Beyond the call of duty | AMA (WA)


Dr Chris Wilson | AMA (WA)

Beyond the call of duty

Friday October 30, 2020

Dr Chris Wilson

Being on call is synonymous with doctoring. When I tell non-medical friends why I can’t make it to an event, they understand – at least at a superficial level. What is less appreciated is the significant burden on-call shifts place on us, especially during the registrar years.

If your roster involves on-calls, it’s probably at least once a week, if not more frequent. You likely also have entire weekends on call that loom large on your calendar. They fall between regular shifts, after hours and overnight. On-calls ruin your sleep even if you’re not that busy.

But they usually are busy and quite stressful. We accept them, though, because we know we’re offering a vital service, not just to our patients and our hospital, but frequently to a large portion of the State. We know on-calls are an opportunity to learn and grow as a clinician and are often a vital part of training.

That said, it is beyond frustrating when the work done while on call isn’t appropriately acknowledged. We’re not looking for a pat on the back (although sometimes that would be nice), rather appropriate pay for work done.

And when we talk about appropriate pay, we’re not even talking about the paltry $11/hour we get for giving subspecialty advice to all comers at all hours. We’re talking about being paid the correct recall rate as per the AMA Industrial Agreement.

It’s almost expected now by DiTs that our fortnightly pay will be wrong in some way. When you’re working on-calls, it’s practically guaranteed.

On a previous rotation, I needed an 80-line excel spreadsheet to keep tabs on the inaccuracies in my on-call pay. None of that was the fault of the department I was working for, but clearly something was going awry regularly between the department approving it and the hospital/HSS processes.

Most of that was the substitution of recall hours for overtime, especially when those recall hours straddled the end of a regular shift. Despite the only reason to be working was that you were on call and fielding a myriad of requests from ED, the ward and other hospitals across the State, somehow this extra scope of practice from the norm was considered overtime. This interpretation is one the AMA (WA) disagrees with and one that has been a longstanding issue.

On the face of it, conflating recall and overtime might seem trivial, however, they are not the same thing. Labelling it as overtime devalues the work of the practitioner, fails to
recognise the burden carried being on call and robs the practitioner of the higher recall rate they are entitled to.

That higher rate also acts as a marker of risk for the hospital – of both staffing costs and staff safety. Where the recall cost for a department is too high, that should trigger consideration of alternative rostering methods, not just a rethink of how to devalue the work being done.