Flashback Friday: The balancing act | AMA (WA)

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Flashback Friday: The balancing act

Saturday November 26, 2016

Australian Medical Association (WA)

Work-life balance is a term that we hear often and like most other professions, the medical community has its own peculiar struggles in this area.

The never-ending rosters, the arbitrary shift work, the unenviable stress, continuing off-the-job study, along with professional courses and seminars leave little time for enjoying life’s little pleasures and pursuing activities that are good for you – body, mind and soul.

Call it what you may – work-life co-existence, an impossible luxury or a dream that often seems just beyond your grasp – it holds the key to our sanity and happiness.

 

But what does it really mean for you – and those around you? Do you successfully find that happy path or is work-life balance just another vacuous term thrown about by smug-faced life coaches, devoid of any substance.

Shiree Treleaven-Hassard, a 45-year-old intern and single mother of two children, says the past year has been a roller coaster of random shift work, no regularity and not much opportunity to take any leave.

“To be honest, I am nearly at my ‘not coping’ threshold,” Shiree says.

“I have no issue with shift work – or working hard. But what I have struggled with is the randomness of the shifts.”

Four of Shiree’s five terms this past year have involved random shifts that have included late night finishes and early morning starts. Her only ‘regular hours’ term incorporated a 12-hour shift once every week with no leave cover.

Currently looking forward to a two-year appointment at Fiona Stanley Hospital that begins next year, Shiree is in the process of selecting her term preferences. She has consulted with medical workforce staff about her options and avoiding random shift work. However, it is slim pickings.

Shiree could opt to go 0.5 FTE and have a job share arrangement, but she simply can’t afford to. The other option is to request ED for three set shifts per week (at 0.75 FTE).

The thought of having fixed days of work appeals to Shiree but it’s an arrangement that would limit her to Emergency Medicine.

“I feel very privileged to be a medical doctor. But I often ask myself if I have made the right decision,” she says.

“I’m not sure how the following two years will turn out. I am very happy to have a challenging yet satisfying career; I just have to navigate the logistics.”

Like Shiree, there are hundreds of doctors in WA who are faced with making difficult decisions; choices that can have serious ramifications on their future careers, their wellbeing and that of their families.

UNSAFE SHIFTS = UNSAFE DOCTORS

Earlier this month the Australian Medical Association launched its 2016 Safe Hours Audit, an online survey to assess the fatigue risk of the working hours of salaried doctors and doctors in training, including GP registrars.

The previous audit, conducted five years ago, found 53 per cent of hospital doctors were working unsafe hours, with reports of continuous unbroken shifts of up to 43 hours.

Will that figure of 43 hours be relegated to the past?

AMA Federal President Dr Michael Gannon says that fatigue and quality medical care do not mix.

“Fatigue can impair judgement and work performance, and potentially affect patient care and the wellbeing of doctors,” he says.

Doctors across the country are being encouraged to take the 10-minute survey (www.safehours.ama.com.au) and anyone who completes the audit will be able to access an instant risk assessment report, which offers an analysis of the fatigue risks of their roster.

Chair of the AMA (Federal) Council of Doctors in Training Dr John Zorbas has written a compelling article (see page 25) on the damage an unsafe roster can wreak on the life of a doctor.

TAKE A BREAK OR BREAK DOWN

Debilitating rosters aside, there are other hindrances that contribute to an unhealthy work-life balance such as inadequate access to paid leave. A majority of the complaints received by the AMA (WA)’s Industrial team from interns and RMOs relates to leave access.

Consider this. Doctor Stressman dreams of travelling to Peru with her partner. As per the requirements, she submits an application for leave on the designated day for submissions of leave requests, usually prior to or at the start of the calendar year, along with hundreds of other doctors working for the same health service.

Within two weeks [as stipulated by the Department of Health Medical Practitioners (Metropolitan Health Services) AMA Industrial
Agreement 2013], she receives a response. Her request has been refused, but she has been put on a waiting list – hardly conducive to planning for the big trip!

Sound all too familiar?

Sanction of leave is the exclusive remit of a hospital’s medical administration. The staff there makes decisions based on the amount of leave cover in the system and of course, more often than not, there just isn’t enough.

Under the Department of Health Medical Practitioners (Metropolitan Health Services) AMA Industrial Agreement 2013 (the Agreement) governing public hospitals, the employer is obliged to ensure that there are sufficient staffing levels to allow employees to take leave.

Therefore an employer who refuses a leave application based on inadequate staff numbers is in breach of the Agreement.

Keep in mind too that the Minimum Conditions of Employment Act, which is incorporated into each enterprise bargaining agreement, has a provision that stipulates the right of the employee to take any leave accrued the previous year with just two weeks’ notice to the employer.

PARENTAL LEAVE: NON-NEGOTIABLE

Access to parental leave – and in particular, concurrent parental leave – is another anathema to balancing the scales between work and life beyond medicine.

The problem here lies in the fact that medical administration adheres to the letter of the Agreement, despite being advised again and again by the AMA that the conditions are overridden by the more favourable provisions contained in the Extended Provisions of the Fair Work Act, a nationally-applicable law.

These provide that each parent (mother and father) is entitled to take up to 52 weeks of parental leave from their workplace, but this has to be subsequent. The only time both parents can be on parental leave at the same time is when they access what is called “concurrent leave”.

Concurrent leave is available for up to eight weeks and is usually taken at the birth of their child and immediately after. The fact that the Agreement still references only one week is irrelevant, as the more beneficial provisions of the Fair Work Act override the Agreement.

The other problem is that WA Health tends to treat parental leave in the same vein as it does annual leave. However, parental leave is akin to sick leave – it’s non-negotiable! It is available as a matter of right, contingent only on the live birth of a child and on the practitioner having given the required 10 weeks’ minimum notice of the intended commencement (and proposed end) date of their leave.
It is frustrating that employers need to be constantly reminded of the fall-outs of refusing leave requests. If doctors are worked to

the bone without a break and leave applications are repeatedly knocked back, not only does loyalty to the employer take a precious beating, the amount of sick leave taken surges.

DUTY TO SELF

Doctors have a particular set of skills and with it comes immense responsibility. The greatest responsibility a doctor should uphold, though, is duty to self.

The oft-chanted counsel that most physicians will testify to hearing is “put the patient first” – a sure-fire recipe for burnout. Achieving the correct life balance means placing your priorities (outside of your career) at the top of your list.

Write them down and work towards achieving them. Say ‘yes’ more often to yourself, your partner, to your children, to your family and friends. Once you say ‘Yes’ to your wider life, learn to say ‘No’ – with a smile – to any unreasonable work demands that could derail your daily living and wellbeing.