‘I desperately want to quit’: the often unbearable burden on Australia’s junior doctors | Health


In a busy Melbourne hospital, Paul arrives at work to dozens of patients in the waiting room. The junior doctor is completing a rotation in the emergency department and says morale has plummeted with staffing shortages and huge caseloads.

“No one wants to be at work at all,” he says. Several of his colleagues have quit, and people are calling in sick for their shifts more often. Paul is sent up to 10 messages a day about shifts that need to be filled within the health service, to be paid at “crisis rates”.

“I desperately want to quit. The combination of last year and this year is just exhausting,” he says. “You’ll start a night shift and you have nine or 10 hours of wait time and like 40 people waiting to be seen. It’s like this massive wall of work that you know you’re not going to get through, even if everyone works at twice the pace.”

Simple comforts that once eased the stress of chaotic shifts, like sharing a meal with a colleague, have fallen by the wayside. “You can’t even recognise your co-workers if you walk past each other in the street, because [at work] you’ve got an N95 and a face shield,” Paul says. “You end up just getting really burnt out and really tired.”

An already strained system

Prof Samuel Harvey, a psychiatrist and deputy director of the Black Dog Institute, says Covid-19 has put additional pressure on a health system that didn’t have much spare capacity in the first place.

Even before the pandemic began, more than half of doctors were working long hours that put them at risk of clinical fatigue. Medical professionals have a higher suicide risk than the general population, and a recent review led by Harvey, published in The Lancet, found between a quarter and a third of doctors report significant mental ill-health in their early years of training.

“Many of us have been aware of [mental health issues in doctors] for a while, but I think Covid-19 has brought it into sharper focus,” Harvey says.

Historically, there is stigma associated with reporting mental health issues: a BeyondBlue survey of doctors and medical students previously found that 40% said they judged peers with a history of mental health disorders as “less competent”.

Junior doctors – those in training for specialist accreditation, which can take up to a decade – report higher levels of distress than their senior counterparts, says Katherine Petrie, also of the Black Dog Institute. A combination of long working hours, studying for exams on top of full-time work, taking on extra research projects, and the competitive pressure of getting accepted on to specialist training programs creates a “perfect storm” for mental distress, she says.

A study co-authored by Petrie, Harvey and their colleagues prior to the pandemic found that junior doctors in Australia worked an average of 50 hours a week. One in four reported working more than 55 hours in an average week, which was associated with a doubling in the risk of common mental health problems and suicidal ideation.

“There was such stress on the resources and the staffing before Covid,” Petrie says.

AI rostering seeks improvements

Reduced total working hours and better rostering systems have been floated as options to alleviate these crippling pressures.

Prof Mark Wallace at Monash University says it is unlikely, however, that hospitals will be open to systems-wide changes while struggling with Covid. “Just when you need the most optimisation, the most management of resources, is whenever everything’s under pressure and nobody’s got any time to think about it,” he says.

Wallace has been involved in developing an AI-powered rostering system, known as AlertSafe, that takes into account how fatigue levels increase over time, as well as the effect of circadian rhythms and working at night. He is in discussions to trial the system in Victorian hospitals.

“The way fatigue builds up over a long time can depend on shift patterns,” he says, adding that studies of similar rostering systems overseas have previously found a 15% drop in medical incidents by minimising staff fatigue.

Despite the evidence, it has been “very difficult” to implement the rostering system in hospitals, even when there has been union and senior management support, Wallace says. “It quickly falls back into how things used to work before.”

That means long hours and overtime workin a system which risks jeopardising fatigued doctors and their patients.

Nearly half of doctors surveyed by the Victorian branch of the AMA said they’d made a clinical error as a result of fatigue
Nearly half of all doctors surveyed by the Victorian branch of the AMA said they’d made a clinical error as a result of fatigue. Photograph: Carly Earl/The Guardian

In a 2021 Hospital Health Check report, released by the Victorian branch of the Australian Medical Association, 47% of training doctors said they had made a clinical error due to fatigue, while the same percentage said they were never paid for unrostered overtime.

Bree, a junior doctor currently working in a stroke unit at a Melbourne hospital, describes it as “a thankless job with consistent abuse”.

Some of the stroke team has been seconded to Covid wards, causing staffing shortages. “The other weekend there were two people covering 75 patients,” Bree says.

While her officially rostered hours have not been excessive, she says she has worked “plenty of overtime” updating patients’ families on their conditions, adding: “They ‘forgot’ to roster someone on stroke next week and are trying to get us to work 16-hour shifts to cover them.”

Bree has tried escalating her concerns multiple times. “All I got was a 10 minute ‘check-in chat’ with administration and a request to ‘check-in again’ at the end of the [three-month] rotation.”

Allegations of systemic underpayment are common: in the past year, five class actions have been brought by thousands of junior doctors in Victoria. In New South Wales, a similar class action is under way, with more than 20,000 training doctors claiming unsafe excessive hours and underpayment.

Hayden Stephens, a lawyer representing the claimants in both states, says the cases are motivated by a need to address the dangerous effects of excessive working hours and clinical fatigue on patient care.

“A common theme is not just their own welfare but the genuine concerns they have in relation to their patients,” he says. “It’s really out of frustration … that they’ve had to resort to legal process to embark on cultural change in their own workplaces.”

Stephens is currently investigating similar actions for junior doctors in the Australian Capital Territory and South Australia, though no claims have yet been filed.

Dr Anthony Llewellyn, who provides career support to trainee doctors, says bullying of junior doctors is also rife, calling it “an international problem in medical culture”. In a 2018 survey he conducted of first- and second-year doctors in NSW, more than half of respondents reported being bullied, and one in six said they had experienced sexual harassment.

Of those who had experienced bullying or harassment, 40% chose not to speak out, says Llewellyn. “When they did choose to take action, most of them reported that the action was not positive for them.”

None of the doctors who shared their personal experiences with Guardian Australia were comfortable being identified by their real names.

Majority fear burnout

As states begin to reopen and significant numbers of Covid patients are admitted to hospital, the strain on an already fatigued workforce is now becoming clearer.

The Royal Australasian College of Physicians, which represents 28,000 specialists and trainees in 33 medical specialities, conducted a survey of its members in September and October.

Reported for the first time by Guardian Australia here, the survey found significant levels of distress among doctors: 87% of respondents said they were concerned about staff burnout, while 76% were worried about an increase in Covid-19 hospital admissions.

“There have been industrial issues associated with the demand on medical staff, meaning longer working hours, out-of-scope activities that medical staff have been asked to do,” says Prof John Wilson, the president of RACP. “It also means that leave arrangements have unexpectedly been altered or could not be taken as promised.”

“The current environment is leading people to look for escape options,” Wilson says.

The college believes that without additional resources, the health system will not cope with the current level of demand. Wilson is calling upon the federal government to release modelling to help medical colleges “plan and also advise on distribution of workforce and training of new medical specialists”.

Systemic problems recognised

A potential upside of the Covid pandemic is the attention it has brought to the mental health of doctors, Harvey says. As an example, he cites The Essential Network, a federally funded mental health service for healthcare workers, which launched last year.

“We’ve now moved to a point where almost everyone is saying: we agree, the current system is not doing enough to protect the next generation of doctors moving through,” Harvey says. Llewellyn agrees, saying there is now an acknowledgement within the medical community that giving junior doctors “resilience training” to manage workplace stress is not an adequate solution to the problem.

At the end of the day, says Monash University’s Harvey, “if you’re going to try and find ways to have junior doctors … work less severe hours, then there’s going to be a financial implication for us as a society.”

“We as mental health professionals would say that’s the price we have to [pay], because we can’t keep on operating in a system where so many junior doctors become unwell.”

Crisis support services can be reached 24 hours a day: Lifeline 13 11 14; Suicide Call Back Service 1300 659 467; Kids Helpline 1800 55 1800; MensLine Australia 1300 78 99 78; Beyond Blue 1300 22 4636

The Black Dog Institute also operates The Essential Network, a confidential service for healthcare workers.


Please enter your comment!
Please enter your name here