LONDON (AP) — Thousands of doctors in England are staging their 11th walkout on Thursday in a long-running dispute with the government over pay and working conditions, disrupting hospital services just days before the U.K. general election.

The five-day strike by junior doctors — those in the early years of their careers — shines a spotlight on the troubles besetting the chronically underfunded National Health Service, Britain’s state-funded public health system, a topic that is a a top concern for voters going to the polls on July 4.

Junior doctors, who form the backbone of hospital and clinic care, have been locked in the pay dispute with the government since late 2022. They went on strike for six days in January — the longest in NHS history — and hospitals had to cancel tens of thousands of appointments and operations.

The latest strike begins Thursday and ends on Tuesday, just two days before voters cast their ballots to choose a new House of Commons.

The British Medical Association, the doctors' union, say their pay has dropped by a quarter over the last 15 years and have called for a 35% pay uplift. The union says newly qualified doctors earn about 15 pounds ($19) an hour — the U.K. minimum wage is just over 10 pounds an hour — though salaries rise rapidly after the first year.

Dr. Sumi Manirajan, deputy chair of the junior doctors committee at the union, said that years of underinvestment has resulted in young doctors leaving in droves to countries that offer better pay, with those left behind seriously overworked and underpaid.

“Doctors that I trained with in London, some of the best in the country, have left to go to New Zealand. And actually what it makes me think of is why am I not doing the same? I want to be valued for the work that I do,” she said.

Manirajan, who recently graduated and works in obstetrics and gynecology, added that she sees many women waiting for more than a year for routine procedures.

“These patients are in pain, and it hurts us to see us see these patients come in again and again with the same problem that we know we could treat if we had enough doctors,” she said.

The Conservative government says it gave the doctors pay raises of between 8.1% to 10.3% last year and said that it was a generous settlement. It maintained that authorities can't make a pay offer during the preelection period but the union refused to call off the strikes.

Manirajan said that it was unfortunate that the government chose to call an election while knowing that the dispute was unresolved.

The medics' union said it was ready to talk, and it has already had some discussions with the opposition Labour Party, which has a considerable lead in polls.

“It is difficult to comprehend how either the Conservative Party or the Labour Party can deliver on their manifesto commitment to recover NHS performance over the next Parliament without first ending the dispute,” said Siva Anandaciva, chief analyst at The King’s Fund think tank.