What’s been described as the largest underpayment class action in Australian legal history has just been settled. Who was allegedly underpaid? Thousands of junior doctors who, subject to court approval, are set to share back-pay of more than a quarter of a million dollars.
Amireh Fakhouri, who brought the claim on behalf of junior doctors in New South Wales, alleged that when they worked in the state’s public health system from December 2014 to December 2020, NSW Health had failed to pay the overtime and weekend meal break entitlements she and her colleagues were owed.
More than 20,000 claimants are now set to be eligible for a share in the nearly A$230 million settlement.
But repayment was never the main goal of the class action. Fakhouri, who is now training as a GP in Victoria, said she hoped instead it would change the work culture in medicine.
Junior doctors work themselves to exhaustion in unpaid overtime. It is demoralising – so I took a stand
The fatigue affects our wellbeing and our ability to care for patients. Hospitals are only as good as their staff so we must look after themhttps://t.co/USLKaLQwGx
— 💧John Holmes🐨 (@jhaue) April 29, 2024
A rite of passage?
Our health-care system has routinely relied on the labour of junior doctors. These include interns (those who have completed their university medical training and are in their first year of being practising doctors), residents (who have completed their internship and hold a general registration) and registrars (specialists in training).
Junior doctors often provide much of the staffing for night and weekend shifts and complete burdensome administrative tasks for consultants (senior doctors).
Overworking junior doctors has been normalised for decades. We see this depicted in books (such as The House of God and This is Going to Hurt: Secret Diaries of a Junior Doctor) and TV shows (such as House and Scrubs).
This is a safety issue. Doctor fatigue has considerable effects on patient safety through potential medical errors, poor quality patient care, longer patient recovery, reduced physician empathy and impacts on the doctor-patient relationship.
A 2020 study found that when doctors reported even moderate tiredness their chance of making a medical error rose by 53%.
Put simply, stretched, demoralised and tired doctors will do harm. Eventually, that will affect you.
It’s not just long hours
The expectation of working long hours is only part of the culture of medicine.
Our research and global evidence shows “teaching by humiliation” and other forms of verbal mistreatment have also been normalised.
A 2018 study of NSW interns and residents found more than 50% experienced bullying. Some 16-19% (mostly female) experienced sexual harassment.
Some of the junior doctors who are victims of mistreatment later become the perpetrators, perpetuating this harmful culture.
Junior doctors are suffering
The impact of long hours on junior doctors and of the abuse they are subjected to is vividly evident through research, including ours. Junior doctors have significantly high levels of depression, anxiety and thoughts of suicide.
As we’ve been saying for almost a decade, there is a desperate need for better work-life balance for junior doctors and deep culture change in our health-care system.