MEDICUS MARCH 2016

O P I N I O N

Dr Chris Wilson Co-Chair, AMA (WA) Doctors in Training Committee DiTs more than a line of budgetary expenditure

S ometimes it seems we need a business degree on top of our medical degrees to assist in day-to-day hospital work. Activity- based funding, coding, financial ‘remediation’ and all the other terms we are bombarded with constantly were never taught at medical school and have little to do with direct patient care. While there’s no doubt they are important in the bigger picture of health, the current trend towards running hospitals like profit/loss making businesses leaves most DiTs with the distinct impression that we are a line of expenditure our employer would prefer not to have. It’s the feeling of being under constant attack by ‘creative’ new medical administration practices designed to cut costs, but that instead diminish our ability to deliver care to the standard we desire. It means seeing training positions vanish in front of our eyes while the prospect of a consultant position at the end becomes more uncertain. It’s sharing the frustrations of our senior colleagues that no one is listening. Everywhere we turn, we see evidence of hospitals treating us as little more than an expense. At the end of 2015, a Perth tertiary announced its plans to move to a ward-based rostering system. No longer would DiTs be attached to a single team with a clear support structure; they’d instead be attached to a ward and required to do the work for any specialty with patients on that ward. The benefit to the hospital was a reduction in FTE.

The cost, a little thing called patient care. A ward-based DiT would need to choose between ward rounds, sacrifice attendance at departmental teaching for a conflicting clinic and complete discharge summaries for patients they had barely met, let alone taken a history from or completed an examination. Ward-based systems turn DiTs into administrative paper- pushers, diminish their involvement in clinical care and disregard a hospital’s duty to train its next generation of consultants. Unsurprisingly, the DiTs at the tertiary in question were outraged. The clinical experience promised when they signed contracts had been taken away before the new year had even started. Thankfully, with the support of their RMO Society, senior clinicians and the AMA, the groundswell of DiT anger led to a hasty retreat and plans were scrapped. Now, like a malignant cancer, ward- based rostering has resurfaced at another hospital. The reasons for it are the same, as are the reasons we oppose it. Like ward-based rostering, reducing RMOs from five terms to four is another administrative brainwave that a single tertiary refuses to let die. In an attempt to sell it to DiTs, the hospital in question is tying the proposal to a promised improvement in access to leave. Forgetting that this is from a hospital notorious for not staffing its DiT ranks adequately to cover leave, the underlying intent is not to improve conditions for DiTs – it is to reduce costs.

Four RMO terms isn’t a new concept in WA – it was tried previously in WA Health and failed. Further, when we surveyed DiTs in 2015, 75 per cent supported the current five term format. DiTs are not naïve to the financial plight we find ourselves in as a state or the need to rein in health spending. This might come as a surprise to our administrators, but we don’t oppose saving measures. In fact, ask any DiT for options on how we could work more efficiently and I’m sure they’d have a fistful of suggestions. What we do oppose is the token, ham-fisted approach to consultation on major issues that affect not only the way we work but our education and training. Announcing significant changes after decisions are made is not consultation. A survey with leading questions designed to support a single outcome is not consultation. The current approach of senior administrators belittles the intelligence and importance of our DiT cohort. Our message is simple – DiTs want to work with the Department and the What we do oppose is the token, ham-fisted approach to consultation on major issues that affect not only the way we work but our education and training

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