The true cost of testing the market | AMA (WA)


AMA (WA) | Dr Stella Fabrikant

The true cost of testing the market

Friday October 30, 2020

Dr Stella Fabrikant

In January 2015, Steve Fenner, founding Head of Psychiatry at Fiona Stanley Hospital (FSH) called, struggling to find a lead for commissioning of Western Australia’s first Youth Mental Health Unit.

Although busy with private and public work, I had experience and passion in youth psychiatry, and service development. I agreed to help, passed on my practice of 10 years to a junior colleague, and joined an amazing group of clinical leaders at FSH. Mixed in gender, background and seniority, we were united by a drive to create innovative tertiary services, which genuinely put patients first. Under-staffing meant long days and donated work, but we mindfully built teamwork, camaraderie and processes for each sub-specialty.

The FSH youth ward had double the productivity of acute adult wards. Our integrated inpatient and community model received very positive feedback and evaluation. It was adapted for the second Youth Mental Health Unit at Bentley Hospital.

Challenges included financial recovery and restructuring before FSH consolidated. Amalgamation with Fremantle and separation of mental health from other FSH specialties reduced our autonomy. We experienced churn of executives, the resignations of Steve Fenner and the next two heads of department. Stress led to ill health and cascading resignations.

From 10 consultants in the department, eight resigned; two have not been reappointed.

Exit interviews are avoided. An independent review report was “lost”. Clinical positions filled and terminated, contrary to specialist advice, with token process.

Use of contracts as management tools contributed to a workplace where senior consultants felt disempowered, and junior colleagues intimidated to speak up. Six new consultants were recruited this year. Six senior consultants are seeking other options due to feeling disrespected and undermined. I could not have imagined this when I joined FSH.

Last August, while on sick leave, I received a letter from the FSH Chief Executive thanking me for my service to the organisation, and informing that I would not be offered further employment.

I phoned our Service Director protesting the insensitive communication, and asking why. She apologised, undertook to speak to HR about wording of letters, and said I could reapply for my position.

I said that through 25 years working in health around Australia, my experience was that consultant contracts are renewed unless there is a problem.

I was told that practice has changed in WA, and positions are advertised to “test the market”. This provides value for money. She suggested that, as a taxpayer, I should understand. I did not.

As a taxpayer, I think we should not be wasting resources, fuelling staff instability, undermining clinical services, treating senior clinicians as commodities, and damaging the reputations of our more successful organisations. Resignations and unfilled positions indicate the market.

She maintained the stance, refusing to disclose the percentage of consultant contracts used to “test the market” five years after commissioning.

I asked our Head of Department why she had not told me that my contract would not be renewed, and to explain the reason. I highlighted the instability it would cause, as the other youth psychiatrists had left or were leaving. She said she was not involved in the decision, and was told this is the process.

The non-renewal of contract stunned and confused me, and my team. Notification by standard letter felt hurtful, and the wording inappropriate. I am still unaware of any rational reason for my dismissal, or problem with my overall performance.

Clinicians come to work to treat and care for patients, not for “service to the organisation”. Health services exist for the same reason too, but our executive seem to have it the wrong way round.

As a clinician, the callousness of my termination and weak responses from my Service Director and Head of Department suddenly made the workplace feel ‘unsafe’. How could I trust the organisation with the welfare of colleagues and patients?

I am sad, angry and relieved in equal measure to be leaving FSH. I am trying to shed any remaining sense of responsibility, knowing that the hospital executive has to own the consequences of its choices. However, it is hard to sever attachment to long-term patients and colleagues.

Unfortunately, it may be they who experience the consequences, as I have never met “the organisation” the executive claims to represent.

This article was first published in the August edition of Medicus, the AMA (WA)’s monthly magazine.