Working conditions as a doctor

Discussion in 'Postgraduate Forum' started by onthesunway, Apr 27, 2018.

  1. onthesunway

    onthesunway New Member

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    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
     
    Last edited by a moderator: Apr 28, 2018
  2. pi

    pi Junior doctor Emeritus

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    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.
     
  3. onthesunway

    onthesunway New Member

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

    Benjamin Resident (JCU MBBS) Administrar

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    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.
     
  5. pi

    pi Junior doctor Emeritus

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    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.
     
  6. onthesunway

    onthesunway New Member

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    Very insightful, thanks for sharing it with us.
     
  7. Benjamin

    Benjamin Resident (JCU MBBS) Administrar

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    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.
     
  8. govpop

    govpop Regular Member

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    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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