Junior doctors launch class action claiming systemic underpayment by public hospitals (Australia)
abc.net.au/news/2021-03-16/junior-doctors-lau...Posted Mar 16, 2021, 8:14 AM UTC
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abc.net.au
Good.
Unpaid overtime is seems as one of the rites of passage for getting a speciality training position.
It’s downright exploitation by hospital administrators.
Very happy to see this finally being addressed.
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In competitive disciplines it can be absolutely barbarous. Unaccredited surg regs vying for finite training posts can work dozens of hours per week for free for however long it takes to get into their programme. And the theft doesn't necessarily stop once in training, either.
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There is a scandalous army of unaccredited orthopaedic registrars (mostly Indian specialists without Australian qualifications) doing a sizeable chunk of the public orthopaedic operating without ever getting a place on the training program. It is just awful.
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It really fucks those people over.
Not just because they're used like sweatshop labour, but because spending interminable years as unaccredited surg fodder closes doors to many other programmes. And not just because of the opportunity loss, but also because it's anathema to take a trainee who'd cost them so much more in wages by virtue of their PGY seniority.
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Reminds me of this unaccredited reg I worked with, a middle aged russian surgeon who was a great surgeon - the bosses knew and would call him to help out in complex cases but they would never ever ever let him get onto the training program. So he's still doing unaccredited registrar, on yearly contracts.
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The worst part is that a few of these programmes have introduced limits to the number of times you can apply (gen surg and neurosurg iirc). You can waste 8 years as an unaccredited and then become completely locked out of that pathway.
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It's not being addressed lol its being talked about. Nothing will change.
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Because in my discipline there isn’t overtime. Your day involves your cases and patient care. Takes as long as it takes (same in general and cardiac residency). While I think residents should make significantly more, it SHOULD NOT be hourly. The clock does not matter in the hospital except for changing who’s on call.
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You seem to be conflating operational/clinical requirements with remuneration.
Residents/doctors-in-training are wages employees, not (generously) salaried or fee-for-service consultants.
There is no reason why they shouldn't be paid for the hours they work, like literally everyone else in the hospital save for the aforementioned senior doctors (sometimes). Imagine the uproar if nurses or any other hospital professions were de facto rostered on for twice as many hours as they were paid for.
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I was a resident 6 months ago. I’m much more familiar with that setup. A chief GS resident is probably worth 250-400k for the hospital system (probably worth 4 FTEs). That being said residency is not a time based event. It’s about duty, service and education. That’s why a salary is appropriate. Overtime, not so much. You’d have inefficient residents getting paid to stay 2-3 hours after sign out to clean things up (or single ones with nothing else to do). It’s just not a good model
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You’d have inefficient residents getting paid to stay 2-3 hours after sign out to clean things up (or single ones with nothing else to do).
Yikes. I'm going to go ahead and assume you're an American (probably from a particularly reactionary state) because that argument sounds like it comes from the same school of thought as "universal healthcare will cause a tsunami of freeloading patients to bankrupt our highly efficient and effective health system [which is eschewed and outperformed by, and at least twice as expensive as, those in the rest of the civilised world]."
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Starter comment: This has been a known issue for decades, with the AMA wanting to take action for at least 10 years (I was involved with the industrial side of the organisation). They haven't been able to until now because junior doctors are terrified of adverse consequences for employment or access to training programs if they put their name forward as a plaintiff. Lots of doctors have been blacklisted for being 'difficult to work with' or for reporting sexual harassment, so this isn't an unreasonable fear and these doctors are very courageous IMO.
What I find interesting is considering how to have a fair system. Obviously there is a big problem of workloads being excessive and junior staff not being supported to claim overtime for work that is absolutely essential to do immediately. There is a strong peer expectation not to hand over 'routine' jobs to the evening or night cover, and the evening cover jobs are generally too busy to do those jobs properly anyway. (Covering 4-5 units as well as doing admissions).
However, some residents and interns do work less efficiently than they could, and some seem to constantly stay late without it really being necessary. They might feel more conscientous by being there, use the quieter hours to do non-urgent discharge summaries, or the very rare case may just stay late for the extra cash. The consultants are usually not around at 5 or 6pm, and the registrars are often not on the ward to supervise the finish time of the residents. Also the registrars aren't trained or supported in people management; they are there to learn how to be a consultant. So how do we get better, fairer, supervision of the junior staff so that they can get support if they are constantly working overtime but they also don't work late when not needed? Nurses have a NUM but the heads of surgical units seem to not even bother learning their intern's names, let alone take an interest in managing their ward work.
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Maybe consultants should take handover. Rather than juniors handing juniors jobs that still need doing. Consultants can be handed back the jobs they ordered that are outstanding since after all a. they're likely creating the workload b. they're responsible for these patients at the end of the day. c. they probably have more standing in the argument of lets get more staff.
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What do you think would happen to the resident that consistently give back the consultant unfinished jobs?
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I'm a junior Dr in Australia and I think the last paragraph of your comment really exemplifies the exact thinking that is driving this whole problem.
Residents and interns are learning - it's not their (my) job to be 100% efficient all the time and that's reflected in that fact our base salary is about 1/7 of what yours is. Do you want your intern to be fast or do you want him to be safe? Do you want to train somebody to cut corners or to be thorough?
Do you imagine any of us want to stay late to do non-urgent discharge summaries? We are forced to this because of hospital targets - my hospital requires 1) patients leave with a DCS and 2) discharges leave before 10 AM. Have you ever finished finished a medical round before 10 AM? Most of us juniors see the hospital so much we have tetris syndrome.
I'm at a brand new hospital with great dr:patient ratios, great allied health, heaps of SMO and Reg involvement with us and I'm still working so much overtime that I didn't even earn minimum wage last week.
Edit: Other totally unnecessary examples of unpaid OT would be SMOs rocking up at 4pm for a PM round, being stuck in clinic until 5pm and not being contactable to answer questions, and spending 30 minutes chatting about their cat to the reg while we're waiting.
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Do you imagine any of us want to stay late to do non-urgent discharge summaries? We are forced to this because of hospital targets - my hospital requires 1) patients leave with a DCS and 2) discharges leave before 10 AM.
So those are urgent DC summaries that would justify OT pay, I agree with you. It should be paid. In Vic at least OT is double time, and consistent OT would warrant additional staff for the unit.
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My follow up questions would then be 1) what are non-urgent discharge summaries / jobs? I agree it's never sick patient urgent but it's always urgent from an admin/beds/targets point of view? 2) does being non-urgent mean it's somehow okay not to do? I guess your idea is that we'd catch up on slow days but how often do those come by?
I guess it's all really a bit beside the point anyway, I would be paid too if I claimed, but I can't because I need the directors reference.
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Also in Australia. My hospital changed their system after advocacy by their RMO society, so that overtime claims no longer require approval my consultants, and are only seen by medical workforce. The hospital has also fostered a culture of people being encouraged to claim their overtime without any punishment - I have been told to not only by medical workforce and other junior doctors, but also consultants as then their department can be assessed as needing more staff. Medical workforce has even amended my claims at time to give me more overtime pay.
It doesn't fix the problem of people working horrible hours (haem at my hospital regularly finishes at 7-8pm), but at least we get paid!
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A new intern colleague worked 100 hours in a week but at least they got something like $6000 kangaroo bucks before tax
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This a a great, nuanced comment. We've all worked with that phenomenally inefficient resident/junior who leaves tons of jobs undone and the next person has to come clean up the mess. There is actually very very little supervision for ward work until something goes wrong, so most of the time a couple of juniors will be staying very late cleaning up the messes of the some other crap juniors who don't do their jobs and leave on time.
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American residents: you guys are getting paid???.gif
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Unions exist for a reason! ASMOF (the union that mostly goes hand-in-hand with the AMA) has been fighting for our rights for decades, and things have already improved just within the last 5 years.
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What have they done?
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I'm mostly familiar with their work in my home state, and these are just what come to mind:
Increased our base salaries for junior doctors, fought for quite significant improvements in overtime and reduced the amount that is unpaid (yes, I know the above article is about unpaid overtime, but the fact is it was peevishly much worse), got us a good amount of sick leave, instated the 10hr rule between shifts and the 48hr rule post night shifts etc.
If you look at the Enterprise Bargaining Agreements for junior doctors in Australia in a state where the AMA and ASMOF are joined, look at any clause that benefits the doctor beyond what is guaranteed by federal labour laws. ASMOF are to thank for that.
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It's much easier to claim overtime now. In the past you needed to be directly signed off by a consultant.
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Yup, about a third of my salary last year was rostered overtime. I made 150k USD as a PGY5
Shits good.
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Honestly though, that's how it should be. I'm a PA in the US that works with residents, and I feel pretty bad about how hard they work relative to their pay.
I think reform of both medical student loan debt and resident pay would go a long way towards alleviating much of the bitterness US residents have toward the system, and the associated burnout that stems from it.
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medical student loan debt
What?
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OKaaaaayyyy!
Yeeeaaahhh!!!!!
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BS. Next you're going to tell me you get more than 10 days off a year.
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6 weeks
I work 44 hours a week tbf so fairly long hours
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I love that we are so shell shocked by the residency training system in the US that it is shocking to learn that residents in many European countries and Aus/NZ get paid overtime. It is not universally that way…Europe has dozen countries and not all hospitals even within the “good” countries honor overtime hours (looking at you Germany), but the concept of overtime for hours past 40-50hrs/week in the vast majority US residencies is laughable.
Basically every country that pays its residents as much or more than we do pays overtime: Denmark, Norway, Sweden, Finland, Netherlands, Australia, New Zealand, Switzerland, Austria, Germany. Unsure about France and Belgium but I believe they do too. And we spend 45-120% more on healthcare per capita (PPP and nominal) than all of those countries, so it’s not like we can’t afford it but they can.
It’s not uncommon for residents in some of these countries to make $90k USD with 4-6 weeks of vacation and the option of months of family leave (reduced pay and extends residency, but still).
F in the chat for our Canadian homies though. They are suffering along with us.
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It's a separate system in Australia - trainees in an accredited college program have those privileges. For those struggling to get into a program it's not so easy. For every accredited registrar there are 4-5 unaccredited registrars.
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Depends on speciality and state. Rural WA will be more likely to pay overtime than RPA.
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What are you talking about, I’ve worked at 6 hospitals and RPA is the only one where I felt the approach to OT was close to reasonable (albeit not perfect). They are also one of the only hospitals in NSW that pays OT for (most) phone calls, as per the award.
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That’s your experience in whichever speciality you work in. That’s not every speciality. There’s a reason they lost their accreditation for cardiothoracics training and it wasn’t for having the kind of culture where people feel comfortable requesting overtime they’re owed. The ICU is equally as bad yet somehow has flown under the radar.
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What is the salary and overtime pay like for unaccredited registrars?
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Generally the same. The way they screw you is the rostering and the grunt work.
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Well at least high salary and overtime pay is much more than at least 95% of medical residents in the world get.
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It’s paid based off your PGY (with some exceptions), so the rate of pay is the same unaccredited vs on program, although the hours worked or duties are usually different and hence different compensation.
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I'm once again wondering why there are so few Dutch folks here (am in NRW). Higher base salary (around €56k-60k nowadays), lower cost of living and paid overtime in roughly 70% of hospitals (adding easily €7k-20k) with very similar weekly hours. No ANIOS, no waiting times, no need for a PhD for anything, recognition of completed residencies under the EU directive 2005/36/EC. Six weeks vacation minimum for all, much longer paid parental leave (12-14 months vs. what seems to be 16 weeks).
I mean, I get the unwillingness to stay long-term. Or is there is a career bias against finished residencies in other EU countries?
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The Netherlands is definitely on the bad end of the spectrum in terms of getting a residency due to competitiveness, but 40-50 hours for IM and 50-60 for surgery is unheard of in the US and most of the world. You also have the option of doing residency at 0.8 FTE in NL which is absolutely laughable here too. I understand you all have absolutely insane competition to get a residency spot, but once you get a spot, it really is rosy compared to 98-99% of the other medical residents in the world.
The working conditions in the Netherlands are better than all but what, 5 countries? Maybe 7? and those countries make up less than 1% of the world’s population if you consider conditions in Netherlands > Germany. 2% if Germany is better.
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Yeah that’s very fair. And I should say that we as Americans are lucky too. We don’t have it as good as North Western and central Europe, but we have it better than the vast majority of the world. Especially because we have such high pay after residency and excellent training during residency.
Also those housing prices….wtf. So like €750k for a 1500 sq ft house? (140 m^2 )
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Oh and because like as already mentioned, the worst case for a Dutch medical graduate is driving 30 minutes to Germany, learning a very similar language, and completing training that is 100% recognized in their country with similar working conditions.
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Overtime pay? What blessed plane is this? In Canada there’s resident unions, and they’re barely better at securing any extra money or rights than occur in the US.
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MARDocs (The Union for residents in Nova Scotia, New Brunswick and PEI) is great! We went to arbitration during our last contract negotiation and won on all of our demands. We're also the highest paid residents in Canada (as of 2019, could have changed).
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I am curious to know. Are there any unions for medical students and doctors in Australia or UK?
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The BMA (British medical association) are the standard one in the UK. Problem is, they’re about as useful as a chocolate teapot.
There are other options like HCSA (hospital doctors union) but honestly given the monopoly the government has on medical jobs in this country (almost entirely NHS) nothing ever really changes.
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A chocolate teapot sounds like a delicious molten mess.
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The AMA is the only union that represents medical practitioners in Australia. Medical students get an associate membership.
(Technically it's the "Australian Salaried Medical Officer's Federation" but it's part and parcel of the AMA)
Although it is a trade union they are heavily focussed on professional advocacy and public health messaging as well. The media will often interview the AMA president on the medical issue of the day.
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ASMOF and the AMA don't always go hand-in-hand. In NSW they split a while back, and it's very much reflected in the strength (or lack thereof) of their junior salaries and Enterprise Bargaining Agreement compared to other states where AMA membership automatically grants ASMOF membership. The strength of a union lies in its numbers, and in NSW that strength is sorely lacking.
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They split in the last year or two. Salaries in NSW have been a joke long before that. Fuck Gladys
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Don't forget that we were in the same union as the hospital cleaners before asmof.
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Oh huh, didn't realise it was that recent. Yeah fuck that, I'm glad I'm not in NSW!
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I am not sure what stage of your training you are at, but NSW generally pays there registrars better than other states. When I was going into internship I was frustrated that interns in other states were earning up to $20,000 a year more than us. I went to work creating a graph to demonstrate the salary discrepancy, but soon realised that NSW catches up to and in fact overtakes many states by PGY-4 and beyond.
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Sad to see this happens in other parts of the world. Residents in US get wrecked by low pay. Hospitals benefit from the cheap labor. Smh.
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Unfortunately a lot of junior doctors only know the part of the problem. It only gets worse in the later stages of training... as a fellow in sub specialty training, they know I am in a position where I can not complain, as they are the gate keepers of my sub specialist interest... I get paid 9 hours of pay for approximately 30 hours of clinical workload per week... total. This is not hyperbole
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Here I was wondering if someone felt the same way, and I guess is a worldwide phenomenon. This whole "it's for the patients" speech gets me tilted.
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"This is now my eighth year of being a junior doctor and I've worked at several health services in Victoria, and I can tell you this is happening everywhere," she said."
This is so true. In Australia as long as you're not in an accredited training program you are treated like trash. Yearly contracts, constantly having to suck up to the bosses to get references for application to training programs only for the bosses to screw you over cuz why pay more for an accredited registrar when you have a non-accredited registrar who's just as good and much cheaper and not protected by college guidelines?
That's why you get junior doctors in their 8th year, struggling to get onto a competitive training spot.
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In NSW at least registrars are paid by their PGY. Being on the training program or not does not change your salary. I'm not necessarily disagreeing that some bosses could give poor references for unfair reasons (like retaining you), but clearly some people are getting on so it isn't reflective of the overall culture.
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Yes, some people of course are getting on. But we all know who gets on the programmes and who doesn't. 🤷♂️🤷♂️🤷♂️
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The point is, residency is by no means a “high end salary position”.
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Oh yeah, for sure. "I worked 100 hr weeks when I was your age, for half of what you earn." The consultant says.
But their salary back then could buy them a house and support their family, and to get into a training spot all they had to literally do was to put their name down on a piece of paper or just raise their hand. It's a little bit different now.
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Yes, but lawyers and investment bankers and business consultants get paid A LOT more than junior doctors.
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Nope. Wrong. Base pay for a 'big 3' consultant is around 6 figures, quickly rising although notoriously up or out. They do get worked hard though. Banking is similar.
Source: was one of those consultants in a prior life
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Nah man, interns in NSW are on about 65-80k including OT. My friends of the same age were finished uni earlier and starting on 90-120k in finance type jobs.
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Myself and most of my friends made 90 - 120k working in NSW as interns. The base salary is 70k, you make atleast another 10k purely in rostered overtime and unsociable hours, and the rest is unrostered overtime. We have it pretty good. I make more than my friends working graduate jobs in law in finance who honestly work more hours (although they aren't necessarily in the most competitive firms).
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Australian PGY5 locum here. This article really highlights one of the (in my opinion) biggest problems with the provocational junior doctor work - lack of (strong) advocacy for our rights.
We shouldn’t have to go to lawyers for a class action lawsuit, just to be paid what we’re owed. We shouldn’t have to keep silent when bullied by senior staff. We shouldn’t have to be made to feel that we could be ‘black listed’ if we speak up about our concerns.
My experience has led me to the realisation of just how little power I have on the healthcare system that I’m a part of. I’m seen as an expendable cog in a very large machine, and I’d be replaced with many such ‘cogs’ if I was to vacate the role I work in as a ‘junior’. That’s what led me to locum - the job is the same, the lack of appreciation and in some cases, disrespect is the same - but the pay is much greater. And despite the lack of career progression, it’s a fair trade. There are so many doctors on the ‘locum trail’ who are doing it because they’ve had enough.
The AMA in my opinion, despite all they do (such as negotiating the medical officer award) and also ASMOF, fall miserably short in holding hospitals to account for junior doctor welfare. In my opinion, they really are there to maintain the status quo, and are filled with those who are after their own resume buffing agenda to further their medical career.
The current prevocational medical training system in Australia is becoming a powder keg, worsened by the increasing number of medical graduates (just visit the MDANZ website for some numbers), the colleges’ refusal to increase specialist training numbers (because why would they?), and the governments’ unwillingness to act, both at state and federal level.
EDIT: Spelling
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This seems to be something that happens in many parts is Aus but as a counterpoint, I never had troubke getting overtime paid. My first job in North NSW the consultants used to walk me to the overtime log whenever I stayed late and make me put in claims, as coming from the UK I wasn't in the habit of doing so. So I carried on doing that in the other hospitals I worked ( SE QLD) and never really had any issues. From what I hear this is a problem in the cities, less so in regional areas, at least in Queensland
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A few years ago I used to work in postgraduate medical education supporting PGY1 and 2 doctors and we would drill into them they had to accurately record their hours for occupational health and safety reasons (eg they’ve recorded that they’ve finished at 5pm but at 7pm they are still there and do something that results in an adverse event for a patient or they fall down the stairs and we then have a falsified timesheet which is an official record to add to the mess). Sure sometimes seriously inflated hours would be questioned but it was also really important intel so we could see if a particular unit needed an extra intern rostered or other efficiencies/changes.
Inaccurate recording of hours opens a whole dangerous can of worms so I’d hope that at least these junior doctors aren’t being made to falsify their recording of hours. But on the whole I witnessed a range of disturbingly archaic views about what junior doctor training should be like and many relics of the ‘we did it tough so you should too’ ethos.
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yes, it's hospital dependent. I never had any trouble, but my friends in other hospitals in the same city "weren't allowed to work overtime" which really just meant they weren't allowed to claim it.
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Every graduated attending physician knows it's the right thing to do to pay Residents/Junior doctors more for the amount of work they do.
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As a dissenting opinion, I have never had any issues in claiming overtime - it has always been encouraged, it has always been approved, it has never been flagged as an issue. I do not have a single friend who reports difficulty in successfully claiming overtime.
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It depends on your department head (or whoever is approving your overtime). I personally have no issue claiming OT, but my friend in orthopaedics got all of his OT rejected, and he did like double the OT I did (this is a NSW hospital).
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"This is now my eighth year of being a junior doctor" ??????
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This is extremely familiar for doctors in the UK. Everyone recognises the need to stay late, but there's pressure not to report additional hours or seek payment for extra hours worked (colleagues have been told that it's 'unprofessional'). Nominally there is a system in place for it via Exception Reporting, but because reports have to be signed off by your supervisor, you risk upsetting the consultants that allow you into theatre/clinic, which can severely impede your training.
“You should be in medicine to help people, it’s not about the money” is the most infuriating statement I’ve heard from seniors when people exception reported staying late to try and get paid for it.
(I want to clarify, if a patient is acutely unwell and no one else is there to deal with it, I am more than happy to stay late to deal with it. I don’t exception report this usually, it’s a relative rarity. Staying late to finish routine ward jobs is where the issue lies)
I've always wanted to ask in reply to that "oh ok, so the hospital operates for free to help patients?"
But I don't.
I’d just love to ask “so you’re happy for me to call you personally to query things when you’re not on shift? It’s about the patients, not the money after all”
Just flip it on them - it’s not about the money for them? Then they should have no issue handing over what’s owed.
Bingo
As a nurse, I really don’t get this mindset. I am happy (well, I’m not happy about it, but I’m more than willing to do it) to stay late when shit has hit the fan with a patient, there’s a new, sick admission to be settled in, whatever.
But I sure as hell don’t clock out until I’m actually leaving. Considering the huge charting burden when something like this happens-which is the one thing I really can’t pass off, I can get home very late. But the hospital needs to pay me for that time. I am paid based on hours worked, and if that’s how your pay is arranged (I know in the US, that’s usually NOT how docs are paid, so it isn’t so simple there), it is a labor violation to not claim those hours. Good on these docs for standing up to get paid what their owed.
Doctors are paid based on the hours our rota states. Whilst we can exception report in the NHS to try and get back pay for staying late it’s a really long slow progress and I’ve never had any success. You also have to meet with your supervisor who has to sign off on the overtime which makes it harder.
It would be a far simpler system if we clocked in when we arrived at work and clocked out when we left 👎🏼
Aren't nurse's hourly and doctors salaried?
That care is being paid for; it is not unreasonable or immoral to expect to be paid for your part in that!
I'd request overtime pay for that situation as well, no two ways about it. There's a reason our work hours are what they are - someone did the math and thought the amount of time I'm paid at work is about the same amount of time it takes to complete my tasks. By reporting a situation like that as overtime, you tell those people that they need to redo their maths with regards to a) increasing your work day, 2) staffing more people in each shift or 3) increasing the overlap between different shifts to assure secure handovers of acutely ill patients.
If you’re good at something never do it for free.
-Joker
Of course “free” in this context is relative.
European Working Time Directive (I know it doesn't apply to you anymore but you seem to have no new contradicting laws?), more like European Working Time Suggestion.
I have a former classmate who was in my oral state exam group. She took an IM residency position at a non-profit, church-affiliated hospital in the city we studied at. Has a locally prestigious hem/onc department. Everybody who applies there knows they don't pay any overtime compensation at all, although this is completely illegal. She gets paid 40 hrs/week of base hours and any hours she adds outside of on-call gets not written up. She works mid-50ish hrs/week.
She loses up to €20,700/year (pre-taxes) on this. There are hospitals/departments within 20 min of car commute which pay every second of overtime but apparently she is happy..
If you do write them up and submit them within the first six months, you will be fired. They don't even need to provide a reason. Afterwards, they will fight tooth and nail to not pay a cent and then don't offer you a contract renewal after two years. Both are not the end of the world in our modular system which makes it easy to reapply but this shouldn't exist at all.
People in medicine are aware they are not signing up for a 9-5 job at all times. This doesn't excuse systems from either paying out overtime the same way in most other industries or compensate the hours.
Yeah, especially big hospitals and university hospitals still have a mindset of "be happy youre here". Many consultants still talk about "I had to write 50 applications and worked 80h a week, be glad you have a job here".
Nevermind that there is literally a doctors shortage nowadays and unless youre dead set on a certain hospital or city you can easily find a new job within weeks if not days.
Ive literally just written an email because for the last 6 months there have been 0 times my pay sheet showed any overtime compensation. Despite me dutifully documenting overtime and it showing on my time stamps. Not to mention the fact our pay and time sheets seem to be made incredibly confusing on purpose. I know nearly no-one who understands them and many people dont even check.
A colleague of my girlfriend had a whole year of overtime marked as "taken as free time" when in fact she didnt take a single day. Got a few hundred euros from that.
6 months waiting time is not automatically a catastrophe, I've seen departments which wait a long time to see how many of overtime hours get compensated by additional days off but in the end pay out just fine. But yeah, still sucks.
Supposedly the overtime itself is payed out after 3 months (if not taken as free day) but overtime bonus should arrive with the next pay slip. Which hasnt happened so far for me.
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