Senior doctors must act on junior doctor wage theft

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.