As a junior doctor in a busy New South Wales emergency department, Dr Fahad Khan expected long hours, high stress and the pressure of life-or-death decisions.
What he didn’t expect was the creeping fear that his job might kill him.
Only weeks into his first year, after working multiple 15-hour shifts in a row, Dr Khan found himself slipping into microsleeps behind the wheel on the drive home.
“Within about five to ten minutes of driving I’ll start to have microsleeps,” he said.
“When I get to the lights I might fall asleep, and then I’ll get a beep and a nice person swearing at me through the window.”
To survive the commute he came up with strategies: pulling over to nap or keeping a friend on the phone for the entire 40-minute drive.
For the past two months NSW doctors have taken to the streets, protesting what they say are dangerous working conditions — excessive hours, chronic understaffing and wages that are far below those of their peers interstate.
Their dispute with the NSW government has reached an impasse with no resolution in sight, according to the doctors’ union, the Australian Salaried Medical Officers Federation (ASMOF).
Dr Khan, who is paid $38 an hour, said the situation is unsustainable.
A junior doctor in NSW makes $76,009 annually according to the award rate.
“I just think it’s very disappointing that junior doctors have to, collectively, have a plan on how to not die when you’re driving home,” he said.
Things the public don’t see
To endure the relentless pressure of the job, Dr Khan says he and his colleagues have found themselves confiding in each other about deeply personal, often distressing experiences.
“There’s just some really ugly things that the public isn’t aware about,” he said.
He says he recalls one colleague getting kidney stones — twice — because he couldn’t find the time to drink water or take a toilet break during punishing shifts.
Another doctor admitted to wetting the bed at night, overwhelmed by stress. One even discovered, to his horror, that he had soiled himself without realising it.
Dr Khan believes the NSW public health system has become toxic for doctors, with many fleeing to other states or leaving medicine altogether.
“An exodus would be a good way to describe it,” he said.
Psychiatry registrar Dr Jemma Cho is one of them. Nine months ago she walked away from her medical career.
She had worked as a registrar at St Vincent’s Hospital in Sydney and Lismore Base Hospital, but says the working conditions left her emotionally depleted and disillusioned.
“I was incredibly burnt out and I had lost trust in the system. It was bleak,” Dr Cho said.
“I didn’t feel like I was making a difference in the way that I wanted. I lost sense of meaning for my job and [it] just wasn’t worth it anymore for me.”
Earlier this year, more then 200 NSW psychiatrists resigned from their jobs in protest over a pay dispute with the Minns government.
Their case will be decided by the Industrial Relations Commission (IRC) which began hearing expert evidence on Wednesday.
Crisis escalates
In early April doctors across NSW walked off the job for three days in a rare and dramatic protest.
They called for a number of key changes including a guaranteed 10-hour break between shifts to ensure safe working hours, and pay parity with doctors in other states — which would require a 30 per cent increase.
But their demands were dismissed by the government as “unrealistic”.
Premier Chris Minns said meeting those demands would cost taxpayers an additional $11 billion and further strain an already overburdened health budget.
Neurosurgery registrar Dr Tom Morrison, who represented the doctors during negotiations, said talks have stalled.
“I don’t think it’s ambitious to be asked to have safe working hours,” Dr Morrison told 7.30.
“I don’t think it’s ambitious to not have to work 30 hours [continuously] treating patients, and I don’t think it’s ambitious to be asked to be paid the same as every other state.”
Dr Morrison, based at Liverpool Hospital in Sydney, said tensions escalated sharply in the lead-up to the strike.
Two days before the planned walkout, the Department of Health sent a letter to doctors warning they could be referred to medical regulators if they proceeded.
The IRC had earlier ruled that doctors must not strike for at least three months.
Dr Morrison says he and his peers took that as a threat.
“These are bodies for serious professional misconduct, not for people who are standing up saying, ‘we’re working in an unsafe system’,” Dr Morrison said.
“People were just astounded that there’s been such a dramatic escalation.”
Then came the claim by the government that hundreds of chemotherapy appointments had been cancelled due to the strike. Days later Health minister Ryan Park’s office admitted the information was incorrect.
Dr Morrison said the accusation was offensive and that he felt that the government was trying to suggest that doctors are putting patients’ lives at risk.
“I don’t think anything the government’s done has encouraged doctors to work for NSW Health,” he said.
“If anything they’ve made it clear that the system has these deep cultural problems … and now it’s in crisis.”
Mr Park declined 7.30’s request for an interview, and he didn’t respond to questions. Instead his office pointed to his statements made in previous press conferences.
Is pay rise a ‘sugar hit’?
A special commission of inquiry is looking at how we can better fund the healthcare system in NSW.
Professor Jeffrey Braithwaite, founding director of Macquarie University’s Australian Institute of Health Innovation, serves as a member of the inquiry’s expert panel. He said funding health is a complicated challenge.
“Healthcare is like a black hole. You could pour dollars into it and not reach the bottom,”
Professor Braithwaite said.
While he sympathises with the NSW doctors’ demands, including calls for a pay rise, Professor Braithwaite believes that increasing salaries won’t solve the deeper issues within the system.
“There’s a case for them to be paid more … but after that you just reckon you deserved it, and that’s what you’re worth now — so it’s only a sugar hit,” he said.
Professor Braithwaite’s research into modern healthcare systems, including NSW’s public hospitals, has revealed that many of them could operate much more efficiently.
His findings show that 60 per cent of healthcare provided is of high quality, 30 per cent is wasted due to bureaucracy or inefficiencies, and 10 per cent results in actual harm to patients, including accidents and errors.
Shifting these numbers, he said, is essential for meaningful reform.
“These numbers have remained fairly sticky for a couple of decades,” he said.
“It’s not good enough”.
