Public hospital doctors in the Australian state of Victoria voted to begin industrial action after the government failed to meet their demands on issues such as long shifts, unpaid overtime, and shorter parental leave allowances than those of other public employees.

In a recent vote by members of the Australian Salaried Medical Officers’ Federation Victoria, 97% supported escalating industrial action, claiming that the public hospital system is at a breaking point.

“Clearly we don't want to do things that are going to impact patient safety,” said Simon Judkins, MD, emergency physician and president of the Australian Medical Association (AMA) Victoria. “But we will be looking at doing things like billing services and stopping doing billing … but also not attending admin-type meetings that the hospitals need us to attend and expect us to attend after hours.”

The vote is the first time in 20 years that Victorian public hospital doctors have decided to take industrial action. It occurred after a year of negotiations with the state government over doctors’ pay and working conditions. 

“Victorian doctors in our public healthcare system provide world-class treatment and care all over the state, and we will continue to support them,” said Victoria Health Minister Harriet Shing in a public statement. Negotiations and discussions are continuing “in good faith,” and hospitals will put plans in place to ensure that patients continue to receive the care they need, she added. 

Doctors Cite Fatigue 

Long shifts are a key issue, said Stephanie Davies, MD, pain management specialist and chair of AMA Victoria’s Doctor in Training subdivision. “Under the current terms, we can be working up to 12-14 hours per shift, not including overtime,” she said. Fatigue is taking a toll, and many doctors are cutting back to part time or leaving the healthcare system entirely. “We're seeing shifts across the state unfilled every day … and those jobs aren't filled because everyone's already working to their max capacity.”

Doctors have been pushing for the maximum shift length to be reduced to 12.5 hours and for two weekends off per fortnight instead of the current 3.5 days, Davies told Medscape News Australia. 

Overtime is also a sticking point. Everyone from doctors in training to senior consultants is being shortchanged on overtime for on-call work, according to Judkins. “They get called but they're not getting remunerated for that, so it's just expected that's another freebie,” he said. Systemic barriers to getting overtime approved mean that doctors’ unpaid work essentially props up the healthcare system, Davies added.

Public hospital doctors also say that they receive less paid parental leave than other public servants do. “It was really disappointing, especially when there's a really large female proportion of our workforce,” said Davies. 

Dispute Over Funding 

Negotiations have lasted for a year, and the existing agreement expired at the end of February. While the state government had agreed to continue working toward a solution, “we haven't seen any improvement or any kind of significant move to reach an agreement,” said Davies. “It's all been slow-moving, and nothing substantial, which is what the members want to see.” 

The state government has cited an alleged lack of funding as a reason for denying the demands, but “there is this frustration that clearly they can find money for other workforces, but for some reason they can't seem to find the money for public hospital doctors,” said Judkins. 

Shing, who was appointed Victorian minister for health in April, recently announced that she is stepping down and will not be running for reelection in November.

The industrial action, which is protected under the state’s industrial relations laws, could initially see doctors participating in protests and refusing administrative tasks, including after-hours meetings. It could escalate to work stoppages as a last resort. The AMA has stressed that patient care will not be disrupted and patient safety remains an overriding priority throughout any industrial action.

“We just put our heads down and get the work done,” said Davies. “But nobody notices the consequences that may or may not happen along the way of a fatigued doctor that's on their fifth long shift of the week or their seventh shift of the week.”

Davies and Judkins are both involved with AMA Victoria and reported no relevant financial relationships.