What junior doctors’ unpaid overtime tells us about the toxic side of medicine
WHAT’S been described as the largest underpayment class action in Australian legal history has just been settled.
Thousands of junior doctors, 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.
A rite of passage?
THE health-care system has routinely relied on the labor of junior doctors. ese include interns (those who have completed their university medical training and are in their rst year of being practicing doctors), residents (who have completed their internship and hold a general registration) and registrars (specialists in training).
Junior doctors often provide much of the sta ng for night and weekend shifts and complete burdensome administrative tasks for consultants (senior doctors).
Overworking junior doctors has been normalized 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, as well as TV shows, from House to Scrubs.
This is a safety issue. Doctor fatigue has considerable e ects 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 percent. Put simply, stretched, demoralized and tired doctors will do harm. Eventually, that will a ect 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 normalized.
A 2018 study of NSW interns and residents found more than 50 percent experienced bullying. Some 16-19 percent (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 signi cantly 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 the health-care system. But there is often little sympathy for junior doctors. In 2022, one hospital threatened to remove comfortable lounges to prevent juniors napping on quiet night shifts. Just last week, we heard of a similar case involving junior doctors at another hospital, who were told “sleeping is not part of your job description.”
A culture of silence
THIS class action was needed because on a day-to-day basis, junior doctors mostly do not complain. ey internalize distress as failure (not being tough enough) and fear that a diagnosis of depression or anxiety will result in patients and colleagues avoiding them. ey don’t report mistreatment or reject overwork as, often, their senior doctors control their career progression.
is is important, because contrary to perceptions of doctors as wealthy elites, our research shows junior doctors often
nd it hard to progress, get a job in their
city of choice, or nd full-time roles. e pressure on junior doctors to “make it” in an increasingly competitive environment grows stronger. Such professional problems reinforce the culture of not complaining for fear of blow-back.
Most of those who do take action, report ine ective or personally harmful outcomes when reporting to senior colleagues. is ful ls a vicious cycle of silence as junior doctors become ill but do not seek help.
What needs to be done?
IT often takes brave public legal action such as this lawsuit to catalyze culture change– to nudge hospitals to prevent junior doctors from working back-to-back shifts, to protect time o for a personal life, ensure meal breaks, and provide means to hold powerful senior doctors to account.
Culture change is hard, slow and requires multi-pronged strategies. We need a safe way for junior doctors to report their concerns, and training so they know their options for responding to mistreatment. We need senior doctors and hospital managers to be trained in how to encourage and respond constructively to complaints. When this happens, culture change is possible.