Blog

Time to bring up the ‘L’ word

Monday August 3, 2020

Dr Megge Beacroft, Chair, AMA (WA) Doctors in Training Committee

Every year around this time, shortages of junior medical staff become apparent. Leave relief pools have disappeared, there are desperate emails everyday from medical workforce asking for critical shift cover, and morale in the hospitals is starting to plummet.

While the absence of our annual northern hemisphere workforce supplementation will exacerbate this problem for 2020, it is neither new nor unpredictable.

Having been around the table for a while now, I have heard the same line too many times. Junior doctors lack loyalty. I have heard it at focus groups looking into the workforce shortages, at medical workforce summits, and at committee meetings.

It is absolutely 100 per cent false – a throwaway line that fails to appreciate any of the root causes or realities of the doctor in training (DiT) workforce problems faced by WA Health.

We are loyal to our patients and entirely committed to becoming the specialists who will best serve the health needs of Western Australians.

WA does not lack graduating doctors; it lacks specialists. Training specialists – from GPs to surgeons who are fit for purpose in WA – takes time, five to 10 years in fact.

During that period, doctors are required to move around our uniquely set out health service in order to gain necessary experience. Neurosurgery is over there, ophthalmology over here, women’s health somewhere else. Almost no hospital in WA can provide a training doctor with an intern to specialist experience in any specialty.

So, we move around, not because we hate job stability and accruing entitlements but because there are a number of skills we need to pick up in order to serve our patients – and you can’t get them all in one place.

We navigate through a series of 6-12 month contracts through our increasingly fragmented health service in order to develop these skills as there is no system-level career development or thought-out workforce progression. This is not disloyalty.

Surely health system managers should see that this is, and always has been, a necessity of training specialists in WA and think about progress toward training length contracts, or career development pathways that don’t require resignation and re-application to navigate this process!

As the pre-vocational space gets more complicated and competitive, it gets increasingly important to achieve something toward a specialist training goal every year. This may be in the form of a research opportunity, attending critical courses, or exposure to a particular rotation.

Employers make no commitment to their training doctors. When filling out the annual job application, knowing there is only a chance at picking up the skills you need when the rotations are finally released, being unable to apply in advance for periods of leave or specific training, and simultaneously remaining acutely aware of all of the other ‘adult’ things you have to do when you finish training (I’m speaking to you, biological clock), why wouldn’t the best candidates apply to more than one hospital and accept the job that gives them the skills they need? Surely, some matching of candidates to jobs beyond a generic selection criteria that doesn’t change year to year would not only attract and retain the best candidates to a hospital but create a more positive work environment to boot!

In a high-stress environment, surrounded by trauma and suffering, access to leave is essential. Please don’t misunderstand me – I love my job, but it is well known that prolonged exposure to long hours and high stakes takes a toll. We work long hours and make tough decisions and time away to reconnect with loved ones and recharge is vital.

Lack of healthy leave allocations increases burnout and compassion fatigue and leads not only to mental health problems but loss of our colleagues to non-medical professions and in some cases, even suicide.

Why is it that, despite known leave liability and workforce numbers, we don’t have a high-level strategy to address leave? If you have ‘X’ doctors all entitled to ‘Y’ weeks of leave a year, you need ‘X x Y’ weeks of leave cover which is ‘(X x Y)/52’ in FTE.

This isn’t rocket science and it is much cheaper for the taxpayer to provide leave year in year out than pay us all out at higher levels when we inevitably leave to gain other skills.

Yet I have had colleagues denied leave for their own weddings despite being owed more than three months of leave, and colleagues asked to provide a death certificate before being granted leave to go to a parent’s funeral. Is having to quit your job to get married or go to a funeral a lack of loyalty? I think not.

Perhaps a central pool of available leave should be built into accreditation requirements for hospitals or if we move to a centrally controlled recruitment process. Things are about to get critical in our hospitals and we haven’t got any staff in quarantine or self-isolation yet. If now is not the time to commit to some of these essential changes, when is?

Let’s stop blaming the doctors and look at the system that is in desperate need of improvement. Let’s look after each other out there. And although I’ve said these things a hundred times before, I will repeat them – louder and louder – until we get action.