Unsafe work patterns, fatigue, unclaimed labour demand reform

Doctors in Training (DiTs) across the State are operating in a system that is fatigued, overburdened, and failing to safeguard the wellbeing of its workforce. New data from the AMA (WA) HHC reveals a rise in overtime hours, unsafe rostering practices, and a demoralising culture of unacknowledged labour.

Unrostered, Unclaimed and Unwell

DiTs are now working more overtime than ever before. On average, DiTs report five hours of unrostered overtime per week and are on call one night per week. Despite some improvements in compliance with the Industrial Agreement, more than 15% of rosters continue to breach fatigue management rules. Compliance with fatigue-safe rosters drops off significantly over a DiT’s career:

• Interns: 91%
• RMOs: 88%
• Service Registrars: 76%
• Trainees: 81%

This trend reveals a system that prioritises early training oversight while failing to sustain protections as responsibilities increase.

The situation is further worsened by unsafe on-call expectations. Only half of DiTs feel safe to return to work the day after an on-call shift, and nearly 40% report getting less than 4–5 hours of sleep on those nights. As one doctor put it bluntly:

“To be honest, it’s not a safe working environment for patients or staff.”

Even when sick, doctors often continue working – out of fear of letting down colleagues. The unpredictable and excessive hours are also pushing doctors towards alternative employment: 31% of DiTs report interest in part-time roles, yet only 52% believe they could negotiate such arrangements. Many are now considering locum or casual contracts, which offer higher pay and more control over hours.

Overtime Barriers: A Culture of Silence

Despite working long hours, many DiTs still don’t claim their overtime, with reasons for not claiming being:

• “It’s not worth claiming” (37%) – Whether due to short increments of time or cumbersome claiming processes, many simply don’t bother.
• Workplace culture (18%) – Doctors cite direct or implied pressure not to claim. “Passive-aggressive remarks from senior doctors” are a recurring theme.
• Cumbersome processes (12%) – “Claiming requires handwritten forms, supervisor approval, HOD signatures, and documentation in a DMR. Routine tasks like writing discharge summaries or ordering bloods don’t count if not documented precisely – despite being essential clinical work.”
• Fear of retaliation (12%) – “The person approving my claim is the person I need a job from. It’s a conflict of interest, and a threat used.”

Unclaimed, unplanned overtime is also not evenly distributed, with service registrars being three times less likely to claim their hours as compared to interns. These figures demonstrate a system that continues to rely on excessive, and often unremunerated, labour.

Practical, Immediate Solutions

Doctors have proposed simple, tangible reforms to improve safety:

• Restrooms with privacy and security for night shift JMOs.
• Guaranteed post-call recovery days: “Performing critical procedures whilst significantly fatigued is a huge risk to patients.”
• Clearer rostering between day/night duties: “Two days or two nights, not unpredictable 24-hour blocks with no clear rest time.”

These provisions could be immediately implemented by health service providers, ensuring better safety for both clinicians and patients.

Conclusion

The data is clear. Fatigue, unclaimed labour, and unsafe work patterns are the norm, not the exception. It’s time for urgent reform – not only for the doctors, but for the safety of the patients they serve.