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While it may have been standing (just) until COVID hit, years of underinvestment in structural/systemic problems and poor understanding of doctors in training (DiTs) issues at a mid-bureaucracy level are actually to blame.

Until COVID, the poorer-performing hospitals would rotate the dubious honour, then a few years of focus on specific issues would bring results back up temporarily until that group of DiTs (the crazy glue), or the motivated MEU/Workforce/ Wellbeing person (The Duct Tape) who had been propping everything up moved on, and the whole thing fell down again.

This year’s survey lifts the veil on just how unsteady it all is underneath.

Yes, morale can be lifted temporarily by a dedicated RMO society and MEU/Wellbeing team, as we have seen hospitals do in previous years.

But it doesn’t hold up to a workforce so understaffed, so overworked, doing 15 hours a day, on call all the time, covering multiple roles, seeing their family once a month, grumpy and exhausted, with no leave available, waking up at 3am to study for exams because, heaven forbid, covered leave is available.

These workforce problems have been brewing for years.

Yes, a few less doctors have come from the UK this year because of COVID, but we at the AMA (WA) DiT Committee have been advocating for systemic change to medical workforce planning, DiT career development and progression, and recruitment processes that are the root cause of these issues since long before COVID.

It seems to me that the graduate more-med-students-and-cross-your-fingers-maybe-throw visas-at-the-problem technique used up until now has well and truly failed, and we should be looking at solving the real problems.

We are willing to help, and have bent over backwards to make ourselves available over the last few years to help solve these issues. You know where to find us.

Uncovered/ internally covered leave is not a solution

It never has been.

The guilt of leaving your team one member short is enormous and often insurmountable.

The stress of trying to reshuffle all of the on-calls and late shifts in order to make any ‘internally covered’ leave less of a burden on those left behind only makes the weeks before and after this leave more unbearable.

Leave is a fundamental right, and even more important in medicine, where what we do is hugely emotionally and intellectually taxing, and the things that balance that out (family, exercise, free time) are so much more important.

Those who have read my column before will be familiar with this.

There are X doctors that make up the establishment numbers of any hospital owed Y weeks of leave.

If Y = N FTE, why do we not have N number of doctors added to the X establishment number as a part of the accreditation requirements of that hospital? How is it that a hospital can be allowed to recruit to a number dozens of FTE short of its leave requirements year after year, then act surprised at the burnout data?

How on earth are they surprised that we feel so emotionally and often physically fatigued we are reporting unsafe care when they can only provide covered leave for a small percentage of their workforce?

Continued over-administration and increasingly complex bureaucratic systems continue to erode the doctor-patient relationship that once formed the cornerstone of medicine, and is driving many doctors from clinical practice altogether.

This is seen in the compassion fatigue ratings, and in almost all of the free-text answers in this year’s survey.

I have seen these problems continue to increase year on year, despite many promises of time in motion studies and reform projects. COVID did not cause this, nor should it be the reason we continue to ignore it until there are no doctors at all standing behind the CoWs (Computers on Wheels).

To their credit, some hospitals have been investing in wellbeing and targeted improvement programs, but it is not enough to hold the straw house together in the face of a strong wind. Starting to really get to work on the bigger systemic root causes is the only way to strengthen the cornerstone foundations of our health service.

This year’s survey clearly shows we are at the end of the roll and bottom of the bottle of the goodwill the clinicians can sustain.

This article first appeared in the October-November edition of Medicus magazine: www.amawa.com.au/medicus/november2022/#page=18