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LONDON — Tens of thousands of doctors in England walked off the job Friday for another four-day stretch, with growing concerns that their bitter pay dispute with the British government will drag on into the winter.

The fifth round of strikes by doctors at the early stages of their careers is set to last until 7 a.m. Tuesday morning. Some of the junior doctors on strike started their first jobs in the state-funded National Health Service only days ago.

The action by junior doctors, who do much of the routine work in hospitals and who work very long hours, will inevitably add to the backlog at the embattled health service. According to the NHS, the number of procedures and appointments being canceled or rearranged is set to hit 1 million by the time the doctors return to work, at a cost of 1 billion pounds ($1.27 billion).

The British Medical Association, which represents the approximately 75,000 junior doctors, has been asking for a 35% pay bump to get pay back to 2008 levels once inflation is taken into account. But the government is only offering them 6% with an additional consolidated increase, and Prime Minister Rishi Sunak has insisted there will be no more discussions.

Junior doctor Sumi Manirajan, deputy co-chair of the BMA’s U.K. doctor committee, said she sees colleagues at “burnout point” every day.

“All we’re asking for is our pay to go back to the 2008 levels. We’re not asking for a pay rise,” the 29-year-old said at a picket line outside University College Hospital in north London.

“My friends have left the NHS after a year of service and have gone to Australia,” said Manirajan, who has been a junior doctor for three years.

For its part, the government insists that its pay offer is fair and that meeting the pay demand would further stoke inflation across the U.K.

“We as a government have to be responsible in the pay settlements that we give, and we listened to the Independent Pay Review body,” Treasury minister John Glen told Sky News.

Like other nations in Europe, the United Kingdom has faced disruptive strikes as workers, from teachers to train drivers and nurses, have pressed for pay that keeps pace with a sharp increase in consumer prices. On Friday, the biggest rail workers union, the Rail, Maritime and Transport union, said 20,000 of its members working for 14 train operators would walk out on Aug. 26 and Sept. 2.

Last month, the government announced pay increases for millions of public sector workers, including teachers, who were one group who decided to call off their strike action in the wake of the offer made — 6.5% in their case.

The junior doctors aren’t the only grouping in the NHS who are in a dispute with the government over pay. Radiographers and senior doctors, known as consultants, have also walked off the job recently, though nurses have ended their strike action after a ballot of members failed to meet the required number of votes to back another walkout.

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