The Overworked, Sleep-Deprived Junior Doctor
The overworked, sleep-deprived junior doctor is a stereotype as old as time itself. 70-hour work weeks? Sure. Multiple skipped meals? No worries. Unclaimed overtime? Of course, boss. However, in recent times we have started to see a shifting of the tide.
With an emboldened junior workforce, support from the AMA and training college administration as well as favourable public opinion, meaningful change is being made. Recently, we have seen the withdrawal of training accreditation from Westmead Hospital’s ICU department in response to ongoing bullying. In 2017, a $3 million JMO Wellbeing and Support Plan was announced by NSW Health. Despite these positive steps, there are still numerous examples of deliberate exploitation of junior doctors.
Sunshine Hospital, within Western Health in Victoria has recently seen registrars launch a class action, alleging not only being overworked above and beyond their contracted 43 hours per week, but also for having their mandated five hours of clinical training neglected by senior hospital staff. Perhaps even more concerning is that since the class action has been launched, many have retracted their allegations for fear of future repercussions affecting their career progression. Such a culture of compliance by fear and threats is unhealthy but sadly not isolated. Only a year later we were introduced to Yumiko Kadota and the abusive working conditions she faced as a surgical registrar at Bankstown Hospital .
180 consecutive hours on call. One day off. Another 80 consecutive hours on call. Sounds like a nightmare, right? This was the reality for Dr Kadota as she pursued her dream of becoming a reconstructive plastic surgeon. What made this case unique was that it captured the imagination of the general public. Being interviewed by the ABC's 7.30 report, her mistreatment and exploitation by senior surgeons angered fellow health professionals and the general public alike. Perhaps it was her personable nature, or the almost comical absurdity of her working conditions. Whatever it was, it has acted as a catalyst for change. Change that is desperately needed.
The AMA recently reported that 40 percent of junior doctors agreed with the statement that their work was causing a deterioration in their mental health. Another 40 percent reported that they had experienced bullying or discrimination in the preceding 12 months. From a patient perspective, worryingly, the 2019 NSW Hospital Health Check Survey reported that 61 per cent of doctors in training were fearful of committing a clinical error due to overwork. So, what is being done about this?
As mentioned earlier, there has been some concrete action taken. NSW Health’s $3 million JMO support package is promising in its broad scope to not only “support the health and wellbeing of our junior medical workforce” but also to increase “assistance when burnout and other mental health issues do arise”. Furthermore, in a move that may seem well overdue, NSW Health has also introduced restrictions on shifts, limiting shifts to a maximum of 14 hours and mandating at least 10 hours between shifts. 14 hours is a long time in anybody’s language and this step has been welcomed as a major step in the right direction. This change came following a revision of the AMA guidelines regarding scheduled working hours, overtime and on-call. While many of these changes are isolated, the support from the AMA, various doctor support groups and unions as well as greater awareness in the general public of the issues faced by junior doctors. These structural changes, however, are only one part of the solution.
The other component is much more insidious and persistent -- culture.
A culture that is accepting of abuse and mistreatment as ‘tough love’. Of ridiculous hours as ‘learning your craft’. Of discussion of concerns about mental health and burnout as a sign that maybe they’re ‘just not meant for the job’. This is pervasive and requires change from the ground up. Change that may come in the form of seventy junior doctors at Royal Hobart Hospital penning a public letter expressing their concerns over working conditions and the “corporate culture” that treats them as cannon fodder. A program known as ‘Ethos’ is currently being trialed across St. Vincent's Hospitals in Australia. This is an evidenced-based approach at providing an avenue for staff to report unprofessional, unsafe or unsociable behaviours. What is a well-intentioned attempt at change hasn’t been without its problems though, with concerns from staff that the program encourages trivial complaints and causes undue stress for those who are the subject of complaints. This only serves to highlight the difficulty at introducing long-lasting and positive cultural change within the medical community.
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Perhaps even more concerning is that since the class action has been launched, many have retracted their allegations for fear of future repercussions affecting their career progression.
Hard work, commitment to the job, and passion for patient care have always been key pillars of the identity of most, if not all, medical professionals. But for too long these traits have been exploited to the detriment of the health of young doctors - keen to make positive impressions on their seniors, in pursuit of a treasured spot on their training program of choice. Be the change you want to see in the world (or maybe just the ward). While cliched, it means instances of bullying can begin to get called out. Or resist requests to not claim overtime. It would be naïve to not acknowledge that this takes immense courage and yes, that a senior supervisor may attempt to disadvantage you because of it. But with the AMA and various support organisations emboldening junior medical staff to speak up about mental health and to call out inappropriate workplace behaviors, the ability to enact lasting cultural change is growing. Perhaps the current generation of young doctors won’t use the ‘I had to do it, so you have to’ approach to their interns and juniors when we hold the positions that have been used to exploit and intimidate.
Support is available for those who may be distressed by phoning Lifeline 13 11 14; Mensline 1300 789 978; beyondblue 1300 224 636.