The British Medical Association — the main trade union and professional body for doctors in the UK — is eliminating 200 jobs. According to the Guardian, the reason is a financial crisis that has been building for nearly two decades.

Here is the puzzle: the BMA now has more members than ever — 200,000 doctors — yet it loses millions of pounds every year. How can that happen? The answer is that the organisation spends far more than it brings in from membership fees and services. To stay open, it has needed money from another organisation it owns: the British Medical Journal, a respected medical publication. Since 2008, that journal has given the BMA approximately £86.8 million — an average of £5.1 million per year.

The job cuts affect the people who help doctors with workplace problems. Industrial relations officers (IROs) work in NHS hospitals and clinics, helping doctors with pay disputes, grievances, and contract issues. The BMA is cutting these roles from 23.5 to 14 staff. Three of seven regional managers are also losing their jobs. Between 14 and 20 people in the science and ethics teams face redundancy. Cutting IROs by roughly 40% means the union will struggle to help members with local workplace disputes — the whole reason trade unions exist.

The BMA's own employees are upset. The GMB union, which represents them, filed a formal complaint that the BMA broke its own HR rules and tried to stop staff from talking publicly about the cuts. Employees voted to say they have no confidence in the chief executive, Rachel Podolak: 91% voted yes. Chairs of 110 local negotiating committees sent a letter directly to Podolak saying the cuts are wrong. The BMA's own committee of hospital doctors also voted against the job losses.

There is also a trust problem. The BMA told the Guardian that "as few as 20" jobs would go. But the organisation formally notified 200 people that their jobs were at risk. The BMA has said nothing publicly to its members about the restructuring or why it is happening. Meanwhile, its main news pages celebrated a deal with resident doctors (junior doctors in training) on June 29, which ended strikes and boosted their pay.

The timing matters. The resident doctors' vote ended just days before the jobs crisis became public. The BMA had spent enormous time and resources on that dispute — 15 rounds of strikes before a deal. The internal job cuts were already happening while that fight went on, suggesting the money problems were serious all along.

What this shows is an organisation spending more than it has, propped up by a medical journal that cannot keep doing that forever. Cutting the people who represent doctors in their workplaces while saying nothing to members about why is a big contradiction. That is why staff are angry and have lost faith in leadership.

The BMA has not yet explained what it will do to fix its money problems for the long term. Will it keep getting money from the British Medical Journal? Will it cut services in other ways? Will it charge members more? None of these questions have been answered publicly. For a union that spent the last two years demanding that NHS employers be transparent about their plans, the BMA's silence about its own future is striking.