Survey puts spotlight on plight of service registrars

Since the inception of the HHC, it has been apparent year upon year that for DiTs in our State’s public hospitals, burnout peaks in the registrar years. For trainees, there is peace in the knowledge that for the most part, they are afforded allocated teaching time, opportunities for mentorship and, if nothing else, certainty. 

Each year Ahpra’s Medical Training Survey (MTS) asks college trainees to rate aspects of their training, ranging from wellbeing to examinations and equity within their program. The 2024 MTS told a tale of 20 extra weekly hours of overtime for surgical trainees, RACP registrars unable to meet their training requirements, and some deeply troubling reports from ICU trainees regarding the perceived fairness of their assessments. With fees being what they are, colleges have a lot to answer for. 

Whilst relatively low levels of satisfaction are reported by those in a training program, service registrars are not captured by the MTS, nor specifically by previous HHCs. This year, over 200 participants identifying themselves as a service registrar in the HHC were directed to a separate set of questions that aimed at quantifying the scope of the problem. In a nutshell, it quantifies what we all anecdotally know: with training bottlenecks being the worst they have ever been, service registrars report worse working hours, more anxiety, and a very limited capacity to access meaningful opportunities for career progression.

When considering the mounting competition in the State and across the country, it goes without saying that the service registrars operating in our hospitals are at a uniquely vulnerable time in their careers. The HHC found that almost half felt that their roster was significantly different (i.e. worse) to a trainee’s, and almost 40% refrained from raising a concern at work due to fear of a detrimental career impact. 

As it stands, there is little to no protection from career implications for registrars wishing to query their working hours or rostering, or even just to submit overtime. The AMA (WA) has raised concern regarding these rosters with many a health site before, but the inherent silence of the issue (and need for confidentiality) limits the information medical executives are able to receive. In our upcoming meetings with health services, we will be finally able to draw upon this critical feedback to ensure hospitals are alert to the inequities that exist. In the meantime, I implore each health site to consider how their service registrars can access the same conditions and opportunities as trainees, and what they can offer to this exponentially growing pool of DiTs.

It is important to note that the issue of training unevenly distributes itself amongst pre-vocational DiTs, and can often deepen inequities. A couple of months ago I was discussing college training with a consultant, who reflected that as a junior registrar in the ’90s he was approached by a few different colleges asking him to choose their specialty training program. I do not believe this was an entirely uncommon story for many of our colleagues who trained a few decades ago, and still even the most accomplished service registrar could be waiting 10 years (or more) for entry into cardiology training. 

It is an unfortunate reality that a profound bottleneck seems to sift out the very doctors that a specialty needs. When asked about their application process, 30% of HHC respondents who had applied for a program reported a lack of transparency. Further, DiTs who are International Medical Graduates (IMGs), female or gender diverse, or non-Caucasian told countless anecdotes of overt discrimination throughout the process. Doctors from minority groups are now disproportionately affected by training bottlenecks and, predictably, the harder the program to get into, the less diversity there seems to be.

As we approach what feels like a point of critical mass, it is clear that service registrars want and deserve more from their workplace. For the first time, the HHC was able to quantify the way that training pressures bleed on to DiTs and the health system more broadly, necessitating action from the major health sites in WA. The AMA (WA) hopes to soon be starting a conversation directly with colleges about how things can improve for DiTs, but in the meantime, collective action – from intern to consultant – will be a critical step in the right direction.