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Working conditions as a doctor

onthesunway

New Member
My daughter just goes to medical school this year. I read a bit information about junior doctors' working conditions (long hours without being paid, etc), suicidal rates, etc. Since you are a junior doctor now, you will have first hand experience about them. Could you please tell us how you feel about it? Many thanks.

Moderation edit (pi): this was originally posted elsewhere, better suited as a new thread
 
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pi

Junior doctor
Admodistrator
My daughter just goes to medical school this year. I read a bit information about junior doctors' working conditions (long hours without being paid, etc), suicidal rates, etc. Since you are a junior doctor now, you will have first hand experience about them. Could you please tell us how you feel about it? Many thanks.
I can only speak for myself here, but my first few months as a junior doctor have been really good in all honesty. I've worked both on the wards and in the emergency, and have felt very well supported from my seniors, nursing, and allied health staff throughout my time in each environment. In regards to my personal mental health, certainly there have been some stressful moments, but nothing overwhelming for me thus far. I know I have people, both inside and outside of work, who I can talk to if I need to, but I haven't needed to debrief/vent to anyone.

In regards to hours, I've done some unpaid overtime. For example last week I probably did maybe 8 hours unpaid overtime cumulatively? Honestly, I don't see it is a big deal. If I have work to do, then that's my work to do, so I'm going to stay until it gets done. Sometimes the work can be too much to do, in which case I have the option of handing some jobs over to the next person rostered, but I'd hate to leave them with discharge summaries (never handed these over) or anything that requires a good knowledge of my patients. Furthermore, given I'm only a few months in to my first ward job, I acknowledge I'm not as efficient as someone who has been doing ward jobs for years, so my overtime inevitably reflects some of my own inherent (but improving... I hope!) inefficiencies.

Taking a broader look at the workforce though, things are definitely worse than I have personally experienced. Bullying is real and does happen, although hopefully less than 5+ years ago, and people are adversely affected by that. On the note of overtime, some units are much busier than others, for example some of my surgical intern colleagues work 6am-9pm every day with probably 5 hours overtime per day (mostly unpaid), so again I have it relatively easy there.
 

onthesunway

New Member
I can only speak for myself here, but my first few months as a junior doctor have been really good in all honesty. I've worked both on the wards and in the emergency, and have felt very well supported from my seniors, nursing, and allied health staff throughout my time in each environment. In regards to my personal mental health, certainly there have been some stressful moments, but nothing overwhelming for me thus far. I know I have people, both inside and outside of work, who I can talk to if I need to, but I haven't needed to debrief/vent to anyone.

In regards to hours, I've done some unpaid overtime. For example last week I probably did maybe 8 hours unpaid overtime cumulatively? Honestly, I don't see it is a big deal. If I have work to do, then that's my work to do, so I'm going to stay until it gets done. Sometimes the work can be too much to do, in which case I have the option of handing some jobs over to the next person rostered, but I'd hate to leave them with discharge summaries (never handed these over) or anything that requires a good knowledge of my patients. Furthermore, given I'm only a few months in to my first ward job, I acknowledge I'm not as efficient as someone who has been doing ward jobs for years, so my overtime inevitably reflects some of my own inherent (but improving... I hope!) inefficiencies.

Taking a broader look at the workforce though, things are definitely worse than I have personally experienced. Bullying is real and does happen, although hopefully less than 5+ years ago, and people are adversely affected by that. On the note of overtime, some units are much busier than others, for example some of my surgical intern colleagues work 6am-9pm every day with probably 5 hours overtime per day (mostly unpaid), so again I have it relatively easy there.

Thank you very much for sharing your experience. You have been very helpful. Thanks again.
 

Benjamin

Admin (JCU MBBS)
Emeritus
Thought I should chime in here as well.

Work as a junior doctor is incredibly variable, not just within hospitals & departments but even within individual teams within departments. For example, my current cardiology rotation has 3 different teams all of which do varying levels of overtime & have varying levels of support. A lot of it comes down to who the bosses are & how the units are run. Some hospitals / units don't pay overtime as a general rule, others will pay every minute of it.

There are certainly terms which are fairly consistent with regards to the presence of overtime & the availability of clinical support - these tend to be the more 'acute' terms like surgery & medical specialities that have a lot of emergency cases or are considered high turnover wards (lots of admissions & lots of rapid discharges) - e.g. cardiology.

At the same time there are also terms which are very consistently 8-4 jobs with minimal overtime, these tend to be jobs (at a junior level) that do not have a lot of turnover or don't have a lot of emergency / critical / immediate jobs. Psychiatry is a reasonable example of this though again it depends on how the unit is run. Palliative care is probably another good example as the majority of things (at a junior level) are all planned & all go relatively slowly when compared to the rapid admission/discharge rate of cardiology/surgery etc.

There are also jobs which are very strict about their rostering & make work hours / getting you out on time a priority. These tend to be the shift-work jobs such as Emergency / Intensive care / Ward call jobs with 12 hour shifts etc. You can invariably become trapped & work overtime but often there is someone coming in to directly replace your job & so you can get away on time.

As you can expect from my above description I have had a fairly variable experience in terms of stressful jobs, long hours & fatigue. I have called in 'sick' because I knew I needed the sleep or a day off to relax, I have made mistakes because of my fatigue/high workload (thankfully caught & corrected). I have had days/weeks where I wanted nothing more than stop getting out of bed at 5:30AM & getting home at 7PM having not been out in the sunlight. At the same time I have also taken additional overtime shifts because the work I was doing at the time was so stress-free that I was happy to take the money in exchange for the fatigue.

It is hard to give an accurate picture of what working as a junior doctor is like so instead here is a snapshot of my current job:

Monday - 0730 start. Typically many discharges prior to the weekend & so only have the 'longer' stay patients on Monday morning / ~10 patients at most on a Monday. Usually finish on time at ~1600-1630.

Tuesday - 0700 start. "On take" day which means all cardiology patients admitted to the hosptial in the last 24 hours come under my team's care. Patient list expands with anywhere from ~10 - 20 new admissions. Most of these will be discharged on the same day after a run of normal investigations. Some will get interventions & get discharged 24 hours after that. Rarely make it out of the hospital by 1730.

Wednesday - 0730 start. Typically discharge another 5 or so patients after observing for another 24 hours. Usually back to our 'baseline' or if it's a bad week will have added a few more patients to the 'longer' stay patient list. Hopefully have sent as many home from the Tuesday admissions as possible. Usually out by 1700.

Thursday - 0700 start. "On take" day again. This day depends entirely on how many patients from Tuesday's "on take" we got out before today. If we got them all out then it's essentially a repeat of Tuesday, if there were any still here from Tuesday then Thursday sucks & I won't make it out of the hospital before 1830.

Friday - 0700 start. Get as many patients as possible discharged before the weekend or organised to be discharged over the weekend. Everyone needs a plan for the upcoming 2 days so even if we only have 10 patients this can still take a while. Usually get out by 1700.

In regards to hours, I've done some unpaid overtime. For example last week I probably did maybe 8 hours unpaid overtime cumulatively? Honestly, I don't see it is a big deal. [...] my overtime inevitably reflects some of my own inherent (but improving... I hope!) inefficiencies.
I personally think this is the wrong way to look at overtime. Every minute you spend in the hospital should be paid for, even if it is as a result of your 'inefficiency' as a junior. The departments you are working in as a junior doctor are well aware of the fact that they are employing & giving work to junior doctors & that it comes with an element of ineffiency when compared to employing only senior registrars / having bosses do all the work. As such you should be paid for your work & also keep in mind that if you are not being paid to work then you are also unlikely being insured for any jobs that you do while not being paid.

Even ~8 hours cumulatively is ~$320/week before tax as a junior doctor. Over a year thats ~$16,000 & that's not taking into account overtime loading (with overtime loading it is $480/week or $24,000). I have tried to claim all the overtime that I work as a junior. The vast majority of it has been approved and the terms/rotations that haven't I will refuse to work at again.
 

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pi

Junior doctor
Admodistrator
I have tried to claim all the overtime that I work as a junior. The vast majority of it has been approved and the terms/rotations that haven't I will refuse to work at again.
I think this is entirely network-dependent, although it shouldn't be. In my network, claiming overtime at any level is basically unheard of and given that, no one wants to be the first in case it gives them an undesirable reputation. It's an unfortunate situation, but it's the reality.
 

onthesunway

New Member
Thought I should chime in here as well.

Work as a junior doctor is incredibly variable, not just within hospitals & departments but even within individual teams within departments. For example, my current cardiology rotation has 3 different teams all of which do varying levels of overtime & have varying levels of support. A lot of it comes down to who the bosses are & how the units are run. Some hospitals / units don't pay overtime as a general rule, others will pay every minute of it.

There are certainly terms which are fairly consistent with regards to the presence of overtime & the availability of clinical support - these tend to be the more 'acute' terms like surgery & medical specialities that have a lot of emergency cases or are considered high turnover wards (lots of admissions & lots of rapid discharges) - e.g. cardiology.

At the same time there are also terms which are very consistently 8-4 jobs with minimal overtime, these tend to be jobs (at a junior level) that do not have a lot of turnover or don't have a lot of emergency / critical / immediate jobs. Psychiatry is a reasonable example of this though again it depends on how the unit is run. Palliative care is probably another good example as the majority of things (at a junior level) are all planned & all go relatively slowly when compared to the rapid admission/discharge rate of cardiology/surgery etc.

There are also jobs which are very strict about their rostering & make work hours / getting you out on time a priority. These tend to be the shift-work jobs such as Emergency / Intensive care / Ward call jobs with 12 hour shifts etc. You can invariably become trapped & work overtime but often there is someone coming in to directly replace your job & so you can get away on time.

As you can expect from my above description I have had a fairly variable experience in terms of stressful jobs, long hours & fatigue. I have called in 'sick' because I knew I needed the sleep or a day off to relax, I have made mistakes because of my fatigue/high workload (thankfully caught & corrected). I have had days/weeks where I wanted nothing more than stop getting out of bed at 5:30AM & getting home at 7PM having not been out in the sunlight. At the same time I have also taken additional overtime shifts because the work I was doing at the time was so stress-free that I was happy to take the money in exchange for the fatigue.

It is hard to give an accurate picture of what working as a junior doctor is like so instead here is a snapshot of my current job:

Monday - 0730 start. Typically many discharges prior to the weekend & so only have the 'longer' stay patients on Monday morning / ~10 patients at most on a Monday. Usually finish on time at ~1600-1630.

Tuesday - 0700 start. "On take" day which means all cardiology patients admitted to the hosptial in the last 24 hours come under my team's care. Patient list expands with anywhere from ~10 - 20 new admissions. Most of these will be discharged on the same day after a run of normal investigations. Some will get interventions & get discharged 24 hours after that. Rarely make it out of the hospital by 1730.

Wednesday - 0730 start. Typically discharge another 5 or so patients after observing for another 24 hours. Usually back to our 'baseline' or if it's a bad week will have added a few more patients to the 'longer' stay patient list. Hopefully have sent as many home from the Tuesday admissions as possible. Usually out by 1700.

Thursday - 0700 start. "On take" day again. This day depends entirely on how many patients from Tuesday's "on take" we got out before today. If we got them all out then it's essentially a repeat of Tuesday, if there were any still here from Tuesday then Thursday sucks & I won't make it out of the hospital before 1830.

Friday - 0700 start. Get as many patients as possible discharged before the weekend or organised to be discharged over the weekend. Everyone needs a plan for the upcoming 2 days so even if we only have 10 patients this can still take a while. Usually get out by 1700.



I personally think this is the wrong way to look at overtime. Every minute you spend in the hospital should be paid for, even if it is as a result of your 'inefficiency' as a junior. The departments you are working in as a junior doctor are well aware of the fact that they are employing & giving work to junior doctors & that it comes with an element of ineffiency when compared to employing only senior registrars / having bosses do all the work. As such you should be paid for your work & also keep in mind that if you are not being paid to work then you are also unlikely being insured for any jobs that you do while not being paid.

Even ~8 hours cumulatively is ~$320/week before tax as a junior doctor. Over a year thats ~$16,000 & that's not taking into account overtime loading (with overtime loading it is $480/week or $24,000). I have tried to claim all the overtime that I work as a junior. The vast majority of it has been approved and the terms/rotations that haven't I will refuse to work at again.
Very insightful, thanks for sharing it with us.
 

Benjamin

Admin (JCU MBBS)
Emeritus
I think this is entirely network-dependent, although it shouldn't be. In my network, claiming overtime at any level is basically unheard of and given that, no one wants to be the first in case it gives them an undesirable reputation. It's an unfortunate situation, but it's the reality.
It definitely is network dependent and I would avoid any place that didn't pay overtime at all costs. I hate working overtime as it is - knowing that "just an extra hour" means I can't go for a surf/swim/jog/get outside while the sun is still up is hard enough when I'm getting paid time & a half, let alone doing it for free.

Moving to a new hospital this year I was concerned that they wouldn't pay my overtime as they did at my previous hospital ... so I made sure all the cardiology residents were on the same page & we all sit down on a Friday afternoon before we go home & submit our overtime claims together. Its a bit hard to deny an entire department of residents, especially when the emails all come minutes after eachother.

In saying that I am particularly opinionated on this & as such there is a good reason that my current speciality of choice is shift work based.
 

govpop

Regular Member
In saying that I am particularly opinionated on this & as such there is a good reason that my current speciality of choice is shift work based.
Sounds like you work in a particularly good system but I would just point out to the OP that even in shift work based specialties going home when your shift is "officially" over is the exception rather than the rule.
 

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johnno123

New Member
Hello guys,

I am seriously considering pursuing a career in medicine and I want to make sure I know exactly what I am getting myself into so I've got a few questions. I am relatively new to the world of medicine so apologies if these questions sound silly.
1. How many hours do medical interns/residents tend to work per week? And are there any internship/residency programs that can be undertaken part-time in Australia?
2. How much do medical interns/residents usually get paid in Australia?
3. What can be done with a medical degree if someone does not wish to study further or work crazy hours?
4. Do uni results in medical school have any influence on the specialties that you will be able to study? If not, what do medical specialty colleges look at when ranking applicants for positions?

Apologies if these have already been answered.

Any help would be greatly appreciated.
 

chinaski

Regular Member
I would point out that generally interns and residents don't work the longest hours, nor carry much comparative responsibility in their roles. I commend your intention to learn more - in so doing, I would suggest you think beyond the first couple of years after graduation and consider the bigger picture.
 

failedlobster

worlds biggest procrastinator
to add onto Johnno123's post, what was the reason you decided to pursue medicine and do you still feel that you are pursuing it because of that reason or has it changed/been refined?
and what has been the best experience so far?
 

medhopeful2001x

New Member
I saw in one of the chats, where several older members who are doctors now mentioned how there is a lot of sexism, and cases of older doctors treating younger doctors/interns etc badly. Are there any truth to these claims? It was just quite surprising to hear, and left a sour taste in my mouth as a hopeful future doctor.
 

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Benjamin

Admin (JCU MBBS)
Emeritus
1. How many hours do medical interns/residents tend to work per week? And are there any internship/residency programs that can be undertaken part-time in Australia?
2. How much do medical interns/residents usually get paid in Australia?
3. What can be done with a medical degree if someone does not wish to study further or work crazy hours?
4. Do uni results in medical school have any influence on the specialties that you will be able to study? If not, what do medical specialty colleges look at when ranking applicants for positions?
The standard full time roster for interns and junior doctors is a 76 hour work fortnight or 38hrs/week. This is the base/minimum & often you will work more hours either in the form of rostered (surprise extra weekend shifts) or unrostered overtime (still have jobs to do so can't leave till they're done). Some rotations / specialties are worse than others - shiftwork jobs (i.e. ED / ICU / ward call) tend to be quite strict with your hours and you will rarely do unrostered overtime, but this comes with the caveat of doing shiftwork (i.e. nights / evenings / changing rosters).

Internship (PGY1) is a full time job, there is no capacity to do it part time. Residency and registrar jobs are a bit different, largely resident jobs in public hospitals are full time - theoretically you can do part time resident gigs at a public hospital but it's very rare & needs a lot of things to line up. Registrar or training position jobs are a different ballgame altogether and depend entirely on which speciality you are training in - some will allow part time training (GP / ED / ICU) while others "allow" it but it almost never happens (Surg etc.). There are options for part time jobs but they mostly exist outside of the public system in private hospitals or locum positions & are usually shiftwork jobs, they come with the downfall of halting your career progression for the year/s you work in them. It is a fairly common trend at the moment for junior doctors to take a year off after working for 3-4 years & locum around Australia - doing so you can make almost the same amount of money while working half the time & have flexibility to not work if you want. I am not sure how long the locum industry will continue like this.

The base salary rates for interns / residents / registrars are available on all of the Medical Award documents for most states. The QLD one is called the MOCA5 (https://www.qirc.qld.gov.au/sites/default/files/2019_cb34.pdf?v=1559787610) and the rates are on page 40. There are some nuances for each state but in general QLD works such that L1 = intern L2 = PGY2 resident L3 = PGY3+ resident L4 = registrar. The upshot is that in QLD your base rate is $75K. For QLD evening & night shifts are at 115% more, Saturdays at 150%, Sunday at 200%, overtime at 150% for the first 3 hours then 200% thereafter. These don't stack though (so overtime on a Sunday is just 200%, not 400%). Another issue is whether your hospital pays your overtime - some do / some don't. I think in my intern year I earnt around $90k due to overtime / nights & evenings in ED etc.

In general university results don't factor into whether you get into a specialty or not, except in the situation where you achieved an award / medal - often awards/medals are counted on the CV. Each college is vastly different in terms of what they expect & how the application process runs, your best way of finding out is looking at the college websites themselves. Generally speaking they all want to see that you have brilliant references, a CV with teaching/leadership/research experience & can interview well (mixture of clinical / non-clinical interviews). Many of the colleges also have exams that essentially bar you from progression until you pass them.

I would point out that generally interns and residents don't work the longest hours, nor carry much comparative responsibility in their roles. I commend your intention to learn more - in so doing, I would suggest you think beyond the first couple of years after graduation and consider the bigger picture.
As Chinaski has said, there is a fair bit of overtime in your intern / resident / registrar years but it pales in comparison to working on-call as a consultant in the public hospital or private practice. There are very few consultant jobs that don't have an on-call role.

I saw in one of the chats, where several older members who are doctors now mentioned how there is a lot of sexism, and cases of older doctors treating younger doctors/interns etc badly. Are there any truth to these claims? It was just quite surprising to hear, and left a sour taste in my mouth as a hopeful future doctor.
There is absolutely truth to these claims. You need only to look back recently in the news to see reports of sexual harassment in the hospital workplace with reporting to authorities / media often coming at the cost of the victims career ('Sending lambs to the slaughter': Parliament told senior doctor sexually harassed junior staff). Similarly, there are certainly hospitals that are well known for serious bullying -- three Intensive Care departments in Sydney have lost training accreditation in the last months as a result (Third major Sydney hospital unit banned from training junior doctors).
 

chinaski

Regular Member
Similarly, there are certainly hospitals that are well known for serious bullying -- three Intensive Care departments in Sydney have lost training accreditation in the last months as a result (Third major Sydney hospital unit banned from training junior doctors).
I would suggest it's not a matter of some hospitals having an issue with bullying. It's an issue that is essentially endemic throughout the profession itself - not just isolated pockets. I say this not to sound discouraging, rather because it something that deserves a greater awareness and underlining, as uncomfortable as it may be to hear about. The stuff getting covered in the media is really only the tip of a much bigger iceberg.

ETA: I'd also add that I am not in the habit of lying or exaggerating in conversations about my profession (in reference to any conversations seen in the chatbox).
 
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medhopeful2001x

New Member
I would suggest it's not a matter of some hospitals having an issue with bullying. It's an issue that is essentially endemic throughout the profession itself - not just isolated pockets. I say this not to sound discouraging, rather because it something that deserves a greater awareness and underlining, as uncomfortable as it may be to hear about. The stuff getting covered in the media is really only the tip of a much bigger iceberg.

ETA: I'd also add that I am not in the habit of lying or exaggerating in conversations about my profession (in reference to any conversations seen in the chatbox).
No I didn’t mean to imply you were lying. It was just something that seemed really concerning to me, so i wanted more information. Sorry if I insuated that.
 

whoartthou

New Member
Hello guys,
3. What can be done with a medical degree if someone does not wish to study further or work crazy hours?
3. A few friends and friends of friends have decided to go into finance, management consulting and stock trading. I know of one person becoming a CFO of a start up after completing his medical degree and PHD. These particular jobs do not require any specific degree. Just remember if you want to be successful at anything you need to put in the dedication and time. The jobs mentioned may also involve crazy schedules. I know of management consultants travelling 3x in a week and working 12 hours each day when they have project deadlines. You need to focus on what you want and what motivates you.
 

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TKAO

crossed fingers for ATAR
Gold star winner
I've got an additional question regarding WA and their working conditions. I was scrolling through the amsa internship guide 2019 (as any normal person would do hahaha) and got to the WA hospital check survey (pg 27) and noticed that virtually ALL of them rate incredibly poorly on the leave and rosters/payslips/overtime fronts. This corroborates with information that I got from talking to junior doctors in a local tertiary hospital that also said that their overtime is never/rarely ever paid out and their hours can sometimes be very miserable. It looks structural - why is this? Surely not all of them are as bad as it seems? Am I being to optimistic - is WA just really bad for junior doctors?
 

chinaski

Regular Member
So, you've got formally documented evidence, and anecdotal evidence heard directly from those working in the system, but despite holding a smoking gun, you're still looking for evidence to the contrary? When you say "it looks structural", you mean it looks endemic.
 

TKAO

crossed fingers for ATAR
Gold star winner
So, you've got formally documented evidence, and anecdotal evidence heard directly from those working in the system, but you're still looking for evidence to the contrary? When you say "it looks structural", you mean it looks endemic.
Not necessarily looking for evidence of the contrary - I guess I made it seem like I wanted to hear something positive. I just want to know if there is any reason why its all this bad across the entire system?
 

chinaski

Regular Member
Because the public system is universally pretty poor, regardless of where you work. Western Australia is a geographically isolated pocket of the country, which would make it comparatively easy to foster bad behaviour in a bell jar. If you happen to work in a hospital that is supportive and pleasant most of the time, that is still regarded as the exception rather than the rule.
 

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