Opinion

More trainee doctors removed from hospitals over concerns for their welfare


Evelyn Lewin


26/06/2019 3:01:51 PM

Dr Evelyn Lewin applauds medical colleges for taking a stand against toxic work environments for junior doctors.

Stressed young doctor
This week saw a further two trainees temporarily removed from a NSW hospital by their medical college.

Gruelling hours, understaffing, stress, bullying, harassment.
 
Sadly, these are not new issues junior doctors face in hospitals. Far from it, in fact.
 
However, it seems like the tide is slowly turning, as several medical colleges have taken a stand and pulled trainees out of undesirable working conditions.
 
That is what happened this week, when two junior doctors were removed from a NSW hospital by a peak medical college.
 
This is the fourth recent example of such an occurrence in the last nine months.
 
This time, it was the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) that temporarily withdrew two trainees from Tamworth Hospital over concerns of unsafe shift work, overtime and on-call hours.
 
This follows from the news last week that Sydney’s St George’s Hospital has had its intensive care unit barred from training junior doctors by the College of Intensive Care Medicine (CICM), amid allegations of bullying and dysfunction among senior doctors.
 
CICM President Dr Raymond Raper said that ‘taking [away] accreditation is the last resort’.
 
‘It’s a terrible situation for St George … we feel terribly for them. [But] we have to look at the welfare of our trainees and our Fellows,’ Dr Raper said.
 
In October last year, CICM also took away Westmead Hospital’s ICU training accreditation in response to reports of bullying and harassment.
 
Meanwhile, in November, the Royal Australian College of Surgeons banned Sydney’s Royal Prince Alfred Hospital's cardiothoracic surgery department from training its registrars in 2019 over similar allegations.
 
While it’s upsetting to hear of issues such as bullying, harassment and unsafe shift work occurring at hospitals, it’s refreshing to see medical colleges intercepting to improve the lives of its training doctors.
 
And so they should.
 
After all, students choose to study medicine for a variety of reasons, but a common goal is almost always to help people.
 
Doctors are usually caring people who believe they have entered a caring profession. And yet, the way our profession sometimes treats junior doctors is hard to believe.
 
For so many years, appalling treatment of junior doctors has been almost a ‘given’.
 
If junior doctors complained – about long hours, stress, being overworked, bullying, and so on – they were often dismissed, belittled even, as more senior doctors said conditions used to be ‘so much worse’ for them.
 
When you think about it, it seems inconceivable that we expect junior doctors to withstand such conditions, and still expect them to do their job properly.
 
Many can’t.
 
That is potentially why research from Beyond Blue found that, compared to older doctors (51–60 years), younger doctors reported higher rates of burnout.
 
It’s possibly also why doctors abandon the medical profession altogether.
 
I personally know of so many who have walked away from careers in medicine. While their reasons are varied, I wonder if that would still be the case if the medical work environment was more supportive.
 
As doctors, we are taught to care for our patients, but we also need to care for ourselves – and for young doctors in training.
 
Earlier this year, Dr Yumiko Kadota made headlines when the young registrar resigned from a hospital’s plastic and reconstructive surgery department due to being overworked within a toxic culture.
 
Perhaps one of the saddest – and most alarming – aspects of a story that made headlines throughout the country was the fact no senior doctors came to Dr Kadota’s defence during her struggles, which included working 24 consecutive days.
 
So she did the only thing she felt she could in such a distressing situation – she resigned.
 
I applaud her for coming forward and sharing her story.
 
I also applaud senior medical staff, like Dr Raper, who will not tolerate work environments that impede on the welfare of junior doctors.
 
Banning hospitals from having trainees, or temporarily removing such doctors from those environments, will not stop all of the issues that plague junior medical staff.
 
So much needs to be done to get to the root of bullying and harassment, to secure better working hours and curb overtime, to better support junior doctors.
 
But at least removing trainee doctors from toxic work environments is a step in the right direction.



bullying culture harassment trainee doctors



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Dr Syed Ali   27/06/2019 7:17:11 AM

Great start, but a lot needs to be done, this is just the tip of the iceberg. I, don’t know whether there are easy answers to this question, it simply means more decks on hand- More funding, more trainees, more specialist with in the hospital (24/7) cover especially in Acute care areas- Emergency, ICU, Anaesthetics.


Elysia Thornton-Benko   27/06/2019 7:27:48 AM

Glad to see that the colleges are taking a stand and sending a clear message that this kind of treatment of doctors in training is unacceptable. Wish I had such support during 2 years of toxic misery in a training program in a major teaching Sydney hospital in 2005-2007. Having said that- a move to primary care was the best decision for me personally and professionally, and overall to date, the world of GP has been a very positive experience.


Anon   27/06/2019 8:04:41 AM

Surely the best way to deal with the problem is to address the cause - the source of the bullying is not the students.


Dr Farid Zaer   27/06/2019 8:44:47 AM

By these actions we will play into the hands of administrators and government officials who will legislate on how doctors should behave, practice and go about their daily lives in hospitals run by them.Children need correction , and that is how administrators will look upon us and dish out punitive actions, and directions of conduct in hospitals. We are not far off from becoming puppets. Training future generations must be on the top of every training program for obvious reasons-because we get old, we die.


Dr Jay Janitha Mudiyanse   27/06/2019 9:19:13 AM

I am was a victim of bullying as well, leading to resignation from my Emergency registrar job. Very keen to be involved in anything that can be done to stop this.


Dr Michael Chalwe   27/06/2019 9:38:22 AM

What happens to the seniors who bully these Doctors.Can they be reported to AHPRA.I think they should


Dr Julian Fidge   27/06/2019 12:15:44 PM

We know that over-working inexperienced doctors is dangerous for patients, so how do the hospitals get away with doing this? Why isn't it treated as endangering patients and AHPRA notified that senior doctors are dangerous and are endangering their patients?
Dr Julian Fidge


Dr Ian Light   27/06/2019 12:17:46 PM

There is huge pressure for everyone in critical care and fear of making mistakes makes perfectionists very ugly and they take it out on all around .
They will project self - hatred on others below them in the pecking order
.Also egomaniacs some with serious clinical ability but also bullies will get to high
places .
Bullies ought be removed and closely watched for medical error
But you have to have as clinically astute replacements and that is the problem .
In the end even these psychopaths will have to tone down for the Critical Care Unit will make mistakes .
Full honour to the Colleges for their forthright decisions .


Dr.Shanika Fernando   27/06/2019 1:21:30 PM

At last.... a welcome change!
This is something junior doctors face on a regular basis. Most of these doctors keep quiet and bear up due to fear of further bullying and harassment.
Their voices should be heard.
It’s time to bring in legislation against such institutions as well as individuals.


Francois Jacobs   27/06/2019 3:51:04 PM

This condition seems to be endemic in the medical world. If trainee doctors have a strong enough case, there should be regulation from central government and medical councils to regulate their working hours.
Unfortunately, medicine has never been an 8-5 workday, so any extra work not being done by trainee doctors, should then become the responsibility of senior doctors, including consultants and professors. Not sure how this will pan out, but at least, the work load will then be shared equally.
It may also mean that the ability to gain experience may be jeopardised, but this is debatable.
Those units that were closed, or where the trainees were withdraw, are they now not available for training? What is their long term status?
I do agree however, that bullies should be removed, or even deregistered if it is proven beyond doubt.
So, the ball is now in the court of the colleges to come up with a practical solution.


Feeling disgusted   27/06/2019 10:11:57 PM

This issues does not only stay in the hospital grounds, it has spread into the GP realms as well.
Training GPs were told by the clinic manager that they don't have sick leaves, if they do take a day off, it will come out from their personal leave, clinic providing poor consultation rooms e.g. refusal to fix a flickering light nor changed a worn out chair (causing that GP backache), not fixing the air con for many months (causing poor circulation)! Poor room hygiene. A GP was even refused parental leave and given a choice to resign instead. When he chose to resign, he had to leave the town due to a restraining clause in the contract!

Imagine being the sole bread winner of the family, caring for the patients yet not being provided a healthy environment to work in and "forced" to resign.

Trainee doctors has been victimised over and over and suffering in silence.


Dr bill mcneil oam   27/06/2019 10:16:03 PM

Dr suess summed it up in “ yurtle the turtle “ . As much as we can whimper and moan about the system. I watched with disgust junior colleagues willing to do anything— including sexual impropriety to climb to the top of the stinking millionaires pile. I always finished on time and would bill for even 5 minutes of overtime. No admin or boss ever complained! I had no agenda and nothing to lose. My only ambition was to serve the country in the field of medicine throughout my career that my work might be worthy of recognition by the Order of Australia like so many of my professors . Ticked that box by 30 years old so happy to chill. Blame the training but blame the trainees for their ruthless ambition and unwillingness to say no en masse. They all want to be king of all they can see in the land of salamasond.


Anonymous   27/06/2019 11:45:12 PM

These doctors are too thinned skinned . It’s part of the rigorous training to becoming a specialist . It’s even worse for n the U.S.

Get over it


Dr Melanie Smith   28/06/2019 3:16:51 AM

It is so sad that this seems to be endemic in medical culture. Hopefully the actions taken by these colleges are sign that something is starting to change. But this is also not isolated to hospital training environments.... significant stress, poor workplace and employment conditions affect General Practice trainees in community placements too. It will be great to see RACGP recognise that this is not just a "hospital problem" and there is in fact a whole lot of increased danger for GP trainees who are often employed and supervised by the same person, under individually negotiated contracts and are not protected by an employment Award. They often work in far more isolation than hospital based trainees with far less access to peer support. Time to step up and change the culture everywhere. Stop leaving our future GPs unprotected and ignored.


simran khosa   28/06/2019 12:48:24 PM

It's good to see that something is being said & done on this issue. SO many training doctors suffer as a consequence bullying, overwork, stress and toxic work environments. It's rarely ever spoken about and as a consequence very little support is available. We really need to do everything we can to highlight this problem and help in creating learning environments that build confidence and skill.


Dr Brendan John McPhillips   28/06/2019 5:46:52 PM

Yes, Bill McNeil, well done for climbing the ladder ethically, but badly done for blaming those in powerless positions for aping their superiors - what else were they to do - and perpetuating a system that abuses and denigrates. And I'll bet most of those clawing their way up were men. Did you ever pay attention to the women, or are they also to blame for complying with the Weinstein's they worked for.
One thing is clear - the way 'helping' professions treat their own is, more often than not, abusive. That is, perpetuating the very ills they are meant to be healing. Blaming the victims, Bill, is not the way to go. Ever!


Dr Mark   29/06/2019 12:09:15 AM

Have you noticed it's always the public hospitals? It's always the older more senior "staff specialists" paid for by the taxpayer. These people do not generate an income, or have to hold onto patients. As far as I'm concerned, if you are paid a "salary" then you are not a real doctor. Go out there and try and run a business and attract patients and see how much of a bully you are then.


Dr Michael Lucas Bailey   29/06/2019 9:45:38 AM

Isn’t this just punishing the registrars, do they get to continue their training in another accredited position? How does this work if there already aren’t enough accredited positions. Isn’t this also playing unto to the hands of the hospital and buying supervisors who will likely replace the accredited registrars with non-accredited ones who are even more likely to be abused and also have less supports. Doing something is good, but is this the right thing?


Anonymous   29/06/2019 10:37:35 AM

GP registrars seeing the similar trend.
Tea breaks , lunch breaks ( unpaid time) for fit in patients, paperwork.
Senior GP's don't need to be involved as they are busy seeing patients.
Admin people are there to remind GP registrars that it is registrars job to manage time. At the job interview they mentioned that they want team player.


Ed   5/07/2019 1:06:42 AM

Very few understand the pathomechanics of the root problem. 1. Trainees victimised themselves in a sick profession as they know what they're getting into, 2. Hospitals administrators, practices owners, managers want cheap Labour as they don't want to pay specialists, 3. Specialists are lazy and used to generational bullying system. 4. Specialists don't want competition, so to protect their income, so no "official training posts are available" until they have used, abused and humiliate the trainees so they fresh blood to burn out.5. In complicity with specialists, the hospital administrators force trainees to continue to be used with the hope and false promise t o be "given an official or so called, accredited training posts" and if you're from overseas, after finally getting into a training program, they will fail you on the exams until you're tamed or you have put your head down. Another entirely intense topic is the usage of junior doctors in the bush that can't cope in the waiting g


Anonymous   8/07/2019 9:38:22 AM

I wonder how Canberra Hospital ICU is still accredited for training. One of my friends was narrating her experience working as pharmacist there. The kind of bullying is beyond imagination. On a teaching session one morning in 2016 with 40 people in the room a consultant snapped at a trainee’s question and apparently said “my shoes are new otherwise I would have booted you out”. It was appalling to hear that. In this day and age who says such a thing to anyone in public. It’s a shame that such people are still working in the healthcare system without being punished. After this incident 3 trainees left the job and moved out quoting various reasons. Having come from healthcare background, I wish someone reports such bullies. Most people choose to move on and not worry about the system. I culture of its not happened to me why should I worry is truly worrisome.


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