Australian Junior Doctors Protest Working Conditions

Junior doctors in Australia’s largest state are on the brink of strike action over working conditions, after a hospital administrator derided them as “clinical marshmallows [sic]” in a leaked email.

The email from an administrator at John Hunter Hospital in New Lambton Heights, Australia, was commenting on a request from a junior doctor who had objected to being rostered for 10 night shifts in a row. It included the comment, “Oh, that’s right…I forgot. Lifestyle before career,” and was accidentally sent to the wrong person, who then shared it with others.

The comment triggered an uproar among junior doctors (a term that describes interns, residents, and registrars) across the state, culminating in a protest outside the hospital in question and a threat of strike action if the state government did not address long-running workforce issues.

“Junior doctors have been frustrated with working conditions,” psychiatry registrar Rhys Gould, MD, who works in the public system in New South Wales, told Medscape Medical News. “It’s how much they’re paid — which is even worse in New South Wales because they’re paid so poorly — and the general culture within hospitals and within our universities.”

Last August, thousands of junior doctors in the state settled a class action lawsuit against the New South Wales Ministry of Health for a decade of underpayment of entitlements for overtime and meal breaks.

There are also long-standing cultural issues in medical training, said Claire Hooker, associate professor of health humanities and arts and health at the University of Sydney in Sydney, Australia.

“Junior doctors, and doctors in general, experience long-standing workplace stressors that center on a hierarchical culture that means that teaching by humiliation and supervision by humiliation is normalized and interpreted as a method of toughening people up,” Hooker told Medscape Medical News.

That culture has negative implications for the doctors and their patients, she argued. “You need to have civil, open working relationships; otherwise, you get scared of reporting breaches of patient safety or of probing to get adequate patient histories,” Hooker said.

The cultural problems within medical education and the health workforce were starting to change for the better, Hooker said. “These issues have gone, in the 10 years that we’ve been working in this space, from pretty much unsayable to definitely being talked about quite a lot.”

Another issue is workforce shortages in state hospitals and public healthcare, which recently prompted the mass resignation of around half of the state’s public psychiatrists.

As with public psychiatrists, junior doctors in New South Wales are paid significantly less than their counterparts in other states. Gould said that he took around a 60%-70% pay cut to move from private practice back into the public system for his training.

He has also experienced poorly structured rostering of shift work. “I remember routinely having rosters where I would have 4 day shifts, then a day off, then a night shift, then a day off, then an evening shift, and then 3 day shifts,” Gould said. “So, facetiously mocking us for prioritizing our well-being and the well-being of our families and wanting to have a lifestyle, that’s really emblematic of all of the problems built within the culture.”

All these factors have been building for some time to create a disgruntled workforce, Gould said. John Hunter Hospital “may be the flare-up where this happened, but this could have happened anywhere.”

The backlash against the comments “highlights a health system, and a workforce, under immense pressure due to inadequate funding and resourcing,” said obstetrician Kathryn Austin, MD, president of the Australian Medical Association’s New South Wales branch.

“Staff are being made to do more with less, and this is resulting in stress and frustration at all levels,” Austin told Medscape Medical News.

The Australian Salaried Medical Officers’ Federation of New South Wales has called on the state government to address the chronic understaffing and “systemic issues forcing doctors to work excessive hours in unsafe conditions.”

The New South Wales Minister for Health Ryan Park condemned the “marshmallow” comments and acknowledged the importance of junior doctors in the health workforce. He said that the government was working to address issues of understaffing and underresourcing.

“We are committed to fostering a workplace where junior medical officers feel valued and respected,” Park told Medscape Medical News. That effort includes implementing safe staffing levels in hospital emergency departments and abolishing a wage cap.

Gould, Hooker, and Austin reported having no relevant financial relationships.

Bianca Nogrady is a freelance medical journalist based near Sydney, Australia.