KEY POINTS:
It was with grave concern that I read the article "Nationwide junior doctor shortage sparks fears for patients' safety".
I have clinical responsibility for one of the departments alluded to in the report, which describes the out-of-hours cover as "at the minimum, with no 'safety net'." This is
blatant scaremongering designed to frighten vulnerable people needlessly.
Consultants and registrars are working together to provide the best possible clinical care for their patients. When required, for example when it becomes busy, the next tier of clinical support becomes available. Also, as needed, additional consultants are called in from home.
To suggest that services are running with no safety net is wrong. And this is not just my hospital. This system works in most New Zealand hospitals.
However, the current system is not without major problems. For example, our department recently was prevented by union intervention from financially rewarding the registrars for picking up additional duties and acting professionally and responsibly in providing care for their patients during a busy period.
Using staff to cover colleagues even when workloads are not extreme and services are not already at a minimum is deemed to be in breach of the Multi Employer Collective Agreement (MECA).
The union says that longer hours cannot be worked and when there are no other workers available to provide the services required, where do you turn?
Strictly, under the terms of the agreement, this was providing "cross cover" out-of -hours and therefore illegal. Morally, to me it was providing services in a professional manner in a time of extremis.
Other services are addressing shortfalls by using consultants and other staff in new and innovative ways. Innovation often stems from times of adversity and it is certainly to be hoped that this will happen now. However, it is pertinent to consider why we have come to this position.
Good health is vital for a country. Health is also politically very sensitive - it can win and lose votes.
An adversarial environment has developed in all the health negotiations relating to pay and conditions and collective agreement. District Health Boards blame the unions and the unions blame the DHBs.
The patients lose at every turn, feeling progressively more anxious as the stories become more and more alarmist.
The reality of the situation is stark, but not irretrievable. There are too few junior staff to service the positions available in New Zealand. Rosters require certain numbers to be able to function within the strict legally binding MECA agreements.
Workloads across different DHBs (for people with similar roles) are widely variable, as are the training and educational opportunities. There are good and bad employers, good and bad employees.
Arguments will go back and forth about what is right and wrong. But there are certain things we need to accept.
Yes, there is a crisis in the workforce at the moment. There are too few doctors, nurses and midwives. A brain-drain to Australia is developing.
Entrenched adversarialism will get us nowhere fast. Strikes do no one any good, and negotiation cannot work if people refuse to move or mediate.
It seems that union empowerment is a direct consequence of disadvantaged members, and the better the member conditions, the weaker the position of the unions.
It would seem to me that in the days after the anti-smacking legislation comes into being, we should suggest that the DHBs and unions get a quick slap, pull their heads in and start putting their patients first.
The usual suspects are being wheeled out for the annual battle of the Multi Employer Collective Agreement. Gladiatorial lines are drawn in the sand over which neither will step, and a bit of scaremongering thrown into the arena will entice media interest and get a few good stories.
I personally have had enough of it. Get some new blood to the table from both sides, stop fighting and start caring.
I am very proud of the way our department's staff (both senior and junior) have risen to the challenge of the shortfalls we face, showing their professionalism and vocation. This is despite many extraneous factors, not because of them.
* Dr Keith Allenby is Clinical Director, Women's Health, Counties Manukau District Health Board.
