At least 10 hospitals in NSW risk being stripped of accreditation to train junior doctors as ‘serious concerns’ raised in Industrial Relations Commission court
Interest among junior doctors in New South Wales to become psychiatrists is half compared with Victoria because of poor pay and work conditions, a court has heard.
As a result, NSW was facing the potential “collapse” of its trainee system, the Industrial Relations Commission court in Sydney heard, as day one of arbitration between psychiatrists and the state government got under way.
At least 10 hospitals in NSW risk being stripped of accreditation to train junior doctors to become psychiatrists because of “serious concerns” about quality of training due to staff shortages, the court was told.
The doctors union, the Australian Salaried Medical Officers’ Federation (Asmof), representing psychiatrists, is arguing for a special levy to increase their pay by 25%, claiming the boost will stem the flow of specialist doctors leaving the state’s public system. In January, 206 psychiatrists in NSW threatened to resign: 62 have resigned, while others await the IRC outcome.
Thomas Dixon, representing Asmof, told the court that NSW had a poor uptake of training positions in psychiatry compared with Victoria.
In the period 2020-24, Dixon said the total number of trainees in Victoria grew by 63%, compared with 28% in NSW. Those rates were 62% in Western Australia, 54% in South Australia, 30% in Queensland and 35% in Tasmania.
Victoria had 200 applications for training positions in 2023 compared with 135 in NSW in the same period.
Dixon said junior doctors were “not coming through the supply pipeline as they should because of the dysfunction that’s becoming manifest about overwork and being relatively underpaid”. Because of those issues, “attraction issues invariably arise”, he said.
Giving her evidence for Asmof, Dr Pramudie Gunaratne, the chair of the NSW branch of the Royal Australian and New Zealand College of Psychiatrists (RANZCP), said the college was undertaking emergency accreditation visits to ensure supervision requirements were being met.
Gunaratne said the state is struggling to manage its trainees due to a shortage of full -time staff specialist supervisors.
Gunaratne told the court that trainees have contacted the college claiming significant workforce gaps were affecting their training. She gave an example of one trainee who complained the quality of their training was diminished because they had six different supervisors in a six-month period.
Gunaratne said different local health districts were “on notice” about the college’s “serious concerns and serious risk of de-accreditation”.
RANZCP is planning emergency accreditation visits to Westmead, Concord, Liverpool, Royal Prince Alfred, Sutherland, St Vincent’s, Lismore, Blacktown, Royal North Shore and Hornsby hospitals, she said.
Gunaratne said those visits were a “direct response” to letters from trainees and coordinators of training detailing concerns about the lack of supervision and risks to their own safety.
“If it’s found sites are not able to meet the standards that are required, those sites will be unaccredited,” Gunaratne said.
She warned closures would result in the “collapse of the trainee system – we were already at a knife’s edge”.
Gunaratne told the court that the mass resignations were the result of a “fairly organic process” from several meetings where psychiatrists were “incredibly frustrated and angry”.
Dixon tendered in court evidence a letter, dated September 2023, signed by 16 clinical directors of mental health from 16 local health districts in NSW, which stated it was “near impossible to recruit psychiatrists into staff specialist positions”.
He also presented various reports from stakeholder groups that warned of over-reliance on locums and visiting medical officers (VMOs), rather than full-time staff specialists.
Dixon argued that use of VMOs and locums cost the state a higher hourly rate than full-time staff specialists and also compromised continuity of patient care and the training of junior doctors.
Giving her evidence for Asmof, Dr Kathryn Drew, a former director of medical services for mental health at the northern NSW local health district, described how VMOs affect a hospital’s budget.
If a hospital loses a full-time specialist, Drew said a VMO replacement can only be “employed for 0.6 full-time equivalent without going over budget”, because the VMO has a more expensive hourly rate.
The hearing, which is scheduled for five days, continues.