The night before public hospital doctors in Australia’s priciest state, New South Wales, went on a three-day strike to protest against pay and working conditions, I went to bed thinking what it must be like to be in their shoes.
I would be nervous about the reaction from the public who might judge me for being yet another greedy doctor.
But I’d be extra nervous about the administrators who had labelled the doctors “clinical marshmellows” [sic].
After the strike, would I have a job to return to? Or be branded a troublemaker? What would my colleagues say? God forbid, I might even relinquish the precious credential of being a “team player”. Of all the insults, this is the one that really gets under a doctor’s skin.
But to be honest, the thing that would steal my sleep is guilt. Guilt at not fulfilling my duty to patients. At not living up to my own expectations. The faces of my patients would keep me up. Who would check their sodium level? Who would convey their scan results? Who would explain the cancelled surgery? If 500 oncology appointments were being deferred, how would I face my patients again? Amid their own challenges, was it even ethical to expect them to understand mine?
This is the unwritten code of healthcare. Other professionals strike, doctors don’t. Until now.
It is no secret that public hospital conditions are overstretched. What is clear is that the willingness of public hospital doctors to keep the system functioning at a high personal cost has finally reached its limit – here, in the UK, South Korea, New Zealand and elsewhere.
Private practice is far more lucrative (albeit with its own considerable headaches).
To avoid being “the absolute worst” paid public hospital doctors in the country, the striking doctors want a 30% pay rise, which the NSW government finds untenable. After offering a 10.5% rise over three years, it has also failed to explain its $11bn price tag to repair the healthcare system, most of which is related to infrastructure improvement and not doctors’ pay.
Still, the government may have found some sympathy for its stance until it condemned the doctors for jeopardising lives, which predictably opened a Pandora’s box of revelations about the realities of being a public hospital doctor.
One doctor recounted seeking advice from an exhausted specialist, who then called back five minutes later because they couldn’t recall whether they’d spoken. Another operated all night and was expected to turn up to the “regular” day shift two hours later or risk the ignominy of cancelling a list. Another received a phone call on average every seven minutes over a 24-hour period. And in a truly upsetting case, one doctor describes being told to return to the floor immediately after witnessing a confronting death.
Would you want to be treated by any of these hungry, thirsty, distressed, sleep-deprived doctors? Not if you could help it. For their sake, and ours, we would want these doctors to be well rested and better treated but the government has so far even rejected their call to be guaranteed a minimum 10-hour break between gruelling shifts.
The strike is about pay and conditions but the government is conceding neither.
If you find the latter part inexplicable, it isn’t. If public doctors were afforded only better working conditions (sick leave without guilt, mandatory breaks between shifts, scrupulously paid overtime, no surreptitious administrative work), hospitals would struggle – and those in charge know it.
It takes up to eight years of university to qualify as a doctor, depending on whether the medical degree is an undergraduate or postgraduate undertaking. A final year student works on the wards as an unpaid intern. When that student becomes an actual intern, the pay in NSW is AUD $38.44 an hour, a base salary of about $76,000.
In the same state, it takes a brisk eight months post high school to become a police constable. The first half of training can be completed online. In the second half, students are paid $1360 a week plus allowances. The starting constable salary in NSW is about $81,000 (set to increase to more than $97,000 by 2027).
Five years later, the constable is well into his career, while the doctor is still forging a career path, paying many thousands of dollars in exam fees on the decade-long quest to become a specialist. Along the way, obtaining a four-year full-time PhD, a degree many public hospital appointments require, involves getting by on an abject annual stipend of about $33,000.
Police and doctors both serve the public valuably and there is a shortage of each. The point is not to compare their relative value to society but to illustrate the power of different unions, earning one group a “historic” pay rise and another a threat to be reported to the medical board for professional misconduct.
When Australian doctors last took strike action more than 25 years ago, medicine was considered a noble profession. One thing you could always count on is that the doctor would stay back to serve the patient, no matter what. But today, with an estimated 10 administrators for every doctor in the US, the altruism of doctors has been wrung out.
Yet, there has never been a greater need for a strong public hospital system that attracts the best talent whose mission is to care for all the people all the time.
By condemning public hospital doctors for wanting better pay and conditions to help their patients, the costliest move might turn out to be an own goal.
Ranjana Srivastava is an Australian oncologist, award-winning author and Fulbright scholar. Her latest book is called A Better Death
