Running on fumes for years: junior doctors say system is unsafe, not just underfunded

Junior doctors in New South Wales have long decried what they describe as unsafe working conditions and unequal pay. In February, junior doctors went on strike after a leaked email referred to the group as “marshmallows” for questioning working hours. Recently, the NSW government released its report from the Special Commission of Inquiry into Healthcare Funding, which calls for further efficiencies and funding.

InSight+ spoke to advocates to ask about working conditions, and what the report might change.

Earlier this month, junior doctors spoke to the ABC about what they say are still unsafe working conditions for doctors and patients. In the same report, Professor Jeffrey Braithwaite, a member of the inquiry’s expert panel, said that health care in general was like a “black hole”, that couldn’t be filled.

“There’s a case for them to be paid more, but after that you just reckon you deserved it, and that’s what you’re worth now — so it’s only a sugar hit,” said Prof. Braithwaite.

Negotiations between Premier Chris Minns’ government and advocates have hit a stalemate, but junior doctor and student doctor advocates say conditions must change.

Tom Morrison, Australian Salaried Medical Officers’ Federation (ASMOF) Junior Vice President, has been representing junior doctors in meetings with the government, and doesn’t agree with Prof. Braithwaite’s assessment.

“I think it’s a lazy argument to say more money won’t fix the problem. It’s like saying more petrol won’t allow your car to go further. If the tank’s empty, you need more petrol. And we’ve been running on fumes for years,” said Dr Morrison.

It’s about safety, not just wages

Dr Morrison says that working conditions are beyond reasonable and have been for years.

“When you push individuals to work beyond what they’re capable of doing and then put them in extreme environments where they’re making life-and-death decisions for patients, things get unsafe. In my case, it’s doing very large periods of on-call work and being constantly sleep deprived,” said Dr Morrison.

“If you’re flying a plane, you have mandatory rest periods. And if you haven’t met those safety thresholds, it doesn’t matter if there’re two hundred passengers waiting on the tarmac – the plane’s not taking off,” he said.

“Whereas in medicine, it’s the reverse – we have to do it anyway,’” said Dr Morrison.

Dr Morrison said that while wages are important, the main issue is still safety.

“There are no minimum safety standards that are enforced in New South Wales, or about the number of hours you can work in a row. Also, NSW doctors are paid 30% less than doctors in the rest of the country,” said Dr Morrison.

“That’s why a traditionally mundane, restrained group like the medical profession has come out in force with 6000 people striking,” he said.

Dr Morrison said that he has been happy with the public’s support.

“People agree that you shouldn’t be working for 30 hours in a row and making life-and-death decisions,” said Dr Morrison.

Morrison said that the pandemic created more work and a higher degree of care for the average patient.

“Due to the pandemic, with people leaving the system, we’re doing more with less. But the funding to catch up with that has not been appropriately matched,” he said.

The Commissioner’s report

The NSW Government recently released the report from the Special Commission of Inquiry into Healthcare Funding.

“The Commissioner has said the system has been woefully underfunded for public expectation and has been for years,” said Dr Morrison.

The report does not support the idea that further funding would be futile, rather suggesting that while improved efficiencies are required, the system needs further and sustained funding. It includes 41 recommendations for health workforce development, education and training, and funding and procurement, suggesting significant re-evaluation of the current systems that would improve working conditions.

Writes Commissioner Justice Richard Beasley, “If universal health care is the aim of the NSW public health system, at least parts of that system are underfunded. They have been for some time.”

Medical students feel “disposable”

Melody Ahfock is the President of the Australian Medical Students’ Association (AMSA), which represents over 18 000 medical students across Australia. Mr Ian Burton is President of the NSW Medical Students Council (NSWMSC).

Both say that working conditions are causing students to look outside of NSW when thinking about work.

“Fundamentally, this is about the way the government, health care, and to a degree the public, view junior doctors — which is disposable, effectively,” said Ms Ahfock.

Ms Ahfock agrees that current working conditions for junior doctors would be illegal in other industries.

“There are a lot of studies showing the correlation between tiredness and the equivalence of a high alcohol blood volume. Essentially, tiredness is similar to working under the influence,” she said.

“The cycle of abuse is being perpetuated by more senior health staff,” she said.

“The Victorian intern, for example, in 1992 would have been paid about $76 000. That’s the same as a current NSW doctor in 2025, and the equivalent purchasing power today would be $173 000,” said Ms Ahfock.

“But ultimately this isn’t a pay dispute. This is a dispute about patient and doctor livelihood,” she said.

Mr Burton is a student at UNSW. He says that his fellow students are looking outside of NSW.

“Obviously, pay isn’t the be-all and end-all, but it’s a consideration,” says Mr Burton.

“Junior doctors are given an unreasonable amount of work. And in New South Wales, you’re being paid less to do it. That extends to working extremely long shifts, being told not to drive home, because it’s unsafe. [Driving unsafely] shouldn’t be a condition of employment,” he said.

Mr Morrison agrees that attitudes to junior doctors “toughing it out” are no longer automatically tolerated.

“There’s this idea that junior doctors should suffer through the early years because they’ll be well paid later. But more and more, I see that the public isn’t buying that. They want doctors to be well enough to care for them,” said Dr Morrison.

Hope for better negotiations

Dr Morrison said that he has not seen much movement during negotiations.

“We’ve had over 15 meetings with the NSW Government. And every time we meet with them, their stance has been completely adversarial. And it becomes disheartening when they frame it like doctors are demanding luxury,” said Dr Morrison.

“We’ve been very open to thinking outside the box. But their attitude has been that the system can’t be changed — and that’s just not true,” he said.

Dr Morrison is hopeful that there will be a way to get better conditions for junior doctors.

“I’m optimistic that the government will realise that this is not a simple pay dispute, that it’s about the nature of the health system,” he says.

“The hope is that once the public truly understands how unsafe things are, they’ll support change. And I think that’s already happening.”

Recently, the World Medical Association has said that it is updating its Statement on Physicians’ Wellbeing. The move is largely in response to unprecedented pressure being put on physicians after the pandemic.

Subscribe to the free InSight+ weekly newsletter here. It is available to all readers, not just registered medical practitioners.