Technology means ‘on call’ doctors are never away from their work


The boundaries of on-call work need to be clarified because digital connectivity is being used to force public hospital doctors into doing routine workplace tasks from home, medical groups say.

Email, smartphones and online connectivity are enabling home-based doctors to access to electronic clinical records and imaging and to conduct case conferencing and video consults away from the clinic, an inquiry into  technology impacts on the workplace has been told.

And while this can prove useful in emergency scenarios, it also leaves doctors at risk of being exploited by public hospitals seeking to maximise efficiencies by asking them to complete routine work from home during periods where they are paid to be on call,  according to the AMA and the Australian Salaried Medical Officers Federation.

Doctors in Training (DIT) are already expected to perform medical imaging and radiology tasks when at home while rostered on as on-call, the groups write in a joint submission to a Senate Inquiry on the future of work and workers.

“Traditionally on call rostering can have the exclusive or combined purpose of providing clinical advice over the telephone and/or requiring availability to return to work for coverage of an absence or to meet the needs of a public patient in their care,” the submission says.

“The introduction of technology is expanding this meaning, at least among certain medical craft groups, to now include performance of work previously only completed within a public hospital setting.”

This makes it easy for doctors to fall into the trap of never being away from their work and leading to fatigue, which is already a huge problem affecting 50% of the medical workforce, the submission says.

“The lived experience of many public sector doctors is that innovations such as email, digital transmission of clinical images, smartphones and the like simply result in additional workload, responsibility and interruption when out of the workplace. This contributes to poor morale, fatigue and is often part of a deliberate cost containment strategy of public sector employers,” the submission says.

Currently for a public hospital, work in the on-call period is cheaper and less regulated, and with the enablements made through technology there is an incentive for hospitals to ask more of doctors during the on-call period, it notes.

“We think some new industrial regulation is needed to ensure public hospital employed senior doctor and DIT entitlements keep pace with technological changes when they are on call”.

“The practice of public sector medicine has seen the creation of significant additional workload and response pressures through technological advancement but can be inoculated to preserve quality patient care and ensure sustainability.

“Technological advancement is inevitably going to disrupt the established norms surrounding these concepts in the practice of public health medicine. Therefore senior doctors and DITs must be given significant ownership to any mooted technological change to guarantee public patients benefit, effective and efficient implantation/integration and to ensure medicine remains a reqarding and much sought after career.”

Dr Roderick McRae, a Melbourne intensive care physician and chair of the AMA Federal Council of Public Hospital Doctors, says the boundary lines between ordinary and on-call hours have started to blur, and this is likely to intensify as technology continues to disrupt the healthcare sector.

“There will need to be a concept derived of what is traditional in-hours work and the nature of the work that occurs. And if that sort of work is being conducted in what are traditionally out-of-hours times, then a different form of remuneration would need to occur,” he told the limbic.

“This isn’t a merciless cash grab, it’s just to ensure there is adequate compensation for those people who do this work,” he said.

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