This evening I went on the radio – Hack Triple J – to talk about the issues affecting junior doctors in Australia. Some of the systemic issues I mentioned include:
- Burnout and poor mental health
- Bullying
- Sexism
- Structural racism
As well as every day interactions, gender and race biases also affect the selection processes into medical schools and training programs. In addition, these processes are marred by ableism, classism, and nepotism, which means that career progression is not always fair.
Without junior doctors, public hospitals would simply fall apart. Junior doctors are an intrinsically motivated and hard working group of people. So why is it that they aren’t getting paid for the hours that they work? Typically, a junior doctor may work twenty hours of overtime a week, if not more. Not only are these hours not paid, junior doctors are discouraged from submitting overtime claims in the first place.
I’ve heard senior doctors say that they were never paid for overtime “in my day”, and therefore neither should we. This is not a good reason to underpay doctors. The demands on doctors today are different from those in the past. One such example is the adoption of electronic medical records, which have significantly increased the workload and shown to contribute to physician burnout.
I remember as an intern being told that we mustn’t claim any overtime during my General Medicine term. The Professor who was the head of unit said that we should be able to complete all of our tasks within the rostered hours, implying that we were inefficient if we didn’t. This dismisses the fact that we might be going on ward rounds all day and unable to get to discharge summaries and other non-urgent (but still important) tasks until after hours.
I also remember being discouraged from claiming any overtime as a Plastics resident. Again, the direction came from the Professor who was the head of unit. We were rostered on from 7am but came in at 6 every morning for the ward round. We were not to write down 6am as the start of our shift because the administration considered 6am as “night shift” … If 6am is not considered a normal time to start a day shift, why were we made to start that early, and not getting paid for it? Starting an hour early every day for a twelve week rotation adds up to sixty hours of overtime. The number of hours we stayed back after the end of our rostered day was even more.
The very fact that overtime forms need to be signed off by Heads of units also makes it difficult for junior doctors to claim overtime. It is intimidating for interns and residents to talk to a departmental head, let alone ask them for extra pay. Junior doctors are under a lot of pressure to impress their bosses, particularly if they have not yet been selected onto a training program and therefore rely on references from them. This means that junior doctors feel the need to show that they are dedicated, accommodating, team players – all of which are highly valued qualities. We stay back at work to help the team. We stay back because we are interested. We stay back because we are committed. Because of this huge need for approval, junior doctors are extremely vulnerable to exploitation.
There is also the expectation that doctors should be willing to put in the extra hours because we are higher up in the moral hierarchy of jobs – altruistic professions are not monetised like other professions are. We became doctors because we want to help sick patients, not because we want money. To demand payment for the hours that we work is seen as ‘greedy’ whereas it’s perfectly reasonable – and normal – for any other professional to do so.
Not being paid for the work you do would make anyone feel undervalued, and it leads to low morale and a diminished sense of personal accomplishment – one of the domains of burnout. Junior doctors are already exhausted as it is. To underpay a group of people who are already overworked is gross. There are further reasons why not paying overtime leads to burnout. When doctors don’t claim overtime, it gives the hospital the impression that that job was not that busy “because no one worked any overtime”. This affects the next group of doctors who do that rotation. It is absolutely important for doctors to log all of their hours. Even if the claim ends up being rejected, that record needs to be kept because it shows exactly how much work an individual doctor has done for that particular rotation. Hospital units need to know how many hours each doctor is working for adequate staffing. If they don’t have these numbers, they cannot justify recruiting extra doctors – this leads to understaffing, overwork, and burnout.
There are currently class actions underway in Victoria and New South Wales for unpaid overtime among junior doctors, with talks of other class actions happening in other states. For too long, junior doctors have been overworked and underpaid. There are many systemic and cultural issues we have to fix – overtime pay is a relatively small issue with a simple solution. Pay us what we work. We are caring and hard working people, but we don’t work for free – the exploitation must stop.
You make some excellent points. Importantly, though, ableism is subtle but prolific in selection processes for medical school, unreasonably inflexible medical curricula, strict processes for the internship match, health service workforce planning/rostering, and the structure and function of the health system itself. Ableism is not a side note, but a highly relevant and toxic issue in Australia’s system. Countries such as the US and UK have policies that attempt to remove barriers for people with chronic illness or disability from applying to medical school, recognising that personal experience is invaluable in connecting with patients, understanding the health system, communicating with families and working in collaboration with nursing and allied health staff. At every step, people with a lived experience as a patient face often unsurmountable challenges to becoming/remaining a doctor. As a patient, I know I’d rather have a doctor who would communicate with myself in a way I could understand and truly empathises with me than a doctor who has no physical impairments but is rude, dismissive, fails to explain a diagnosis or treatment plan, or fails to demonstrate any care for the individual.
The impact of unpaid overtime and unreasonable working conditions are only more pronounced and harmful in those with chronic illness and disability, who need to attend regular appointments as part of their own care and already have substantial medical bills. Consider that females are more likely to develop an array of chronic illnesses (e.g. autoimmune diseases), and the impact is even greater.
It is frequently difficult for able-bodied people to truly understand the struggle of those with visible or invisible disabilities at the best of times, but it is so important not to forget how rife ableism is in the general community, health systems and medical education/training/workforce. There are already so many barriers for people with chronic health conditions or disability in getting into medical school and progressing in their careers, and working unpaid overtime and in toxic conditions also undermines their own health and wellbeing (e.g. missed appointments, workload unsafe for person’s needs/capacity, etc.).
Well written Yumiko. The underpayment and exploitation of junior doctors needs to stop.
Hey miko,
I don’t think unpaid overtime is a huge issue – if there was ‘compensation’ by way of carreer development or mentorship.
The problem is the number of unaccredited years. Everyone knows that consultants get well remunerated whether in a public hospital or in a productivity-based private model.
The sad thing is that many capable docs sink a decade into the hospitals and have no fellowship to show for it.