Many thanks to Trent Yarwood, specialist infectious diseases physician and member of the Far North Queensland Senior Medical Staff Association for this overview of the current disquiet amongst Queensland doctors.
The move comes as part of Premier Newman’s wide ranging health reforms – including decentralisation of the health system by creating independent hospital and health service boards – as outlined in the Queensland Blueprint for Better Health and follows on from the thousands of health jobs already lost in the restructure and closure of preventive health programs.
Like other aspects of the reforms, though, the move to contracts is a shell game, shifting risk and professional responsibility to the health services, while keeping control firmly in the hands of the Charlotte St offices.
The stated intent of the contracts is to allow a direct employment relationship between doctors and their local health boards. In reality, the contracts are almost entirely set in stone and only the specific details of the performance criteria are open for negotiation. The government has made it very clear that there will be no further negotiation on other aspects of the contract – which were released to doctors for a comment period of 10 days, shortly before Christmas.
Other states in Australia have similar contracts for senior doctors – however in South Australia, they are underpinned by an award, and contracts in New South Wales contain significantly greater protection of doctors’ working conditions.
Queensland senior doctors concerns are mainly centered around:
- No protection of any basic work conditions (sick leave etc) in the contract, but referenced to an external document which can be changed at any time
- Primacy of operational requirements over working conditions – doctors can be redeployed to: another hospital, a different position, extended working hours or shift work; on call as required without anything more than being told it will happen. Fatigue provisions are similarly in an external document subject to review.
- The contracts are excluded by law from being covered by the industrial relations committee and if local dispute resolution is not satisfactory, the only option is to bring action in the Supreme Court.
- Doctors may be summarily dismissed for “disobeying a reasonable instruction from the service” or “putting at risk the profitability of the service” – potentially placing financial concerns ahead of patient welfare.
And finally, the contract itself is basically meaningless, as the government have mandated that at any time, the director-general may issue a directive that overrides any condition of the contract.
The state government has been disingenuous in its promotion of these contracts. As well as focusing on divisions in the AMAQ (an overwhelming majority of members hold a different view to the President – who has been an LNP candidate), the government has been using the two Queensland Audit Office reports into the Private Practice allowance to promote the need for reform.
Reading the media headlines about the QAO reports, you could be forgiven for thinking that much of Queensland Health’s financial woes are a direct result of fraudulent doctors. In fact, the second QAO report identified 7 from a sample of 88 (from a pool of 3000) who may have been fiddling the books, but a much larger problem with administrative systems (lost leave forms etc.) and concluded that it could neither substantiate or refute significant fraud.
The private practice scheme which is “losing the government millions of dollars” was in fact never intended by the government to be cost neutral. It was budgeted for to try and attract and retain specialists to Queensland in the post Bundaberg review, as prior to this, Qld doctors earned significantly less than their colleagues in other states. Queensland specialists are being made out to be taking advantage of a system that is functioning exactly as it was designed.
This revision of history and smearing of the profession is just part of why doctors feel the government is out to get them. Since coming to power, the Newman government has appointed Queensland Health’s first non-medical director-general and appointed a non-doctor as the chair of the Queensland Medical Board. If you add this to the government’s unprecedented attack on the state’s legal professionals, then Queensland’s doctors have many reasons to be wary of the Government’s assurances that the Director-General of Health will “not use these powers capriciously”.
Public hospital specialists make substantially less than they would if they chose to enter private practice, but are being rewarded for their public service with smears and draconian contracts forced on the with almost no consultation and no negotiation. Although they are free not to sign, this will mean a pay cut off around a third from 1st July and no certainty that the government will not further erode the award through legislative change. The Department of Health has taken great pains to ensure doctors their remuneration will not change by signing the contracts – the concerns are clearly about patient care .
The government has been very bullish in its media response to doctors disquiet – “take it or leave it” and “get on the train or get under it”. It seems increasingly likely that large numbers of Queensland specialists are going to leave it.