What’s been described as the most important underpayment class motion in Australian legal history has just been settled. Who was allegedly underpaid? Thousands of junior doctors who, subject to court approval, are set to share back-pay of virtually 1 / 4 of a billion dollars.
Amireh Fakhouri, who brought the claim on behalf of junior doctors in New South Wales, alleged that once they worked within the state’s public health system from December 2014 to December 2020, NSW Health had did not pay the time beyond regulation and weekend meal break entitlements she and her colleagues were owed.
More than 20,000 claimants are actually set to be eligible for a share within the nearly A$230 million settlement.
But repayment was never the essential goal of the category motion. Fakhouri, who’s now training as a GP in Victoria, said she hoped as an alternative it could change the work culture in medicine.
A rite of passage?
Our health-care system has routinely relied on the labour of junior doctors. These include interns (those that have accomplished their university medical training and are of their first yr of being practising doctors), residents (who’ve accomplished their internship and hold a general registration) and registrars (specialists in training).
Junior doctors often provide much of the staffing for night and weekend shifts and complete burdensome administrative tasks for consultants (senior doctors).
Overworking junior doctors has been normalised for many years. We see this depicted in books (reminiscent of The House of God and This is Going to Hurt: Secret Diaries of a Junior Doctor) and TV shows (reminiscent of House and Scrubs).
This is a security issue. Doctor fatigue has considerable effects on patient safety through potential medical errors, poor quality patient care, longer patient recovery, reduced physician empathy and impacts on the doctor-patient relationship.
A 2020 study found that when doctors reported even moderate tiredness their probability of creating a medical error rose by 53%.
Put simply, stretched, demoralised and drained doctors will do harm. Eventually, that can affect you.
It’s not only long hours
The expectation of working long hours is barely a part of the culture of medication.
Our research and global evidence shows “teaching by humiliation” and other types of verbal mistreatment have also been normalised.
A 2018 study of NSW interns and residents found greater than 50% experienced bullying. Some 16-19% (mostly female) experienced sexual harassment.
Some of the junior doctors who’re victims of mistreatment later grow to be the perpetratorsperpetuating this harmful culture.
Junior doctors are suffering
The impact of long hours on junior doctors and of the abuse they’re subjected to is vividly evident through research, including ours. Junior doctors have significantly high levels of depression, anxiety and thoughts of suicide.
As we’ve been saying for nearly a decade, there’s a desperate need for higher work-life balance for junior doctors and deep culture change in our health-care system.
But there is usually little sympathy for junior doctors. In 2022, one hospital threatened to remove comfortable lounges to forestall juniors napping on quiet night shifts. Just last week, we heard of an identical case involving junior doctors at one other hospital, who were told “sleeping will not be a part of your job description”.
A culture of silence
This class motion was needed because on a day-to-day basis, junior doctors mostly don’t complain.
They internalise distress as failure (not being tough enough) and fear that a diagnosis of depression or anxiety will end in patients and colleagues avoiding them.
They don’t report mistreatment or reject overwork as, often, their
senior doctors control their profession progression.
This is significant, because contrary to perceptions of doctors as wealthy elites, our research shows junior doctors often find it hard to progress, get a job of their city of alternative, or find full-time roles. The pressure on junior doctors to “make it” in an increasingly competitive environment grows stronger. Such skilled problems reinforce the culture of not complaining for fear of blow-back.
Most of those that do take motion, report ineffective or personally harmful outcomes when reporting to senior colleagues. This fulfils a vicious cycle of silence as junior doctors grow to be sick but don’t seek help.
We desired to lift the silence
We used theatre to lift the culture of silence about health-care employee distress attributable to workplace pressure.
We conducted interviews with junior and senior doctors about their experiences and used their verbatim stories to craft the script of the play Grace Under Pressure.
The aim is for this “verbatim theatre” to facilitate conversations and actions that promote positive culture change.
What must be done?
It often takes brave public legal motion reminiscent of this lawsuit to catalyse culture change – to nudge hospitals to forestall junior doctors from working back-to-back shifts, to guard day off for a private life, ensure meal breaks, and supply means to carry powerful senior doctors to account.
Culture change is tough, slow and requires multi-pronged strategies. We need a protected way for junior doctors to report their concerns, and training in order that they know their options for responding to mistreatment. We need senior doctors and hospital managers to be trained in encourage and respond constructively to complaints.
Our research shows that when this happens, culture change is feasible.
Correction: we’ve updated the article to reflect the proper value of the settlement.