The doctors’ union is warning that the New South Wales health system “will go off a cliff” next week if the resignation of more than 200 psychiatrists – half the cohort – comes into effect.
The specialist doctors indicated they would be submitting their resignations in December amid a standoff with the government over concerns about pay and the state of the mental healthcare system.
There are 443 psychiatrist positions at NSW Health, but 30% to 40% of those roles were already vacant prior to the standoff. Another 205 are set to resign, the minister for mental health, Rose Jackson, said.
As the date of their resignation – 21 January – looms, appeals from the state and federal governments to withdraw them have become more urgent.
On Monday the federal health minister, Mark Butler, urged the state government and the doctors to resume negotiations to avoid “devastating consequences for psychiatric patients and their families in New South Wales”.
In a statement released Wednesday, the doctors’ union, the Australian Salaried Medical Officers’ Federation (Asmof), said: “Within a week of the mass resignation of psychiatrists, the NSW health system will go off a cliff, such is the magnitude of crisis the Minns government has created and the people of NSW face.”
What are psychiatrists asking for?
Psychiatrists have been in discussions with the NSW government about the workforce crisis for 16 months, amid a staffing shortfall of 140 psychiatrists in the state, with about one in three psychiatrist positions remaining unfilled.
As a plan for recruitment, they want to see psychiatrists receive a special levy similar to that which emergency doctors received in 2015, increasing their pay by 25%.
The Australian Salaried Medical Officers’ Federation (Asmof) said NSW psychiatrists were demanding pay parity with psychiatrists in other states – citing a 30% gap – to address what the doctor’s union called the “root cause” of the state’s already understaffed mental health service.
The acting executive director of Asmof NSW, Ian Lisser, said the psychiatrists did not want to resign but had been left with little choice.
“The NSW government is happy to pay millions in dollars to locum agencies as a Band-Aid solution but refuse to make a meaningful offer to our dedicated permanent staff.”
What does the NSW government say in response?
Jackson said: “We recognise that there is a really legitimate claim for more support for our psychiatrists.”
But she also cited a 4.5% wage increase for government employees last year and said that the offer of a 10.5% wage increase for all doctors over three years was still “on the table”. Asmof NSW has already rejected the offer, which was made in April.
Dr Pramudie Gunaratne, the chair of the NSW Branch of the peak body for psychiatrists, the Royal Australian and New Zealand College of Psychiatrists (RANZCP), said the 10.5% offer was made to all public sector doctors as part of the union’s broader industrial negotiations. “It was rejected by union members and is completely separate to this issue. Psychiatrists couldn’t have accepted it even if we had wanted to”.
The NSW health minister, Ryan Park, said the government could not afford the 25% pay increase – which would add up to an extra $90,000 on each psychiatrist’s salary – because it would set a precedent other medical specialists would also ask for.
Jackson said the government was also willing to discuss better conditions for doctors such as educational opportunities, leave arrangements and other allowances.
What do psychiatrists in NSW earn and how does it compare to other states?
The minimum base salary for a psychiatrist in NSW is $186,241, but depending on seniority the base salary can go up to $251,618. However, many do not work full-time and are therefore paid less. According to the NSW government, of the 443 positions, 290 are full time.
According to the NSW government, by including various allowances, $40,765 in superannuation and annual leave loading, their total package can be worth up to $438,000.
According to Asmof, the equivalent salary in Western Australia is 51.66% higher, 44.6% in the Northern Territory, 38.98% higher in South Australia, 28.44% in Queensland, 25.51% in Tasmania and 2% higher in Victoria. However, in Victoria, as most psychiatrists do not work full-time, they are paid an hourly rate which amounts to 31% more than NSW.
A first year staff specialist in Victoria, paid 40 hours at an hourly rate of $165, will amount to $662 a week or $345,291 per annum.
WA Health said that the minimum base salary of a specialist psychiatrist in Western Australia is $202,725, with a total package, including allowances, of $354,700. The maximum base salary of a doctor in Western Australia is $298,489 with a total package, including allowances, of $450,462. The total package does not include superannuation.
Guardian Australia has seen one agency advertising multiple locum consultant psychiatrist roles starting 21 January in metropolitan and regional areas of NSWwith a rate of $3,050 a day.
What effect will the resignations have?
RANZCP said the resignations will disrupt the care of “some of the most vulnerable people in our community” with acute and critical mental healthcare needs. RANZCP is concerned those people could find themselves in the judicial system without access to healthcare.
Lisser said when the resignations come into effect, hospitals will be left without consultant psychiatrists who are necessary to admit patients from the emergency department into the psychiatric ward. As a result, anyone in NSW could be affected if they needed emergency care and beds are taken up by mental health patients “waiting to be seen by a psychiatrist that is no longer working in the system”.
“We are also very concerned that the burden of treatment will fall on trainee doctors, nurses or paramedics,” Lisser said.
What contingency plans will be in place next week?
Park said he and Jackson had been working on a range of contingencies with the secretary of NSW Health, Susan Pearce, and the chief psychiatrist, Murray Wright.
The NSW government had also been in discussion with the commonwealth and the private sector around additional workforce capacity, Park said.
Starting on Monday, a mental health emergency operations centre will be in place “to give visibility across the system as to where there are potential gaps and how we fill those gaps”, Park said.
The government will also increase support for its existing mental health line and work with Health Direct, the call centre that provides general health services, including mental health services.
But, Pearce warned, “it is very difficult to overnight replace 200 psychiatrists”.
Lisser warned “the government’s contingency plan relies on increasing the burden on already overworked staff … who will be forced to work beyond their scope of practice which is both unethical and puts everyone, including both patients and staff, at risk”.
“There is one solution to this crisis and that is to retain psychiatrists in the NSW Health system,” Lisser said.
