By EK Wills
When you go into a caring profession, you anticipate that you are caring for others. What you don’t expect in return is a lack of care for the profession. Burnout is characterised by the World Health Organisation as resulting from chronic, unmanageable workplace stress. This month, the Brisbane Times reported “Most psychiatrists are feeling overworked, under-resourced and are reporting burnout symptoms” on a national level and the ABC has also reported on the level of burnout in psychiatrists in the country.
The culture in medicine encourages selfless dedication to the point of expectation and, in a system that is woefully underfunded, this creates a perfect breeding ground for exploitation. I’ve written before about the toxic culture of medical training that equate to an abusive relationship. The other end of the candle burning out doctors relates to the employer, New South Wales Health, which has now resulted in a crisis for the state related to an exodus of doctors, specifically psychiatrists, out of the system.
In New South Wales, the most expensive state to live in, the Department of Health has an award that is not commensurate with the rest of the country. Paramedics and nurses in NSW were recently awarded 20%+ increase to their salary because of a lack of increase overtime.
The salary for doctors is also significantly less per year than other states ($20,000 a year less than Queensland) for its junior doctors and can be even worse for newly graduated consultant psychiatrists (up to $80,000 a year less than Victoria). Recognising this is a lot of money (an annual wage for some professions), what needs to be considered is that medical specialties have high risks and complex methods of practice that require over 10 years of training. For example, psychiatrists have extensive assessments with their patients in order to holistically evaluate and approach treatment with their patients. By extension, ongoing care requires containment of risk including suicide and harm to others, as seen recently in the terrible incident in a Sydney shopping centre.
The base pay for junior doctors is the starting point and when overtime rates are not paid this has a cumulative effect. Just last week a class action by NSW junior doctors resulted in a payout of millions of dollars in unpaid overtime after years of this insidious culture of doctors being perceived as part of the problem with the system. This is in context of the recent media around doctors rorting Medicare.
This class action is unique because doctors have spoken out against the system in defence of their own needs. Usually silence is perpetuated by the collective not wanting to appear entitled. Doctors are acutely aware of the vulnerability of their patients but have reached a point where their own mental health is at risk which can affect their ability to do their job.
While the lead plaintiff says it was never about the money, it’s useful to also note that NSW Health also continues to take half the benefit of salary packaging from its employee doctors which does not occur in any other state.
The accumulation of these pressures has resulted in the current crisis. Doctors don’t usually unite together and unionise but psychiatrists are leaving the public system in droves. Many accusations are being made about them fleeing to the lucrative private sector but private hospitals are also finding it difficult to recruit psychiatrists. Several forums debate the reasoning and it appears related to the public system overflow to private, creating higher levels of complexity, higher patient loads and risk for psychiatrists to manage. The remuneration is also hamstrung by private health insurance rates that do not equate with the level of complexity required.
A recent survey by the RANZCP (Royal Australian and New Zealand College of Psychiatry) indicates that almost half the psychiatrists intend to retire within the next decade. This is partially due to demographics (many are older psychiatrists) which indicates that fewer doctors are interested in becoming psychiatrists now. It’s also also interesting to know that there are fewer applicants in New South Wales than in any other state in Australia.
Waitlists to see psychiatrists are currently long but will only get longer if the system doesn’t support its health workforce.
