Patient safety concerns as doctors-in-training risk burn-out

Almost half of doctors-in-training (46%) who responded to the 2022 AMA (NSW) Hospital Health Check survey indicated they made a fatigue induced error – an 8-point increase over the previous year’s survey results.

The finding corresponds with an increase in the number of respondents who indicated they felt concerned for their personal safety due to fatigue associated with long hours – 56% in 2022, up from 47% the previous year.

“Omicron wiped out the workforce. Staff furloughs meant longer hours for doctors-in-training who were forced to cover shifts for sick colleagues. Not having enough doctors impacts patients. When there is this much pressure on the health system both the safety of patients and doctors is compromised,” said AMA (NSW) Doctors-in-Training Committee Co-Chair, Dr Sanjay Hettige.

“The risk of human error increases with fatigue – small mistakes such a medication errors or poor communication during handovers can have ramifications. There is also the risk of staff becoming burnt out or suffering from poorer mental health, which we know can lead to higher rates of doctor suicide,” Dr Hettige said.

“The bottom line is – we need to build capacity in the system and the only way to that is to bolster the medical workforce. Hospitals need doctors – not substitutes,” Dr Hettige said.

The AMA (NSW) Hospital Health Check is an annual survey of doctors-in-training in NSW that looks at working conditions in hospitals across the State. This year, 1766 respondents responded to questions on rostering, overtime, leave and sick leave, unacceptable behaviour (such as bullying and discrimination), and hospital facilities, such as rest areas and safe parking.

The 2022 survey found a significant jump in the number of respondents who reported working more than five hours of unrostered overtime – 72% up from 60% in 2021. A further 53% of respondents rated their inpatient workload as ‘heavy’ or ‘very heavy’.

“More people than ever are coming to hospital, and they are coming in sicker and staying longer. There is tremendous pressure across the system and doctors-in-training are at the coalface.

“We are working harder and longer, but under an Award that is more than 30 years old. For a significant number of doctors-in-training, those contract conditions were written before they were even born. NSW risks losing doctors-in-training to other States that offer better entitlements,” Dr Hettige said.

Doctors-in-training co-chair, Dr Jacqueline Ho added that in the last Budget, the NSW Government promised it would recruit more than 10,000 healthcare workers over the next four years.

“If the State is going to meet this promise it will need to take a closer look at what it’s offering doctors. It’s a very competitive market and doctors-in-training are being lured by better contract conditions in other States. This, coupled with high costs of living – particularly in Sydney – and it doesn’t take much for other places to look really attractive,” Dr Ho said.

The AMA (NSW) Hospital Health Check revealed some positive improvements – more doctors are claiming for the work they do. About a third of all doctors (33%) claim all of their overtime.

“While there is still a notion that doctors should work 60- to 70-hour weeks and accept that only 40 hours will be paid, that is slowly changing. There have been some improvements to the system which makes it easier for doctors to claim their unrostered overtime, as well as changes to the culture of medicine which makes acceptable to get paid for the work you do,” Dr Hettige said.

There have also been improvements in the number of women claiming their overtime. While these figures are still below their male counterparts, there has been a steady increase over the years.

In 2022, 30% of women in medicine (who are doctors-in-training) claimed all of their overtime, compared to 39% of men. By contrast, in 2021 only 25% of women claimed all of their overtime (compared to 36% of men).

There are also differences in claiming for some specialties. In the 2022 survey, 38% of women in surgery claimed all of their overtime, compared to 57% of men. While in emergency medicine, the number of respondents who claimed all of their overtime was 23% – for both men and women.

“The discrepancy between men and women is a hallmark of the deep-seated and entrenched systemic and cultural sexism in the profession that we continue to address. Encouragingly, this improvement reflects progress towards gender equity, recognising that women are just as capable, competent, and worthy as their male counterparts, but there is still a long way to go across the board,” Dr Ho said.

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