Junior doctors have taken to the picket lines once again in their ongoing row with the government over a new contract.
The fourth walkout comes as ITV News reveals that the number of medics applying to work abroad has jumped dramatically.
And with both sides so far refusing to get back round the negotiating table, the dispute is no closer to being resolved.
Here's what we know.
When does the strike start?
The 48-hour strike got underway at 8am on Wednesday.
Have patients been disrupted?
While junior doctors will provide emergency care cover, more than 5,100 operations and procedures have been cancelled.
Overall almost 25,000 procedures have been cancelled as a result of the long-running dispute.
What is the dispute about?
Junior doctors are protesting against a new contract which the government says will create a truly seven-day service.
They are currently paid more for working unsocial hours at night or at the weekend. But under the proposed new contracts, the Saturday day shift will be paid at a normal rate in return for a rise in basic pay.
Dr Johann Malawana, chairman of the BMA's junior doctor committee, said the government "risks alienating a generation of doctors" as he defended the industrial action.
Dr Anne Rainsberry, national incident director for NHS England, said the strike was "deeply regrettable".
What has the government said?
It has condemned the strike as "irresponsible".
Are there more strikes ahead?
Yes - and the next round of strikes could have a far more major impact.
On April 26 and 27, junior doctors will completely withdraw their services - meaning no emergency care will be provided.
Do you support the strike?