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I RECENTLY asked a number of exhausted junior residents how the community can best show their appreciation for their dedicated service at the frontline of the pandemic crisis. As all Australians owe these doctors a debt of gratitude for their contribution, we should be concerned that stopping public hospital “wage theft” was their answer.
Wage theft is no longer just an emotional term, or a cultural, doctor wellbeing or patient safety issue. It is a crime from which public hospital leaders are not exempt.
It has been widely publicised that in Victoria from July 2021, the Wage Theft Act 2020 (Vic) has made it a crime for an employer, including a government funded public hospital, to deliberately underpay employees, dishonestly withhold employee entitlements, fail to keep proper records of employee entitlements, or falsify employee entitlement records to gain a financial advantage. Offences under the Act attract a penalty of up to $991 320 for organisations and up to $198 264 for individuals, as well as up to 10 years’ imprisonment. Although Victoria is the first state to introduce this legislation, other states are following suit, and Federal Labor is pushing for national changes.
Given the severity of these penalties and the gravity of the pandemic crisis, it is disturbing that junior doctors have had to resort to class actions for tens of millions of dollars in wage theft against NSW Health, and against Peninsula Health, Monash Health, Latrobe Regional Hospital, Eastern Health, Royal Women’s Hospital and Western Health in Victoria.
Public hospitals have always relied on the goodwill of all doctors to work extra unpaid hours to uphold the highest standard of patient care in overwhelmed wards, surgical theatres and accident and emergency departments. And for as long as anyone can remember, a blind eye has been turned to the chronic underpayment of the entitlements of doctors-in-training to overtime, extra shift allowances, on call penalties, breaks and training periods. What has changed?
How has the pandemic impacted junior doctor workplace conditions?
“Unpaid training hours were much longer in my day” is now an invalid response. The pandemic crisis has exacerbated the extent of underpayment of basic entitlements for junior doctors – to a level it can no longer be ignored. In 2021, an AMA survey found that many are working often in excess of 25 hours a week overtime, most of it in a volunteer capacity.
Workloads, necessary infection control measures and pandemic training are onerous for all health workers. Overtime and additional shifts are frequently requested of junior doctors as many medical staff are forced to take sick leave or to furlough following close contact with a confirmed COVID-19 case. During each long shift, junior doctors are called upon to provide extra care to isolated sick or dying patients and their angry families, who are separated due to pandemic restrictions. Consequently, there is little time for breaks and debriefing, particularly for doctors caring for patients with COVID-19, who are isolated from other staff.
The AMA Victoria Hospital Health Check recently surveyed more than 1000 junior doctors working in public hospitals across Victoria, and found:
- 47% reported making a clinical error due to fatigue;
- 50% said they had made an error due to excessive workload or understaffing;
- 47% reported never being paid for unrostered overtime; and,
- 34% raised serious concerns about their workload but were ignored.
To compound these unprecedented pressures, other serious occupational health and safety issues have emerged for all health workers (here, and here), which are affecting their mental health and productivity at work. Widespread concerns have been expressed about ill-fitting PPE, late vaccine booster doses and expectations to return to work too early after close contact with a confirmed COVID-19 case.
It is unknown how many doctors and other health workers have been infected with the virus at work and have infected their loved ones.
There are also reports of unacceptable levels of patient anger and violence towards health professionals.
Junior doctors, in the formative years of their careers, are also understandably anxious about all these risks to their safety, particularly when managing excessive patient caseloads in unpaid work hours, which are not being fully recorded or monitored by public hospitals.
Who is ultimately responsible for wage theft in public hospitals?
Doctors-in-training are deterred from claiming overtime from the day they begin their internship for fear of being labelled inefficient, incompetent or greedy. Any claims for overtime require sign off by a consultant, usually the very same person who acts as a referee for the junior doctor’s reappointment.
Legitimate claims for overtime may also be rejected by the head of department, on the basis that consultants are failing to efficiently manage their residents’ workloads. When junior doctor claims are occasionally approved, pay slip errors are commonplace due to faulty manual processes or outdated human resources IT systems. In turn, hospital CEOs are regularly questioned by their boards about their failure to meet tight budgets across individual departments (here, here, and here).
However, blaming and fining public hospital consultants, heads of departments, HR departments, CEOs and boards for wage theft will not fix the problem. Chronic underpayments will only be addressed when state governments and their treasuries are held accountable for the shortfalls in funding (here, and here) for basic payroll entitlements and contemporary HR IT systems in public hospitals.
Why must senior doctors act urgently?
Complacency by public hospital leaders is no longer an option as junior doctors are likely to win in their class actions when they present extensive evidence of systemic wage theft to court in 2022, with the support of the Australian Salaried Medical Officers Federation, the AMA and the AMA doctors-in-training.
All the issues raised in this article have been previously widely reported in the general media (here, here, here, and here), which is why nobody will be able to claim they were unaware of their responsibility to address the extent of junior doctor wage theft when the cases go to court.
As another cohort of idealistic junior doctors have just begun their careers in January 2022, senior consultants must urgently re-examine how they manage legitimate claims for the basic pay entitlements by subordinates, as well as notifying public hospital management of the need for adequate funding for payroll. It’s time for public hospital boards, CEOs, HR departments, heads of departments and consultants to stop the blame game and to demonstrate collaborative leadership on workplace law and fair pay.
During the pandemic and beyond, we must all hold state governments and their treasuries accountable for their own legislation on wage theft – well before the junior doctor class actions go to court in 2022.
At the time of releasing the AMA public hospital report card at the beginning of the Omicron outbreak in November 2021, federal AMA President Dr Omar Khorshid warned:
“During the pandemic, Governments have come to understand the importance of health advice in driving policy. It is time for the same approach to be taken to public hospital funding and reform. If we instead continue with the blame game that has plagued our federation for many years then patient access to care will suffer even further and health outcomes across the community will deteriorate”
In January 2022, our public health system descended further into crisis and our patients, families, friends and communities are relying on all health workers on the frontline to absorb excessive workloads under ongoing extreme pressure. In this situation, fair pay for basic entitlements of junior doctors is only one of a myriad of critical issues facing public hospitals.
However, continuing to expect junior doctors to perform significant additional volunteer hours in the presence of many other serious occupational health and safety issues is not only grossly unjust – it’s criminal (here, and here).
Clinical Professor Leanne Rowe AM is a GP with no vested interest in junior doctor payments. She is a past board member of Barwon Health and writes this article as a concerned community member and an advocate for quality of patient care. She is also the co-author of Every Doctor: Healthier Doctors=Healthier Patients (www.everydoctor.org) and the medical writing site www.medicineisbeautiful.com
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.
Horrified by the winging of arguably the highest paid profession in Australia, the profession with a ridiculous status and the profession with the likelihood of continual employment. Shame on you.
The profession itself creates difficulties for junior doctors ( and indeed patients by long waits, gap fees and arrogance) with the know-it-all attitude of consultants, the demands of absurd exams (which do not add to knowledge and good practice), the costs involved for these poorly constructed exams, the difficulty obtaining further training ….
Did you medical practitioners ( – the title Dr should be used only for doctoral degrees, not for a profession -) know that others who work as hard as you do do not get overtime pay as it is considered included in salaries much lower than yours? Ask any graduate engineer or scientist or teacher!
So stop complaining, give your patients a better deal and do your job serving the public with some humility.
(Apologies to the relatively small cohort of medical practitioners who are really decent.)
A few days ago the Vic Govt announced a $1.4 billion new funding boost for public hospitals. There should now be no impediment to the approval of basic pay roll entitlements of front line health workers including junior doctors in Victoria. What is happening in other States?
This has been occurring for so long with Junior Drs fearful that raising this will be career limiting
Some Senior Drs have also had issues .
It is some what disheartening that many executives in these hospitals are on above award payments
“What comes around,goes around !”……….I give my support to the ’cause’
Older doctors like me find it difficult to comprehend the salary changes that have taken place since we trained, but regardless of how we did things we all need to understand the regulations, contracts and expectations of the junior staff. Good or bad is not a factor, that boat has left the dock, the train has left the station. It is how it is. Because many established doctors may disagree with the current system, with some validity, those with the potential to impact a junior’s career should not be involved. It should be down to administration to sort this out. They approved it and they should be responsible, not trainee’s superiors.
I resonate with all the comments below about the personally distressing impact of junior doctor wage theft.
To change this, we must focus on the fact that wage theft is now a crime in Victoria and will soon be so in other states. In 2022, this means that HODs and other public hospital leaders no longer have any discretion over whether to reject fair claims for legitimate additional hours worked by junior doctors. Turning a blind eye to the chronic underpayment of junior doctors is no longer a defence. In Victoria, public hospitals will potentially attract fines of nearly $1m, and individual HODs up to nearly $200K for wage theft.
However, fining and terminating managers or HODs will only exacerbate public hospital funding woes. During the pandemic and beyond, we must all hold State Governments and their treasuries accountable for the chronic underfunding of public hospitals (which is the root cause of wage theft) – well before the junior doctor class actions go to court in 2022.
NB: Wage theft definition = deliberately underpaying employees for overtime, extra shift allowances, on call, breaks and training periods; dishonestly withholding employee entitlements; failing to keep proper records of employee entitlements; or falsifying employee entitlement records to gain a financial advantage.
All doctors should be paid for their time and work, right from the beginning. Wage theft for doctors continues during their entire careers in various forms. From unpaid clinical overtime, free off site phone calls for senior doctors, free attendance at meetings, emails, free involvement in administrative activities, medicare cuts, telehealth cuts and expectation to be be called anytime for ‘your’ patients and provide free advice. Qld health had sent a debt collector letter to my private practice interstate and forced me to pay back more than 2k, claiming that I was overpaid 3 years back ! Very embarrasing letters to the reception. I even dug up old rosters but they didnt budge, threatened to add to my credit history, so I just paid. Sad state of affairs where doctors are not valued despite displaying altruistic attitude.
I agree with this article and endorse honesty and fairness when remunerating for the TRUE cost of health care. Wage theft in medicine occurs at all levels, and I unfortunately the standard is set and permission granted by the Commonwealth Government. Their many forms include the regulation of doctors via Medicare and restricting MBS items to procedure/ face to face time only (in contrast to many professions charging for emails, letters and reports, inc prep time; others for a quote or supervision/training; travel between sites, etc) and setting MBS fees considerably less than AMA rates and then reduced to 85% for bulk bill. State/Territory Government’s perpetually underfund Public Health/ Hospitals at clearly unrealistic levels, whilst obviously mismanaging other portfolios. The classic was the Dept of Health’s CEO recent receipt of a 2.5% wage rise for “hard work during COVID” whilst the Public Hospital Dr’s were granting only a 1.5% increase because COVID has “hit the Government hard and times are tight”, etc, etc, etc.
SA salaried hospital doctors have recently achieved a much needed revision to the Enterprise agreement with SA Health, on conditions and overtime to be paid to junior doctors for hours worked. This was well supported by senior staff and consultants, despite bullying emails sent by exec to all medical staff. Though effective in intimidating some juniors to not attend for fear of reprisal – this unconscionable tactic galvanised many consultants to step up in support of the juniors and attend stop work meetings conducted by our salaried MO association(SASMOA). There is strength in numbers when united in a just cause.
Ever heard of Blind Week Payment? It is a money grab dating back to the 1980s and 1990s that allows the LHD to deduct one week’s salary, on resignation, due to ‘Pay cycle changes” back then. No matter that it was 40 odd years ago, and virtually untraceable. So you see, wage theft is not limited to just junior doctors. It is occurring at every level, right up to and including at retirement, after decades spent working in the public hospital system. Don’t expect a golden handshake as you leave the building. Instead, you will get your pocket picked on the way out.
I’ve claimed every cent of overtime last year as an intern at a regional hospital, in contrast to my partner who, 5 years ago, at a major tertiary centre, did not claim at all due to the ‘culture’. Hope the tide is turning and more people know their worth!
I tend to make a habit of referring fewer private patients to a former head of department that ‘didn’t believe in overtime’.
Consultants should not have the power to approve overtime due to conflict of interest. Senior consultants/heads of departments are directly involved in selection for training programs, registrar rotations and later consultant sessions and freely discuss candidates across health systems.
Furthermore many consultants can’t helped but be entrenched in a culture of ‘I endured so shall you’. Many senior consultants do not understand that their ordeal led to a more direct route to career success without the external pressures trainees face nowadays due to extreme competition.
To seriously address wage theft, overtime approval should be taken away from consultants. Perhaps a state or nation wide transparent policy about criteria for overtime and an approval system bypassing unit consultants.
Full support junior doctors getting paid all the hours they work! (I usually am happy to sign off for my registrar if they stay back – not sure if admin ends up paying them)
Also VMOs too in some public hospitals still get paid for only part of the session they have to work – not all the hours worked.
It would be easy to use an app to check in and out of the hospital if the hospital admin is seriously interested in addressing the issue of wage theft! AMA should help facilitate this!
I’ve been swindled out of 10.000$ in just one year by what seemed to be kind, considerate and well-respected GPs owning a rural practice, pocketing the management plan payments of all their trainees over years, amounting to 100.000$ of wage theft. When I contacted the AMA they said ‘that’s what happens all the time, nothing you can do’.
Is Australia a country of the law or a country of the entitled old boys illegally enriching themselves at the expense of patients, colleagues and the system?
Another example of wage theft is the expectation that you will read emails and attend online meetings in your own time.
What a powerful article! Well done Professor Rowe and for bringing wisdom into the issues raised and debate!
I cannot believe the young doctors are still being exploited in 2022!
It is grossly unfair, and as Prof Rowe says, a form of abuse – financially and emotionally for the young doctor. There are industrial laws to address underpayment of employees. It is enshrined in industrial law for all employees to be paid for overtime. Every employee is valued and should be compensated for their hours at work. It will be interesting to hear the outcomes of the class actions!
Yep. Happened to my wife and I both as junior Doctors at the Alfred and Monash in Melbourne. We had a lot of consultants tell us that they had it worse so we were actually lucky. We both wanted to specialise but changed plans and left the public hospital system as soon as we could. Now as a GP VMO at a rural hospital in NSW I still see it and it’s not just the juniors doctors getting screwed. The times need to change for better health outcomes
In my experience it was never a consultant refusing to sign an unrostered overtime form but a DOT or a HOD who stated all the following reasons as above (noone claims but you, you must be very slow etc) and would also say that there was no budget for unrostered overtime). I think the focus should not be shifted from management and their role onto consultants and at the moment it appears to be the aim. PS even if consultants did not approve overtime in some cases, once again it was probably a result of *tough love* from management.
As an independent voice on this topic, I am sending all public hospital doctors a message of support and acknowledgement at this hugely challenging time.
Great to have all views on my opinion piece – from residents, consultants and HODs. JDoc – HODs must now recognise that this is 2022 where wage theft is a crime from which they are not exempt. However, blaming and fining HODs will not fix wage theft.
We need to advocate together on the root cause, which is inadequate public hospital funding for basic payroll entitlements for our precious junior doctors.
We are all failing to hold State governments accountable because we are stuck in a blame game between public hospital leaders, HODs, consultants and residents.
in the words of Dr Simon Judkins et al in ‘The other long COVID: impacts on health systems and clinicians’ (also published in MJA insight Plus 31 Jan 2022)
‘It is clear that the pandemic has affected the entire medical workforce from medical students to consultants, and if there is ever a time for solidarity of purpose, it will be in the coming months and years’.
As a consultant & HOD of a surgical unit, I have always acknowledged the hours that our junior staff work, as I can remember the long hours of unpaid overtime that I did & the pressure from administrators to not claim this.
Up until recently I have always approved the overtime that has been put in front of me, but now all timesheets are lodged electronically & I have not been asked for approvals.
I hope that more consultants are like me & not like those that JDoc has experienced.
How will the Health Dept ever know the true costs unless claimed?
Reasons why I worked a lot of unpaid overtime:
1) New consultant not wanting to sign forms as he thought it would reflect badly on his dept – “just take an extra half day”. He didn’t know we never took half days, routinely stayed hours late, and came in on our days off.
2) Being told it’s because of inefficiency, not because of the ridiculous admin demands heaped on junior doctors that outstretch the ability of any one person. Out of touch bosses who don’t recognise how the demands of interns/RMOs has changed significantly
3) Not able to get the overtime approved because “it has to be pre-approved”
4) Onerous/admin heavy processes to actually get the overtime – having to justify everything, getting patient stickers, tracking down the form in the first place, etc. When you’re overworked and exhausted, it’s actually just too much.
5) “No-one else claimed overtime, why are you?” The implication being that you’re a lazy or incompetent intern, and not good at your job. What they don’t see is the massive pile of unfinished discharge summaries left over by previous teams that left on time, but admin are breathing fire in your face to finish.
I’m 9 years out now, nearly finishing a training program. There’s no way I’d put up with this now, but junior doctors are at the bottom of the heap and often too scared to speak up.
start and leave on time …everyone…. do not be pressured
I fully agree with this article. As a senior hospital doctor, I am very grateful for the dedication of the junior staff, and alw ays encourage them to keep a record of their hours and to claim them. This is the only way forward. Unfortunately, it is not always or only the senior staff who are unsupportive but the hospital administration, which regularly underpays (and incidentally also underpays the senior staff and does not always support fair conditions). We need to work together as s profession to actually implement the Hospital award conditions for all as an initial step, and then aim for better conditions. The current system is out of date, unfair and unsustainable.
unpaid “training” hours was always rubbish. after 10 or so cases of pulmonary oedema, acute onset chest pain, gi blood loss assessed in casualty, you could handle the next steps in your sleep. im sure it was the same for general and orthopaedic registrars in their after hours case loads. unfortunately senior DIT swallowed that Kool Aid and insisted that rostered service maintaining a government promised 24 hour emergency capacity was in fact training for the rest of the specialist career and income generation.
Warwick Ruse FRACP, EX Pres AMA(WA), Dep Director (WA) PSR in its first 17 years
Unless actual hours worked are documented, there will be no understanding of the workforce strain, or financial incentive to increase workforce numbers and share the workload.
While HODs face pressure to run their departments within budget, they should be strong advocates for their staff well-bring, and ensure the department is efficiently rostered.
Agree 100% with JDoc. Too many consultants are in positions of power to approve overtime who still say “back in my day we worked 7 days straight without extra help, you have it much better” etc. They want to see others go through what they went through. Juniors are powerless to act unless their direct seniors support them, rather than try to further the exploitation.
If you don’t think consultants share a good part of the blame for wage theft then you’re deluding yourself. Every junior doctor has been in a position where their boss outright denies them their financial due for time worked. As much as we need changes on the government level, we also need to root out all of the old bullies that hold positions of power like HOD.