More than half of Canberra’s trainee doctors are failing their exams because they are overworked and burnt out, an internal review has found.
- An internal review has pointed to long working hours, poor mentoring and little time for study as reasons Canberra’s junior doctors are failing exams
- Trainee doctors in the ACT’s health system fail twice as often as the national average
- The reviewers also found regular breaches of safe work requirements among trainee doctor rosters
ACT physicians doing their basic training had a pass rate of just 37 per cent last year, far below the national average of 70.6 per cent.
A review commissioned by ACT Health to determine why found staff in the Hospital Medical Office were regularly working paid and unpaid overtime.
After auditing staff rosters, the reviewers determined ACT Health had breached its legal obligations on multiple occasions.
The reviewers, Australia’s first Chief Medical Wellness Officer Bethan Richards and Physician educator Anne Powell, pointed to a culture of overworked and under-supported doctors at Canberra’s hospitals as the reason for high failure rates.
It found a burnout rate among basic physician trainees of 78.9 per cent, which was “well above the international average of 51 per cent”.
“Following several interviews with basic physician trainees, it became apparent that trainee wellbeing and burnout may be significant factors contributing to the low clinical exam pass rate,” the review said.
“There is a need for a review of safe working hours with a balance between training and service delivery.”
The review, released under freedom of information laws, was handed to Canberra Health Services in January with recommendations for a formal review of junior staff overtime.
Opposition health spokeswoman Giulia Jones said the rostering system was “clearly” inappropriate.
“The Canberra Liberals have heard over years and years and years about the stress that people work under in our hospitals in Canberra,” Ms Jones said.
Canberra Health Services launched an investigation in August into junior doctors’ pay, after concerns were flagged by some staff.
“It’s very clear from the report that there were some changes prior to these low pass rates that did affect the pass rates for these trainees,” Health Minister Rachel Stephen-Smith said.
“Prior to those two years, our pass rates had been strong and it was the change that really was what drove the commissioning of this external review to understand what had driven that change and to ensure that those issues were addressed.
“Of the 50-plus recommendations, about 38 of those are assessed to already have been addressed and the remainder are continuing to be worked on.”
Roster audit finds several legal breaches
After speaking to staff, the reviewers audited rosters and found that the enterprise bargaining agreement and safe working hours were “often” breached.
Trainees reported feeling pressured to work even when unwell, with the review finding the sick relief roster was not adequately staffed.
Brutal hours often left trainee doctors little time to prepare for exams, with some trainees at Calvary Hospital saying they had been forced to work 150-hour fortnights.
“Several [trainees] reported regularly working a roster that comprised 12 consecutive days on, two days off followed by a further 12 consecutive days. One of the two days off was often utilised to sit a trial examination,” the review said.
The reviewers reported “several concerning stories about coercion to come to work despite requesting sick leave”.
Two-thirds of trainee doctors consequently reported feeling “down, depressed or hopeless” several days a fortnight.
The director of physician training is now monitoring rosters to ensure further breaches are not made, according to Canberra Health Services.
Ms Jones said the Health Minister needed to consider a serious overhaul of the system.
“We are not respecting these people as humans,” she said.
But Canberra Health Services’ executive director of medical services, Dr Nick Coatsworth, said many of the recommendations made by the reviewers had already been implemented.
Dr Coatsworth pointed to a better mentoring and supervision system to ensure trainee doctors were getting time to learn.
“There’s plenty of people to look after patients … if for some reason the registrar isn’t turning up to those protected teaching sessions, our director of physician training is onto it in real time to work out why,” he said.
He said Canberra Health Services was also partnering trainees who had failed exams with those who had passed, to help support them.
“We have done a lot to build this up in the past two years.”