Medical workforce culture: is it changing for the better?

Medicine has never been an easy job. But a decade of surveys, strikes and reform campaigns has forced Australia to confront a harder question: is the culture of overwork, burnout, bullying and silence in medicine actually changing?

AMA President Dr Danielle McMullen describes medicine as "inherently difficult", with doctors putting enormous pressure on themselves and each other to keep performing. 

"It's never going to be an easy road, but there's a difference between that and an unsupported tough road," she says.

Has Australian medical workforce culture genuinely improved? Or has the language around doctor mental health simply outpaced the reforms needed to back it up?

Overworked and underpaid

While flexible working arrangements in healthcare have become more common, Dr McMullen says doctors are burnt out, having done more with the same or fewer resources for years.

"Doctors are feeling stretched and broken. The first thing to go is often a break with colleagues, teaching and training — the things that bring joy."

The Medical Board of Australia’s 2025 Medical Training Survey reflects this crisis, with 45% of trainees describing their workload as 'heavy' or 'very heavy'. The strain has spilled into open conflict, with NSW and Victorian doctors both striking over pay and unsafe rosters.

Psychologist Dr Anna Kios,  Director of Mind Culture Life Australia, argues awareness hasn't been matched by structural change. 

"Medicine now speaks fluently about wellbeing, but language is the easiest — and cheapest — part of a culture to change." 

Psychiatrist Dr Tahnee Bridson, who founded Hand-n-Hand Peer Support in 2020, says she sees doctors — junior ones especially — absorbing the daily cost of chronic understaffing, and salaries that haven't kept pace with living costs. 

"People have to sacrifice themselves in order to make up for the fact that there's not enough staff, and most of the time there's barely even appreciation." 

The problem is about retention as much as wellbeing, she adds.

"People get sick of the system and leave it, and then the burden just gets doubled for those remaining."

Less bullying, or just less visible?

The MBA's code of conduct requires doctors to maintain respectful relationships, with ongoing or serious breaches affecting registration. An MBA spokesperson says building a culture of respect in medicine is a shared responsibility and addressing racism "is both urgent and essential".

Dr McMullen credits campaigns like the Royal Australasian College of Surgeons' work on harassment with real progress, but admits issues persist. 

The 2025 MTS found 30% of trainees still report witnessing or experiencing bullying, harassment, discrimination or racism, which is nearly double (56%) for Aboriginal and Torres Strait Islander trainees.

Dr Kios argues hierarchy hasn't weakened so much as gone quiet.

"Control can still be exercised through rosters, teaching access, references and exclusion," she says. "It rarely looks like bullying on paper, and is easily reframed as an ordinary management decision."

GP versus hospital pressures

Pressure differs by setting, says Dr Bridson: GPs face isolation, financial pressure and mounting demand, while hospitals face staffing shortages and rostering strain.

Dr Kios says a small GP practice can blend boss, colleague and legal duty-holder into one person, with no HR to escalate to. 

GPs also sit at the front line, with 2024 MTS data finding GP trainees were most likely to name patients and families as their top source of unprofessional behaviour.

Hospital risk is more ideological, she adds.

"The ideal of the good doctor is internalised so deeply that doctors police themselves. Exhaustion becomes evidence of commitment, distress becomes evidence of inadequacy".

She adds this problem is reinforced by a hierarchy where seniors hold concentrated power over rosters, assessments, references and progression through training.

Fear of consequences

Dr McMullen believes coming forward with mental health issues is more accepted than it used to be, but Dr Bridson points to a fear that hasn't moved: Ahpra notifications, which anyone can trigger. 

"It becomes a big cloud hanging over people because they're just so scared of getting in trouble," she says.

That fear can stop doctors seeking help, even though most wouldn't need to be reported.

Trainees worry that speaking up may jeopardise career progression, she adds.

Dr Kios agrees the stigma has shifted from 'weakness' to 'consequence', pushing help-seeking off the record and undermining psychological safety at work.

The AMA and RACGP want the Western Australian model adopted nationally, which fully exempts treating doctors from mandatory reporting, letting doctors seek mental health treatment without fear of being reported.

Still an individual fix

While the conversation has shifted from personal resilience to workplace safety, Dr McMullen says, acknowledging the problem isn't the same as fixing it and 'wellness washing' is everywhere.

"Five or 10 years ago the solution was a yoga retreat. Mindfulness and physical activity are useful, but you can't meditate your way out of an unsafe roster."

Dr Kios agrees the focus remains on individual resilience-building rather than systemic fixes.

"Resilence and self-care are the personal protective equipment of psychosocial risk. When they become the main response to unsafe rosters, the system is asking the injured person to absorb the hazard." 

Wellbeing itself, she argues, has become another standard to perform.

"The 'solution' has quietly become part of the cultural pressure."

The reform still needed

An 2022 MJA paper argues Australia needs systemic change over individual resilience training, calling Every Doctor, Every Setting (EDES) — the draft framework launched in 2020 — commendable but incomplete. It says a national framework requires whole-of-career coverage, independent governance, and reform of mandatory reporting laws.

Dr McMullen's frustration is funding. Both EDES and the Better Culture project — a national initiative tackling bullying and discrimination — require ongoing money that isn't guaranteed. 

She says the system reforms that would have the biggest flow-on effect are around workforce: better planning, clearer training pathways and safe staffing.

Others say higher pay is also top of the list, alongside dedicated wellbeing roles and measuring burnout as routinely as clinical outcomes.

Dr Kios argues the most powerful reform isn't a program but law; psychosocial hazard reforms now require practices to control hazards, giving doctors something more durable than goodwill. 

The Clinical Oncology Society of Australia's Healthy Workplace Culture framework makes a similar point: a healthy culture means living stated values, not just stating them — and fixing that is up to leaders, not individual doctors.

Dr Kios says real sustainability for the workforce depends on treating causes, not outcomes. 

Still, she sees progress. 

"Earlier generations accepted sacrifice as proof of vocation; newer doctors see an employment relationship with reciprocal obligations."

They also have tools their predecessors lacked — legal language for harm and annual data, she adds.

"Naming a problem that was always there is not trivial; naming it with evidence is how cultures are eventually forced to change."

Where doctors can turn now

Doctors are encouraged to have their own GP, with confidential support available through Doctors' Health services in each state and territory.

Connection matters too, through networks and events like the biennial Australasian Doctors' Health Conference.

"Those who are struggling the most are often professionally isolated. Reaching out to professional networks can help ease the burden," says Dr McMullen.

Dr Bridson's Hand-n-Hand Peer Support built an anonymous network after noticing doctors were reluctant to talk to supervisors or competitors. 

"People could talk to others in similar situations," she says. "They realise they're not alone, and they feel heard."

Key takeaways:

• Burnout remains high, with pay disputes, unsafe rosters and heavy workloads ongoing problems.
• Around a third of trainees still report bullying and racism, with rates nearly double for Indigenous trainees.
• Fear of Ahpra notifications still stops doctors seeking help for mental health issues, though few would be reported.
• Experts say change remains focused on individual resilience-building rather than systemic fixes.
• Real change means law reforms, workforce planning and well-funded and independent support services.