Venting alone won’t cut it

Tell us about yourself and what led to your role as Co-Chair of the Doctors in Training (DiT) Practice Group

I am an RMO with an interest in surgery who has spent the majority of my time at Royal Perth Hospital, but also some time at numerous other WA health sites. I commenced medical training with UWA at the height of COVID-19, and when my placements were suspended, I took the opportunity to get involved in multiple advocacy efforts. Since then, my interest in advocacy has continued to grow, resulting in an array of positions held on committees across my medical school and junior doctor career.

When I started working, it didn’t take long to recognise the list of problems in the health service. If you spoke to any JMO, odds are they could tell you about working some ridiculous overtime shifts; pay checks being wrong; or fears about getting onto training.

Like many of my colleagues, I initially found comfort in venting about these problems, but it soon became evident that venting alone does not fix these issues. So, encouraged by DiTs’ success with things like accessibility of overtime claims, I got involved within my local JMO society hoping to make a difference.

When the AMA did a site visit, I signed up and won a competition for a year of free membership. Towards the end of last year, I joined the Enterprise Bargaining Committee, where I gained invaluable experience and enjoyed working collaboratively with doctors, both junior and senior, from across WA to improve our health system. From here I found out about the DiT Committee. After a year there I took the opportunity to step up as Co-Chair, because I believe it’s my next best chance to improve the experience for DiTs in WA.

Over the past few years, there have been massive gains for DiTs and a culture of change has been started. As Co-Chair, I’m excited to progress this change and represent junior doctors across WA.

What are the issues facing DiTs?

The list is long, and many of them have already been said, but that does not make them any less relevant.

JMO representation

JMOs expect representation across the health system. It’s encouraging to see the increasing number of committees established in recent years consisting of JMOs advising hospitals, health services or the wider WA health. However, there remain many concerns about these committees; with many of them heavily weighted towards seniority, minimising the impact of JMO perspectives. Additionally, within these committees there are ongoing questions as to how much of what JMOs are saying is being taken on board, with many meetings carried out without minutes, and the outcomes being without clear accountability or transparency.

Further, there tends to be unequal expectation that JMOs be voluntarily involved in these committees, while those from HSPs or other bodies frequently receive compensation for their time. We need clear accountability and transparency of these meetings, and JMOs need to be compensated for time spent in these committees. JMO involvement must not be tokenistic.

Burnout

Increasing numbers of JMOs are leaving the health systems or moving to other health systems to find the job satisfaction and reward they thought they’d receive by completing a medical degree. Given that the majority of the day-day care in our health system is from JMOs, this is a massive public health crisis.

Currently, DiTs regularly work overtime hours without being asked, for the good of their patients – and thankfully the health system is finally starting to recognise this with easier accessibility to overtime. But there’s so much more we can do to reduce burnout.

Without a concentrated effort to reduce burnout, it is only going to get worse, as health services are increasingly recognising the gap between the workforce they have and the workforce they need. Consequently, health services seem to be increasingly looking at JMOs in terms of their capacity for ‘service delivery’ and less at their need for training.

Solving burnout requires a multipronged approach, focusing on numerous factors such as increased availability of non-clinical days, commitments to supporting the training needs of JMOs, strengthening of working rights, flexibility of workforce, and reducing JMOs’ administrative task burden.

Updates for the 21st century

Workforce: Changes in training structure and requirements mean JMOs are going through training later in life, which means they are increasingly looking for options to progress their career with a greater component of work-life balance. Great wins have been made in this area with the recent Industrial Agreement improvement of parental leave and commencement of overtime at 10 hours. However, support needs to continue for efforts to increase the number of part-time and job-share options available, and improvements of working rights.

Infrastructure: Hospital systems in WA are increasingly out of date. Any JMO will be able to give you a list of complaints about their hospital’s IT capabilities, or lack of it, and tell you in great detail how this slows them down and adds to their administrative burden.

Despite the increasing prevalence of computers in our daily lives, finding functional computers in hospitals is surprisingly difficult. Further, the systems on these computers are frequently prone to error, slow speed, poor data connections, crashing, and being generally confusing. A concentrated effort must be made to advance this technology, and soon. While we in WA are still debating how to get a first-generation EMR, most doctors on the east coast are well accustomed with their use, and countries like America are already on their third, fourth and fifth generations with deep AI integrations.

Specialist training

The costs of training, as well as delays in getting onto training, and the competition to get onto training, all continue to increase – despite the recognition that we need more specialists! Further, recent specialist training surveys and national medical training data suggest those already in training are increasingly dissatisfied with their training. We need more discussion with colleges to increase training spots, satisfaction and quality; and to reduce the delays and costs. And we need more JMOs in these discussions.