Welcome to the AMA Victoria 'doctors4hospitals' blog.
This is your opportunity to have your voice heard about the Victorian public health system and help influence the new EBA for all Victorian public hospital doctors.
We would like to hear your opinions and stories about your time working in Victoria's public hospitals.
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«Oldest ‹Older 1 – 200 of 228 Newer› Newest»As a junior doctor working in a major tertiary hospital and in the middle of my specialty training I am in a good position to reflect on how the health system has declined over the last few years.
I have watched the pressure of work rise, trying to do the best we can with diminishing resources and ageing equipment. Yet hospital administration -preoccupied with keeping the budget- have turned a blind eye to the problems.
Here are some of the things that concern me:
-Patients needing emergency (not immediately life threatening) surgery having to often wait up to 2-3 days for their surgery because the hospitals try to keep elective surgery going at all costs in order to keep the waiting lists down so the government can use the figures to promote themselves when the next election comes around.
How do you explain to a patient that they will have to wait 1-2 days for their appendicectomy because someone is having a bunion removed and the hospital is forced to give priority to the elective case in order to meet its performance indicators with the government?
-'Use and abuse' attitude of hospitals towards the junior doctors. Many hours of weekly overtime not paid, allowances refused and constant breaches of pay entitlements not to mention almost the lowest starting doctors' salaries in the country .
Many junior doctors are too afraid to speak out in fear of damaging their careers. Most are disillusioned, often deciding to change careers or take an extended break to reconsider their options.
Instead of Mr Brumby having his photo taken in front of the media and proclaiming all is well with the health system, perhaps he should spend a day shadowing a junior doctor, especially in an emergency department. Then he might realise what an exemplary job they're doing on a shoestring budget something that his taxpayer funded chauffeur driven lifestyle isn't accustomed to.
2 issues.
1) Doctors need to support eachother more rather than being so fragmented - in believing that if they look after themselves, all will work out best. The UK NHS has managed to 'divide and conquer' their young Doctors - and we are headed the same way.
2) The AMA had all our support during the previous round of bargaining, yet settled for a second-rate outcome. I hope this is not repeated. Dr Travis certainly seems to have a bit more fire in his belly.
As a second year doctor working in a tertiary hospital. I pretty much agree with anonymous comments on September 9 11:27AM.
As a junior doctor, I normally find myself being abuse in terms of workload by the management, some of the nursing staffs and some of the patients/relatives involved in the treatment of care.
I've tried explain myself to the management once when I get complaint by a patient's relative due to the workload and the experience I get from hospital medical support unit and management regarding the issue is that it is all my fault and it is essential for me to reflect on the issue and move on.
Call me a whinger but the truth from my perspective is that the expectations from the public and the hospital administration for the junior doctor to perform to their best of the ability is a dream!
NB: the job involves in the hospital for junior doctors does not include treating patients only but coping with abuse from some relatives, nursing staff and expected to work as miracle worker to solve any administration blunder paved by the administration. (ie getting calls from relatives put through by the switch board straightaway to the doctor and expected to answer the questions on the spot for patients which you have never ever seen in your entire life!
Guess that's my 2 cents worth of input. Hah!
That's it Kennett, Bracks, and Brumby - and I've special contempt for you Wooldridge. This is my last year as a hospital doctor in your bastardised system.
I've run your specialist units in the face of rising numbers of presentations, rising expectations, complexity and hospital demand for 'throughput'. I care for patients in 'phantom' wards to keep your figures impressive. I have been directed to send desperately sick patients home because the ED is overflowing. I have had patients die slowly from complications of the false economy involved in theatre 'cancellation'. My hospital's waiting time for urgent tests is measured in months. I am embarrassed by what I am forced to tell my patients - that the system cannot provide for them and has let them down, though were they to have health insurance.. ... ...
I've been bullied, abused, deliberately underpaid, and mismanaged by your hospital 'administrators' for the sole purpose of meeting unachieveable KPIs. I have performed the tasks of four of my colleagues at once when administration has seen fit not to replace their absence - and personally borne the risk and stress inherent to a ridiculous workload. I have had colleagues who have suicided from similar events. I have had my professional integrity questioned openly and publically by administration and 'supervisors' when I simply requested my award entitlements to be met. I cannot, sadly, remember my last 'training' experience.
I have held your underfunded and sadly mismanaged system together through the dark years to it's current state. Maybe it needs to collapse for you to take notice Mr Brumby. I can only tell you that it won't take me with it - your free lend of me is up. Take as much time as you like with the EBA, play games with them, hold out, sway public opinion against the 'greedy' doctors on $30 an hour or less - I won't be fighting you, nor will I be going anywhere near one of your public hospitals as long as I draw breath.
I am an emergency physician working in an outer urban hospital who frequently encounters access block in my small hospital. I have trouble transferring patients requiring urgent care because other hospitals are choked up with their own patients. My situation is not an isolated one. We need more beds and we need to be paid more to deal with the demanding conditions the government are asking us to work in!
I am a junior doctor and I know multiple interns working at the Royal Melbourne Hospital who have been rung up and harassed by the HR department for putting in claims for overtime that they had no desire to work but were forced to due to excessive workload and insufficient staffing.
I agree with all the posts above but for the sake of simplicity I will not repeat all their comments as they have already been documented.
In trying to make this EBA bargaining round successful, I think it is important to acknowledge the failures of the last few rounds. The AMA certainly has a difficult job in negotiating with a tough state goverment, and the results they have achieved are really very poor when they are considered objectively.
First of all it now appears acceptable to negotiate the next EBA after the previous one has expired, and to not win back-pay for any salary increases.
Clearly ambit claims made by the state goverment (eg for junior doctors to pay market rates for rent while on secondment to the country) are common, but the AMA tries to depict the fact that these are not written in to the AMA as something to boast about. These claims were ridiculous to begin with.
Junior doctors continue to reap less benifit from any agreement when compared to senior medical staff - the difference in the continuing education reimbursement ($1000 cf $20,000) is the prime example of this.
Pay rises have been minimal, and have not kept up with inflation.
The greatest problem the AMA is going to have this time relates the Ministerial Review. This was heralded as THE huge achievement of the last negotiations, and used to justify the poor results of that negotiation. Well suprise, suprise . . . . the review has had little or no media attention, and the State Goverment is clearly not interested in implementing any of its findings. It is going to be very difficult for the AMA to sell to its members any EBA that does not address most of the major findings of the Ministerial Review. But PR and spin seems to be the area that the AMA IR unit are most succcessful in.
The only reason I have strong feelings on any of these issues is because the AMA visit our hospital regularly and get all the junior doctors fired up about how poor our conditions are compared to interstate. These aren't issues I would otherwise think about on a day to day basis. But the AMA makes us thinks about these issues, makes us feel badly done by, and the when it comes to the crunch fails to achieve significant gains with any new EBA.
Lets hope this year is different . . . . . but I doubt that it will be.
I'm a specialist in training in a major metropolitan innercity hospital.
I'm seriously considering going back to WA, where I did medicine (am a Victorian) to return to a state where there was already a strong EBA and a culture of complying with it particularly well.
Since then, my colleagues have received major pay boosts - the CME entitlement there is auto-paid and is around $9000 a year at my level.
I love Melbourne, but I've had it up to here with the conditions...
The strain on the public health system is multifactorial. More money and resources are desperately needed to halt the downward spiral of the system which is buckling under the pressure of increasing workloads and decreasing facilities.
As a relatively young doctor in training I have now been out of school for 12 years. All of these years have been spent in training at university and hospitals around Melbourne. I have just completed my final Royal Australian College of Physicians exams at the age of 30 after years of hard work and study.
Time to celebrate- I think not. I am now expected to accept a pay cut to $60k and another 4 years of hard work to specialise further. Research institutes who demand research activities on top of my clinical responsibilities will provide funding for my salary. This is in addition to universities who also expect doctors in training to educate the medical students and nursing staff whilst on the job with no remuneration. No wonder colleagues are quitting medicine, leaving interstate or remaining disgruntled. How can we look after the states sickest when we can barely look after ourselves?
In the public health system moral is low, people are overworked and underpaid in arguably the most important jobs in society. I could easily earn more money and have better work conditions in countless other jobs advertised in the newspaper each week. Not to mention have time for exercise and a family of my own. Doctors are overworked, underpaid and many of my colleagues have contemplated leaving the field and some have.
Victoria is the lowest paying state in Australia for doctors. South Australia has just increased its remuneration for doctors in its public health system and I call for our state government to at least match it. The system needs more money and more resources to boost moral or the brain drain and exodus of qualified practitioners will continue.
Anonymous
I'm a final year student and has been accepted to work as an intern in a certain tertiary hospital. I haven't signed the contract yet, and I'm probably going to move interstate and work there as a sign of protest
A major issue that needs to be addressed is the clause in the current EBAs forbidding doctors from speaking to the press, without going through management first. It's an insult to our integrity, and it discourages many doctors from reporting serious problems within public hospitals to the public.
Censorship AMA - not very becoming!
If Victoria is still treating us so badly i am seriously considering moving interstate once i pass my part I - and i would imagine a lot of people would do the same. afterall, Perth and Brisbane have the sunshine and the beach, and the proper respect to their doctors in terms of renumeration.
I am yet another doctor who was at the end their tether, but now happily resigned from Victoria's appalling conditions and heading elsewhere for better pay and conditions.
As a registrar in psychiatry i watch in dismay as interns break down, become ill, through working unsupported in an acutely stressful environment owing to the understandable lack of applicants for psych training at my hospital, where numerous registrar resignations are welcomed as a cost saving measure, and the rest of us shoulder the burden of extra after hours on call and working two positions at once. Our (some excellent)consultants are too demoralised and overworked to supervise us adequately and training is constantly being touted as a privilege, and impeded apon by service requirements.
The only specific solutions I can think of is that doctors should be paid extra to cover unfilled positions, and that training should no longer be monopolised by the public system which is too invested in extracting maximum energy from once young and idealistic doctors and regards training as a nuisance at best. then they might have to make positions more attractive.
The minute I get out of this so called training I will endeavour never to set foot in a public hospital again.
Many years ago in private practice we wondered if our legal reprt fee should be increased. The accountant at the time made a broad comment that:
If you hear nothing, your fee is to low
If they complain and send more work , it is about right.
If they refer no mor work, the fee is to high.
I feel the same applies to negotiations with Government.
If you complain and keep working ,the terms and conditions are ok.
If you vote with your feet, urgent remedy is required.
What price a life? Mr Andrews tells us that it is worth between 24 and 39 dollars an hour...Bargain! When the I.T guy on the help-desk for the computers that I have to queue for (and don't work) makes more than I do it is apparent our priorities have gone kaput.
Reward for Effort.
We encourage it in private business, in our children and indeed our politicians. Yet The Government as the ultimate representative of the wider community fails to acknowledge and reward the efforts of individuals (not just doctors) in the public health system.
Support, train and retain.
Look at any Business Magazine and business gurus write of the need to support staff to encourage them to stay. There is support given to employees in terms of funding for courses, time off work to study and strategies aimed at career development. Why is this any different in the public sector?? Ultimately producing the best medical practitioners will result in the best medical system. Government should provide funding specific to training, reimburse all training cost, establish bursaries and attract doctors from interstate and overseas to work in Victoria.
38 Hour week
Why do we continue to accept a 43 hour week for training registrars?? In some hospitals and in some disciplines there is clear exploitation of doctors’ generosity in rostering them for 43 hours of work at ordinary pay, without the provision of training time. The solution is to have a 38 hour week, plus 5 hours mandatory training time. If no training time is rostered by the hospital then this will be paid as a training support allowance. Any hours over 38 actually worked would be paid at overtime.
All for one, one for all.
Ultimately it is us as individuals and the AMA collectively who must act in order to pressure change. The future of medical practitioners, the public health system and patients is what is at stake.
I have a dream.
I have a dream that the private health system will establish a competitive market not only for specialists but also trainee doctors. Then the public system faced with the prospect of trainees moving into the private sector to work, will be required to reach benchmark standards. Think about if St Vincent's Private offers 5% above award rates and funds the full cost of training because it wishes to get the best and brightest, then there is every possibility St Vincent Public may do the same??? If you don’t think this already happens you need only look at how much CEOs of Health Care Networks are paid. In order for the public system to attract CEOs of a certain caliber they need to meet industry standards, that take into account both the public and private sector. Competition; it is what makes us strive for greatness and perfect systems.
I am a Senior Registrar in the Victorian public hospital system, where I am forced to do my time - including A LOT of UNPAID overtime. I cannot say anything to my bosses, as they did so before me & all my predecessors had to go through the same hell. I am held at ransom by my piece of paper at the end of each rotation that needs to be signed off by the supervisor. If I raise my voice too loudly, I get no signature, and there goes another year wasted. What a great life this is.
The AMA promised to change things in 2006. Great help guys! Now we have our Ministerial Review, and it is still sitting on the desk of the government & DHS - UNOPENED.
One thing is for sure, after my one final year as a trainee - I am LEAVING the public hospital system for good. Off to private land, where I actually get paid for all the work I do.
And thanks for all the fish !!!
I'm pleading with the ama to not back down on oncall renumeration. We should be paid per phone call, not the current ridiculous around $70 for a whole night oncall, where you can get woken up every hour or more, resulting in minimal sleep & compromised patient care the next day. At least if hospitals had to pay us a little per call, some of the non-urgent & sometimes non-clinical calls we get overnght might be defered to the morning.
"Why do we continue to accept a 43 hour week for training registrars?"
HERALD SUN July 2008
www.news.com.au/heraldsun/story/0,21985,24020617-2862,00.html
AFTER working 77 hours in seven nights, it's no wonder Dr Joseph Sgroi barely had the energy to celebrate his 33rd birthday with his young family last week.
But the Royal Women's Hospital obstetric registrar says the long hours are just part of what is needed to provide appropriate medical care.
Despite cramming two working weeks into one, Dr Sgroi said fatigue never compromised the safety or care he provided for his patients.
"Most people would see it as being taxing and onerous, but I think it is just what needs to be done in order to run an efficient service," he said.
"It does have some effect on your body and on your mental state, but it doesn't affect my performance or the way I treat my patients."
Dr Sgroi conceded some doctors struggled under the conditions and said more flexibility and rewards should be introduced to ease the strain.
Oh dear.
I work 77 hour weeks too - only trouble is I'm paid for 43 come rain, hail, and shine! "We don't pay overtime here" I'm told.
That's Correct
Overtime is not paid if you work a week on and week off arrangement ie cramming two weeks work into one. In fairness to the system our hours are averaged over the fortnight.
Is the AMA actually capable of updating their EB update on time?
"EB Update will be published that afternoon."
Oh Really? Which week did that ever happen on?
Dear Anon (Sept 17, 2008 1:23pm),
Rather than be critical of the AMA why not support them. If you are not already a member, become one. If you dont attend meetings, do so. If you are concerned by certain aspects of the Industrial campaign then voice them at formal meetings where your presence, name, title and opinion can be formally recorded.
There are many faults in systems. The only way to fix them is by actively participating in change.
I hope this helps with your concerns.
Keep agitating.
I patiently waited for the 'Ministerial Review' which the AMA heralded as concrete proof of the current conditions , something which they could take to the government during the EBA negotiations.
Here we are now, with a scathing Ministerial review pointing major problems in the health system in Victoria and the way it treats its doctors yet we are struggling with the EBA and it has been completely ignored.
While I respect the AMA for the work they do, the impression among many doctors is that they just don't drive their negotiations hard enough.
There is little point sitting down and negotiating ad nauseum with a state government more preoccupied with spending millions of dollars on propaganda TV advertising to promote itself than fixing the health system.
The only way they will listen is for hardcore action. Bring back the strikes, the refusal of coding DRGs , the stories in the media of how the system is hurting. The only time they pay attention is when their image is tarnished and are in danger of losing a re-election.
So dear AMA, I plead....please don't take the soft approach. It's time to go after them in the same ruthless manner that they have treated us all these years and they deserve nothing less.
If you want to see results, drop the fist on the boardroom table and start organising some industrial action and media advertising showing the decrepid state the health system is in.
There seems to be a trend that the Victorian government only agrees to negotiate when actions were taken as we can see in the the last few incidents-nurses strike, teachers strike etc. But doctors principles are to care for the sick no matter what happens and it seems that the government is taking advantage of our good faith. Let us hope that the doctors are not forced into the corner and have to do what our counterparts do and affect the patients well being.
I hope something happens and happens soon - my hourly rate hasn't gone up in over 12 months but my college fees, medical board registration, indemnity , HECS and soon to be paid exam fees aren't going anywhere.
I actually can't afford to be a hospital registrar any longer!
With our bizzare (but technically within guideline) roster, and hospital policy of non payment of JMO overtime since a new CEO arrived at our hospital, there's no spare time to even contemplate a locum shift to make ends meet. Why junior staff wages are seen as a 'cost-saving' measure to cover managerial failure is beyond me. My bank of goodwill runneth empty!
I'd also like to take this opportunity to thank my bosses for all their support during my study - the denial of study leave, the 'favour' shifts for the unit, the 'crossing off' of overtime and the lack of cover when others in the units are away due to a 'non-locum' policy. All this so I can argue with the radiology secretary who is clearly more away of what constitutes medical urgency than I am!
I can honestly say I hate this system, and the way it chews us up. No wonder the bosses are deserting it like rats.
To Strike or NOT Strike
We would all like the opportunity to express our discontent with the system by rolling out hardcore industrial action. Whilst I am not a Industrial Lawyer I do know one thing.
Changes to Industrial Legislation means that it is illegal for workers to strike. Moreover should an association like the AMA Co-ordinate this form of industrial action t could land the AMA in Court. Not withstanding the huge cost implications this would have for the organisation, it would also mean that resources would need to pulled away from what is the key function of the AMA; that being strategic negotiation.
However in saying this I believe (however we would need to seek legal advice on such a matter) there is a range of industrial action the AMA could employ to get the message across.
A few suggestions.
1. Day procedure patients to be admitted overnight by order of the doctor. Most hospitals now have a day procedure unit. the patients normally stay there until 6pm and are discharged. There is the capacity to keep them overnight. But with the support of anaesthetic staff and surgeons all patients could be admitted. This would not cause bed block, but would force the hospital to have extra night duty staff (nursing).
2. All junior doctors to hand in pagers and be called via mobile phone. This I think has already be canvassed. But to work well the RMO Societies would need to draft a document with all the doctors mobile numbers and hand it to switch. Switchboard would need to input the doctors mobile number into the intranet paging systems so that nurses could easily identify the numbers to call without tying up switch board. Costing would need to be done to demonstrate the cost to government if the AMA was to proceed down this line.
3. On country rotations all junior doctors oncall overnight would be asked to attend to the patient (i.e. the hospital) whenever they are called by the hospital. IE no telephone consultations. This will mean doctors need to get out of bed, but it would also mean recalls every time they do so. Eg A doctor would go into the hospital to visit the patient and write up Intravenous fluid order rather than just give IV fluid orders by telephone.
4. All Senior Medical Staff to attend to a patient in hospital at least once overnight during there oncall, assuming they get an oncall allowance.
5. ALL doctors to wear white coats (specially produced with logos and symbols of strike action) that need to be laundered by the hospital. Cost implications to hospital. Hospitals are required to launder white coats for doctors.
I encourage people to write their suggestions for Industrial action that would aim to place pressure on the system, without causing an adverse impact to patient care.
I am an O&G trainee nearing the end of my training. I realise that the NSW Health System provides for a better remuneration package than that on offer in Victoria.
I have recently accepted an offer to shift north.
So Sydney here I come!!!!!!
I am an intern and I have been driven close to the edge this year.
Amongst other things, the amount of unpaid overtime I have had to work just to keep my patients alive is staggering.
Rather than being paid automatically for overtime you have done, you have to grovel for and justify it. Nothing was more demoralising than when someone from medical administration called me to say that, despite giving reasons for working the overtime I was claiming, including thorough clinical details and patient identification numbers, my consultant had refused to authorise my overtime pay.
He had crossed out the hours I had claimed and simply written "not agreed to".
I think the whole hospital might have heard me yelling and cursing. It's not even about the money- as if the meagre pittance of a few hours overtime would make any difference- rather, about being valued for the hard work and long hours I put in. Personally, I hadn't "agreed" to those overtime hours as well. I had much better things to do, such as going home to my family. I stayed back because my patients needed me, and there arent enough doctors and hours in a day to attend to their pressing medical needs and the demands of their families in the 8am to 5pm shift that I'm paid for.
At least one of my patients has died this year because we didnt have time for something as basic as properly managing his electrolytes. If we'd had more time, and if the relevant specialist unit wasnt full to the brim and could have taken him on, maybe he'd be alive today.
I hate the medical system and the type of doctor it has turned me into; someone who cuts corners out of sheer necessity, and resents patients when they get sick at 4:45pm because I know I will have to either cut more corners, work overtime that will run me down and I wont get paid for, or hand them over to an equally stressed evening cover doctor who, come 10pm, will be faced with the same dilemma.
Meanwhile patient expectations continue to climb, and I stay back until 11pm talking to a patient demanding to discharge herself because a nurse was too busy to bring her a cup of coffee.
The stress really gets to me sometimes. It's not unusual for me to cry all the way home from work.
I don't know how I will survive the rest of the year.
I honestly, sincerely & strongly believe that the government will NOT listen without proper, coordinated industrial action.
I concur: "The only time they pay attention is when their image is tarnished...."
They have had the ministerial review sitting on their desks for almost a year now!
It is time to act !
If it's illegal for doctors to go on strike, there are a few options. We could take a leaf out of the hats of nurses, allied health etc who had "strikes" in the past.
If nursing staff could close beds while still being at work, could it be possible that doctors could admit (urgent) patients only via ED? No electives, no outpatient admits, no private patients in public hospitals etc. See how they will meet the KPI then.
It is unfortunate how junior DIT are only occasionally being paid the actual hours worked in selected hospitals, and where they are forced to work unsafe hours including being oncall and recalled for 72hours continuously.
Vote +1 for strike action.
AMA victoria needs more media attention focused on the impending collapse of the victorian health system. The general public has an unrealistic view of the conditions which junior doctors have to work. The fact is while we have to work in the public system in order to specialise, the victorian labour governent is literally able to hold us hostage. No more I say. We need a strong voice, united, giving a clear message to the government - Pay us what we're worth!
All this talk of productivity measured pay increases - we have reached the limit of how much they can cram into our day in the name of productivity.
If nurses and police can threaten (sucessfully) to strike in order for the government to take them seriously, why can't we? I say cancel elective surgery, postpone all but essential outpatient services and everyone ensure that they take their UNPAID lunch hour!
Just finished a night shift in an unnamed hospital - where we operated most of the night on plastics cases. They couldn't be done during the week because of 'surgeon availability'. But in truth, the surgeon isn't available b/c he gets paid fee for service after hours. So it is MUCH more profitable to put off operating until out of hours.
Don't blame them either - we get paid peanuts for in hour lists!
I identify with the comments of one of our more junior colleagues - the intern above.
I too cannot stand both the doctor, and indeed the person, this system has forced me to be. I am now callous, cold, and judgemental. I am impatient with the hesitant or difficult patient in front of me when I know there are thirty more in the waiting room to go. I hate my work and my hospital, I distrust my referring colleagues and have NO faith in those who are supposed to be my administrators/managers (particularly when our HMO management consists of untrained, wet-behind the ears twenty somethings who haven't the foggiest idea which end of a stethescope is which).
To be constantly operating on the brink of chaos and looking after the sickest of the sick is a tremendous burden personally, professionally, and psychologically. I too have cried often in anger, frustration and simply being strung out after too many hours on, with too many patients, too many acute issues with no support and a system which is adversarial, accusatory and defamatory. I have worked through times when the administrators don't know the difference between a neurosurgeon and a rheumatologist, a cardiothoracic doctor and a gastro-enterologist. To them they are gaps on a roster, and any name, irrespective of experience, training (a laughable concept) or ability will do.
I am a fellow now. In the past ten years I have seen the system crumble, stress levels rise, the system lurch from one crisis to another, and the increasing hostilities (and assaults) from patients and families for issues I am powerless to control. These include waiting times, bed availabilities, standards of nursing care, charges for prescriptions, over crowded wards and clinics, and a hospital which has essentially been a building site since 2005 (with the bricks held on to the outside with chicken wire).
My only advice to you is that you have the opportunity to get out now. The hospital experience is only getting worse, not better. There are plenty of other professions that will gladly welcome and reward a high achieving, intelligent, articulate individual such as one who has the skills to enter, and complete a medical degree. This one only serves to take its pound of flesh and devalue you at every opportunity.
Me? Come February I'm gone (private interstate) too. W.A here I come!
Gday, Nick Miller from The Age newspaper here.
There's some really interesting stuff in these comments but I'm hamstrung - I couldn't run anonymous comments from an unchecked source in the paper.
If anyone wants these issues to be more widely aired feel free to get in contact with me, via The Age or email nmiller (AT) theage.com.au.
Anonymity assured, I just need to be able to verify your story is from a genuine source!
cheers
ISSUES: OVERTIME MUST BE PAID. / EDS MUST BE CLEARED.
I am a first year doctor working in a large tertiary hospital.
I am concerned about the fact that many junior doctors are not able to voice their concerns publicly - I included - for fear of being sacked or not having their contract renewed.
We are often forced to work - and I use the word forced intentionally - extra hours each day (6am work round with surgical unit) yet are not paid until 8am on our contract. When we ask for this pay, we are told that "We don't pay overtime", This is care that we are providing to patients. Surely we should be paid for it. When you have to wake up at 530 am and know that you are not going to be paid until 8am, morale plumits.
Yet we can not speak out because we fear that we will not be offered positions in our respective hospitals in the future.
The government needs to provide more funding and incentive to junior staff and allow overtime rates to be paid in full.
Secondly, emergency departments are stretched to the limits. We all know that they are on the brink of collapse, if it were not for the staff and particularly the nurses, these department would have failed a longtime ago.
THe government must act now and must ensure that the ED is cleared up, and that better pay is provided to keep doctors in the system and happy.
MORALE IS VERY LOW.
I have a friend who is an advanced trainnee about to become a consultant. He has already established a private practice for next year. He has a PhD and has been offered a place as a unit head at our hospital, however he has rejected this given the deteriorating state of the hospital and system as a whole. He has warned me, even at my level, to just hurry up, get through and get out of the public system.
ARE YOU LISTENING MY BRUMBY????????
We must take action now.
We must start to make some sort of impact. The government are dragging their heels and they are not at all concerned with what we have to say.
Junior and senior staff are working long hours, mostly unpaid, and are exhausted. Can you imagine what would happen on a building site, if you asked a bunch of unionised builders to work for 4 hours each day without pay! They'd be on strike and blocking Burke St if you asked them to work 4 Minutes for free, let alone 4 hours. And then we're called and asked to help out the hospital and work an extra night shift! Give me a break. You all can relate, and you all know how insignificant we feel.
But time and time again people, we see this happening in our profession. Long hours, unpaid. How can we be happy with our profession and our environment. How can we properly care for patients, when the system won't properly care for us.
I am for admissions ONLY via ED, as has been previously suggested.
I believe in the Public Hospital System, however, I like others will run from it when my training finishes - in 3 years! - because the grass is greener on the other side. Much Greener!
Ladies and Gentleman, we have to make a move. No matter how it has been done "in the past" or what consultants say "when I was a resident....we didn't get paid" blah blah, it is now irrelevant.
In this day and age, with the amount of work we are undertaking, we are due to get paid each and every minute we work!!!!
As an aging consultant in a regional hospital, many of the comments to date do not applky - BUT
Waiting still for a contract which recognises my skills.
Looking for some form of compensation for teaching - my hospital gets paid for taking students but I don't!
Locums get paid 20 times as much as I do when there is no other surgeon available.
- yeh I know - become a locum - it's on the cards.
Yet when the scuttlebutt about the attitude of a regional hospital is that nurses are given 101/2 month contracts to avoid benefits and overtime at a public holiday intensive time of the year, what hope have we?
I am a junior doctor at the Alfred Hospital. Having just moved from interstate this year, I am making approximately $20,000 less compared to last year - despite working even longer hours. My requests for payment of overtime have been refused and whilst doctors are forced to work overtime to ensure good patient care, their extra work is not being acknowledged with a blunt refusal to pay the extra time worked. This makes absolutely no sense and plays on a doctor's compassion for patients - if your patient had just had a heart attack with an irregular heart rhythm and it was the end of your shift - would you hand over to the next doctor (and risk substandard care) without doing any extra work or stay behind an extra hour to ensure that the job was done properly?? I know which option doctors and the public would prefer - however doctors seem to be punished by hospital bureaucrats who seem to care more about the bottom line than good patient care.
Similarly there are not enough doctors in the public hospital system and the Government is not making any substantial moves to recruit doctors to Victoria.
When you see reports in the media of hospitals in QLD with $17,000 'sleep easy' chairs and free catering for staff as part of QLD's effort to recruit junior doctors - what is Victoria doing? Our state pays doctors one of the lowest rates of pay in Australia. It's a disgrace.
Emergency Departments are overwhelmed yet there are not enough doctors to handle the load. Elective surgeries are being canceled because there are not enough available anaesthetists or hospital beds. The system is at crisis levels yet it seems that the Government is not willing to acknowledge this.
I have been working in the public hospital system for nearly 30 years. Pay and conditions have never been as as good as they are now. We have a great system and I am sick of all the whingers
Joseph asks for ideas re industrial action (19/9). A lot of the ideas mentioned would take significant cultural change and be onerous on already exhausted staff. In additional the small costs of these changes would take some time to bite.
Strike action would seem out of the question legally. So, significant action that will force rapid meaningful negotiation is needed. The tactics used in SA give a possible route - mass resignations (never accepted). A possible interim action could be mass applications for reduction of employment to half-time (which of course also will not be accepted, but provide notice of out intent and unanimity).
I should say that I don't see the reasoning behind the "all admissions via ED" proposal. EDs are already dangerously overcrowded, and even if ED staff were not required to actually process these patients (don't even think about suggesting that they do!), the mere presence of additional bodies could impair the ability to provide urgent care to those patients who actually need it.
I am a 4th year doctor and this year I applied to do the Diploma of Obstetrics to further my education.
Costs:
Application fee: $175
Lecture course: $715
Written examination: $330
Oral examination: $1000
Textbooks: $350
Total: $2570
(by the way this is nothing compared to fellowship exam fees)
As an HMO4 I am entitled to $1000 Continuing Medical Education allowance. However I was told the only thing that I could claim of the above was the books. I duly submitted my receipt - and heard nothing. After 3 months I enquired after it and was told they knew nothing about it - ie the receipt was lost. When I complained about that and the inability to claim the other (clearly educational) expenses their response was "you're lucky you can claim anything at all". Thanks a lot, HMO services.
I don't necessarily believe that we should get an educational allowance over and above our salary - because continued study is an expectation of our profession. However, I believe our salary should incorparate the TRUE COST of this, especially for doctors in training where it is thousands of dollars per year.
In contrast, when I worked in WA my salary was >$10,000 per year more than Victoria for the equivalent level. In addition, professional expense allowance of around $80 was paid automatically every fortnight. Morale was high, work was enjoyable and medical administation helpful and approachable.
I'm sorry, but having had a taste of a better medical system I don't intend to stay in Victoria beyond this year. Morale here is terrible and my enthusiasm to change it has been quashed by the apathy of the system.
By the way, I'm happy to be quoted if necesssary! Karina Severin
It's time to take industrial action NOW! It's time to take a stance for the sake of Victoria! It's now or never!
To that guy who has worked for 30 yrs, called us whingers and said that pays and conditions have never been better... do you realise that the inflation has never been worse? Rents, utility bills,petrol etc have never been costlier. I'm pretty sure you must be working in the private sector.
Well, Nicola Roxon, I'm happy to hand over my 'non-essential' duties to the nursing staff at my tertiary suburban hospital!
Please, Ms. Roxon, feel free to circulate through Melbourne's hospitals that junior medical staff will be handing over 'low-level' tasks to nursing staff who are perfectly capable of doing them.
Quite frankly I'd love to regain the hours I spend on cover shifts putting in drips, catheters and talking to families.
Then maybe I'd get away on time and not have to beg and scrape for a few hours of paid overtime.
What a bloody joke.
An easy way of "striking" without compromising patient care is to not compromise patient care.
Consultants and registrars of units should not be pressured to discharge a patient an extra day early to "help the hospital bed situation". Instead I say, discharge the patient when you feel it's suitable to do so, not when the bed manager pressures you to do so.
Keep them an extra day or so in hospital to get those tests that they need done or to get fully better. The way bed occpupancy is around the state, it won't take much to tip the hospitals into bed block if just a few units do that. Reinforces the AMA's points about bed capacity in the state.
The beauty of it is, it is not illegal to look after your patients well and it is hard for the government to accuse doctors of "striking" and for them to advocate for discharging patients early. The last thing they need are "patients being kicked out of hospital early" media reports amids the "long waits in ED" reports as a result of bed blockages.
Win win situation.
Dear Anonymous (September 25, 2008 9:48 PM)
I find it extraordinary that you can post a comment labeling your colleagues as whingers without actually identifying yourself.
Complacency leads to inefficiency in the functioning of systems. I have no doubt the great pioneers of medicine strove to be the best.
I am also certain that doctors in the early 20th century had a worse deal than what we currently do. Should we just accept that we are now better off????
I ask of you anonymous, how can it be fair that the Government offers your colleagues a 3% pay increase each year, when inflation sits at over 4%. This despite vast improvements in productivity and the increased costs associated with training; not only from the perspective of senior colleagues devoting time to train, but also junior doctors spending huge amounts on College fees and courses.
Medicine has dramatically changed in the last 30 years. Whilst I cant vouch for the period 1978 – 1998 I certainly can for the period thereafter. Over the last 10 years that I have worked in the Public Sector and as a past Federal representative of Junior Doctors to Government I have noticed more and more junior doctors becoming stressed, tired and leaving. I have seen colleagues of mine take their lives. I have counseled colleagues who feel pressured by senior members of staff and medical administration.
Dear Anonymous, I too like you feel privileged to be a doctor working in the public system and serving the comminty. However anonymous whilst you might feel the system isn’t broken, others do. Listen to those around you. Respect their views and strive to help them.
I have been working in the public hospital system for nearly 30 years. Pay and conditions have never been as as good as they are now. We have a great system and I am sick of all the whingers
can we please have an update of what the ama wants and what the dhs is offering. we keep getting ama emails without any details.
thanks
ama member
I work in QLD. I feel a genuine sense of sympathy for those DIT's in Victoria. QLD conditions were like Victoria but changed 4-5 years ago. Some brief thoughts:
If you are still early in training or have a young family, you should seriously consider moving states or jobs.
Amavic, despite effort, was unable to secure large salary increases last time. If they can't do it this time (and the gov will play hardball) then next time there will be an ovesupply of grads, and no chance of increases.
In QLD we work hard like anyone else. (the nap pods are to take 20 min breaks like powernapping. they did not cost 17k) We get paid 90%+ of overtime, which amounts to many thousands per individual (For me 35% of my salary which is >110k is OT) It is is not the money which matters, it is the fact that you don't resent your patients and the extra work.
Look after each other, it doesnt seem like anyone else will.
As well as being a consultant in a public hospital, I am the mother of a young baby. It would be great if the AMA could incorporate the 18 weeks of paid maternity leave just announced by the Federal Government into the current EBA negotiations. As a result of the announcement, if I choose to have another child I will actually be worse off than under the previous system. This is because the baby bonus has been cancelled, to be replaced with minimum wage for 18 weeks. With my current baby I received an approximately $6000 payment plus 12 weeks of full pay maternity leave. It would be great if that were to increase to 18 weeks of full pay with my second child.
I have been a doctor for nine months. In that time I have been transformed from fresh-faced, eager, motivated graduate to a stony, jaded and angry intern. After this short amount of time – a mere nano-second in the context of a life-long career – I have grown weary of this profession that once held so much promise.
Doctors are frustrated by the better working conditions of other hospital staff
I cannot count the number of times I and other junior doctors have become resentful of competent, caring nursing staff who leave for their meal breaks – two or three per shift. – when we have not been to the toilet or eaten for 6 hours or more.
Patients and families are demanding and have unreasonable expectations.
They expect miracles, updates, 30 minute phone calls, cures and instant results several times a day. Worst of all - after playing the sick role for a week they rant and rave when, told they can go home, leap from their beds and demand instant discharge complete with paperwork and medications. When they demand things rudely I stifle my urge to scream at them to ‘Write to your local MP – I can’t fix it’. Meanwhile, to compound the stress, on a cover shift from 5pm-10pm interns are paged in excess of 30 times for separate issues across a multilevel hospital with inoperable lifts (do the math!).
Medical errors occur on a regular basis.
Patients die waiting for scans, operations, test results or because people were too busy to check a test they ordered or take a proper history. Interns who wanted to save lives quickly begin to hate the system in which they work.
No time to care, no time to learn.
In my last six weeks as a Medical Intern during my day shifts I have not fully examined a single patient. Ward rounds are brief and incomplete. Patients with pneumonia or CCF go days without a stethescope touching their chest.
As a profession we are being split apart when union is the only solution.
Out of sheer frustration doctors blame each other. ED is angry at ward doctors for not coming to review or admit patients. Wards are angry at ED for sending too many patients or for not making perfect initial diagnoses. EDs are angry at GPs and patients for countless non-emergent presentations.
Doctors blame each other because this is infinitely more satisfying than blaming the immovable, immutable behemoth that is the Government and the system.
I want to love being a doctor. I want to improve patients’ quality of life. I want to provide good patient care. I want to LEARN how to do all these things better. But underpaid and overworked, when it seems like the whole world is against you: I hate being a doctor, I fear becoming a registrar and I resent patients because I have worked 16 hours straight trying to fix things, inevitably failing because one intern can’t fix the health system, and all I want is to be able to eat dinner before midnight, get more than 4 hours sleep, go to the toilet and afford private health insurance so I never have to be on the receiving end of any of this.
The Ministerial Review was clearly (yet another) con job by Bracks to get through the last election. It means absolutely NOTHING.
We must NOT allow this sort of con job to be pulled again by Bracks' disciple Brumby.
I think public hospital doctors should beging letting the public and the media know about some of the things that really go in our public hospitals. Then maybe people will wake up and see that things to need change urgently.
For a start, I work at a major tertiary hospital in Melbourne. When patients awaiting category 1 cardiac surgery have been on the waiting list for 30 days, the hospital physically admits the patients to the ward so as to avoid a financial penalty. This also means that these patients are not counted as having not had there category 1 surgery within 30 days, which is one of the statistics the DHS reports. This practice happens every week. What is horrifying is that there are at least 3 episodes this year where these patients, who are sometimes admitted for 3-4 weeks before getting their surgery, have suffered life-threatening pulmonary emboli due to being immobilsed on the ward! Others have also suffered non-STEMI's. I can assure you that the instructions to admit these patients does not come from doctors, but rather from administrators.
I am sure that this is not unique to my hospital. These patients are being cancelled because there is not enough theatre or ICU capcity to operate on them.
I also think the public should be aware that when a junior doctor is sick (and remember, it may be a junior doctor who is doing their surgery or giving their anaesthetic), they are not replaced (ever). This means that other, already overworked, junior doctors have to pick up the slack. Ie. patients are being operated on by doctors who have been on call for 3 months without relief, doctors who are fatigued to the point where they actually fall asleep standing up in theatre, and doctors who consider themselves too tired to be able to safely drive home at the end of the day (but who still battle on and perform that operation or make that clinical decision which is of such importance to the patient). I personally think this is a scandal, and it would not stand up in court if a malpractice suit ever arose.
I also think the public should know just what a doctor shortage there is, and that even big inner city hospitals are now relying on overseas trained doctors to fill their staff. Many of these doctors do have good training, but many clearly don't, and there are definitely times when poor English and poor understanding of the Australian health system results in bad patient outcome.
I urge other visitors to this blog to anonymously post their concerns, and hopefully there will be some media attention so as to put pressure on the State Goverment.
What about T-shirts? Passive, I know, and a lot less action than most of us would like to take, but I recall the nursing staff getting brightly coloured shirts during their industrial action last year.
Obviously it doesn't affect patient care but it puts the issue front and centre and I'm sure the hospitals won't like us all walking around with a big sign saying how badly they're trying to screw us.
I agree
Tee shirts with the slogan
"Your Doctor is SICK"
now sick could mean cool, acutally ill or sick and tired of the system.
or
"Victorian Doctors on the move"
copying the slogan "Victoria on the move" and in reference to doctors moving interstate.
Or "Victoria NOT the place to be"
"Tired, Overworked and Stressed - Go see your doctor!!!! - Oops wait on, your doctor is Tired, Overworked and Stressed TOO"
or "Help us Help you"
Whatever industrial action does occur, for it to be most effective, junior medical staff need to be supported by senior medical staff in their actions.
Junior staff are concerned that industrial action (even just a t-shirt) will affect their end of term review, reference or college application. As a junior doctor I keenly support the AMA and will support any action, but without senior support, not all of my colleagues will do the same.
The AMA and Hospital RMO societies need to consult with senior medical staff and gain their key support for any action.
In many hospitals it is senior medical staff, that are the reason that conditions are poor, and junior staff are not receiving overtime or allowances.
Senior staff need to understand that just because they had to work long hours with little recognition doesn't mean that the same is acceptable for current junior staff.
It took me from the late 1980's until a few years ago to become a doctor & then qualify as a specialist in emergency medicine. Working in the Victorian public system as a senior doctor has left me tired & disillusioned. I have just resigned.
I'm tired of fighting - because that's what you have to, to even find a bloody bed to see a patient. The only time the pollies care is when their loved one is the one in the resus bay or the trauma room. Despite heroic efforts by my medical & nursing colleague (and the odd administrator), the patients in the emergency department get treated IN SPITE of the system, not BECAUSE of the system.
Let's hope some long service leave restores my energy and interest. Otherwise, I'll find some other way to pay the bills.
I agree with the T-shirts. It's passive resistance, without placing patient care in jeopardy. It would also bring the issue into public view. I reckon a number of different T-shirts with different slogans on them.
"Lowest Paid in the Country"
"Most efficient = lowest paid in Victoria"
On the front "Are you tired, stressed or overworked?" On the back "So am I!"
How about a doctor to patient ratio? Obviously wouldn't be the same across all units, but would hopefully prevent days where a unit is looking after upwards of 50 patients.
I'm an almost-finished, but deferred medical student, and I'm not joking to say the comments I see and hear from future colleagues have sent me to the point where I don't think I'll go back to finish my degree. The non-payment of OT is simply outrageous - it's not as if junior doctors are raking it in.
Like most people I've also seen the horrendous and dangerous fatigue that compromises px care, especially with anything that rapidly evolves.
While I can at least understand why mindless admin people refuse to pay overtime, the complicity of senior doctors in this is disgraceful.
Here are some ideals I made note of when working in the NHS and apply just as equally to the Alfred and other second rate teaching hospitals
1. The patient comes first (over friends, family and self)
2. Never accept mediocrity
3. Never let your frustrations turn to apathy
I am a senior registrar who has worked in the Victorian health system for eight years. Morale in the public health system of this state is at an almost irretrievable low. Doctors, who should be leading a motivated health care team, are at loggerheads with an administration who refuse to pay for even a barely adequate health care system, and with nurses and allied health staff who are similarly frustrated with the state of the hospital system. Continuous cutbacks and restrictions on equipment and facilities, combined with unrealistic expectations of staff make the daily grind almost unbearable for many of us. To make things worse hospitals will not pay overtime caring for staff looking after the most unwell patients, will not accord the staff basic allowances (including equipment for patient care and even a staff area to have 5 minutes break) and repeatedly breach workplace agreements.
Morale is low. Quality of care is rapidly being sacrificed and the long term health of the system is suffering.
The health minister must look further forward than the next election and realize that a major injection of funds is needed to prevent the health system from rapidly becoming no better than third world medicine.
Many interesting comments, all of which I agree with. I too am a disillusioned senior registrar about to finish my Emergency specialty training and upon completion, abandon the public health system for good. I can't in good conscience support a system that has abused me and my peers in such a systematic and degrading way for so many years. The $20K CME allowance isn't enough to entice me back and is really an affront to registrars, who can buy 3 textbooks with their $1000, while watching their consultants jet off overseas (business class) to conferences that they don't even show up to, while we have to fight (and often lose) to get our 5 hours a week paid training time. My consultants spend their CME money on flash new computers for their kids, overseas holidays and new i-phones, none of which are used for work. What do I get as someone who actually has to go home each night and study? A couple of free textbooks. What a load of BS. Maybe if everyone was treated better as a registrar they wouldn't think about leaving and they wouldn't need the $20K CME carrot to keep people in the system.
As far as hoping to change the system what everyone needs to keep in mind are the following facts:
1) Nothing mentioned on this page is "new" information to the AMA, the government or the Colleges.
2) All of these organisations have a vested interest in maintaining the status quo, and no amount of whining about how bad it all is, to anyone, will change it. They know IT ALL, and could change it anytime they want, they just won't because it will simply cost too much, and could lose the government the next election.
3) This system has evolved because our predecessors (read "bosses") have allowed it to and we have them to thank for being such pushovers and creating a culture of compliance and dependence on hospitals for our bastardising training system.
4) The reason they haven't fought to change the system earlier is that as you learn more about it, you come to realise that YOU CANNOT CHANGE THE SYSTEM. No amount of letter writing, petitions, campaigns, haggling, arguing, lobbying or meetings will ever change the system. Why? Because WE CAN'T STRIKE. WE HAVE NOTHING TO BARGAIN WITH. WE NEED THE SYSTEM MORE THAN IT NEEDS US. The only thing yo can do is LEAVE. (As seen recently when ALL the Emergency Physicians in Adelaide RESIGNED, and their demands were miraculously and instantly met). Did the AMA achieve this for them...? No.
5) When you need the hospital more than they need you (ie for training positions) they will always have the power to dictate pitiful working conditions and YOU ARE POWERLESS TO CHANGE IT.
6) When the situation is reversed (ie when they need to fill a shift) you have the power. Next time you're called by a HMO manager to fill a shift demand $200/hour. Or just say "no". When they laugh at your outrageous request for higher pay, tell them to get stuffed and hang up. You still have your day off, and they still have an empty roster. (I did this once and they called back a few hours later and paid me the $200/hour as they couldn't get anyone to do the shift). Or tell them to get the locum agency to call you. Why accept the lowest locum rates in the country (Victoria) to help a system that won't help you? Screw the HMO manager, they're earning double what you are and the biggest challenge they'll ever face is filling an empty box on an Excel spreadsheet. Compare that to your usual day at work.
7) VOTE WITH YOUR FEET. Why risk being driven to suicide (as some of our colleagues have been) or depression, or hypertension, or tears, or realtionship breakups? (Heard of any HMO managers or CEO's killing themselves recently because of their job stress?) Why not just pick up and move interstate? Wouldn't you rather have better conditions, better pay, less ill-effects on your health and realtionships, plus better weather, and then fly back to Melbourne once a month to see your friends and family? Do you really see them that often anyway? Get Skype and you can video-chat with them every night, for free!
8) THE PATIENTS WILL BE FINE. Don't ever let the guilt of the "but what about the patients?" lobby guilt trip you into accepting substandard conditions. While the public wants free healthcare, then they will get a crap system. If they want to pay more, then they will get a better system. It's no use whining about how little you're getting paid - the money has to come from somewhere, and as long as the public refuses to pay more for public healthcare, then your salary will NEVER go up. I can't stand to hear people say "patients are consumers these days" and they "have the same rights as consumers". I'm sorry but that is bullshit. If they are consumers then let them pay market rates for my services. And make them pay for proper equipment and facilities for me to treat them in. As long as we live in a society where healthcare is seen as a "right", but where people aren't willing to pay for it, then YOUR SALARY WILL NEVER GO UP, AND YOUR WORK CONDITIONS WILL NEVER IMPROVE.
9) "I can't leave as it will just increase the stress on my colleagues". Don't let the fact that your colleagues are too apathetic to get out make you feel bad for leaving. If they had any brains they'd be doing it as well. YOU OWE THEM NOTHING as it's their continued acceptance of piss-poor working conditions that continues to make your work so difficult. Just look after "number 1" (ie yourself) and let the system fall down around the fools who choose to stay. Or let your boss (who I guarantee earns a least $250-500K p.a.) come in on their day off to write discharge summaries. After all, they created this mess.
10)No private company would treat equivalently educated, trained and skillful employees as badly as public hospital doctors are treated. Anyone else with equivalent qualifications in the private sector would start on a 6-figure salary, with a phone and a car, and as they progressed they'd get a designated car-park, a personal assistant, a laptop, their own office, free lunches & dinners, and overseas trips for professional development, as well as performance and end-of-year bonuses and if they didn't I'm sure they'd at least be able to, oh I don't know, maybe go to the toilet or eat something during their day at work. Unfortunately we don't even get these basic food and toilet privileges as public hospital doctors. Do you think prisoners in Victoria's (privately run) prisons would accept it if they weren't fed and weren't allowed to go to the toilet for 10-14 hours? There'd be riots... If patients want professional service THEN START TREATING AND PAYING US LIKE PROFESSIONALS (which as I've clearly explained, will never happen in our lifetimes...sigh). And on this point here's an anecdote: my sister is a corporate lawyer, last year her CHRISTMAS BONUS was more than my after-tax salary for the year... She writes contracts and I save lives...
11) IT IS ONLY GOING TO GET WORSE. Demand is going up and up, doctor number are going down... hmm I wonder why. How do they plan to fix it? By improving my conditions? Paying me what I'm worth and treating me like a valued employee so I'll stay? No. DHS has spent millions concocting plans to massively increase intern numbers (yet is providing no infrastructure to help supervise and train them... more cannon fodder) and is enticing foreign doctors with incentive packages including free health insurance, rent assistance and spousal employment assistance, (which I assume is cheaper than my currently unpaid overtime) yet most of us would actually stay in the system if they just improve a few of the conditions. Instead they intend to send more lambs to the slaughter, put more kerosene on the fire... pick your own analogy, it's all bad. For this DHS can go to hell, and so can the Victorian public for not supporting us. And they'll all get what they deserve, a crappily designed, dangerous system, run by incompetents, supervised and controlled by morons. Good luck.
My advice? VOTE WITH YOUR FEET. LET THE VICTORIAN PUBLIC HEALTH SYSTEM COLLAPSE. Your primary responsibility is to YOURSELF, NOT THE PATIENTS, NOT THE AMA, NOT YOUR COLLEAGUES AND CERTAINLY NOT THE HOSPITAL. Anyone that tries to convince you otherwise is either an agent of the system, or a delusional do-gooder who's too blinded by their "ethical duty" or some other crap to see what's really going on.
If you really want to stay then choose a specialty like Emergency (or even Anaesthetics) that lets you walk straight out of the public system as a consultant and start charging $200-$300 per hour as a locum or private ED specialist. You can earn $200,000-300,000 per year working 2 to 3 days a week, 8am til 6pm and never be on call. The system does not, has not and will never support you in the public system so why are you sacrificing so much of yourself for it?. Don't hold your breath for the EBA, because at the end of the day the AMA is a useless organisation, with no leverage and nothing to bargain with. Cancel your membership and with the money buy a few bottles of nice wine, you'll get more joy out of it, and it might make you feel better after a crap day at work (or you can use it to help with moving expenses, or to buy a new hammock in Darwin, Cairns, Perth, or wherever else you end up). GOOD LUCK!
Surely we have all had enough of the weekly AMA "media release" which is a repeat word for word, except for the name of the hospital whose Doctors are reportedly "slamming government EBA inaction".
As an Emergency Physician working in a busy metropolitan hospital, I share the frustrations of being comparatively underpaid (cf interstate colleagues), and overworked in a crumbling health system.
Surely the AMA should be slammed for not commencing EBA negotiations until the previous EBA has expired, for not negotiating back pay, and for not being adequately aggressive.
Well may the headlines read "AMA slammed for EBA inaction".
A strike is needed, and the time is now
Today a patient of ours died - because of the system. He was stuck in the emergency department in need of at least three critical care/acute services. We had not a spare bed in the hospital. No critical care, no ICU, no HDU, no Coronary Care bed for them to go to. They simply exceeded the care giving capacity of our system.
Mr Andrews will have us believe we have the most efficient hospitals in the country yet patients die or have treatments (both surgical and nonsurgical) cancelled daily. A component of our wage negotiation is productivity increase (from the govt) - Is this a case of having one's cake and eating it too? Wonderful spin Mr Andrews.... Perhaps you'll be here with me to tell the next angry family that I can't treat their relative today? No, of course you won't.
Does any other business in this world give the best computers to the receptionists. Trying to look at radiology on windows 95 is laughable.
What a disgrace that we already run the nations most efficient Emergency Departments and wards, we run our hospitals at or close to maximum capacity year-round, we all work thousands of hours of unpaid overtime a year, (saving the government tens of millions of dollars), and get paid less than anyone else in the country for doing it, and the government wants to introduce productivity conditions into our contracts!! The AMA and the government need to get a grip. I agree with the previous poster, if we can't strike, we should just leave, and let this sinking ship go down. With Daniel Andrews at the helm, we're all doomed.
It is extremely disappointing to see many of the comments here. They are clearly posted by GenYs who in their adult years have only experienced prosperous times and seen non medical colleagues' remuneration soar. If you entered medicine to earn a banking executives salary then change profession. We might experience the highs of prosperous times but we also don't plunge to the depths.As we enter what is likley to be the most difficlut economic period in the last 80 years be thankful you have a stable and well paid job- and start behaving like professionals rather than spoilt children.
To the joker who wrote this below; You are almost certainly the VMO who arrogantly fronts up the ward, pontificates and sniggers a bit then ponces off to private land to turf your 'too hard' or 'friday afternoon' cases into the public system. YOU are partly the reason this system is how it is - not standing up for it, yourself, or your patients in years gone by.
This isn't about banker's salaries- it's about the devaluation and lack of support for those GenX's and Y's who are STRUGGLING and FIGHTING to keep everything going so their patients may remain looked after as best as possible. Tell us which part of their issues are 'spoilt' - I'm seeing stressed, depressed, unsupported registrars and RMOs. I'm seeing people leaving the system that doesn't allow them to do THE JOB THEY ARE THERE TO DO (and no, treating people in corridors and pulling beds from their derriere's is not that job!). Your comment with respect to potentially difficult economic times ahead due to an international credit crisis is demeaning, insulting, and irrelevant.
"It is extremely disappointing to see many of the comments here. They are clearly posted by GenYs who in their adult years have only experienced prosperous times and seen non medical colleagues' remuneration soar. If you entered medicine to earn a banking executives salary then change profession. We might experience the highs of prosperous times but we also don't plunge to the depths.As we enter what is likley to be the most difficlut economic period in the last 80 years be thankful you have a stable and well paid job- and start behaving like professionals rather than spoilt children."
I am a junior Registrar working at Southern Health - another doctor completely dissatified with the current working conditions in Victorian Hospitals.
I find it a ludicrous and frankly insulting situation that the Government can:
a) instigate their own ministerial review into wages and conditions in Victorian public hospitals,
b) deliver the message that there are no incentives for doctors to work in the public system and then
c) pretend it never existed.
What happened to the Government's previous commitment to act upon this review prior to the end of the last EBA, let alone when negotiating this one? It is blatently apparent that the Victorian Government views and treats Victorin doctors with absolute and complete contempt.
The state of play in the Victorian public health system is one of absolute and complete disarray:
- At least 25% of doctors in my year level are planning on leaving next year; I am one of these. Why would we continue to work hundreds of unpaid hours each year, be constantly pressured to work more shifts, work weekends, nights - all for an hourly rate that is surpassed by most waitresses (in fact family members of mine who are check-out staff at Aldi earn a higher hourly rate than junior doctors). My friends and I have realised that we can cross the border and earn a significantly higher wage with better conditions. Already this year, Southern Health is so understaffed (due to doctor resignations) that the Manager of Acute Programs puts out regular "crisis emails" and cries for help, asking if staff will work extra shifts in any field of medicine to meet the shortfall in staff.
- I wonder if Mr. Brumby would be content to earn $25 per hour to be regularly abused - both verbally and physically - as a regular part of his job, by both patients and their families. I wonder if he would be happy to accept working conditions and facilities that he expects junior doctors to?
- Mr. Brumby thinks it is perfectly acceptable to spend hundreds of thousands of tax payer dollars on overseas junkets, to sponsor public servents to complete fully-funded masters degrees or post-graduate qalifications, yet expects Victorian doctors to pay what amounts to tens of thousands of dollars each in compulsary post-graduate medical training expenses... to gain essential skills that will only benefit the health system
- The Victorian Government constantly fail to realise that the public health system continues in its current form ONLY because doctors perform so many unpaid hours, often with incredible stress and pressure placed upon them to stay even longer. 14 hours rostered shifts inevitably last for 16 or 17 hours. If doctors ever actually got the pay they are enetitlement to then hospital budgets would be catastrophically blown out. And then the Government have the audacity to request further "productivity clauses". It is unsafe; it is illegal; it puts patients at risk and it creates a deplorable work environment.
- I strongly believe all Labor ministers should make a committment to give up their private health insurance and be treated in the system that they are apparently so happy with. Maybe if they or their family members were left waiting on trolleys in corridors for hours and hours because there are inadequate facilities and staffing levels there might actually be an impetus to change the system they expect their electorates to tolerate.
Despite all the Government rhetoric and talk of health spending increases, the fact of the matter is that the system IS in crisis and doctors ARE leaving in droves and will continue to leave Victorian public hospitals. This will continue for as long as the Labor Government clings to its denial, its head-in-the-sand approach, and its utter and complete contempt for Victorian Doctors.
My friends and I have frankly had enough. I will not be working in Victoria while the current situation continues, and this is a sentiment echoed by an amazingly high percentage of junior doctors.
Quit.
I am a baby boomer with the work ethic to match, but the Gen Y's are right and we were wrong.
I have spent 11 years as a specialist surgeon in a major regional centre trying to prop up the public system. I have come to the realisation that it is just not worth sacrificing my health and sanity.
For the first time in years I am happier in my Professional life: I have control over my hours, do the work I enjoy doing with less of the crap, and do not have to put up with public hospital health bureaucrats restricting my ability to treat my patients. I also get to see my wife and kids. I feel liberated!
anonymous's entry on October 4, 2008 4:55 PM is a 5 star comment. highly recommended.
it is so true that about this rhetorics regarding "patients as consumers" if they are then pay market price for it.
i want to ask "where is my training??"
Oh, when the medical system is run by a bunch of managers and nurses how on earth is it going to run well?
look at the ward, the nurses are in charge. they close wards because "only 1 nurse for 4 patients"... what a joke. i don't see that ratio for doctors?
the complacency with the now bosses created the problem now we are facing. this is a lack of foresight from them. they only see what was happening then, not what will happen.
i am waiting for me training to finish and then say goodbye to the public system. afterall loyalty is earned, not granted. why should you be loyal to a system that does not value loyalty?
I like how people always defer to the universal justification for indifference - "Things used to be worse before, just shut up and quit whinging." By that lazy and convenient argument, does that mean we should just accept whatever horrible working conditions we're faced with, no matter the consequences? By that argument, should I just let patients die from sepsis since 100 years ago we didn't have antibiotics, so we shouldn't expect more now? Should I let a barber perform surgery on a patient since that was ye olde classical treatment? When we run out of cubicles shall we just use stretchers made out of bamboo and hemp and treat patients in the hallways? Hell there was less than that half a century ago, and hey, as far as I can tell, people were HAPPY TO HAVE IT.
There is NO logic to this argument. Imagine if your computers broke down and you took it to your IT guy and he said "well 100 years ago we didn't have computers so just shut up and live with it". Is that a satisfied outcome? Well I may not have much leverage to argue with whatever he says since he's probably earning more than me, and I have been well schooled in acceptance and resignation, what with the effective systematic attacks by hospital administration on my individuality and rights.
Another argument I love is "If we pay one overtime, the rest will want it, and then we'll be broke".
Sure, the lowliest paid employees of the hospital are the crippling cause of the failing health system. I know, imagine if interns demanded an extra $50 a day, 5 days a week, 52 weeks in a row, for 100 interns - that'd be like a million dollars!
Now let's review the national budget shall we - $3.2 billion on "revitalising the public health care system" including funding SUPER GP clinics (whatever that means), but a meagre paltry sum compared to, and I quote, "providing a $55 billion Working Families Support Package, which rewards families for their hard work and helps them cope with the rising costs of living."
Gee, will we ever get to see any of that $55 billion or what? I mean, I think I should be rewarded for my hard work too.
Talk about screwed up priorities. The reality is that providing safe healthcare costs money - and it's not because doctors are greedy, thieving, amoral creeps. It's because IT COSTS MONEY. Infrastructure is not just a word. It's beds, equipment, maintenance for the equipment (I tell you it's a real mood killer when the anasthetic machine breaks down right after the patient is tubed), etc. THEN COMES STAFF, and we're a whole bunch of diverse employees, ranging from orderlies to consultants.
Of course I can't speak for all doctors, since lowly junior staff are quite different from the lofty consultants. But we, junior doctors (whose "junior" career can last years from internship up to senior registrar levels), simply want to be valued as professionals, not just financially, but as people. We hardly have time to tend to matters of continence and feeding, let alone to our family members, some of whom are young children that we will not watch grow up thanks to our 12-15 hour days. We have lost all sense of our own personal selves, and are meager coolies, lowly subjects of hospital administrators who are wholly incompetent to perform their jobs - most of whom have ZERO understanding of our clinical environment.
By the way, lest I forget to mention, it's really satisfying and fulfilling that at the end of a gut busting and heart wrenching work day that stretches up to 15 hours (which is incidentally also the stretching limit of your bladder wall), and somehow magically placating some utterly unrealistic expectations of demanding patients and their families (sure, we have the occasional nice ones too. The ones who, on their wrongful deathbed, still tell you "I'm sure you did everything you could Doctor, and so did Mr Brumby"), you hand in your timesheet and get rewarded with "Well no one told you to do that, you could have just handed it over."
The word "handover", being of course, a mysterious magical self-solving term used by adminstrators as a way of neatly lining up all those Excel spreadsheet cells. Even if the next person coming on duty has no idea about a particular patient's complicated medicopsychosocial history (in GenY medical terms) or the rapport we have developed with his/her family and has about 50 other complex patients to sort out, just .... handover.
Egads! We're just excel cells! We're no longer human!
Let's not even bother negotiating training time, an important aspect of the medical profession and I think the public would like to agree, unless of course keeping doctors up to date with higher education is not important since there are only about 3 drugs in the world (Endone, Stilnox and Valium) and no one needs to keep up with the latest recommendations for management of medical problems, proven by a plethora of studies and trials. Hell what am I saying, continuing education is just for our own egoistic self fulfillment, I mean we simply can't get enough of cheap lunches and lectures, there is no long term benefit in it and back to our original argument, 100 years ago there was no such thing as continuing medical education - so who cares!
--
I don't care what living costs or conditions were 50-100 years ago, it does not dictate how we should live now. How can anyone claim junior doctors are behaving like spoiled children when interns get paid $23.90/hour and are not even renumerated for the 2-8 hours overtime that we have to do everyday to ensure quality patient care, not to mention the 12 hours without food or toilet privileges? Call us anything you like, but whatever we are, we are definitely NOT spoiled.
Just a bunch anonymous cowards who obviously have no power to fight for our own human rights.
The joker is Gen X and fulltime public hospital employee. I undratke no private work- not even a single locum shift. The public system is imperfect and frustrating but hey overall I'm happy enough.
I often wonder how the AMA actually present the case for doctors salary increases beyond CPI with a straight face.
As I said grow up boys and girls and get on with the job.
In reply to anonymous's post on October 4, 2008 4:55 PM.
I agree with your statement 100%!
I think AMA is useless despite how they potray themselves having "doing something". I am an AMA member currently and I have already think of stop renewing my membership for next year as the subscription few goes up and up and ALAS nothing is achieve.
Overwhelmingly the most disheartening experience for me and my junior Doctor friends has been when, despite all our efforts, the public hospital system has failed one of our patients. As idealistic final year medical students we thought we were moving into a system where the best medical care would be available to all. Then we slowly realised that, because the system was on the brink of collapse, occasionally a patient would not receive appropriate care, sometimes with devastating outcomes.
It is clear to anyone working on the front line that the public hospital system is being held together by the medical staff that work in it. Nursing and Allied health staff are also helping but it all really comes down to where the buck stops. And in the public system, but for a few exceptions like the Emergency Department (where everyone from interns to consultants are on the front line), it stops with the junior doctors. They are the people going the extra mile so patients get back into the community alive.
Sometimes I think we are all running around the hospitals with Gaffa tape madly trying to keep the whole thing from falling apart.
Pay is not that important to me. As one previous post so eloquently put it, "If you entered medicine to earn a banking executives salary then change profession." But patient care is. That IS why I entered medicine. All I want is to be able to offer patients good quality care inside the public system with out having to work 14 hours a day to achieve that.
Yes we need pay parity and CME allowances but what we really need is more hospital beds, more staff and better equipment. Teachers have maximum class sizes, Nurses has nurse to patient ratios but we have patient lists exceeding 30.
We need to campaign for a better system as well as for better pay. All the double time in the world will mean little the next time your patient dies because of an over stretched system.
email: blogger08(AT)internode.on.net
Médecins Sans Lits (MSL) - doctors without beds
To follow on from the previous post on bed access block, I thought it was timely to help ED staff cope with the crisis by changing their perceptions.
A lot of us would have liked to work with Médecins Sans Frontières (MSF) but our families oppose us on the grounds of safety and that perhaps their life insurance won’t cover us in such potentially hostile environments.
Well, here’s the silver lining in your clouds - YOU get to work in almost Third World conditions, having to treat patients without beds, in corridors with little or no privacy, and no end to the queues in sight, and little likelihood of timely access to proper operating theatres or ICU/CCU wards.
Yes that’s right, YOU can run your own mini-ICU and mini-CCU with only minimal support from inpatient units, and not only that, if you are lucky to be stuck in areas with a baby boom, you get to run a labour ward as well.
What’s more, you can do this in the comfort of a First World country and still see your family occasionally.
Of course, there may be some hostilities from those in the queue, but this just makes it all the more authentic for you.
Now if only we could get some Red Cross tents outside the ED to work in and we could have a real M.A.S.H. feel to it.
Be thankful for the blessings the governments have bestowed upon us and sleep well, and look forward to another day of challenges.
The ABC's Stateline program would like to talk to any doctors willing to tell their stories, as posted here,
please contact Jospephine Cafagna : cafagna.josephine@abc.net.au or 9626 1500
I have just read the comment from a blogger above:
"I hate my work and my hospital, I distrust my referring colleagues and have NO faith in those who are supposed to be my administrators/managers (particularly when our HMO management consists of untrained, wet-behind the ears twenty somethings who haven't the foggiest idea which end of a stethescope is which
My only advice to you is that you have the opportunity to get out now"
As a medical student-Stuff this for a game of soldiers. there's no way in hell you're going to get me in the public hospital treadmill game, slaughtering my youth and vitality for a brief shot at being a specialist.
Same blogger was right when they said: The hospital experience is only getting worse, not better. There are plenty of other professions that will gladly welcome and reward a high achieving, intelligent, articulate individual such as one who has the skills to enter, and complete a medical degree.
Especially with the medical tsunami coming through, this whole thig is goign to turn into a joke.
I would much rather 'smell the coffee' than live through what you guys are reporting and so with great efficiency will i enjoy joining the military, taking the carrot nice and early and simply waiting around for somebody to pay me the most as a private GP.
Don't care about the system. Will Travel
Relate this to the Mastercard advertisement:
HMO hourly rate to employ: $26/hour
Money saved without employing a registrar: $34/hour
Money saved without employing extra HMO and registrar: $60/hour
Money saved without employing a covering HMO at all when regular HMO call in sick: $75/hour
Mental and emotional trauma suffered by the covering HMO without any senior support and extra help since the administration thinks it is a good thing to minimize cost and maximize production: Priceless
For everything else: We can always save!
I must admit that I've been lurking this Blog for a few weeks, so I thought I better write something.
I am a 2nd yr GP Registrar now about 2 years out of the hospital system. My experiences during the 3years I was there were not as nightmarish as what many of you have documented here. Either things have got unfathomably worse or I must have been just lucky. Fortunately, GP life has been reasonable so far; I'm sure some of my fellow GP regs have had other experiences.
One thing that irks me is that abuse and criticism of junior staff by patients and their "support persons" (aka "consumers")is rampant. It seems they have no insight into the fact that many junior doctors are in less than optimal health themselves, and are frequently expected to deal with workloads and responsibility that is way beyond their skill and experience. Why should be bear the brunt of criticism for factors that are out of our control - such as the population explosion without corresponding growth in healthcare resources?
All this "consumer" is always right business is rubbish. They do themselves no favour by dishing out unfounded criticism. What next? A murder of a hospital doctor? Its happened to GPs and Psychiatrists recently.
How about these "consumers" actually accept some responsibility for making judicious use of a resource as strained as healthcare. There is so much preventable disease burden both acute and chronic. How about thinking twice before engaging in violence and substance abuse? How about actually being compliant with medical advice? How about thinking twice before contributing to population growth for the sake of the bloody "Baby Bonus"? I know, and pigs may fly...
We need to get the message across loud and clear to "consumers"
We need to get the message out loud and clear that the average junior doctor is not a happy camper (you would think thay would have figured that from Gray's Anatomy) and that all we are asking for is some understanding for our situation. The T-shirt campaign seems like a good idea and some posters around the place can't hurt.
I really do hope things improve for public hospital junior doctors.
Let's bust another myth
- the Health Minister crowing about every category one resus patient at triage being seen immediately. What rubbish! Most resus bays in ED are full 80-90% of the time, so there's nowhere to see these people in dire straits.
We had one last week - drug overdose, coma, and it took over ten minutes and a fight with a decent but over-worked nurse to put a category two patient out of resus & into the corridor so we had somewhere to treat the overdose.
I'm sure there are plenty of other examples, but the computers are designed to cook the figures.
To the media looking at this site, I would love to put my name and hospital/patient details here, but while working in the public makes me masochistic, I'm not suicidal.
Yesterday the Minister for Health was invited to respond to quotes taken from this blog site by the member for Doncaster, Ms Wooldridge. He implied that because many of the comments on this site are anonymous they are to be doubted.
How completely out of touch with Victoria’s doctors he is if he doesn’t realise why they require anonymity. Speaking out in any workplace is risky, but for doctors – especially junior ones – can be career suicide. The blog offers doctors an opportunity to voice their concerns without fear. That there are so many entries, and that they are all saying the same thing, should be ringing alarm bells for the government. Dismissing these comments because they are anonymous is a grave mistake.
As an intern who has worked at several Victorian hospitals, I sadly have to inform the Minister that the stories being told on this site are all too true. And these are just the tip of the iceberg. These stories represent the reality that doctors across Victoria face every single day.
Victoria’s public hospital system is not on the verge of a crisis; it is already in crisis. And the Minister’s own review, conducted ten months ago, told him exactly that. The bottom line is that the system desperately needs more money. A lot more money. Simple as that.
Hospitals CEOs are under monumental pressures to adhere to unrealistic budgets, and this pressure is inevitably borne by hospital staff. It is felt particularly acutely by the most vulnerable and powerless doctors – the doctors in training. Hospital managers are expected to perform miracles by finding ways to get more work out of junior doctors for less money. Doctors in training are forced into working too many hours, being responsible for far too many patients, and to perform jobs that they may not have the necessary skills or supervision to do safely.
Disgruntled senior staff are leaving – either to move interstate or into the private system. The remaining senior staff are further stretched for time, resulting in more even work and less supervision and training for junior staff.
Many of the hours worked by doctors in training go unpaid, either because they are expressly refused claims for overtime payments, or they are bullied into not even submitting claims. And for the hours that they are paid, they have to accept the lowest pay in the country. By a long way.
Doctors in training are overworked, underpaid, and feel undervalued by their hospitals, the government and the public.
No wonder morale is low. No wonder patients and their families get angry. No wonder doctors are leaving.
It scares me to think what it’s going to take to get the government to act. Patients are already suffering. They are already dying.
If the Minister for Health would like to verify any of these stories, I’d suggest he visit any of Victoria’s public hospitals and have a chat to the junior doctors. We have no shortage of horror stories for him.
Dr Sarah Mansfield
My friends,
We have two things on our side.
1. Law
2. Truth
We must use these to our advantage to improve public hospital working conditions. Let me elaborate:
1. Law:
A lot of you have complained about non-compliance with payment of unrostered overtime. Did you know that Victorian doctors in training have a unique privilege under federal law regarding authorisation of unrostered overtime? When there is no one available to prospectively authorise it (ie no one we can ask, prior to undertaking the unrostered overtime, whether or not we are “allowed” to incur it), the doctor in training is entitled to self-authorise it so long as it is due to a demonstrable clinical need and that need could not have been met by some other means (such as handing over, which is often not feasible as outlined below). A senior doctor must review the claim within 14 days of submission for auditing purposes but may not refuse to pay if the above two criteria are met.
Furthermore, rosters must include all routinely worked hours including theatre preparation, ward rounds and completing discharge summaries. If less than 95% of routinely worked hours are rostered, the roster is illegal. This means that if you are needing to do more than 30 minutes overtime on average per day the roster is illegal. Almost all overtime should be incorporated into the roster by law. It should be on rare occasions only that unrostered overtime is required.
I have it on authority from one hospital’s administration that there is a plan amongst hospitals Melbourne-wide to employ extra doctors over the next few years to reduce rostered overtime for each doctor. This is commendable and will be necessary to incorporate the large increase in the number of graduates. However, there will be no increase in the total number of rostered HMO hours per week. Instead of afternoons off, junior doctors will randomly be rostered whole days off; the other doctors will be expected to do a ward round on their patients in the morning in addition to covering them in the afternoon. This reduction in continuity of care reduces efficiency and therefore requires a compensatory increase in the number of rostered hours overall; otherwise there will (unlawfully) be a further rise in unrostered overtime. However, hospitals have no intention to provide a compensatory increase in rostered hours. Hospital administration thinks that we are shiftable commodities. We are not. We as residents, interns and registrars provide continuity of care which is critical for reducing preventable medical errors (which as we know are already rife), anticipating problems before they arise and thereby shortening inpatient stays. However, administration has only one aim in mind: to reduce expenditure on us. I know of several hospitals where these new roster types have been implemented and they are a hopeless failure. Junior doctors hate them and are more disgruntled than ever.
If you are unfortunate enough to find yourself on such a roster already (indeed no matter what sort of roster you are on), if you are doing more than half an hour overtime per day, claim your overtime. After all, the hospital is forcing you to claim it because it hasn’t rostered you enough hours. If they don’t pay, speak to AMA. AMA cannot act without a mandate from you, the AMA member. AMA has had fantastic wins with hospital overtime compliance over the last few years. And irrespective of whether the hospital pays, insist that the unrostered overtime be rostered. Otherwise the roster is illegal and AMA will be only too happy to assist in helping the hospital to comply with the law.
No one wants to have to claim unrostered overtime. No one wants to do any unrostered overtime, nor indeed rostered overtime. We are not greedy. We want justice. When within half an hour of arrival at work your stress hormones and blood pressure have tripled and you can already see that getting out at 5pm is a nonsense, you want someone to take responsibility. We have no control over the amount of work presented to us each day. And if we don’t get the work done today, it will still be there tomorrow and then we won’t have time to do tomorrow’s work. Our patients won’t get better and we will accumulate more and more instead of discharging them until we have fifty unsorted patients. Then patients will start dying. So don’t tell me “we won’t pay this because you could have just handed it over”. Be honest. You won’t pay because then you can pretend there is no problem. After all, your only concern is making the balance sheet even. It is only when you have to pay that you realise, “Hey, there is a problem here; maybe we should try to fix it”. When we do not hand over, it is because it is unrealistic and unsafe to hand over so much to an already stressed, overburdened covering intern or resident.
Fellow junior doctors, if you are thinking of deserting the Victorian public hospital system for greener pastures, as so many of you already have and so many more are clearly intending on doing, go out with a bang, not a whimper. What have you got to lose by insisting on your legal rights? The worst that could happen is you won’t be reemployed next year. Their loss! You go interstate and get an extra 30% income and vastly improved working conditions. But you know what? I think you'll find the hospital will grant you your rights and will reemploy you because it knows it is acting both unlawfully and unfairly and it is desperate for medical staff.
2. Truth
We all know that the Victorian public hospital system is in crisis. We see it every day. How can we use this truth to our advantage? Simple: accountability.
I read the Your Hospitals Report and laugh. 80% of patients who present to ED and require admission should be transferred to the ward within eight hours. I have worked in Victorian public hospitals which almost meet this benchmark. Considering that the statewide average is 67% (a definite fail), one would assume that these particular hospitals are doing something right. But these hospitals cheat. They send the patients to the ward before they have even had their admission paperwork, including drug chart, written up! The poor ward doctors from the admitting unit are so snowed under with ward work that it is ANOTHER 3, 4, 5, 6, 7, 8, 12 hours before they can even see the new patients! At any one time there might be four new patients sitting on the ward without any paperwork waiting for the admitting unit medical staff to see them. I feel sorry for the 80 year old Mrs Smiths who arrive sick at the emergency department every day at 9am, get transferred to the ward at 4:30pm but have to be woken up at 2am to have a full history and examination performed by the stressed, overworked night resident who has another twelve admissions to get through because the day residents, despite each doing six hours unrostered unpaid overtime, had no time to do them. Considering a decent medical admission takes about 1.5 hours to complete and write up, it is a miracle that the night resident manages to squeeze these thirteen admissions into eleven hours, as well as insert countless drips and rechart the endless fluid orders for the other sixty patients. The criminal part is, these very hospitals employ enough doctors to do the job but because they only roster each resident bare minimum hours, and because they randomly roster each resident off one day each week, thus severely compromising continuity of care, it is simply not possible to finish the work within rostered hours. And when we try to claim unrostered overtime, administration gets angry with us.
According to the Your Hospitals Report, “the purpose of the targets is to drive performance and improve achievements of these standards”. Considering that without a drug chart the nurses cannot prescribe any drugs to the patient, I would suggest that it is reasonable for the public to expect that a patient be seen by a member of the admitting team and have their admission paperwork including drug chart and fluid orders completed within eight hours of arrival at ED. The following definition is in place currently:
Number of patients transferred from emergency departments to hospital beds within 8 hours.
22.4 Definition:
(a) ED patients transferred to an inpatient bed – this means ED patients whose departure status indicates they were admitted to a ward, short stay observation unit, emergency medical unit, medical assessment and planning unit, intensive care bed, mental health bed, or coronary care unit (departure status codes 03, 13, 14, 15, 16, 18 or 22).
(b) ED patients transferred to an inpatient bed within 8 hours - where the interval between the patient’s arrival (date and time) and their departure (date and time) from the ED to the inpatient bed is less than or equal to 8 hours.
I propose that part (b) be changed to the following:
(b) ED patients have admission notes, drug chart and, if necessary, fluid orders, completed by a doctor from the admitting unit (or, if after hours, the doctor rostered to cover the admitting unit’s patients) within 8 hours AND be transferred to an inpatient bed within 8 hours – where BOTH the interval between the patient’s arrival (date and time) and completion of paperwork (date and time) is less than or equal to 8 hours AND the interval between the patient’s arrival (date and time) and their departure (date and time) from the ED to the inpatient bed is less than or equal to 8 hours.
This is clinically a more meaningful target. If I were to present to an ED, I would prefer to be seen by a member of my treating team within eight hours of arrival and be stuck in the cubicle for sixteen hours than to go up to the ward within eight hours and have to wait sixteen hours to be seen by a member of my treating team. And DHS cannot argue initial stabilisation of the patient has already occurred in ED so therefore an extra eight hour wait is acceptable. Emergency department assessments are often grossly inadequate as ED doctors are overstretched themselves trying to discharge too many ED patients within four hours. One woman of childbearing age with lower abdominal pain and PV bleeding was sent to the ward by ED without a pregnancy test! She was handed over to the ward resident as “likely bleeding endometrial polyp”. The poor resident had to exclude a life-threatening ectopic pregnancy on the ward at 3am when she eventually got around to admitting her. Turns out the pregnancy test was positive! Thankfully she was “just” having a miscarriage. Another time the same night resident was required to admit an elderly patient with digoxin toxicity. ED hadn't looked at the ECG; when the resident finally got around to admitting the patient and looked at the ECG, she realised the patient was having a STEMI (life-threatening heart attack). Of course the quality of ED assessment varies immensely from hospital to hospital but this sort of thing happens way too often for DHS to make the claim that ED has stabilised the patient. Nor is it the ED doctor’s responsibility to complete the admission paperwork: the ED doctor has enough work to do already and the doctor from the admitting unit or covering it needs to assess the patient and document a comprehensive plan as they are the ones who will assume subsequent care of the patient. The ED doctor must NOT be required to write the drug chart. This is solely the responsibility of the doctor from the admitting unit (or covering the admitting unit) as writing it up requires a detailed, thorough assessment and understanding of the patient's history which the ED doctor does not have time for. Nor does the ED doctor necessarily have the requisite knowledge to write up the drug chart for certain specialised admissions.
I am not for a moment suggesting that the patient must have their admission paperwork completed before being sent to the ward. If they are truly medically stable and there is an urgent need for an ED cubicle and an available ward bed, by all means send the patient to the ward, but the admitting unit must have capacity to see and formally admit the patient promptly and within eight hours of arrival at ED. The person to provide feedback to the hospital on time between arrival and paperwork completion time is the doctor who completed the admission paperwork. Otherwise we will have other well-meaning but misguided staff members fudging the figures to make the hospital more money as we know already happens.
There is a poisonous relationship between hospital administration and junior doctors. Administration considers junior doctors as merely extra expenditure which it tries to minimise. We are considered fortunate to be given the privilege of working within the hospital’s hallowed walls, training to become fully-fledged consultants. I frankly can’t remember the last time I had an informal tutorial as a “doctor-in-training”. There is no time, neither for the consultants nor for us. “Doctor-in-survival-mode” would be more accurate. And how are we to study when we have to do three or four hours of unpaid overtime every night just to keep the hospital functioning? How will we ever pass our specialty exams? However, with my proposed definition change, administration would have to publish very embarrassing data. I know of one hospital whose success rate admitting ED patients on time would drop from near 80% to less than 10% with my definition. Therefore, administration would have to ensure adequate ward doctors are employed in order for us to have capacity to assess a new ED patient promptly. This would subvert the Melbourne-wide hospitals’ future plans to roster us inadequate hours and force us to claim unrostered overtime as mentioned above. It would increase our ability to get home on time, improve job satisfaction and, most importantly, lead to much improved patient outcomes.
I have mentioned my proposal to AMA and they will be arguing vehemently for it next time they meet DHS.
Mr Andrews, minister for health, let’s not pretend you’re not reading this. The public hospital system is in crisis and you know it. We are well aware that the Labor government now spends much more than the Kennett government did on public hospitals. However, anyone who has worked in public hospitals from the 90s til now will tell you that things were better in the 90s. And I thought Labor was supposed to be better at managing health than the Liberals!
You are privileged to be in a position to solve the problem and are entrusted by the public to do so. From a junior doctor perspective, I offer the following suggestions.
1. Improve both patient care and accountability of public hospitals for their management of junior doctors by changing the definition of time taken to transfer patients from ED to the ward, for the purposes of the Your Hospitals Report, to require that, in addition, admission paperwork has been completed by the admitting unit doctor within eight hours of arrival in at least 80% of cases, as outlined above.
2. Follow the recommendations of the ministerial review and AMA for the purposes of the enterprise bargaining agreement. We do not want better wages and working conditions because we’re greedy. We want better wages and working conditions because we want to stem the tide of doctors leaving Victoria. We want better wages and working conditions to help Victoria to attract more medical candidates from interstate. We want better wages and working conditions to ensure greater doctor retention, improved morale and healthier competition for specialist and GP training programmes. We want these things because the Victorian public want and deserve only the very best public hospital doctors.
I am a medical registrar at a major tertiary hospital in Melbourne. I have a suggestion for how we can bring more attention to the state of health in Victorian public hospitals, as well as to the working conditions of the residents and registrars working in them.
Each hospital has an HMO society, and one of their functions is to provide a voice to the doctors working in them. Collectively, these societies represent the majority of the Victorian HMOs.
An accurate and thoughtful letter outlining all of our concerns (many of which have been discussed in this blog) could be sent through the heads of the HMO societies, which can be signed by all the residents and registrars who agree with it. Essentially this will act as a petition, which we can present to the state government. At the same time this should presented at a press conference with HMO society representation from each hospital present. This united front will establish the depth of the concerns we have, as well as ensuring that no individual doctor can be singled out by the hospital administration with potential adverse effects on their careers.
I work as a senior surgical registrar in a tertiary teaching hospital. The staff work extremely hard to avoid cancelling patients, but regularly run into non-theatre related capacity constraints which delay theatre starts, create strain between members of the team and cost huge amounts of money in wages for underutilised staff. The example below is typical:
Last Wednesday, we were informed that due to lack of nursing staff on the wards, we didn't have beds for any surgical patients requiring an overnight stay. Frantic phone calls ensued to bring in afternoon patients earlier to try to keep the list flowing - without any effect. We had a ninety minute break in our operating list before a bed was found for our patient - a gentleman with a rapidly progressive malignancy involving his neck lymph nodes and the only urgent case on our list. Our list finished ninety minutes late for the day - a huge cost in overtime for the hospital.
This example did not result in surgical cancellations, adverse patient outcomes or any other event that would routinely generate further investigation. However, it is but one example of the constant 'sub-crisis' generated by operating a system that is permanently at capacity, with no ability to incorporate perfectly predicatable fluctuations in demand. I see it every week in theatre, in outpatients and when I do routine ward rounds in the emergency department for patients bed-blocked from ward beds.
As a registrar working in a tertiary hospital I can definately agree with almost all the factual statements above.
Truth is
Hospitals are running at >90-95 % capacity. Average waiting times before patients were being transferred to ED hover around 20 hours. This represents the on record time. Actual times before patients get a ward bed to look after them would be higher because of innovative use of "short stay" / day treatment rooms etc
Patients are terribly mismanaged in ED. Not that they do not have good doctors; but they are all pressurised by they seniors to achieve a larger turnover..> Most doctors would NOT trust their own emergency departments.
Hospitals are losing consultants to private system. I have seen few (2) very good consultants leave this department here secondary to poor working conditions and lack of support from staff.
You also hear stories about someone who set, established and run an intensive care unit from scratch for >30 years being given the boot by the hsopital as they could not afford paying this wonderful teacher .1 / .2 FTE. He was well known for using windows as whiteboards and his ward rounds used to last for really long hours (teaching)
With more and more teaching staff saying goodbye to public hospitals the standard of care is bound to decline.
In todays public hospitals it is all about meeting targets / DRG's and revenue earned / patient in the shortest time possible. How to obtain more and quick discharges....which sometimes does compromise patient care.
All this may work with a staff with high morale. But a staff which is underpaid; has to struggle to get overtime paid ; has no access to teaching time / training time (which is essence is cheating by hospitals) is unlikely to be able to help this government get through this on going crisis
devbron@yahoo.co.uk
In reply to comment on October 11, 2008 9:49 PM.
Regarding Law - Who would be silly enough to make a stand and threaten their hospital administration with the AMA. Most likely compromising their career ?!?!??! You'd have to be mad. We're between a rock & a hard plate, and the government KNOWS this and is happy to sit on its hands.
As a registrar working in mental health, it is immensely frustrating to see what the lack of resources are doing. Patients wait inhumanely on emergency trolleys for non-existent beds whilst community teams are stretched beyond their limit and only able to focus on crisis work instead of preventative and proactive work. Victorians are therefore missing out on services and this is a recipe for negative outcomes. Doctors are paid less than interstate, work unpaid overtime, are not respected, are pressured to work longer/unsafe hours to cover gaps further destroying morale and causing further burnout that leads to more doctors leaving the system; on top of this patient care suffers from chronic understaffing and loss of skilled staff.
I think that the Brumby/Andrews government are certainly at a crossroads - they can decide to make a significant but worthwhile change to rescue the health system or they can stand back and watch what was once the country's best health system become the worst - and all of us as Victorians, will suffer the consequences of their inaction.
Minister, wake up.
We have reviews, reports, statistics and stories. There are (at this point in time) 92 of them above this one. This is just a small glimpse at the sentiment being expressed in public hospitals everyday.
As a junior doctor this year, I have been spat at, had punches thrown at me, been verbally abused by patients and their families. I take this as (a regrettable) part of the job.
What I simply can't stand is the consistent lack of disrespect I'm showed by hospital administration, and the Government of this state.
Junior Doctors are bullied into working unpaid overtime.
Educational support for junior doctors is a farce.
Supervision is substandard.
Working conditions are poor.
Patient safety is at risk.
Victorians are worse off, everyday.
Minister, are you comfortable with how things are going???
why do so many colleagues not write down their overtime and then whinge about not getting paid enough?
even if the hospital claims not to pay overtime - if you write it down and they don't pay up, they will be getting huge fines; and that's not what they will tolerate.....
If you don't get your 5 hours of PROTECTED training time - write it down as overtime - you can actually study at home, you know
Stop whinging - start using your rights!!!
Could we get tv/radio/newspaper advertising?
The teachers nurses had ads that were widely viewed and increased public awareness.
As a new specialist this is typical of the State Government......Victoria should be leading the way not lagging behind...we are a compact state with many services centralised.....and therefore we should be able to attract better doctors and keep them with better pay and conditions...The way teh department treats training or registrars is a joke- particularly surgical ones. This is all about "bums on seats" for them- they have no commitment to DIT.
As for nes specialists eager to operate or consult and reduce waiting lits whilst private practice is slow- the state government has NO PLAN_ there should be extra lists in the firs 6 moths of each year to target waiting lists and help new specialits. Th elack of organisation and lack of commitment to patients is only making matters worse.
I am glad I am still overseas...I am watching the debate closing- my commitment to the public is dwindling each day..
The stall tactics of the goverment are designed perfectly for the public to perceive us as greedy and to make us feel that way....the "Award" has never been upheld...take a look at the flats in country hospitals...the AMA ratings have done nothing and we struggle to attract doctors there...and they wonder why? A positive experience means a good job and a good living environment...when will they learn???
re: October 4, 2008 4:55 PM.
Hi mates,
I could write a lot - instead I choose to say that I (almost) COMPLETELY AGREE with my colleague, who posted above comment.
Yes, it's all been said already.
Lets stop going in circles and do something or just leave and find a betetr job elswhere.
One thing I disagree though: We DO HAVE THE POWER to change the system. We CAN strike and we can strike effectively. The trouble is, we don't have a lobby to organise all this and we all know how useful AMA is...
So - leave, after all??
regards,
Doc1
I work in the area of mental health. The demand is increasing , I think due to the amount of amphetamine consumed and perhaps the better community literacy about mental health and in my geographical by the massive increase in population. This should mean an expansion revenue and of services but is not reflected in the frontline staffing. The expectations of managers to fulfil the unealistic KPIs set by a financially straitened DHS is driving worst practice (eg discharging dangerous community treated patients to GPs, discharging inpatients without regard to issues such as accommodation (without which little in the way of follow up can be provided). Staffing of HMO jobs is by overseas trained doctors largely, who do their best but are overworked and underpaid. They have to work in the public system under their registration. The network of 3 hospitals where I work is understaffed by 15 HMO's but by getting by understaffed, the hosptial is balancing the budget so there is little incentive to fully staff.
There is alot of sick leave taken and I believe that this reflects the morale of junior doctors. There is a high rate of turnover and many of the overseas trained doctors, once trained up have left to go interstate for better pay and conditions.
It appears false economy to me as it is expensive to use agencies to scout for overseas graduates , expensive everytime a new employee is hired and orientated and expensive to have sick, underfunctioning doctors.
Provision of reasonable pay and conditions and adequate staffing might lead to better efficiency and in hte long run be cheaper.
I am an intern in a major Melbourne hospital.
We are paid $23 an hour.
We work 70 hour weeks but are paid for 50.
When we ask administration why we are paid from 8am, not 6am when ward round starts, we are told that they "don't support unsafe work hours" hence refuse to pay the overtime.
However, "unsafe work hours" are conveniently forgotten when we are asked to back up day shifts with night duty at only a few hours notice. We all know that refusing will hinder our chances of re-employment.
In the evening and on weekends, we see ratios of one doctor to over 130 patients.
Due to a number of resignations, registrars are being replaced with residents, and residents with interns or overseas trained doctors, some of whom are incapable even of ordering a chest x-ray and performing iv cannulation.
No wonder we are moving interstate.
WHY ARE WE NOT RECEIVING ANY NEGOTIATION UPDATES FOR OVER A MONTH????
What's with the delayed EBA negotiations? They cancelled the last one ages ago because a few of the state govt representatives didn't attend because they were "sick". Yeah right. I'm shocked and horrified that responsible adults representing the govt can be allowed to just chicken out like that?
It is time to realise that the AMA is powerless against the state government.
Not only is the health system weak, the AMA is feeble ( I am a member and have submitted over the years with little response to all issues of overtime, attracting doctors to the country etc) ...we should go down the pathway of NSW and all join t a Public Sector Union... at least then the OH and S issues will be on the radar- lead gowns from the 1950s in most hospitals, understaffing of junior doctors in day and especially overnight in hospitals....
the public do not even understand that a "greedy" VMO could earn the whole public list's worth in 20 min in the private and GET THANKED! instead of beating their head against the wall... so why do we do the 10% income for 90% headaches- because we CARE- about patients, teaching and maintaining a system that trained us...successive governments have taken this CARE and ABUSED it and USED it against us - to minimise our wages, reneg on demands, delay negotiations with no back pay, make useless threats about situations such as talk of commercial rent for properties in the country....when the AMA and dpctors rate these places as toilets.... to make us look evil in the public eye.... This whole process is a joke ad a merry go round that we always LOSE on. The media hammered Kennett over patients on trolleys.....Bracks "I am looking into it" was supposed to fix it... but things our now worse and we here NOTHING..NOTHING... the left media should wake up and report it even if it leads to a change...but I suspect the liberals would do no better....unless they decide to understand the way life is.
I am leaving a post this morning because I am absolutely furious. I have just told a man he has been cancelled for the third time because of a lack of ICU beds. A more urgent case has been put ahead of him. This is completely appropriate - the more urgent patient was admitted yesterday and while waiting for operating time has deteriorated significantly - however it is infuriating the system has no capacity for even the smallest increased in workload - the system and the staff are pushed beyond the limit everyday. The state of the hospital and the working conditions for the staff are appalling. I sympathize with my colleagues leaving for the north for a better lifestyle and better working conditions.
Having worked in the Emergency Department of a tertiary hosptial for many years, there is no doubt that the conditions onder which we work are deteriorating. We are seeing increasing numbers of patients with decreasing bed-stock. Our figures are fudged, phantom wards are created, patients are moved to inappropriate wards/ corridors and waitng rooms just so the numbers look impressive. I have absolutely no doubt that what I am doing on a daily basis puts patients ( and my career) at risk, but I am forced into taking short cuts because there is another 3 patients on ambulance trolleys and another 20 or 30 in the waitng room. But the message gets filtered as it goes up the tree to admin and then to DHS and then to the minister. No wonder he thinks that GP superclinics and nurse hot-lines are the solution. The message that needs to be heard loud and clear is that people are dying because of poor access to appropriate health care! We can provide an excellent health service; it's just that this government will not let us.
QLD HEATH ALL THE WAY
QLD HEALTH WHAT THEY OFFER
Resident Medical Officers (inc. Registrars)
Research, Training and Education opportunities
Comprehensive indemnity cover
Additional incentives to practice in rural and remote locations
Salary sacrifice arrangements
38 hour week with overtime provisions (variable)
17.5% annual leave loading
Up to 12.75% employer superannuation
On call allowances (variable)
Four (4) weeks paid annual leave with option to purchase up to six (6) additional annual leave per year (subject to service delivery requirements)
Twelve (12) weeks paid maternity leave (with half pay option)
Vocational Training Subsidy of $1,500 per annum for Resident Medical Officers who confirm their acceptance and remain in a vocational training program
Professional Development Leave accruable at one (1) week per year (up to a maximum accrual of two years)
Exam leave
Other items provided by Queensland Health that vary with location are:
Relocation costs
Accommodation
Phone
Rates of Pay 140% that of Victoria
QLD, Beautiful one day, Perfect the next. It pays to be there
Living in Queensland
Queensland welcomes people from interstate and overseas with ideas, skills and initiative to share a quality of life that ranks with the best in the world. A relaxed lifestyle, affordable homes and easy commuting make Queensland one of Australia's most attractive places to live and work.
With up-to-date technology and services, the lowest taxes in Australia and plenty of space to develop and expand, Queensland is the preferred location for many new arrivals each year.
The people of Queensland enjoy an outdoor lifestyle with world class beaches and waterways, national parks, rainforests and tropical reefs. Our pleasant climate (average summer temperatures of 25 degrees Celsius, average winter temperatures of 15 degrees Celsius) means that Queenslanders enjoy more winter sunshine and warmth than most other Australian states.
Queensland's enviable lifestyle ensures that its current population of over 4 million continues to grow and prosper
Where else but Queensland
i'm a second year hmo in a major metropolitan teaching hospital and i'm nearly at breaking point.
the hours, stress and disrespect shown to me are too much. to top it all off i can hardly make ends meet on my salary, when i have hundreds if not thousands of dollars to pay for college fees, compulsory EMST, ASSET, CCrISP courses etc.
our hospital executive recently sent around an email saying that for any unrostered overtime, we need to have permission from the head of department or executive themselves. i previosuly had the same problem at another hospital and when i kicked up a stink about my $10,000 of unpaid overtime i was not offered a job for the next year. i know that if i fight for my overtime here i'll get a bad reference and my career prospects will be destroyed.
i'm seriously considering leaving the public system and working as a locum for some decent pay.
Alright everyone, so we've all complained and we all know what it is like.
I propose that we now start discussing action and ways to start bringing about change. Forget the AMA, they don't update the talks with the government and are just not going to have the effect that industrial action will. The ANF was useless, and it was only after industrial action that the nurses got their way.
SUGGESTIONS PLEASE ABOUT WHAT WE CAN START DOING - RE. INDUSTRIAL ACTION. NOW IS THE TIME TO HAVE YOUR SAY ABOUT WHAT WE CAN PHYSICALLY DO TO BRING ABOUT CHANGE
? Strike,
? Refuse to be on call
? Admissions ONLY through Emergency?
? Give a verbal handover to GPs about patients, but do not sign/authorize a discharge summary? (you can still complete it, but just not authorize it).
I have posted in here once already (haha - anon quoted in the paper!).
In WA where I did my training and basic residency, the AMA is apparently a registered union. True or not, they actually were very effective at EBA negotiations, and JMS and SMS negotations were separate processes.
CME entitlements for colleagues in my speciality are something between $8000-9000, which in my speciality is about the minimum training cost before considering books and other things.
I rather like the idea of setting up a proper medical union.
Dear Minister Andrews,
The public hospital system is in crisis. It is preposterous to suggest, as you do, that, in negotiating the new EBA, a balance needs to be reached between "rewards" for doctors and retaining the capacity to continue to expand the system. This is tantamount to paying us appropriately and then forcing us to contribute a substantial portion of our take home pay to expanding the system ourselves.
If anyone should be contributing personal income to expanding the hospital system, it is you and your predecessor, Minister Pyke. After all, it is through your combined incompetence, negligence and complacency that the public hospital system finds itself in this unmitigated disaster today.
And do not argue that you do not have enough money to expand the health system and pay us appropriately at the same time. The state government has been the beneficiary of unprecedented economic growth over the last decade due partly to an enormous population boom. In fact, the state government won't even need to fund Victorian public hospital expansion; it can rely on the federal government's $10 billion Health and Hospitals Fund. It is in a very good position to do, being the state with the lowest number of hospital beds per capita.
Minister Andrews, if you want to continue to delay reaching an agreement with AMA over a new EBA, I suggest you come up with a better excuse. Victorian public hospital doctors do not buy your "balance" argument. As the economic beneficiary of the population boom, you have a responsibility to ensure sufficient resources are available to allow us to treat the massive increase in the number of patients. Your responsibility to pay us appropriately is quite independent.
Signed
Outraged Victorian public hospital doctor
I am PGY5, and Gen Y if your definition of such a thing means I want to be paid for the hours I work and I am not willing to sacrifice my mental, physical or emotional health for work. When I am at work, I work hard and for the best outcomes for my patients. I pay my own training fees attending courses such as ELS/APLS. I also work freelance in the arts industry and have previously worked in business/administration which has given me a lot of perspective on working conditions and reasonable expectations of workplaces in a variety of settings.
I love living in Melbourne, having moved here from Perth 3 years ago. I had intended to commence specialist training at that stage. Now I have no desire to leave Melbourne as my life, closest friends and home are here now. However, given the laughable working/renumeration conditions in this state (through word of mouth and from first hand experience having worked as a locum in public hospitals here), I have since decided to only work locum in private hospitals in Victoria and more often now I have been travelling (one week per month) to NSW to locum as they are able to pay me twice as much for the exact same kind of work. (However, it would be nice if there came a day when I was no longer able to work these "big money" locum / crisis shifts - because it would mean the public system had finally been fixed through appropriate staffing levels and retention to the point that there weren't shocking understaffing issues and people, including myself, could happily work in the system more regularly with reasonable conditions. I'd be happy to convert to full time at that stage!)
At present, I have no intention of entering full time work in this state even though I am still keen to complete my specialist training and I would like to live in Melbourne long term. When the time comes, I guess I'll just have to move back to Perth or move north for those 4-7 years and come back here after that. It's been very demoralising seeing my colleagues moving here have to take appalling pay cuts compared to other states and often being so disheartened by the conditions that they decide to move straight back home interstate after one or two years.
Melbourne is such a great city and very enticing for people to move over here from interstate. If only the same could be said for the public health system here.
I suggest mass "propose resignations" besides the idea of strike and not signing the discharges.
The mass propose resignations idea is done by submitting to the hospitals that we the doctors are thinking about resigning in the next month unless certain conditions are made.
Let me know what you guys out there think of this idea. Might be workable as I've seen this happen and is successful before in a Victorian public hospital where 4 out of 5 HMOs of a same rotation propose to quit due to appaling training condition and abuse by nurses.
My apologies, that should say Pike, not Pyke.
Hi all,
I sit on the federal AMA Council of Doctors In Training (CDT); which means I am answerable to the activities of both federal AMA and my masters in AMA Victoria.
I would all draw your attention to the CDT release of the AMA Doctors Health Survey Report (Sunday, 19 October 2008) which highlights the issues junior doctors face being overworked and under-appreciated.
There are a few things I would ask you to do - read the report, and secondly get time off to attend next week's hospital delegates meetings where AMA Victoria will update attendees of what is going on with our discussions with the state government.
We face a climate where there is no real pressure on the state government to advance the cause (elections being a while away) and where industrial options (eg strikes, mass resignations) could leave doctors personally liable to penalties under the pre-existing Workchoices laws (the ones the federal Labor government had promised to repeal)
Finally, the Victorian AMA is only one way to lobby for change. Writing to your local MP is another way to get traction through state parliament, as AMA Victoria has through its media campaign.
Finally, for those of you who are concerned about anonymity, things will be worse off unless the public hears about the crisis of our Victorian hospital system. The media & politicians can work for us - if you agree to help, and they can't publish stories unless they can verify their sources. I urge you all to consider this carefully.
Regards to you all,
Xavier (drxyu@yahoo.com.au)
http://www.ama.com.au/web.nsf/doc/ween-7kh6mt
http://www.news.com.au/heraldsun/story/0,21985,24520245-2862,00.html
Junior doctors committed despite excessive workloads
AMA President, Dr Rosanna Capolingua, today called on governments to urgently increase the number of junior doctors working in the public hospital system.
The AMA call to improve the public hospital system hears the voice of junior doctors in an AMA survey that found more than half were struggling with excessive workload and 41 percent believed this was potentially compromising the quality of care.
Nearly one third of the 914 junior doctors surveyed in Australian and New Zealand for the AMA Junior Doctors’ Health and Wellbeing Survey reported regularly working unsafe hours. Half had worked an average of 50 or more hours a week in the previous year. Junior doctors have said that their health and wellbeing is being affected by this stressful environment.
Hi everyone,
Dr Hawkeye from radio Triple R's Sunday 10am show "Radiotherapy" where we talk about anything loosely medical and even sometimes about serious stuff like this.
I'm wondering if people could suggest who we could approach as the/a most effective representative of junior doctors? We'd love to get someone on the show to push the case and also to answer some of the questions that have come up on this site. We've had health ministers on the show in the past but I'm not sure we could manage it in the next week or two at such short notice.
Viva la medical revolucion...
Solidarity forever.
Hawkeye
PS: podcast our recent shows via the RRR website at www.rrr.org.au
Dear Xavier,
No offence, but my impression of AMA is all talk but no walk!
The talk has been going on for more 2 years and all promises and no progress (or slow progress)!
I just heard that the Geelong Hospital had a mass walk out yesterday after hearing it from a friend.
Why can the Geelong group can do that whereas why not the AMA organise a statewise walkout like Geelong?
If this post is not up on the blog, then I'll be more suspiscious of AMA.
Cheers to the brave Geelong group of doctors!
Having worked in the public hospital system for many years, I have seen a range of services get the most for their dollar. In some, there is no such thing as being paid overtime, even though there is an expectation for you to be there after hours. In others, there is no cover when people are on leave which means that you end up essentially doing two jobs for the price of one. It is also ridiculous how friends doing Ph.Ds suddenly don't get paid a salary even though technically they are qualified consultants.
The other issue is the lack of enforcable doctor:patient ratios as opposed to nursing:patient ratios which obviously doesn't result in optimal patient care.
Victoria has a culture of accepting poor working conditions. Our pay has barely increased over the 8 years I've been working. The salary packaging scheme is barely a consolation. I've got school friends who did commerce who are earning double my salary without doing as much training. There seems to be an expectation that we should just accept these appalling working conditions.
It is about time things change.
I am a doctor working at the Alfred Hospital. I pride myself on being a good doctor, and greatly enjoy the time I spend with patients. However, in my position as a registar, I feel devalued. I am directed to work unsafe working hours and have little control over rostering. I hoped to continue the tradition of teaching as consultants have before me, but now I look forward to finishing my training and leaving the Victoria public health system.
I am a registar working at the Alfred hospital. After six years of medical school, two years of residency and four years of speciality registrar training emcompassing clinical examinations, my remueration is commensurate to the clinical nurse working as part of the team. A fair days pay for a fair days work?
To anonymous regarding Geelong's walkout...
Who do you think spoke during Channel 10's coverage on the event - none other than the president of AMA Victoria's doctors-in-training executive...
So guess what - if YOU want to make a difference, DO something. Write to the newspaper, write to your local parliament member, talk to your patients. Because if it wasn't for the talking and doing that the AMA does for its members - and non-members - doctors would not even have an EBA in the first place.
Come along to the meeting on Tuesday 28 October (12:30pm) at AMA Victoria (293 Royal Parade Parkville) and feel free to talk to those in attendance. We would love to hear YOUR ideas on how you think you can progress negotiations more productively.
Regards
Xavier
As an anaesthesia trainee in the Victorian public system I am itching to finish in two year's time, and go straight into the private system. There I will better be able to treat my patients, and better balance my life. My only regret will be the fact that I will not have registrars to teach, as teaching is an essential part of medicine, that I find enjoyable.
speaking of residents and registrars being overworked and underpaid, how about residents and registrars work in private hospitals for their hospitals without getting paid.......
that's right. the consultants privately bill, but all the work (ordering scans, ward rounds, private assisting) is all done by residents, and registrars....even if the consultant is not linked with the corresponding public health network.
this happens in surgical fields, and ICU and is happening in Victoria. what does the AMA say and do about this?
I am an emergency physician. I left Victoria for Queensland where many of the problems with service delivery are the same but the conditions are better.
ACTION SCHEDULED FOR WEDNESDAY PM.
Encouraged by our friends in Geelong, on Wednesday afternoon, a large group of doctors at the Alfred Hospital will leave the wards at exactly 5:30pm. This group of doctors are required to stay until at least 6:30-7PM each night for a closing ward round; but we are only EVER paid until 5:30.
However, we have all agreed today, to exit on time. If our consultants crack it, then so be it. But we will not be staying a second past 5:30, even if we haven't finished work or charts or whatever. We number 12 at this stage and are a mix of different specialities.
We have contact the media this morning, who are keen to report this.
Join our revolution. Wednesday, 5:30pm.
Xavier - good of you to respond to the query about the Geelong walkout.
Whilst I agree with you that junior doctors have to speak up and act, there still is a perception amongst many that the AMA could be doing much more. Many of my colleagues have refused to renew their membership over the last few years.
In 2006, there was unity amongst junior and senior medical staff. That should have been the time to take a harder stance. We could barely believe that the AMA agreed to the ministerial review, when the current situation could have been predicted back then.
Two years later, and we are still fighting for the same things - paid training time, fairer rosters, payment for telephone advice etc.
We did get a wage increase in 2006, but it was NOT backdated to when the government started stalling the negotiations.
Clearly, it's in the governments best interest to continue to stall negotiations again. If things drag on for months and months, will the AMA demand backdating of any new conditions from when the current agreement expires?
I would like to see us paid fairly, rather than coming up with concessions like the $1000 CME allowance. Most of the items that are eligible are fully tax deductible anyway, so it equates to ~ $700 benefit or $13.50 a week. Given that some training programs have fees as much as $8000-10000 per year, it's laughable.
I completely agree with many of the comments from Sept 18, that the AMA should take a much harder stance this time.
No offence chaps but your blog isn't going to cut it in the real world. Start getting in touch with CH10, ACA, TT and the stuff real people out there watch and make a difference. Who on earth do you think is reading this stuff now (except for us). Get real doctors on TV getting across their real stories and start MANAGING this instead of being ROLLED by the Government (again). We ALL KNOW what happened last time with the 'review' and it makes the AMA look worse than the Government for allowing it to happen.
OK! That's it!
I have just heard today that the state govt has spent 100 MILLION DOLLARS on some ferris wheel!!!!!!!
Count them:
********ONE*******
********HUNDRED***********
**************MILLION***********
**************DOLLARS*************
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
How many beds, and doctors, and nurses, and services could that money have paid for?????????
If the money went to our schools and education workforce, or the emergency services workforce then I would have no problems.
But for a FERRIS WHEEL!!!!!!!!!!!!!!!!
What is going on here????????????????????
The ticket price for a ride on this ferris wheel is just a little less than what I make in an hour.
To be greeted by this news - after staying at work until 2230 last night (Sun night) to ensure the pts under my care were OK & didn't die in the night - is just a kick in the guts.
I couldn't believe my ears.
The govt should be ashamed and embarrassed.
The people of Victoria should be asking serious questions.
And us drs should be standing up for ourselves - if the govt has 100's of millions of dollars to throw away on such trivialities, they can bloody well pay us what we are worth!!!!!!!!!!
The only walkout at Geelong was a photo opportunity of a group of doctors walking down the road in front of the hospital. As far as I am aware no services were withdrawn.
Good on you, AMA. Keep the pressure on. With pts and ward demands etc, unreasonable hours and appalling pay we cannot do this ourselves. There is definitely a groundswell now and the public is on side. The Govt responses are now hollow and desperate as more and more doctors leave the system. This is a strategic battle. You are keeping us informed and tightening the screws on the decisionmakers. Thanks and well done for addressing the inequities and exploitive practices which untimately compromise patient care - something the govt doesn't seems to care about. You are making a lot of noise and the noise is good. The electorate knows there's something rotten in Spring Street. It's time!
How about getting A Current Affair or Today Tonight involved. They are sure to stir up a storm over low pay, ridiculous hours, and crappy support at Victoria's public health system.
And another thing...
I was reading in my local paper about an outfit called "Jobwatch". If you have a complaint about your working conditions, you contact them and they advise you & advocate on your behalf.
They are all about employment rights, and that is what we need.
So all of you who have registered complaints on this blog that clearly contravene the law, should formally complain to this independent agency. The more complaints they get, the louder the message will be.
PS T-shirts are a good start to what should become a SNOWBALL of a campaign to embarrass the government.
The t-shirts should advise all who are disgruntled with the treatment they are receiving to complain their local MP. Again, the more complaints they get, the louder the message will be.
The ED dept I worked in, in SA, advised all unhappy "customers" to complain to the local MP. Sure enough, some money was found for upgrades...
There are a few things i'm wondering about the whole campaign, namely:
1) What specifically are we fighting for? An increase in wages and/or better working conditions? So far the majority of what I've heard is about the wage rises being less than inflation (and therefore effectively a pay cut). I get a rather mixed message when I hear various arguments (conditions, better pay in other states, etc) which don't tend to tie in together with each other particularly well.
2) Couldn't we be doing more with this blog? Namely, making it an actual blog with updates on what is happening (particularly, highlighting things in the press). So far all I see here is essentially a wall for people to complain about things, but not something set up to try and co-ordinate action, discuss issues, etc.
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Clearly, it's in the governments best interest to continue to stall negotiations again. If things drag on for months and months, will the AMA demand backdating of any new conditions from when the current agreement expires?
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I don't remember this verbatim, but it was mentioned in the meeting yesterday that the industrial relations commission does not have the power to grant backdating.
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I have just heard today that the state govt has spent 100 MILLION DOLLARS on some ferris wheel!!!!!!!
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And sadly, does it honestly really surprise you that the government would rather put money towards a triviality that gathers more attention than putting funding towards public services which isn't quite as sexy?
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The only walkout at Geelong was a photo opportunity of a group of doctors walking down the road in front of the hospital. As far as I am aware no services were withdrawn.
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From what I heard it was for 15 minutes, but the point was more to generate attention to what's happening than to shut down services I believe.
Note to AMA:
1) The Agreement MUST be backdated to when our last EBA expired
2) Interstate wage parity must be achieved
3) Work 2 Rule must begin soon so that Hospital Admin notice and the public realise we are NOT out to hurt them, just that we will work the hours we are rostered and refuse to work when we will NOT be paid (Joe the Plumber would realise this is fair...)
"There is definitely a groundswell now and the public is on side."
uh...not sure who you have been talking to. But the public actually have some rather more pressing problems to deal with and our concerns are at the bottom of their list (at best).
I'm not suggesting this cause isn't just but I think everyone involved needs to be focussed on reality rather than imagining that it's Moscow 1918 with the people about to revolt on our behalf.
I am a senior registrar and I don't work for free, DON'T HESITATE to write down overtime and don't agree to work SCHEDULED overtime unless I get paid at public holiday rates. I know it is very hard to be persistent - especially for our junior colleagues. But: senior staff HAS TO support junior staff in standing up for their rights.
Unfortunately the AMA is not representing us, even though they try (a little bit). The time has come to found a new body, accurately representing doctors in Victoria, and maybe even in Australia.
I will organise this, if I get 100 people on this blog to quote:
"Medice cura te ipsum!"
(For those of us without any knowledge of the ancient latin language, it means: Doctor, heal yourself!)
We are fighting for PAY PARITY.
The Brumby government knows exactly what the issues are with our sick health system - they will continue to exploit us because it is the cost-effective solution and the public have little idea.
The Brumby government refuses to acknowledge that it is the good-will of doctors that keeps the public system afloat. Doctors pull the slack when radiographers and nurses go on strike, they teach/exam for free, they take all of the responsibility for adverse patient outcomes and face the lawyers, work irregular hours, they battle for patients to be investigated and treated, they work tremendous amounts of unpaid overtime and put up with open workplace bullying. Junior doctors in particular must study in addition to the long hard hours. Not to mention research.
The Victorian government rewards us with poor pay and even poorer conditions.
$26/hr for a resident is 47000pa for 38hr week. With massive HECS debts accumulated over 6yrs of uni, post-graduate fees and rent, there is not much left.
For surgical training, the fees are around $10000 to $20000 per year. The government pushes for more surgeons, yet we foot the bill with no support. They blame the college for being 'closed-door' yet do not fund additional training positions.
There is now serious erosion into the good-will amongst doctors in the public sector. Morale is at an all-time low, student/resident teaching is diminishing, paperwork is climbing, defensive medicine is reducing training opportunities, proper medical care is being compromised for the sake of a few pennies. Doctors are tired of taking up the slack in a vastly inefficient system that refuses to listen to them and respect them. Just read above blogs.
At the completion of training, who can blame doctors for leaving the public for the private sector where pay is up to 10 times better such that they can actually pay off their debts? Where lunch is complimentary? Or leaving for interstate where pay is up to $100,000 better for certain specialties?
It is only pure good-will that keeps doctors in the Victorian public health system. Doctors who care about equality of healthcare, who care about the future generation of doctors, and who care about high-level research.
With economic hardship knocking at our door, the government must support us with pay parity or the public health system will simply collapse when the good-will vanishes.
The fight is up to us - the AMA can only use what we give.
Medice cura te ipsum!
I am a mother of a doctor currently working in Boston. He has become highly specialized and would like to come home with his family next year. The dilemma is that their extended family live here, they happen to love Melbourne, but salaries, respect, and worth that doctors are given in Victoria is extremely undervalued. Victoria is meant to be the financial and cultural capital of Australia, but the Government does not seem to care to much about
Medical Research , or it's highly capable Medical specialists. Wake up Mr. Brumby, Queensland has..
Victoria's very complacent Government is creating a Doctor 'Brain Drain'
Gee...in all honesty I did not realise that the working conditions in Victoria were soo bad!
I am a junior doctor working in a major teaching hospital, but previously moved from QLD. Not only is the pay ~20-30 thousand less, there is a huge expectation of working 'unpaid overtime'. In addition, the soo called 5 hours teaching time seems a myth than reality.
If Victorian work conditions do not improve, I will be making a quick exit back to QLD!
Today tonight is a good idea. Why don't AMA do something about it?
"Medice cura te ipsum"
Reflections on being worked too hard during night shift
Oh, what a night
There was a met call back at 06:03
What a very stressful time for me
'Cause I remember what a night
Oh, what a night
APO because of packed red cells
Diuresed her and she did quite well
Love that lasix what a night
Oh, I... I had a funny feeling when she talked,
She was blue and I,
As I recall quite hypoxic too
Oh what a night!
Her pH was rising and it frightened me
Just didn't fit the picture clinically
So I called a MET call what a night
Oh what a night,
We have her GTN and other stuff,
(The ICU reg was a resus buff)
We saved the lady, what a night
Do do do do do do do do
Oh what a night!
Do do do do do do do do
Oh what a night!
"the private sector where pay is up to 10 times better such that they can actually pay off their debts? Where lunch is complimentary?"
Don't know where you work...but I've never had time for lunch on a private day - and if I had it would have been at my own expense. Don't get your hopes up mate!
And 10 times better?! Maybe 2 times, but you'll be working more than 2 times as hard; and no sick leave, exam leave, conference leave, family leave, maternity leave, paternity leave, compassionate leave, sabbatical, long service leave, stress leave, gardening leave; no CME money; no superannuation, no salary packaging, no "meal and entertainment" packaging. Need I go on? The poor sods in the public system do have a few things over the private bods.
Maybe we should start a facebook group on this to increase awareness of this issue. AMA Vic reps should take the lead.
The Southern Health DiTs have a group, but I agree that the AMA should endorse and have a centralised facebook group. The nurses had one last year with their ANF campaign.
I think part of our problem is, unlike the nurses, we have no political backing and also, we do a lot of blogging but not a whole lot of walking or demonstrating.
Its time for the AMA to start organising some unified demonstrations, or for us to go back to the fantastic t-shirt idea. We are clearly getting nowhere, fast.
And just a small aside, the song - was that you Riaz?
I am 5th year out HMO. I have been in a acreditted training program for the last 2 years, but the hospital that I am working at (RMH) has been paying me as a HMO4 for the last two years.
1.-It is time that Junior Doctors get paid propertly for the jobs they do. We do work hard and long hours.
2.-We should be able to speak freely without fear... Most of us fear to speek due to the end of the term assesments performed by the registrars or consultants..and the need of referees to apply for a training program...
We need a change in the system...but we are the ones that need to start to implement the changes.... for us and for the future!!!
The whole medical system needs a good review!!
from public hospitals to specialty training colleges....
Remuneration, working hours and conditions, bullying, fair oportunities to get into a training program....
It is time to be recognized for what we do... not only by the goverment but also by our peers.
We need to support eachother... to improve the australia health system..
If we need more specialists in the country .. Why the RACS has made it so difficult for the previous BSTs to enter into the new training program.. Why eventhough they are considered trainees by the college they had to reapply to the training, pay new fees, and having to pay the yearly training fees of $5000.
Interns should not allow anyone to bully them!! they all say that they can say anything because they fear of the consecuences... We should have the opportunity in each hospital to be able to speak up even if it is anonymously ... and report all these incidents.. so they don't happen again
I am a PGY3. I recently got my offer of my contract for HMO3/registrar position at a rate of 27.93 AU per hour... I looked at the rate being offered and the rate i am getting as a loccum of 60-80 AU per hour with flexible rosters. More importantly being able to CHOOSE what job to do. Since locuming my fiancee has noticed a huge decline in my stress level, frustration and despair. She said i no longer complains as much and are generally happier when i get home despite that i STILL come back home late 30mins to an hour over time that i normally dont claim much. Why is that? It's because the pay i am getting has alleviated alot of my stresses at home in regards to paying rents,increasing living costs, fuels, insurances and saving money to get my first home.
I look back at the contract offer - that has unwritten stipulation in it. ALOT more unpaid overtime, unable to choose what so ever, always under pressure from bed managers who wants to get rid of patient at YOUR cost, having to deal and pacify nursing staffs who bullies you, answering to superiors who are as stress as you are, having on call days where you have to sit at home and watch your phone cause you are NOT suppose to plan anything in case you get called, not getting paid on time or being paid less than what you are supposed to - requring meticulous examination of your payslip that is coded in a language unfamiliar to you, less to no family time because what ever is left for you- either need to take locum shift to supplement your wages or you have to study. All these for the sake of humanity?
I still remember when i only had 1 week to find a new place to rent a few years back and had allocated one saturday to allow myself to view this place i was interested in. I did not know i was SECOND on call that day. Was called on friday 4 pm by the medical workforce telling me to work on Saturday. I told them i couldnt cause if i dont see that place i wont have a place to stay in a week's time or be at my landlord's mercy. I remember her exact reply, "No, you come back to work. You are second on call as per roster so you are under contract to work." I explained to her why i could not, she replied, "Too bad. You are under contract so you must come back." I replied, "No! I will not or i will quit!". My registrar implored me not to quit cause the team is already one doctor short. That is the treatment i get as a doctor... my well being means nothing. When i am not first on call, i am second on call... this is pathetic. I dont even remember getting paid for being on call EVER. BTW, anyone noticed why there are so many ED loccum jobs out there? I realise in my previous hospital - when there is a doctor calling in sick, the management would move the ED doctor to the empty position thus allowing them to pay less hour to the locum as ED shifts are usually less in hours during the day shift regardless of the ED doctors opinion or comfort with the new job. Great way to save money i got to admit but too bad for the doctor.
In any case, i have till this friday to sign the paper. Will have to think seriously about continuing in public system. But one thing for sure, once i finish my basic physician training, i will leave the hospital system for good! There are bigger fish to fry out there in the world!
The best way to put this underpaid situation is how my friend puts it:" When you go to Coles and pick up 3 bottles of Coke, you walk to the counter, hand in the money for one bottle, then walk out despite the protest of the cash attendants. I think the police will be with you shortly. If that is the reality and justice of life, then why are you being paid the money for one bottle of coke?"
I'm a medical student just over half-way through my basic degree, and to read these comments fills me with dispair, not only for the state of our system today but for the possible projections for my future. I have been told by older doctors that I will continue to earn more per hour in my casual supermarket job than in the first few years out of med school. Not very inspiring... I'm glad I didn't sign any "study incentive" contracts as a student binding me to Victoria. It's my home state but if need be I will have no hesitation moving.
Back in 2003 I approached several Vic. public hospitals to enquire about taking a salaried position within my specialty after 20 years of private practice, because I wanted to cease being on call 24/7.
I was told they had vacancies, and would like to have me on staff, but had no allocation in the budget to fill existing vacancies. During the same year, and since, I have received numerous letters from NSW and Qld offering me positions on much better salaries than would be offered in Victoria, if they were offered at all.
My wife wanted to stay in Victoria. She has died recently, and I am leaving...
As a non-medically trained person, I have despairingly stood by watching my husband (doctor) and his colleagues be bullied into working dangerously long hours, shifts that do not allow time to recover from the last (such as finishing a week of night shifts on a Sunday night/Monday morning to start days on the Tuesday morning), being denied leave (or being made to feel guilty for taking leave) when themselves or their immediate family members have been seriously unwell, refusing to pay overtime for the extra time required for handover due to no overlap being allowed for between shifts of medical staff (shift ends at 8 but next doctor doesnt start until 8), being made to endure working conditions and practices that in any other industry would be illegal and forced to change because "that's what is tradition" and the mentality within the profession of "we had to endure that, therefore so should you". I have heard over many a meal the horendous things that doctors (especially juniour doctors) are forced to put up with and I can not understand why it is taking so long for the system to change. This lifestyle is impacting on their physical and mental health and is also impacting on their families.
From what I can see, Victoria urgently needs to improve the EBA for their existing doctors and the federal government also needs recruit more doctors whether that be through funding more university places or through immigration. Our health system is collapsing under the demand and there simply aren't enough doctors to carry the burden. Those that are left are having to work harder and longer for less outcomes and that is very demoralising.
From a wife's point of view, I rarely see my husband, and when I do he is usually so tired that he goes straight to bed as soon as he comes home or we fight because he is so stressed out from work.
I never know when he will be coming home because if he is scheduled to finish at 8pm he may actually finish anytime between 8 and 11 -sometimes even later.
Making any plans for a social life are always made with a proviso that his roster might change at the last minute, rendering us unable to attend the wedding, birthday, christmas etc.
I have concern for how this will impact on our children once they are old enough to realise that daddy is rarely around and that his job is the reason that we are missing out on visiting their grandparents for christmas etc. if this lifestyle continues.
Can't the government see that the way they are currently treating doctors is having further reaching consequences than just the doctors paypacket?
Conditions in Queensland improved markedly after the various enquiries. One very important change that may not be widely known is the change in organisational structure. For example the Princess Alexandra hospital changed to a Clinical Council (20 or so selected heads of departments including allied health and nursing) governance model with a Clinical CEO (a plastic surgeon in this case). Everyone knew, regularly saw and could talk to the CEO who they knew understood the problems and was genuinely interested in patient care.
12 Angry - but now frightened - young men:
It is extremely sad to hear that the 12 doctors at the Alfred Hospital who were planning to walk out at 5:30pm last Wednesday - albeit on time! - were threatened with severe legal action and even told by one consultant that their careers in their respective colleges would be "screwed" if they even thought about walking out. One hospital administrator even handed one of them a letter from the Hospital's legal team threatening to sue the doctor for his entire year's earnings if he even thought of walking out.
The doctor makes $26 and our. The arrogant consultant who threatened him (showed him no support) made close to half a million dollars in TAC funding last year (according to the Age) and has a very busy and profitable private practice.
Stay in the system....we're "screwed".
Walk out/Protest.... we're "screwed".
Why be a doctor at all?
as an Alfred doctor, that's pretty sad when our own apparently well remunerated consultants won't help out the junior staff, especially when it involves action (walking out) on unpaid overtime.
Wow, if i were the 12 doctors, i would have talked to my lawyer and sue the arse out of the hospital instead.
1. They did not abuse their rights to go home at the assigned knocked off time. The ward rounds done by the consultants were never agreed upon by the hospital offcially i assume. BUT, it was definitely IMPLIED overtime judging from the response letter from administration and legal team because if it was not, then there was no reason to send off those letter to employees who are trying to go home on time. If they admit it was implied overtime, then they NEED TO PAY overtime and have been refusing so either way they are at fault. So technically on that day they did not walk off, just went home in time. Things would be different if there was an emergency requiring them to stay to treat the patient otherwise anything else should be technically able to be handed over albeit not ideal.
2. The consultant CANNOT fail someone or get someone out of training college based on the fact that they went home on time! You can sue his arse off to the moon if he managed that. What basis is that? If he claims that the ward round is necessary and involve professional responsibility then he NEEDS to tell the hospital management as such and therefore PAY OVERTIME! If he fails to do so, then he has NO RIGHTS to ruin another person's career. That is bullying and inappropriate use of influence.
I am just curious about the tv coverage. Were they informed of all these developments? When is it going to be screened on tv?
I think that it is a tragedy that our young people, our most brilliant and intelligent are singled out in our health system for some "special" attention, not only by nursing staff, but by management.
For example, Eastern Health, hmm... where do I start.....
One young doctor I know was not that long ago "suggested" to take a year off and explore her options by management. When she didn't well lets just say they did their worst.... She was pushed beyond normal... Faced the "Board" and had restrictions placed upon her registration for health reasons.
The funny part about all this is the management dont seem to get punnished in anyway. Another young lady recently appeared in "The Age" newspaper, after being at Eastern Health, no longer feels as though she has the commitment or courage to continue in Medicine..
WHO IS THE BULLY INSIDE EASTERN HEALTH???????
I love bullies. I love to see em cry..
Look out we are coming after you!!!
Whatever happened to that inquiry into Eastern Health about this hey???
In a way, I hope that the Alfred Hospital sue their doctors because there is no way that the hospital is going to win. The Drs can then counter-sue and all this publicity to raise awareness on this issue can only be good. The problem is the public (especially patients) have not the slightest idea on what we're going through. Without the public's support, nobody in the govt will move their inactive and fatty gluteals an inch out of their sits
I'm wondering when the last time any of the government bureaucrats involved in EBA negotiations or hospital administration staff who routinely decline legitimate overtime claims spent any time in a public hospital emergency department themselves, being looked after by a junior doctor doing their best after 10+ hours on their feet with no break and still working on into unpaid overtime.
Will they still be so keen to devalue the efforts of public hospital doctors when they see how hard we work to ensure every patient receives the best possible care we can provide? Will they be so keen to say that my overtime was 'unnesessary' when they see it was used to make sure that they were well looked after no matter how busy the department might be?
As specialty medical registrars who have done 6 years of university & passed post-graduate FRACP exams (self-funded might I add), we are paid $74.40 PER NIGHT, or $4.96 PER HOUR oncall. This is the sum the Victorian government considers we are entitled to for our professional advice. No matter how many times we are called, and how sleep deprived we become, we are not paid anymore, unless we actually go into the hospital.
We may be called by anyone, junior doctors, nurses, patients & their relatives or even next-door-neighbours, at anytime of night. I have noticed through my registrar years that the number of calls is increasing, with the hospital switchboard being less willing or able to act as a filter. It is very disconcerting to have the phone ring in the middle of the night by your bed, to pick it up & have a patient you have never met abuse you.
Increasingly the calls are from people who either don't know or don't care that you are expected to perform a full day's work the next day,including ward rounds, clinic & procedures, despite having little sleep.
It is nonsensical that hospitals will not officially roster you or pay you for working a 24 hour shift, as it is considered unsafe, but that you can be oncall for 72 hours or more, with no reserved sleeping time.
It is not at all unusual for me to work a full day having had only a few consecutive hours sleep, and I have on several occasions worked full days having had no sleep at all.
I have heard of a stressed registrar being reprimanded for documenting in a patients notes that he performed a procedure despite suffering from sleep deprivation! I suspect if all our patients knew how often their doctors were making complex decisions or performing procedures with little sleep they would be quite worried & think twice about signing their consent form. After all, we know that sleep deprivation can mimic ethanol intoxication in its effect on judgement & reactions, yet the former is commonplace at work and the later completely unacceptable.
If hospitals were forced th pay us even a token amount per phonecall (such as the hours wage suggested by AMA), then the number of non-emergency calls overnight would be reduced and we could all get some sleep!
Regarding the Alfred Episode, has anyone sent copies of this letter to the media or the age?
This is big, and the public would be interested in hearing more about the problems in the health system and the Alfred Hospital.
Someone should email details to the age / AMA journalist.
Doctors are not the only professionals the public health system is short on. At my South Eastern suburban tertiary hospital, the waiting list for an outpatient ultrasound or CT is around two months. If you beg for an urgent scan it can be done faster, but all scans are clinically indicated and you can't make them all 'urgent'. Yet it is the doctors who are often on the receiving end over patient's anger over delays, as we are the ones who have to tell the patient that there is no point coming back to clinic for several months, as the won't have the test results yet.
Also on the subject of radiology, plain X-rays are reported on days late, or not at all. This leaves doctors open to medicolegal claims, for missing subtle but important findings that a radiologist would have picked up, or having those findings reported days after the patient went home, meaning that nobody reads the report.
I've left the public hospital system a few months ago for the following reasons.
Comparing myself to my high school friends, I got the highest TER out of the lot,spent the most time in University (and therefore the biggests HECS debt), and 11 years out of high school as an HMO5/3rd yr Reg, I still earnt less annual wage compared to my friends who are 1/a landscaper 2/an accountant 3/an IT tech and 4/a builder contractor (who left high school in Yr 11 to become an apprentice).
Yes, my friends are good at their jobs, but I work more hours per week in comparison,they've never have had to work an overnight shift in their life, I work more weekend shifts then all of them combined, rarely left work on time, and on top of that, I still needed to study hard for my ongoing professional qualifications. Furthermore we have to deal with the stress of knowing that a patient's life is in our hands, without room for any mistakes, in a system which is innefficient, and lacking in the resources we need to treat our patients adequately.
As such, I quit my job in May after working in major Victorian hospitals for my whole working career. In the past 4 months I have been locuming day shifts of only 36 hours a week. I have earned much much more than my yearly earnings in the public hospital system, and have had more time to spend with my wife and children, and much less stress.
In addition, I could never quite understand why the med student who got the lowest grades in med school and therefore couldn't get into a training scheme, earns 4 times as much in a locum position vs. the hard working resident/registrar who has strived hard to get a good training position in our public hospitals????
I worked hard in my five years post grad, having passed med school with honours, and got exceptional references from my consultants in every rotation, but at the end of the day when you got paid peanuts for good quality, hard working, unpaid overtime, in the public hospital training schemes, enough is enough.
I'm happy in my locum position, get treated well, never have to put in unpaid overtime, and get to enjoy my job treating patients because I feel I am properly remunerated for my work. I have given up on my training scheme despite passing my college exams, as in the end, my family comes before my job, and I have no intention of being woken up nearly every hour each night for a mere $77, and having to work 14 hours without a break the very next day for another 4 more years with the bother of another set of exams to study for afterwards.
I'd implore many of you disillusioned doctors to do the same as me, for the sake of your own health, and the wellbeing of your family, unless the government does something soon about the current state of our pay, but I'd spent 4 years waiting, so I wouldn't hold your breath!
I'm a second year med student here in Victoria, and as I struggle through my exams I'm looking for some inspiration, and it's just not here.
My younger tutors are telling me stories about their crappy lifestyles, my older lecturers are telling stories about their '80 hours weeks in the good old days' and my fellow students are all fairly happy to accept this as an inevitable part of medicine.
Is someone going to break this cycle now, or shall I just resign myself to a few decades of crap followed by a Porsche?
I am a final year medical student.
Finishing up the last day of medical school in a spectacular anticlimax yesterday I think about what it is I have to look forward to. Anyone (including me) who has been abused by a nurse or patient, and anyone who has non-doctor friends who get paid the same or more than doctors, will realize that being a doctor nowadays may not be as good as was once thought. I know colleagues who were bullied by human resources for moving interstate. And I haven't even started working yet. After spending a few hours reading about the experiences of fellow doctors I am discouraged by what my future holds.
I totally agree with these comments.
My job at the end of the day often involves telling patients their operation is (once again) cancelled. They are more often than not, upset and angry. How do I justify to them that their open, painful wounds are less important than elective surgeries? Elective cases that we do to satisfy the hospital and government funding. How to I tell my patients that treating the hospital and government is more important than treating them.
Also, the public and health personnel are under the impression that doctors are over-paid. We work hours that are dangerous to our own health, often with no (or very poor) facilities to rest/sleep and being told by our own departments that we will not be paid overtime because of budget issues.
Because we have morals and strong ethics, our own health comes a far far second to our work. We do not insist on taking our 10 minute morning tea time break and refuse to answer the pager. We do not insist on clocking off ontime until the job's done. We do not leave behind mess for someone else to clean up.
My family and friends understand that I'm working more often than not. It would be nice if the rest of the public realises this and pressure the government for better working conditions for doctors.
A journalist from the Age is writing an article about the issue of the mistreatment of junior doctors as we speak for publication this week! I have just spilt my guts but my experience is a few years ago now. Astoundingly she just told me she is having trouble contacting doctors to speak to her anonymously. I hope she does not mind this, her name is Julia Medew and she is the health reporter at the Age. ( I am a real doctor and not her in diguise@!)
Will anyone from the AMA team negotiating the EBA make a comment in here?
Please do...
wrote to and called The Age, left messages and return numbers - they never got back. Guess it wasn't fashionable at the time...
Mmmm, the good old Royal Melbourne - currently our confidential waste paper bins (the ones with ALL the patient details) are overflowing - the company won't pick them up because we haven't paid the bill! The hatchet job here for the sake of the annual bottom line is so stark there's axe marks in the walls...
No New EBA until end of 2009?
Hi everyone, I have it on very very good authority that there would be no new EBA with doctors until at least the end of next year -09- in light of the economic crisis in Australia and around the world. This is apparently the position of the Vic Government.
Apparently this has been the plan for the past few weeks; which is why the discussions with the AMA have been so slow (AMA to their credit have not been informed of this).
Sorry to disappoint. May have to put this blog on hold until next year.
Ps. What happened at the Alfred two weeks ago was disgusting. The way those doctors were treated by management is very distressing indeed.
I am a doctor; so is my fiancee. Our experiences mirror many of the above comments; I would say that medical and surgical residents and registrars are the worst hit.
I also reiterate the earlier comments made by STRONGLY suggesting that the person(s) who allegedly received this letter from The Alfred pass it on to the media.
Not only will it garner positive exposure for the campaign, but you will be able to COUNTER-SUE the hospital for a number of offences, including breach of contract and workplace bullying if they truly were STUPID enough to write such a letter.
I would DEFINITELY do so, had I received such a letter. If you are an AMA member, seek legal advice IMMEDIATELY. If not, it would be worth joining just to watch the carnage that follows!
Go for it - I look forward to seeing how it all turns out!
Mr Brumby and Mr Andrews should publicly declare whether or not they have Private Health Insurance and whether or not they would be happy for themselves and their family's to be treated in the Public System. I wonder how long it would take them to make things better if they themselves had to put up with long queues and stressed out junior doctors.
Wow the Age is interested? She should contact the 12 doctors in Alfred Hospital! Or they should contact her since they received letters from the hospital which serve as a concrete evidence of what has transpired. For the rest of us its more likely the hospital's words against ours.
I have read the AMA EBA proposal. 9 percent increase in hourly rate per anum for 2 years. I think we should ask for 15 percent =/ Seriously, doctors are paid normal rate even when they work at night or weekend as long as its not over their rostered 76 hours fortnightly. Go on the street and ask someone whether they want to get paid normal rate during weekend or doing night shift? Good luck with finding one! I have noticed the senior doctor would get 50 percent more pay evening and double for night shifts etc. Yes i agree they know more etc but i believe junior doctors have it just as bad at night shift. THey should amend that to allow junior doctors to get the same benefit unless they believe that junior doctors dont have a life or family or their job is less important?
I believe they need to add to provide free car parking in the hospital. I mean seriously, HMOs spend 1000 dollars average yearly on car park in the hospital! Stop finding ways to cut cost by exploiting your own employees!
PS: Anyone know whether the government is responding at all or they just dont give a button? Would like to know soon to plan to continue doing loccum or go back to slavery.
Advise please!!!!!!
Hi everyone, I am an intern working very long hours in a busy surgical department. My consultant and registrar love doing a ward round at 6am, and then again at about 7-8pm.
Of course my hours are from 8am 5:30pm.
I have tried to claim the additional time as OT, and have even gotten my consultant to sign it, however my HMO services dept have crossed it out on the last 3 time sheets. I have argued galore about this, and they just tell me that "we don't pay overtime. You should get the evening surgical cover to the ward round with the consultant." That's a ridiculous answer. My consultant said that I should just put up with it for a few years.
Any advise on this issue guys????
Are they allowed to CROSS out my OT sheet, even when I have had a consultant sign it????
Is it any wonder we're sinking in this system? Not only is the government completely disinterested in helping us with simple things like unpaid overtime, but the middle-management and bureaucrats at DHS are showing no interest in improving the basic functioning of hospitals as businesses and workplaces. As part of my ED fellowship training I have to know about "patient flow", and there are some key articles that we have to know about, and most of these are from the "Clinical Process Redesign" at Flinders, and the NSW government health system redesign project that have been published in the MJA this year. If you want to get even MORE disillusioned about Victoria look them up (MJA 2008; 188 (6 Suppl): S1-S40). Here we are in Victoria whining about how badly we're being treated and the government is constantly denying there's a problem, and yet in other states there are people in government and clinical areas WORKING TOGETHER to redesign the health system to make it more efficient and (one would infer) hopefully more pleasant to work in. I'm sure it's not perfect but have a look at these articles and look at the effort they have put in to trying to make hospitals better places to work and treat patients, taking the lead from "lean thinking" models used in manufacturing industries. While other states are redesigning their whole systems with modern management principles and real goals to improving efficiency (a key source of stress in my day), here we are, drowning in patients, with NO INITIATIVE, NO LEADERSHIP, NO HELP, and petty bickering middle management who don't give a toss (and of course a health minister who doesn't believe hard data presented to him by the College of Emergency Medicine). Need I even comment on the uselessness of the AMA? My advice to anyone considering leaving Victoria is GET OUT NOW. We are clearly not valued, the government and DHS clearly have no interest in doing what's best for the patients (or us) and we are being forced to work in an archaic system that was not designed to function with the load it currently bears, and no-one seems to have any interest in bringing us into the 21st century.
To those disillusioned medical students reading this, I would strongly urge you to reconsider your choice of career. The volume of information you will be required to learn for your specialist exams will be far more than I have to learn now, the stresses of the job will only be worse, the time for learning at work will be (and already is) non-existent and the Victorian health system is crumbling: it's an out-dated archaic system with no hint of management leadership or innovation, and a future planned reliance on overseas trained doctors. If you think 2 or 3 years of medical school is too much to sacrifice, believe me there is nothing more depressing than realising you should have left 10 years ago. Get out now, you're smart, and will be highly valued in many other industries, but if you stay do so knowing that you are entering a career that treats it's hardest working, highest educated, most dedicated employees like rubbish.
I really wonder who the idiot at DHS is that decided to spend a few million dollars on recruiting overseas trained doctors to fill gaps in the system, (have a look at their website - it is the only solution they have come up with for the doctor shortage) instead of addressing the root causes of why people are leaving. What a bunch of morons. I can barely read the articles from Flinders without crying, because the concepts of change, innovation and leadership don't exist in the Victorian system. All we have is out-dated attitudes, legal (and criminal) threats to doctors who are so frustrated they take matters into their own hands, ingrained cultures of workplace bullying, and a health minister burying his head in the sand. When I get my ticket next year my family and I are off to sunny Queensland. Goodbye Victorian Luddites! REMEMBER - GET OUT WHILE YOU CAN.
I am overseas trained specialist who has completed all required training (as recommended by my specialist College) to work as a Specialist in Australia. I can work only in Public system due to the moratorium of 10 years on private practice.This means that I am diadvantaged given the poor pay scales in Public while my colleagues (junior and senior) earn well by doing some private work.
I feel the commonwealth policy on moratorium is discrimanatory and exclusive, and this is made worse by State government's inaction to address the poor pay scales in Public. A lot of my colleagues who are in my situation have left Victoria to work in Queensland, NSW and WA which pay far better and have compensate well if specialists work full time with them.
This year we have had a very poor interest in our training program and attempts to recruit to Victoria from overseas has been very difficult as most are taking better offers interstate.
This Blog says it all!!
One "Anonymous" doctor after another.
The years of bullying (by administration and some senior medical staff) have left a tragic legacy where no doctor is willing to put their names to anything we write (myself included).
So much fear regarding our jobs has been created (both of financial retribution and damage to our careers), that we fear to speak out for ourselves and more importantly for the well-being of the patients we care for.
Every "anonymous" doctor will re-collect cases where system wide defficencies have impacted negatively on our patients. Times when lack of doctors, nursing care, and access to theatre for emergency cases has resulted in permanent disability and even death in our patients. Just maybe in a better system this may have been prevented.
All too often these sad events are simply swept under the carpet. Forced to tell patients families "we are sorry for your loss," when deep down we ALL know (including hospital administration, government, doctors and nurses), that things may have turned out very differently.
What angers me the most, is the political "fudging" of numbers that makes the system look like its working. I regret frequently the failures of this flawed system and the public who just accepts them simply because they are kept in the dark.
It is certainly a sad legacy the new generation of doctors have inherited. One of fear and misinformation to the public. No wander the publics scepticism of doctors is on the rise. We have all "allowed" this slow insidious rot to set into the public hospital system. How we are to fix it when the Government chooses to ignore it is beyond me.
Some specific examples of problems at a major tertiary teaching hospital in Melbourne
between HMO administration and doctors, mostly regarding rostering and communication:
o Oncology resident asked to work a night shift (which starts at 22:00) at 17:10, after a full day’s work, and miss the next day of work in their unit.
o Medical Intern asked to cover the entire peripheral hospital overnight on her own when the surgical resident called in sick.
o Surgical Intern allocated to cover specialty surgical resident (who quit). however, surgical intern not told, and first she knew was receiving pages re the specialty unit’s patients. She was also expected to attend both unit’s outpatients and preadmission clinics, when there were blatant clashes in the roster. Also HMO Services told her that although she would be required to cover the extra unit, including attending unit meetings which happened outsider her rostered hours, no overtime would be paid, and she would be expected to still take her allocated afternoon off, but with no provision as to who would do her work when she was out of the hospital.
o One specialty surgical unit lost a resident due to them quitting 2 months ago. HMO services told the remaining residents and interns that the overtime they were claiming was unreasonable, and also told them they would not be getting a replacement resident until February 09. ie. they were not going to replace the resident who had left.
o Surgical resident who is a swiss national here on a working visa which is specific to this hospital was asked to go and work as surgical registrar in Tasmania. Despite her queries as to whether this was actually possible she was sent there , had to pay her own airfare and application to tassie med reg board, and when she arrived the Launceston admin told her that the incorrect box had been ticked on her paperwork and she was not authorised to work anywhere but the Victorian hospital, as per her visa regulations. HMO services filled in this paperwork for her. They are now refusing to reimburse her for flights and her registration application.
o One particular specialty medical unit has long been understaffed from medical resident perspective, and this is unmasked when a poorly performing registrar comes through. 2 residents this year at least, and at least 2 last year have threatened to resign and have experienced significant mental trauma during their oncology trauma. Such as- nightmares, unable to sleep at night, intrusive and panicky thoughts re. patients and workload, and uncontrollable fits of crying. This has been partly because of the lack of support and insight shown by some senior medical staff, who do not seem to realise the magnitude of the workload and the chronic lack of resources and leadership shown to the the residents, who end up running these wards with very little input or help from their registrars or consultants. This is a job that is designated to a specialty medical registrar, not a second-year medical resident!
o Surgical residents and interns are expected to attend unit meetings which means a 6.30 start on Thursday, and they are expected to attend ward rounds, which start at 7am every other day, but are only allowed to claim workdays to start from 7.30am on their timesheet. This happens in multiple surgical units in this hospital.
o Medical registrars are being told not to claim any overtime anymore. This is despite the fact that many of them routinely work at least 30-60 mins overtime daily, and would only claim if they were genuinely held back due to patient-related problems. Apparently this is to do with funding to the medical specialty unit who pays their wages.
o Medical interns are being told that for each unit, between the two of them they have to take 3 afternoons off a week, because the department can’t afford to pay them overtime. This is the comment from one current medical registrar:
o “I'm med reging at austin now and the fact that the interns are being told to take two half days per week is not ideal, and difficult to sustain (between take days, post-take, clinic days) - there physically isn't enough days in the week for both interns to have 2 afternoons off without affecting the function of the team. It just means that things happen slower, discharges get delayed, patient care is not optimal. With a hospital on bypass every second day, you would think that there would be an incentive for all teams to be working at full capacity...”
the designated sickleave/on-call system is never working by this stage in the year either, because doctors just call in sick because they’re so tired from working so many cover shifts and weekends- and on some units they can be working 8/10 weekends in a term- and then the doctors who are designated ‘oncall’ just switch their phones off and make sure they’re uncontactable. There is not enough slack built into the system, so when people feel they’re being exploited and have had enough, they get angry and don’t feel they owe administration anything more.
Being a junior doctor has got to be one of the most punishing jobs out there. I've lost count of the number of times I have worked in unfamiliar jobs with no senior supervision whatsoever, intentionally or otherwise. I've had days where I had to work shifts that would normally be worked by 4 doctors. Most recently I have lost 2 rotations I really wanted to do because they needed someone to fill the gaps left by all the people who have resigned in my health system.
Like many of my colleagues I've encountered abuse, threats of physical violence, worked multiple hours of unpaid overtime (occasionally without eating at any time during the day), and have been thrown in to fill gaps left by missing registrars in just about every specialty. I almost missed a job interview earlier this year as I was told there was no one to cover me as I was already working for 2 doctors at the time. And yes like many others I have turned up to work sick (on occasion considerably sicker than the patients that I was treating), so as not to "let the team down". And the most amusing thing about the whole experience is that i did it all for $3 an hour more than what I got working in a Supermarket checkout while I was in Uni. Makes you think...
Wow. Today unable to haemofilter someone as 'the machine's broken'. Couple that with the surgical list that was delayed as the water was turned off to the operating suite and we're backing a winner today!
I am a specialist surgeon in a regional centre. My theatre list for tomorrow morning has been cancelled due to lack of beds. One patient has waited for 2 years for his surgery. Our paediatric ward has been downsized while the hospital is being "redeveloped" so there aren't enough beds to do more than 4 paediatric day cases per day. My caseload alone could allow for 8-10 children per day to have their surgery. The new improved hospital already seems to have too few beds for our current caseload. So we have one specialist surgeon, one specialist anaesthetist, 5 theatre nurses, one theatre technician all idle tomorrow morning and 120 people on my waiting list unable to be treated due to lack of beds. What a waste of resources. This is in complete contrast to my theatre lists in private hospitals; they are always fully utilised and I have never had a patient cancelled due to lack of beds.
Hi everyone,
I've just skimmed through the posts above. It's disheartening, there's no other way to put it.
To those who are being abused by their HMO managers - talk to the AMA. I know it seems like they don't achieve much but when you give them specific examples it gets easier for them to act. Get what you can in writing, record names, dates and times of any conversations you have with the managers. Talk to your medical directors - they are doctors and the majority of the ones I have met are on OUR side. Though again, the more detail you provide them, the easier it becomes for them to help you.
As I read down the list, eventually discussion turned to industrial action. Many seem to have forgotten that we have done this before - only 2 years ago in fact. Several different tactics were employed and NO patient care was compromised:
1) a staged 'walk out' which consisted of a group of medical staff eating their lunch outside with some press in attendance.
2) HMOs at one hospital wearing hospital scrubs every day for a couple of weeks (regardless of whether they were surgical or not). This got the laundry bills climbing.
3)Completing discharge summaries but not signing. DON'T leave blank - they'll just get shoved on a shelf and done by your successor. Instead we wrote "Not signed - AMA industrial action" in the signature box.
The time to act is now. Mr. Brumby and Mr. Andrews have had long enough. No other profession would put up with this. Could you imagine the nurses, the teachers or the dock workers tolerating this stone-walling?
To those in the AMA - You have done so much for us in the past, we need you to act for us now more than ever. We need you to coordinate our efforts as you have in the past. We need you to increase the media coverage and get it put forward in the papers - not page 12 or 20, but in the first 5 pages. I know you've done alot - I've seen it, but then I've been looking out for it. The message is still not reaching the public. The subject of the hospital system comes up often with the patients I see in ED. They ask me why things are so bad, why nothing is being done - when I mention 'Your Hospitals', I get a blank look in return.
AMA, there is still much more to do.
Hmmm if the government's stance is that the economy is going into down turn, why in the world are they building a 100m dollar ferris wheel? I guess they need to keep the wheel turning eh? I dont believe such a thing as an excuse, since when our economy is not in a downturn? Its all perspective. Perhaps the government need to announce it to the whole of Australia's workforce not to ask for pay rise this year till 2009 and also to Cole's supermarket that it is now illegal to increase food prices as the economy is worse? Get real! That is an asenine excuse and if AMA accepts that then it just goes to show how powerless they are! What if the government says next year at end of 2009 that the health budget hasnt been increased and therefore cant give us the rise? It's like treating a poorly controlled diabetic patient who does not adhere to his medical regiment. Always giving excuses - it will never end. I say stand up to them AMA or perhaps we all should just take a long leave till 2009 and therefore force the hospital to only hire loccum?!
I dont remember them saying the same thing when the nurses are on strike or even the teacher. I think drastic situation requires drastic measurement.
And for the intern who has his overtime crossed off, you need to make a copy of the form your consultant signed and your payslip, also your pay sheet that you filled in. Hospital regulations require them to pay once consultant signs it which i think its rediculous anyway. I believe overtime sheet shouldnt require anyone to counter sign it apart your registrar, the consultant wont know whether you actually do your stuff or not or get the nurse unit manager to sign it would be fairer since they both would be there. Getting the consultant in my opinion is just a ploy as they realised they are not willing to sign it most of the time leaving you in a sticky situation. If they won't pay, all i can advise is to speak to AMA representative or do as the medical workforce said to you - get the other person on cover to do it! Stop attending late evening ward rounds or even the morning ones. But before you do it, you should get the medical workforce to write in black and white that they will not pay even when the consultant signs it! You will need all the documents to be stored well because you will need it to defend yourself when they turn their face and fail your term!
In regards to using junior doctor to fill in position of more senior doctor - you have the right to refuse the job! Protect your own right! Do you honestly think the hospital will stand by your side should you make an error in judgement? The hospital will most likely make a claim that if you could not do the job, you should have refused. Even if they stood by your side, do you think the public, the law and the tribunal will accept that as a reason? That you did not exercise good judgement to refuse to do something you are not able to? Cause that is all they need to ask you! Do you believe that you could not have done the job safely at the time? Your answer will be YES, then the next question would be, why didnt you REFUSE? You would realise that you have lost your career and life away to someone who doesnt care any less anyway. So wise up! Forget about the praises they will give you after the job! Protect yourself!
I recently spoken to a registrar that i used to work with last year. She didnt even know that we are fighting for better treatment and pay for all doctors! I think AMA need to send out plain sight publishing regarding this problem on their website and magazine all the time! She was totally oblivious to it! We need to gardner support from everyone.
In regards to the public, they won't care till it bites them in the butt literally! Whilst we continue to relent to the hospital demands and work back breaking hours to fulfil the public's need, they will not do anything. When i spoke to some of my friends who are not in the medical field, most of them would just shrug or say something in the order of, "quit and do something else", "you should have known it was like this so you can't complain", "oh, you are a doctor so that is the way it is". Bottom line is, IT IS OK IF IT IS NOT THEM WHO NEEDS TO SUFFER and IT IS NOT THEIR PROBLEM - not directly anyway. Alot of them expect us to sacrifice, believe it or not.
Only way to have the public understand is when they experience the system themselve meaning we need to take an active role and TELL THEM THE ISSUE WHENEVER THEY GET FRUSTRATED. I have been doing that for the past few months, it is difficult as often you realise it falls back to the same attitude of "What can i do?" or "Oh, you will get better pay or treatment eventually" (which i believe equates to telling a beggar that if you beg long enough, one day someone will give you a break but not from me!). But for the few that got the message, we have their support!
I believe the best way to rate the pay we should get is by taking a public opinion poll on what they believe our salary per hour is - under the condition that they do not have the privelege to the information before hand. You will be surprised! I have asked many, and all of them are in the order of 50 dollar plus per hour and that is after clearly stating i am a PGY3! But in reality i am getting 28!
PS: To the guy who has inside info on the government response to AMA - i assume other State would follow suit by docking the pay of their respective doctors in order to reflect the economy downturn? How about nurses? Allied health? Politicians? Police force? The army? Private sector employees? Why just us? By the way, we are just asking for standardised pay through out Australia not around the world! My relatives overseas in Taiwan laughed at my pay as a doctor saying i am a fool to have kept staying in the system! Perhaps they are right after all?
To the person who mentioned about the HMO service department who crosses out the OT even though signed by a consultant.
I suggest the following actions you can/may take depending on yourself:
1. Suck it up for a few years according to the consultant's advise. (Worst choice I must say as it does not help you or your coleagues in the long run)
2. Get AMA to seek legal advice. You might want to consider get a group of colleagues who feels the same way to sue the hospital as a group. Happens with the general surgical registrars in a certain hospital near Frankston Beach before.
3. Quit your job and do locum shifts, go interstate or consider a career change like some people have done and mentioned on the posts above.
Anyway, regardless what happens, wish you all the best as I know the hospitals and government plus DHS couldn't be bothered to help us doctors almost always.
Victoria is on the brink of a major setback in public health standards and safety in the medium to long-term. As more specialists leave the public arena for private work, with the resultant increasing workloads placed on our junior medical staff, there will be a significant deterioration in the quality and quantity of training. Not to mention the increasing fatigue, stress, and consequential social issues that come with being a junior doctor.
I once had an idealistic view of the Victorian public health system being second to none in world standards. This system has not only fallen well short of my view, but of the publics as well. As a junior doctor I have seen patients in Victorian emergency departments waiting 16 hours with serious clotting disorders, 14 hours after motorcycle accidents with severe pain and multiple fractures. Finally after beeing seen by the fatigued emergency doctor, many wait 24 to 48hrs for a bed on the ward, in a hospital that is at 100% capacity on a daily basis. I have seen patients die whilst waiting for beds, or alternatively waiting for a doctor who can never come to attend to their care because they're looking after other grievously ill patients. I have also been the victim of physical aggression from patients and families as a result of the tension that this environment creates in Emergency Department waiting rooms. A young male patient in one of the busiest Emergency Departments in Victoria decided to pull a gun out and wave it at staff earlier in the year. I was fortunate not to be in attendance.
I recall many occasions working 14 hour shifts without a single break let alone a coffee or lunch. Ive worked 24hr shifts and felt like the last 12hrs were a complete blur, wondering what I had done to treat my patients. Working a 60hr week is the norm and not the exception. Many times patients or families have approached me complaining that they never see a doctor on the weekend that they can talk to. This is followed by horror when I tell them I'm the only doctor in the entire hospital, and have 200 patients under my care, that I hadn't gone to the bathroom in 8 hours, or that I get paid less than I did when I was working in telemarketing in my early 20s. Welcome to the Victorian Public Health system! Personally, I would never allow my parents or grandparents to be treated in such a system, knowing how poorly it is run.
At my current level, I am about to see almost 50% of my colleagues leave the Victorian Health system in 2009, many for better pay and conditions interstate, some traveling overseas for prolonged periods to reassess their career options, and increasingly, some to quit their medical careers altogether.
I find myself in a dilemma. My 'asylum' in the medical career in Victoria has resulted in my relationships breaking down, family deterioration, social isolation, and a collapse in my physical and mental well-being. I feel a great need to use the skills I have acquired in my nine years to help my community, an innocent community that has become victim to its leadership, but have decided that I also need to care for myself before caring for others. I have decided to commit one more year to the Victorian public health system and no more. Unfortunately in the Victorian Public Health system, workplace abuse is not only written in the constitution, but also handed out feverishly by executives and administration onto junior doctors. 'Economic rationalisation' and the resultant deterioration in health care delivery knows no boundaries if this Victorian government continues its contemptuous attitude towards junior doctors and its utter disregard of their ill patients.
I don't think DHS realises just how damaging this blog is to Victoria's reputation amongst Australian junior doctors. Until now, I naively thought that my hospital was the poorest complier with the current EBA with regard to inadequate rostered hours and non-payment of unrostered overtime worked by necessity. I now realise that many other Victorian public hospitals are just as bad or even worse. I was getting fired up to protest (with AMA's support) about roster non-compliance in my own rotations. But what's the point if most other rotations in Victoria have the same problem? I can't fix all of them. And I now realise that my problems would not be solved by moving to a different hospital in Victoria. For the first time since I moved to Melbourne almost 9 years ago to start studying medicine, I am seriously considering returning to my home state, South Australia. Congratulations, DHS, you win. I give up.
I'm very sympathetic to all the comments here, and although I recognize some of the practices by admin are unethical and some senior staff are unsympathetic I think they are suffering from the same pressure from under-resourcing that we all are. The primary argument here should be with the Victorian government.
This government pays medical staff virtually the lowest rates in Australia, provides the lowest number of beds per capita, doesn't care that staff are moving to other states in record numbers, and has largely ignored the review it commissioned at the end of the last EBA. Now, according to an AMA update on 12/11 they are essentially refusing to debate the issues in negotiation. Victoria should have caught up to the other states 2 years ago, but this was deferred until after the review. Now there are no more excuses, and should be no more delays. The AMA should really be canvassing members with all the legal options available to pressure this government into an agreement. Negotiating alone allows too many delays. That was the lesson learnt in SA as well. We need to take action too, preferably before Christmas when the government will all go on holiday while you and I are still propping up their hospitals!
Interestingly, I heard Doug Travis on 3AW this morning with Neil Mitchell.
He didn't mention the EBA once. He didn't raise the issue of doctors in hospital once. He didn't raise the concern that doctors have about their working conditions and low pay.
He was speaking to Neil Mitchell, one of the most popular radio hosts in the state, and Dr Travis didn't raise this issue once. ? talk about a wasted opportunity.
I thought the AMA was supposed to be speaking to media to get publicity on these issues?
I'm a junior doctor and I'm considering next year as my last year working in the Victoria public health system!
Lah la la la lah...
(Is this happening you some of you as well?)
Don't worry, you're not alone! %)
As a GP, my patient was referred to a local surgeon (large regional centre). He booked her for her semi-urgent cholecystectomy. A nurse at the hospital assessed her as unfit for surgery, notified the anaesthetist(who did not see the patient at all) and the surgery was cancelled, without consulting the surgeon or myself.
It is very worrying that a nurse can cancel procedures.
To the GP above - we empathise completely! The whole inpatient treatment system is now run by nursing staff - the medical staff are simply bystanders trying to prescribe treatments regimens/procedures that 'will or won't' be assisted to be 'empowered' nursing staff. A bed may be opened or closed at a nurses discretion. Nurses get the final say on how an operating list proceeds - specifically timed with respect to 'firsts' or 'seconds' or overtime requirements (and THEY get paid anything 30mins or over). Treatment & investigations are routinely delayed due to 'empowerment' without responsibility - a little knowledge and a big attitude is a dangerous thing.
"I'm very sympathetic to all the comments here, and although I recognize some of the practices by admin are unethical and some senior staff are unsympathetic I think they are suffering from the same pressure from under-resourcing that we all are. The primary argument here should be with the Victorian government."
Don't be too kind to admin. After all, our dispute is not only with DHS but with the Victorian Hospitals Industrial Association which represents hospital management. Instead of passing on our distress and concerns to DHS, they filter them out.
Last year, one hospital administrator was overheard JOKING about the fact that the number of patients continued to rise and that there was no concomitant increase in the number of rostered hours for junior doctors. And yet when this particular administration was confronted by its residents and consultants with concerns about medical resident and patient safety, admin produced dodgy figures "showing" that there had been no rise in the number of patients. The consultants, who had been working there for years, knew full well that this was not true. Admin eventually agreed to employ an extra resident for 2008 but then cut everyone's rostered hours this year so the overall number of rostered hours for residents was virtually unchanged. Residents are STILL dangerously overworked and underpaid at that hospital and consequent massive delays in seeing patients means residents STILL do not feel like their patients are being safely managed.
In 2006, just prior to the state election, Helen Shardey, shadow minister for health (or should I say for cardiac surgery), came to our hospital to talk about what public hospitals would be like under a Liberal state government. She spent most of the talk telling us how much she admired surgeons and in particular her husband who was a cardiac surgeon.
After being advised by a nephrologist that not all medical conditions were amenable to surgery (which was met with much laughter from the audience), one junior doctor had the temerity to stand up and ask her what she thought about paying junior doctors unrostered overtime worked by necessity.
Our CEO was so incensed that her beloved Liberal party candidate could be put on the spot like that by such an irrelevant underling (damn that democracy and freedom of speech!) that she interjected before Mrs Shardey could even reply.
"There are opinions about payment of unrostered overtime other than yours, you know. I will speak to you about this afterwards" she said in a condescending tone.
Mrs Shardey then had the confidence to tell us what she thought. In her husband's day, she said, there was no such thing as unrostered overtime. Things were much improved now compared to her husband's day and will continue to improve in their own time (read: without her intervention). Besides, these things are not so important in a city like Melbourne, she said, because it is such a wonderful place to live that we will stay here despite our working conditions.
Mrs Shardey is still the shadow minister for health. It is very important therefore that we do not vote for the Liberals at the next state election. Labor has clearly demonstrated that they are more interested in building big strutures than looking after public institutions' most important asset: their employees. Consequently, I advise you all to vote for the Greens at the next state election. They are the only principled party and are more likely to demonstrate sympathy for us and understanding of our predicament given that the head of the federal Greens and founder of the party, Dr Bob Brown, is himself a medical doctor.
Vote One
1. patient safety orientated
and
2. Admin annoying
Industrial action
If your comments about our current shadow health minister is true, there is really no point in staying in victoria anymore. I initially thought that the problem lies with the Brumby govt alone. The Green party is never going to win an election. So it's going to be labour vs liberal again in the next election and things are going to stay the same no matter who wins.
Another example of a system in crisis....
Sandringham Hospital do not have a replacement surgical registrar to cover for emergencies for the weekend.
This is because hospital administration (despite having several months notice) had no capacity left to cover for one registrar on annual leave and the other on training leave. The hospital does not have the budget to pay for a locum to help relieve the pressure.
In other words, the emergency department has to contact the on-call consultant directly for any surgical problems (further slowing down the flow of patients through the emergency department), or transfer any potential surgical cases to the Alfred (which is itself under beds pressure)
The system is under pressure because we do not want to work in the Victorian Health System. Junior doctors are the lifeblood of the health system, and in Victoria we are being pushed harder and harder.
It isn't just doctors - nurses, allied health, paramedics are all up in arms against a heartless government.
I am personally fed up. I won't be working in Victoria next year.
I hope this story is yet another wake up call for Premier Brumby & Minister Andrews. You need to rescue your sick health system.
Yesterday and the day before, the news on TV shows the AMA Victoria president talking about how shotfall of beds in the public hospital system causing unnecessary patients death.
The Age from yesterday and today discuss about how a string of CEO are quiting their job from the public hospital due to budget pressure, etc.
Not even once the AMA president or the newspaper talks about the underpaid and overstressed speicalist and junior doctors in the australian public health system, where sometimes they are oncall/work for 12 days or more straight!
This is a total joke with AMA! I don't want to critise about the media since there is no good enough story to begin with provided by the AMA to start any interesting article anyway for mass public.
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