Montgomery, a paediatric junior doctor in the Southern Trust, called for "pay parity, better working conditions and to save the NHS".
"The main reason we need pay parity is so we stop haemorrhaging staff. We are losing staff to multiple countries, and these are highly skilled, qualified staff that we can't afford to lose," he said.
"As a junior doctor you just feel burnt out. The feeling among staff is that morale is low the lowest I have ever seen since I have been working in the health care system."
'Unprecedented action'
Northern Ireland Junior Doctor Chair (NIJDC) Dr Fiona Griffin said the ballot is unprecedented among junior doctors in Northern Ireland.
"Our health service cannot afford to lose these doctors, which is why we need to address the issues around pay urgently. This can be done with an immediate above-inflation pay rise and a commitment to full pay restoration in Northern Ireland," she said.
Dr Griffin called for the government to engage with NIJDC as a "matter of urgency". She said failure to address pay in Northern Ireland now equates to a 30% reduction in 15 years.
Dr Montgomery, who works as a senior registrar at Craigavon Area Hospital, said Northern Ireland has lost too many doctors to other countries which means wards are struggling every day to meet demand, and not just at winter time.
Originally from Limavady, he qualified in 2017. He said he was reluctant to leave Northern Ireland but wants a better work-life balance with his partner who also works in the health service.
On average, he works 48 hours a week but realistically it works out at approximately 55 hours.
"Too few doctors mean it is a lot harder to get time off for annual leave even for things like weddings.
"I have friends who struggled to get their own wedding day off even though they let the department know 18-24 months before their wedding," Dr Montgomery said.
Each year, Northern Ireland employs about 270 newly qualified doctors.
In 2023 there were 20 jobs that became vacant because the doctors chose to work outside Northern Ireland.
According to health unions, the ongoing negativity is having an impact on attracting younger people to the profession.
A potential walk-out would impact on waiting lists and patients waiting to be seen on wards with consultants expected to cover junior doctor roles.
'Pressure on services'
The BMA has stressed that strike action is a last resort and it would welcome any approach from the Northern Ireland secretary to talk to them.
The union warned that if there is no progress they would have to escalate action to longer strikes.
In a statement, the Department of Health said it "fully understands the scale of the frustration among health and care staff about pay".
"Unfortunately, the 2023/24 health budget provided no scope for a pay offer to be tabled for this year," it added.
"We recognise that this is not a sustainable position and remain committed to pursuing all avenues to help achieve a resolution.
"The department respects the right of every individual to take industrial action. However, doing so at this time - with no route to a successful resolution currently available - would only further add to already severe pressures on services."
On Friday the Royal College of Nursing announced it would be taking strike action, along with unions representing some other health sectors, on 18 January.