Is it any wonder doctors look to other jurisdictions for better pay and work conditions, leaving NSW EDs continually short-staffed?
NSW is letting down doctors as a result of “outdated” conditions under the statewide staff specialist award, the worst across all states and territories in the country.
According to Dr Nicholas Spooner, president of the Australian Salaried Medical Officers Federation of NSW and director of emergency medicine at Wyong Hospital, the relatively paltry conditions offered under the NSW specialist award compared to other states and territories was one of, if not the biggest contributor to the statewide health workforce shortage.
“In my experience as a department director … the challenge is it’s an award barrier that’s outside the remit of the medical workforce, Dr Spooner told the NSW Special Commission of Inquiry into Healthcare Funding.
“We can’t pay people more and we can’t offer them other attraction and retention carrots to get them into the department.
“The issue with the NSW award is it’s out of step with the other state awards.
“That means the labour market is defined by the rest of the country, and if there are more attractive conditions, people will look elsewhere for where they would prefer to be employed.
“My opinion, and that of ASMOF, is that the award is one of [the largest barriers], perhaps the largest barrier to the workforce crisis.”
One of the main limitations to the NSW staff specialist award was the universal base pay rate for on-call work, Dr Spooner said, which was not only inequitable given the flat rate regardless of the amount of work performed but had also grown increasingly out of step with modern work models for hospital, particularly ED, staff.
“Since the inception of the special allowance for on-call work, the nature of the modern-day ED has changed. The quantum of on-call and the responsibilities of [being] on-call have changed, so they don’t reflect the basis that [the allowance] was established on,” he said.
“[Now that] we can access EMR and radiology and pathology [reports] at home, rather than on-call being a simple phone call and some advice, it now turns into what one might call a virtual consult or a virtual review where the expectation would be … that you should pull up the notes and pull up pathology and radiology. Which turns a few minutes [on] a phone call into a more laborious endeavour.
“And with the quantum of calls, that means that instead of one or two calls a night that may be on the order of 10 to 20 calls a night.
“[Since] it’s a flat rate … it doesn’t reflect the current work requirements and work intensification that has happened since that was instituted in the award.
The lack of a provision to ensure specialists be paid for overtime work between midnight and 7am was also a significant limitation under the current award structure, Dr Spooner said.
“If you were rostered on a shift that was meant to finish at midnight, but there were other parts of patient care that you had to tidy up, and you were going to stay longer, or if if a sick patient arrived and you felt that it was necessary in order for patient care and safety to stay behind, the award essentially turns off at midnight, [so] there’s no way for you to be remunerated for that,” he said.
“There is the on-call allowance, but there’s only one person who’s on call, at least in the emergency department for the overnight period, and anyone else who wasn’t on call would not be earmarked for that special allowance for that period of time.
“Knowing that there’s no way for you to make a claim would mean that people would adjust their behaviour to try to avoid getting into that time continuing to do work and having no capacity to be remunerated for it, so it’s not particularly common for people to stay back regularly.
“But when there are times when you need to stay back, [and] that leads to an element of resentment.”