Claims underpayment of junior doctors ‘pervasive’ in hospitals

‘It is good to see this gaining some mainstream media traction as it is certainly not a new issue, nor is it isolated to Victoria or specific hospitals.’
 
Dr Sean Black-Tiong, Chair of the RACGP National Faculty for GPs in Training, is referring to a series of new class actions being taken against Victorian hospitals by junior doctors.
 
While the class actions relate specifically to junior doctors in hospitals, he believes it also raises a number of other issues endemic within Australia’s healthcare system, from tertiary hospitals to community general practice.
 
‘It highlights the inefficiencies of the hospital system,’ he said.
 
‘It is already not as efficient as investment in primary care and that is with [alleged] questionable practices … [such as] wage-theft, which contribute to worse outcomes for mental health, wellbeing and burnout.’
 
The class actions are based on claims of ‘systemic underpayment’, with registrars calling for recognition of overtime and the attributed stress that they say has impacted their mental health and potentially patient safety.
 
Dr Black-Tiong supports the class action but says pay is not the heart of the issue, drawing examples from his own experience as a hospital registrar.
 
‘I have always been a strong advocate for appropriate pay for hours worked, [but] this issue is certainly much more complex than the oversimplification of “more money for doctors”,’ he said.
 
‘Firstly, the idea of a blanket refusal of overtime in most units doesn’t make sense. Unfortunately, the nature of a lot of work for junior doctors is that if you just clocked off when your rostered hours end, then at times this can compromise patient care.
 
‘If you’re in the middle of an emergency call on one of your ward patients you can’t exactly stop what you’re doing and head home without initiating treatment and giving an appropriate clinical handover.’
 
Although he says these specific situations ‘statistically shouldn’t arise every shift’, evidence points to considerable levels of stress and uncertainty among junior doctors.
 
Recent research found that a quarter of all junior doctors work ‘unsafe hours’, doubling their risk of developing mental health issues and suicide risk.
 
The Australian Medical Association Victoria’s Hospital Health Check 2019 Survey results showed that more than 50% of registrars reported their working hours ‘often or always’ prevented activities important for their mental and physical health, and 60% had made a clinical error due to excessive workload.
 
Likewise, 31% were advised by their medical workforce unit not to claim the un-rostered overtime they had worked – which was an average of 16 hours per week – while more than 30% reported raising ‘serious concerns’ about workload with their supervisor, which were brushed off or ignored.


 Dr Sean Black-Tiong says the class actions highlight the inefficiencies of the hospital system.

‘So the question must also be asked as to why overtime is arising more frequently than the times that can be attributed to specific events? Which I believe is more the point of the class action,’ Dr Black-Tiong said.
 
‘Potentially, it relates to inadequate support and staffing for the workload or number of patients on the unit. The assumption should not be that the doctor requesting overtime is “slow” or “incompetent”.
 
‘Often it is simply that they are the first one to speak out against the practice of unclaimed overtime, which has been ongoing for years with the powers that be turning a blind eye to remain blissfully ignorant.’
 
Recently, many registrars have come forward with their experiences of burnout and mental health during their training, with workplace measures put in place and research conducted to identify and address the issues with the aim of providing a safer, supportive and transparent training environment.
 
In a similar way to recent high profile examples of people coming forward to speak about their experiences of sexual assault, registrars disclosing their personal struggles with burnout and mental health is helping to create advocacy, according to Dr Black-Tiong.
 
‘I wouldn’t be surprised if there are more doctors coming forward across the country,’ he said.
 
‘My own experience and from speaking with other junior doctors throughout my career is that while not every hospital department engages in this sort of practice, most people know of which rotations to avoid because they are notorious for not paying overtime.
 
‘It is a practice that is pervasive throughout the hospital system.’
 
As part of his role in supporting registrars, Dr Black-Tiong said that more needs to be done in this space.
 
‘If there is an issue with gaps in training and skills, then this needs to be actively managed with additional support and structured remediation to bring trainees up to standards, rather than bullying and belittling them into working unsafe and unpaid hours,’ he said.
 
‘We must [also] ask, why are issues like this unable to be rectified by the hospitals without the need for junior doctors to seek other avenues such as a class action?
 
‘Historically, the goodwill and inherent desire to help people by doctors has often been leveraged against them in industrial relations and government funding issues, both in the hospital and in the community.
 
‘Sadly, the end-cost becomes that of personal wellbeing and loss of job satisfaction or burnout. Ultimately this results in poor outcomes for patients.’
 
The RACGP National Faculty for GPs in Training, which has registrar members completing their hospital terms prior to commencing community placement, provides ongoing support.
 
‘All GPs in training on hospital terms have access to RACGP resources available to all registrar members,’ Dr Black-Tiong said.
 
‘This includes joining the faculty and closed Facebook group, which provides a place for members to discuss with their peers across the country. The faculty also provides free webinars which, most recently, have specifically looked at mental health and wellbeing support around exams.’
 
The RACGP also has a suite of resources dedicated to GP wellbeing.
 
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