There is new drama on the healthcare front. This time, it’s not in the United States, where critics have endlessly dissected the expansion of health coverage since Obamacare was introduced five years ago. Instead, the big battle is being waged in England.

Thousands of less senior doctors walked off the job in London on Tuesday, striking for the first time in 40 years over wages and working hours.

The walkout may come as a surprise to outsiders who know the English system in passing. Unlike the U.S., England has a publicly funded and very popular healthcare network, the National Health Service. In the 68 years since its founding, the iconic system has built steadfast loyalty among the English for reliable—although not deluxe—medical care delivered to all comers.

But as England’s population has aged, the system has begun to buckle under the more extensive care required for chronic conditions as well as intensive needs like hip and knee replacement surgery.

Those pressures boiled over this week when thousands of doctors walked out—postponing surgeries and cancelling appointments—to push back against government demands for cutbacks in pay and increases in work schedules.

An American doctors strike?

While the scene was dramatic, with English doctors in scrubs holding placards denouncing the cuts and passing motorists honking their horns in support, many doctors across the Atlantic are also increasingly unhappy over constraints in the way they deliver medical treatment.

American doctors have traditionally been elites, honored in their communities as they dispensed care through their private practices. And they were compensated handsomely for the seven years (or more) they spent earning their medical degrees.

Until very recently, these physicians largely steered their own careers, with the powerful American Medical Association—which is not a union—influencing much of the medical care policy debate. Their interaction with hospitals largely consisted of stopping in to oversee care for their patients admitted there.

But as American medical care becomes increasingly cost conscious and more focused on outcomes—areas where the U.S. system lags behind its foreign counterparts—that independent model of patient care is fading. U.S. healthcare systems have been consolidating and gobbling up primary doctor practices, meaning that more care is being dispensed by doctors working at—and for—hospitals. Reporting to a workplace hierarchy is very different for doctors who traditionally have operated their own practices and acted as their own bosses.

Faced with a situation in which many feel they are earning less for doing more—and doing so under heavy supervision—some physicians have taken to social media to back the idea of a union. It’s a drastic step for people who see themselves as highly educated professionals, not assembly line workers.

In a posting last year on KevinMd.com, a site founded by Dr. Kevin Pho, one commenter urged medical professionals to “imagine a medical union fighting to provide the best care to ordinary citizens, free from the whims of the political and business classes.”

Such a union, wrote Margalit Gur-Arie, a founder of the health technology consulting company BizMed, could have “the power to shut down every hospital, every medical facility and every practice in every city, every town and every hamlet across the land, bringing the medical industrial complex to a grinding halt.”

Still, most American doctors do not share that sweeping vision, and only a handful of U.S. doctors employed by hospitals have been moving in the direction of unionizing. The biggest reason? American doctors work in a much more diffuse and harder to organize medical system than the one in England.

The NHS: A giant public system

The NHS is a behemoth, employing more than one million people, and supported by taxes and payroll deductions.

England’s government has argued that it has largely shielded the service from budget cuts imposed on other institutions as part of the Conservative government’s austerity approach. But as the costs of England’s health care grow, the government is pushing for changes to ease years of financial pressure on the NHS.

The government’s proposals, which it says are designed to improve treatment and lower mortality, are aimed at increasing work hours on the weekends for the 55,000 less senior doctors, who are the physicians largely responsible for dispensing emergency care.

Unlike their American counterparts, many of England’s less experienced physicians—known as junior doctors—are members of the British Medical Association. This group, which represents about 37,000 junior doctors, labeled the government’s proposals unsafe and unfair.

Last year, there was a near unanimous vote by association members to walk out in protest of the government’s more drastic demands. In addition to the current action, the coming weeks are likely see a 48-hour strike that would encompass medical treatment that is not urgent, and a separate 24-hour walkout that would deny all types of treatment.

Whether the English will continue to side with their medical providers is yet to be seen, but it will provide an instructive example to their American counterparts about the extent of citizen patience and tolerance for medical professionals in the increasingly costly healthcare arena.