It’s about time
BY DR JOHN ZORBAS, CHAIR, AMA COUNCIL OF DOCTORS IN TRAINING
Wage theft. Let’s call it what it is. When you have a contract to do a job, and you do that job, and you don’t get paid… that’s wage theft. Every fortnight, tens of thousands of doctors-in-training have the work that they’ve done processed into government payment systems. And every fortnight, tens of thousands of dollars and hours go missing.
The way we pay the majority of our doctors-in-training, and for that matter almost every government employee in the country, is embarrassing. It shouldn’t be a hard task. Any organisation that employees people needs to know what these people are doing and how long they are doing it for. Seemingly, this simple calculation was left out of the design plans for almost every HR system I’ve come across in the public sector. Every fortnight, we face a gauntlet of timesheets and rosters that almost invariably result in everyone getting paid less than they’re worth. The system takes its Angel’s Share, and I guarantee you it’s more than 2%. After this tax is levied, you then receive a payslip. Well, you might receive a payslip. They often don’t find you, as was the case when for a quarter of my intern year, my payslips were sent to a regional hospital 600 kilometres away from where I worked in an entirely different health service. And when you do find them, they’re indecipherable. There’s a series of figures and digits that put the techniques that casinos use to confuse us to shame. If big tobacco ever wants to make a comeback in Australia, they need to talk to big hospital.
Of course, no doctor is going hungry in Australia tonight. These dollars aren’t going to decide between life and death. But the dollars aren’t the problem. They’re a surrogate marker for time, and in our vocation we know that time is more valuable than almost anything in this world. When our patients start talking about the “if only-ies” of their lives, we can’t help but reflect on ours. Every hour of your life should be an hour worked and paid, or an hour not worked and not paid; it’s not rocket surgery. When we allow unpaid hours to propagate, those are hours that you don’t get to spend with your family. They are hours you don’t have to prepare for your fellowship exams. They are hours that you don’t spend with your friends enjoying your life and theirs, in shared experiences that you’ll never forget. They are hours that are taken from you. Stolen from you. Lost to you. Make no mistake about it, there is no greater time vampire than your payslip.
This is a system that hides risk. If you can’t accurately capture what your staff are doing, then you can’t safely run a health care service. You will be staffed incorrectly. You will be insured incorrectly. Your leave liability goes through the roof, and your overworked underpaid doctors resign as their access to leave slowly erodes. The pennies you save on wages today multiply into the errors and catastrophes of the future. Morale falls while culture crumbles. Come to think of it, the single worst action you could take to harm patients is to shortchange your doctors, your nurses, and every other person that keeps healthcare ticking.
But the worst part of this tragedy is us. We’re the enablers. We’ve been bailing the system out for years, and for what? When the razor gangs make their rounds, it’s the ultrasound fellowships and the research posts that go missing. But never the run of the mill registrar and resident positions. And you want to know why? It’s because we’re cheap. We’re extremely efficient, we’re too busy to complain and we’re terrible at understanding our rights as employees. Meanwhile, everybody wants to talk about resilience and the inherent difficulties we face in medicine that make it ineffably hard to be a doctor. The irony! I can resuscitate a trauma patient with half a liver and no kidneys. I can hold a family meeting for my critically unwell and soon to be departed ICU patient. I can’t explain my payslip to you. Let that sink in for a moment, and remember it next time someone lectures you about the inherent difficulties in medicine.
This system isn’t the brainchild of some villainous mastermind. It isn’t even a direct effort of government to minimise costs. It’s just simply evolved in an environment in which we’ve stood back and allowed it to happen. And it’s hard to talk about. There’s always someone who wants to make you feel shameful. They want to make it about money, and not about time. Every email you send becomes a less and less wanted intrusion. You’re made to feel the villain, and that’s just for asking for what is rightfully yours! Every unpaid hour we’ve been guilted into letting slide just helps to make life harder for all of us, our patients included. We focus so much on the money that we see it as a dirty act, when really it’s about time. Let’s collectively stop talking about money and start talking about time. This is about fair and due process, and enabling a health system than can actually function.
So next time somebody steals from you, stand up and make yourself heard. If your problem isn’t resolved, call the AMA (of which you are no doubt a member, you fine medical citizen you!). If you employ doctors-in-training, take a look at the processes you have around overtime and staffing. If you are a board member for a health service, audit the real hours that your doctors-in-training are working, so that you can appreciate the quantum of the silent risks that your company or service is being exposed to.
When they steal your money every fortnight, they make your life marginally harder. But when they steal your time, they make your life impossible. And you shouldn’t stand for that. Your time is priceless.