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The key issues remain unresolved after nearly 6000 Australian doctors employed by public hospitals in the state of New South Wales (NSW) struck for 3 days in early April to protest inadequate pay and unsafe working conditions.

“The amount of public support and the amount of attention on this issue surpassed all of our expectations,” Tom Morrison, MD, junior vice president of the Australian Salaried Medical Officers’ Federation (ASMOF) NSW, told Medscape Medical News. “The public was genuinely surprised to hear that people are performing life-and-death tasks despite minimal sleep.”

From April 8 to 10, an estimated 3000 doctors stopped work each day, donned red union shirts, brandished protest signs, and chanted slogans such as “Safe conditions, safe care!” and “Stand up, fight back!”

Picket lines formed outside hospitals in Parramatta, Coffs Harbour, Port Macquarie, Kogarah, Newcastle, Penrith, Wollongong, and Liverpool. In total, 34 hospitals participated in the industrial action by dropping down to public holiday–level staffing and delaying nonurgent appointments.

Doctors employed by NSW public hospitals are now paid around 30% less than doctors doing equivalent work in Queensland. One of the union’s key demands was that doctors be paid in line with doctors in other states. This wage gap is particularly concerning for junior doctors, who earn $78,000 AUD per year in NSW compared with $90,000 AUD in Queensland.

Meanwhile, in NSW, the waitlists for elective surgery are ballooning, emergency departments are overwhelmed, and the complexity of medical care is increasing as the population ages. Thus, many doctors are being stretched to the breaking point.

Speaking through a megaphone to a crowd outside Liverpool Hospital, Liverpool, Fahad Khan, MBBS, said he’d seen junior doctors get kidney stones because they weren’t urinating or drinking water. “That terrified me, and I don’t want that to be me, so that’s why I’m here today,” said Khan.

“Doctors are overworked, underpaid, exhausted, burnt out,” Emily Roman, an obstetrician at John Hunter Hospital in Newcastle, wrote in a Facebook post. “Yesterday I worked 8 AM to 10 PM. I was called back in from 2 AM until 6:30 AM to help manage multiple life-threatening emergencies of mothers and babies. I’m due back at work at 8 AM.”

A Government Warning

The doctors’ strike, the largest of its kind since 1984 and the first since 1998, breached an order by the independent Industrial Relations Commission.

“We’ve had 15 meetings with the government. We’ve negotiated 18 months,” said Morrison, explaining the decision to go ahead with the strike. “We’ve gotten nowhere.”

Shortly before the strike, doctors were sent letters suggesting that participating in unlawful industrial action could affect their insurance and lead to disciplinary action. These communications from the NSW Government and hospital management “hardened people’s resolve,” said Morrison. “We’ve had 1000 new members join.”

The strike affected 667 oncology appointments, of which only a small fraction were chemotherapy appointments. The strike also led to the rescheduling of 5355 outpatient appointments, the cancellation of 663 elective surgeries, and the temporary reduction of 33 beds.

NSW Health Minister Ryan Park said the government’s strategy in future negotiations would be to focus on improving salaries for junior doctors who are paid the least. “No one is hiding under a rock and pretending that we’re not aware of discrepancies,” he said.

But Morrison said that a piecemeal approach would not satisfy the doctors’ union. “The system’s broken across the board,” he said. Specialists are also being asked to work on weekends without pay or consideration for their need to sleep, he said. “People aren’t going to stay in the system if there’s no sustainable path forward.”

Industrial Action Paused

Park said it was “not feasible” to offer a 30% pay raise to all doctors and that the government had already offered a 10.5% pay increase over 3 years, including a 3% raise applied retrospectively from July 2024.

When asked about doctors working unreasonably long hours, Park said, “We’ve made it clear that that type of rostering is not appropriate. We have made it clear to health managers that that has to improve.”

Park said there were 600 more doctors working at public hospitals in NSW than at the same time last year and that retention rates were around 95%.

ASMOF NSW President Nicholas Spooner met with the health minister toward the end of last week. “We attempted to find a middle ground and compromise,” said Morrison. “Unfortunately, we weren’t able to. The government wasn’t prepared to commit to either pay increases or changes in conditions.”

At a hearing on Friday, April 11, the doctors’ union agreed to comply with the Industrial Relations Commission’s order to cease industrial action for 3 months. Park said in a statement that he would press the independent body to arbitrate the ongoing wages dispute with doctors.

The tussle with the doctors’ union is one of many battles that the NSW Government has been fighting recently; it settled a class action with junior doctors over unpaid overtime for $229.8 million AUD in 2024, 10,000 nurses struck over low pay rates in November 2024, and 206 psychiatrists threatened to resign from public hospitals over a pay dispute in January.

Morrison, Khan, and Roman reported having no relevant financial relationships.

Felicity Nelson is a freelance science journalist based in Sydney.