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Recently, doctors in training across the country expressed their widespread frustration about the derogatory attitudes of human resources (HR) management in public hospitals. If intractable workplace abuses of doctors in training are not addressed, some public hospital directors and officers may face significant penalties from regulators for breaches of government-legislated work health and safety standards.
Two weeks ago, a public hospital human resources officer’s email referring to doctors in training as “a workforce of clinical marshmellows [sic]” lit a firestorm in social and national media. The insult was described as “a very common attitude amongst public hospital HR/admin towards JMOs [junior medical officers]”, and couldn’t have been more ill-timed.
In November, the government legislated Work Health and Safety (Managing Psychosocial Hazards at Work) Code of Practice 2024 was announced to support changes to work health and safety laws (WHS). It is now in force across the Commonwealth, but it provides guidance to all jurisdictions on how to prevent harm from psychosocial hazards at work.
Of course, public hospitals are not exempt from WHS laws in their jurisdictions, and directors and officers (board members, chief executive officers, and human resources managers) may face significant penalties for breaching them.
To add injury to insult, it appears that some public hospitals have not heeded the outcry following the December 2024 release of the well-publicised Medical Training Survey (MTS) of over 24 000 doctors in training. The surveys performed by the Medical Board over the last 6 years present irrefutable evidence of unsafe working conditions and high levels of intractable bullying, harassment, discrimination and racism, aggression and violence in public hospitals— a period coinciding with many doctors risking their lives on the frontline during the pandemic.
In the 2024 MTS, one-third of trainees (33%) reported having experienced and/or witnessed bullying, discrimination, harassment, sexual harassment and/or racism, spiking to 54% of Aboriginal and Torres Strait Islander trainees and 44% of interns. Sixty-nine percent of doctors in training reported that these experiences had severely impacted their career progression. The 2024 MTS also revealed that 47% of all trainees described their workload as “heavy” or “very heavy”, with 21% working unrostered overtime that significantly detracted from their training. Eighteen percent of trainees reported being forced to work unpaid overtime, which is another red flag given the successful class action in relation to wage theft by doctors in training resulting in settlements of hundreds of millions of dollars by public hospitals.
There were also positive statistics in the MTS, but public hospitals will be concerned at a time of medical workforce shortage that nearly one in five doctors in training are contemplating a future outside of medicine mainly due to their negative experiences.
Following the release of the 2024 MTS in December, the immediate past Medical Board of Australia Chair, Dr Anne Tonkin AO, said (paraphrased): “There is no place for bullying, discrimination, racism, sexual harassment or other forms of harassment in medicine or in any civil society. …. There was no excuse for the lack of professionalism and respect reported by trainees ……I am appalled by what Aboriginal and Torres Strait Islander trainees report”.
The Australian Medical Association (AMA), the Australian Salaried Medical Officers Federation (ASMOF) and others have advocated tirelessly for workplace rights, and for more action on work-related mental health problems and suicide in doctors in training. AMA states (here, here) also advocate and monitor the sentiments of doctors in training annually, and this data supports the negative findings of the MTS survey.
In the past, this long term advocacy on chronic work health and safety (WHS) issues has not always been acted on in public hospitals because of competing priorities for limited resources. No-one would argue that public hospitals must prioritise the reform of intergovernmental health funding to provide equitable, high quality patient care first and foremost.
But as Dr Anne Tonkin AO said in early 2024, with the release of the MTS results based on gender: “the established link between poor culture and increased risk to both patient safety and doctors’ wellbeing requires urgent attention”.
Public hospital directors and officers could face substantial fines, criminal charges and imprisonment for serious WHS breaches
All directors and officers require up to date expert WHS legal advice to fully understand the regulatory environment, their responsibilities, and potential penalties in their jurisdictions because WHS in Australia is changing.
Safe Work Australia developed a single set of laws known as the ‘model’ laws, but the government legislated amendments to the model WHS Act do not automatically apply unless they have been implemented in a jurisdiction. Despite the concerted efforts of Australian governments to put in place laws to help harmonise occupational health and safety laws as part of national reform, a complicated interplay continues between the Fair Work Commission, Safe Work Australia, the Office of the Fair Work Ombudsman, the Australian Human Rights Commission, and the 11 workers’ compensation schemes.
To summarise, if WHS breaches result in serious harm — whether psychological or physical — the consequences for directors and officers may include substantial fines for individuals and organisations (sometimes not covered by insurance), criminal charges, imprisonment and disqualification from managing any other company or organisation. The insurance premiums for directors and officers are soaring because of costly WHS litigation.
Mitigating WHS risks requires a proactive approach by public hospital directors and officers, as they may not be fully aware of WHS non-compliance in their own public hospital. Findings from the 2024 MTS indicate that doctors in competitive specialist training programs with limited tenure are often reluctant to report incidents of workplace abuse for fear of punitive career repercussions. However, such under-reporting is not a defence for directors and officers in WorkSafe investigations and enforcement proceedings, given the MTS and AMA survey findings over the last 6 years.
Public hospital directors and officers can reduce their legal liability by promoting safer work environments for all employees, including doctors in training
As public hospitals are hazardous environments that require occupational health and safety management of the highest standard, directors and officers also require specialised advice to protect them from legal liabilities.
However, it is important to note that legal protection can be built by directors and officers through a range of positive practical measures that would benefit doctors in training, including preventing and managing WHS hazards through the implementation of clear and contemporary policies and procedures, visible support from senior management and supervisors, and monitoring of anonymous independent surveys or other tools to gauge work culture and manage potential WHS issues early, as well as appropriate follow-up after WHS incident reporting.
Directors and officers can also establish fair, confidential complaint processes including whistleblower protections for complainants, ongoing staff training on accountability, and regular HR and other management performance appraisals. Heads of departments and other senior doctors can also be enlisted to play major roles in creating physically and psychologically safe workplaces.
It is recognised that public hospitals must set an example to other Australian workplaces in reducing work-related physical and mental injury. There is a myriad of information about ways to prevent and manage WHS hazards on government and other websites, a snapshot of which is provided below:
1. The right to fair, safe working conditions
The Fair Work Ombudsman has set out clear advice on basic workplace rights including fair rosters and patient loads, breaks, leave, flexible working conditions and cover for leave requirements.
Common well known psychosocial hazards predisposing employees (including doctors in training) to work-related mental injury include: excessive job demands causing fatigue, which endangers safety, particularly in remote or isolated work; low job control, job insecurity and poor support especially after exposure to traumatic events.
2. Bullying, discrimination and racism
All workers have the right to a workplace free from unlawful bullying, discrimination and racism.
The Fair Work Commission deals with applications to stop bullying at work under the Fair Work Act. The Australian Human Rights Commission also has responsibilities to respond to discrimination and racism at work.
3. Amendment to the Sex Discrimination Act
In December 2023, following legislative amendments to the Sex Discrimination Act 1985 (Cwlth), the Australian Human Rights Commission was formally granted new powers to investigate and enforce an employer’s “positive duty” to take reasonable and proportionate measures to eliminate certain types of unlawful conduct. All workplaces, including public hospitals, must now address hostile work environments and eliminate unlawful behaviours, such as direct or indirect sex discrimination, sexual harassment, sex-based harassment and victimisation of complainants or witnesses.
4. Aggression and violence
Under WHS laws, organisations and employers must manage the health and safety risks of workplace violence and aggression, and this is particularly relevant to the rising threat of violence by patients against doctors, especially those in training (here, here).
Directors and officers face severe fines and criminal charges for industrial manslaughter if it is found that their failure to address known workplace hazards led to the death of an employee or contractor due to unsafe working conditions, including assault, accident or suicide.
Conclusion
In this opinion piece, I have simply summarised some well-known WHS laws, standards and rights.
However, the application of WHS laws to the working conditions of doctors in training is not simple because of the need to balance the needs of patients and personal safety. But one thing is clear. There is an urgent need for stronger advocacy: more government funding to help public hospitals comply with government-legislated work health and safety laws, and greater accountability by public hospital directors and officers.
Unfortunately, one human resources officer’s insulting “marshmellows” comment sparked national outrage about the injustice of intractable workplace abuses of doctors in training in some public hospitals.
An apology from the hospital that ridiculed doctors in training is not enough.
In the context of changing WHS laws, all public hospital directors and officers must now confront an important question: Can we afford not to prevent and manage the intractable workplace abuse of a significant cohort of doctors in training?
Clinical Professor Leanne Rowe AM is a GP who has also served as a non-executive director in the health care system for nearly 30 years. She is past Chair of the RACGP and co-author of the book “Healthier doctors = healthier patients”, published internationally by Taylor and Francis. In the past, she has written on WHS issues for Insight+, including bullying, suicide and wage theft.
If this article has raised issues for you, help is available at:
Doctors’ Health Advisory Service:
NSW and ACT: 02 9437 6552
NT and SA: 08 8366 0250
Queensland: 07 3833 4352
Tasmania and Victoria: 03 9495 6011
WA: 08 9321 3098
New Zealand: 0800 471 2654
AMA lists of GPs willing to see junior doctors
Lifeline on 13 11 14
Beyondblue on 1300 224 636
Beyondblue Doctors’ health website
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
Subscribe to the free InSight+ weekly newsletter here. It is available to all readers, not just registered medical practitioners.
If you would like to submit an article for consideration, send a Word version to mjainsight-editor@ampco.com.au.
The HR staff member could have at least got the spelling of “marshmallow” right! All hospital medical staff (seniors included) work under what are now often considered unsafe conditions, long hours and unpaid overtime; without this unpaid work hospital budgets would be in a much worse position that they already are. It is unfortunately true that some hospital admin staff including those HR staff who are employed to support front line health workers and who have comfortable flexible working hours, may work from home, do not do shift work, on call work or night shifts and are eligible for ADO (which medical staff are not entitled to) add to our workload by overzealous regulation and bureaucracy.
I can’t help buy ask how we are still here in 2025? Is it worse or just differently bad?
That it is happening to any individual or professional group is awful, but this is widespread and experienced across health groups, particularly nursing. After 30 years of working in different public health settings i know they are not all the same, but institutions some seem to have a long history where the behavior is so ingrained at senior levels those that stay just replicate the behavior. I have attended meetings shocked by the way senior executive nurses refer to the nurses in the institution, the ease at which they can denigrate whole groups of clinical nurses.
When supporting a colleague recently dealing with HR at a large public health setting I was shocked how inept the application of HR processes was (meaning staff), the way they dealt with the matter, the absence of basic human kindness, failure to ensure their own documentation was accurate, nor ability resolve the issue in a timely manner (in favour of the colleague).
I can excuse an occasional outburst from a stressed colleague in difficult clinical situations (don’t even expect an apology) but what is not excusable is when the HR departments become the enforcer of this culture.
Each year staff are encouraged to complete the “people Matter” survey in NSW – where completion rates seem to be the goal. Only positive data seem to be made public, even when many of us have spent time providing thoughtful detail responses highlighting concerns.
Unfortunately the marshmellow (sic) comment is indicative of attitudes among upper level admin staff that were present when I was an intern (over 30 years ago) and seem to have persisted despite “mandatory” training. Maybe admin staff, when first recruited, should have to spend a week on the wards (including night call) to see what it is really like at the sharp end?
Omg!! Let’s keep John hunter out of all discussion.
100% respondents there would rate the place as being the worst place ever to work at!
From JMOs to senior registrars, anyone who has ever worked there have termed it as a vipers pit.
The leaked email is just a tip of the iceberg.
Honestly, the AMA is for the senior doctors who are the abusers.
ASMOF promises a lot but delivers nothing in the end unless it comes on media and it becomes a PR issue.
Trainee associations are just puppets as the perpetrators threaten them with dire consequences if they speak out for trainees.
A Narrative of My Experience as a Surgical Trainee in NSW
I came to Australia as an overseas-trained doctor of dark skin, driven by ambition, resilience, and a commitment to delivering the highest standards of patient care. Over the years, I earned a reputation as one of the best trainees across the state, excelling not just in surgery but across all disciplines. Despite my skills, work ethic, and dedication, my journey was marred by relentless abuse, systemic discrimination, and institutional betrayal.
My downfall began when I stood up for patient safety, a fundamental principle of our profession. Instead of being supported, I was abused and ostracized by my supervisor and his network of allies. When I raised these issues with HR, the response was not one of support or resolution. Instead, I was subjected to an unbearable level of psychological and mental pressure, forcing me to resign from my post before the six-month term ended. This was not just a professional setback—it was a deeply personal attack. I was threatened that my career in Australia would be ruined, and false rumors were spread across the entire training network.
When I moved to my next training post, I hoped for a fresh start, but the hostility followed me. Right from the outset, the consultants were unwelcoming, their behavior cold and adversarial. The Head of Department told me outright, “I fear for your survival here. We were all told about you. Many people like you suffered here before.” It became clear that this was a coordinated campaign. I soon learned that other trainees from similar backgrounds had endured the same treatment at this rotation—false allegations, suspensions, and even expulsions. The system was clearly stacked against people like me.
HR, which should have acted as a neutral arbiter, behaved instead as judge, jury, and executioner. When false allegations were made against me, I fought back, demanding clarity and evidence. Despite repeated requests—seven reminders from lawyers and representatives—no fixed allegations were ever provided. Yet, I was suspended without notice, a blatant abuse of process that mirrored the experiences of others who had dared to stand up for themselves. The outcome was devastating: I had to request my training college to change my network, uproot my family, and relocate at my own expense. I lost 1.5 years of training, effectively two years of my career, and endured mental trauma so severe that I developed diabetes, hypertension, and anxiety.
Despite all this, I was advised by mentors and legal representatives to remain silent. Their words were chilling: “No one listens to trainees. If you make noise, they will act as a gang and destroy your career. There is no fairness in this system. Just get your degree and leave the country. You will be valued elsewhere for your skills and hard work.”
This is the brutal reality I have faced. After 10 years in Australia, having worked tirelessly across regional, rural, and metropolitan hospitals—logging an average of 80-90 hours per week—I am leaving. I have experienced firsthand a culture that thrives on nepotism, discrimination, and systemic injustice. My efforts, sacrifices, and contributions were never valued because I did not belong to the “right” group.
I cannot, in good conscience, recommend medical training in Australia to anyone unless they have family or connections entrenched in this mafia culture. For those who don’t, the journey is one of relentless struggle, and the costs—mental, physical, and financial—are far too high.
I leave Australia disillusioned but determined, knowing that my skills and work ethic will be valued in other parts of the world. My only regret is trusting a system that failed me at every turn.