Despite last minute concessions by the State Health Minister, the QLD State Government under Premier Campbell Newman remains embroiled in a high stakes conflict with the state’s public medical profession. Citing the need to drive productivity, cut costs, and crack down on doctor fraud, the state government is attempting to force public hospital specialists in QLD onto individual employment contracts.
The doctors employed by the state, who claim the contracts are fundamentally unfair and will degrade working conditions and pay, are in open revolt. Threats of resignation are widespread.
Health Minister Lawrence Springborg has referred to reports by the QLD auditor-general as evidence that the health system is subject to widespread rorting. In fact, the latest report concluded that:
“We could neither wholly substantiate nor disprove the allegations we received of widespread absenteeism by SMOs. This is because the attendance monitoring systems at HHSs lack basic accountability and rely primarily on the integrity of SMOs.”
The contracts strip doctors of their collective bargaining rights, and create a pronounced disparity in the negotiating power of the respective parties. Provisions Springborg was originally seeking included the ability for the government to arbitrarily dismiss doctors; to roster doctors on for shiftwork, regardless of hours worked or fatigue; no guarantee of annual indexation for salaries; uncertainty over private practice arrangements; and being stripped of the right to appeal to the QLD Industrial Relations Commission (QIRC), with no alternative mechanism for dispute resolution proposed.
The agreements can also be altered by a directive issued by the QLD health Director-General at any point. Many SMOs understandably questioned the value of signing an agreement subject to unilateral change.
After significant opposition (including from within its own ranks), the government finally returned to the negotiating table this week. Springborg indicated on Tuesday that he was willing to make some concessions.
These overtures have so far failed to placate the doctors’ representative bodies. At a meeting on Wednseday, 1200 doctors unanimously voted to reject the contracts. The Australian Medical Association is continuing to advise its members not to sign.
“We are pleased to be making some headway, but significant improvements are not yet on the table,” AMA President Steve Hambleton said.
President of the Australian Salaried Medical Officers Association (ASMOF) Tony Sara opted for a bolder approach, declaring that he had already signed hundreds of resignation letters, and was prepared to use them to “exercise the nuclear option”.
Over the past couple of weeks, a growing number of protests and demonstrations have been staged by irate SMOs and their supporters across the state with protests in Cairns, Ipswich, the Gold Coast, Nambour, Hervey Bay, and Brisbane.
Nine hundred doctors met at Brisbane’s Pineapple Hotel on 6 March. There they passed a unanimous motion (excepting one dissenting vote) of no confidence in Health Minister Lawrence Springborg. An overwhelming majority of those present reportedly indicated by a show of hands that they would be prepared to resign rather than sign the proposed contracts.
Prior to this week, the government’s approach was to downplay the level of opposition to the contracts. State Treasurer Jeff Seeney questioned how many of the attendees at the 6 March Brisbane meeting were actually doctors, commenting “I think there was quite a number of union activists involved.”
Springborg had likewise routinely commented that there are many doctors who have no issue with the contracts, and that the threats of mass resignation were pure theatre, designed to spook the public with what he described as a “phantom crisis”.
The Australian Medical Association of Queensland (AMAQ) conducted an online survey last year — finding that an extraordinary 84 per cent of 780 doctors responded that they intended to resign, cut their hours, or move interstate as a result of the contracts.
Only 1 per cent indicated that they believed the process of consultation had been sufficiently transparent, while only 2 per cent thought the contracts were acceptable.
Reportedly, all anaesthetists at the Cairns Hospital are prepared to resign over the dispute. The effects of this would be catastrophic, as the loss of even one specialist at the hospital could be devastating for the quality of patient care, according to Dr. Roxanne Wu, who is a surgeon in service at Cairns, and President of the Senior Medical Staff Association.
The emergency department specialists of the hospitals at Robina, Townsville, Cairns and the Gold Coast have also pledged their intent to resign.
While the demonstrations have largely been restricted to the larger cities and towns, it is regional and rural hospitals that potentially face the biggest hit from resignations.
In February of last year, the QLD Newman government released its Blueprint for Better Healthcare in Queensland. Arresting the state of decline of medical services in rural areas and decentralising decision-making in the system were identified as areas of priority. However, implementing the conditions outlined in the contracts could have precisely the reverse effect.
If the state’s best migrate to greener pastures, they will not only take their expertise with them, but be unable to train future recruits and graduates, condemning the health system to generations of poorly trained doctors and reduced patient care.
If mass resignations take place, rural areas will have the most difficulty attracting and training replacement specialists. Additionally, there are also far less private practice alternatives available to rural Queenslanders.
“The long-term consequences are that you’ll be unable to recruit or retrain doctors in Queensland,” Tony Sara warned. “Essentially the public hospital system and the teaching hospitals in Queensland, and the medical profession in this state, within months or a year or two, would cease to exist.”
Moreover, the aforementioned ability of the Director-General to arbitrarily override the conditions of the contracts is a flagrant contradiction of the Newman government’s stated intent to decentralise control of the healthcare system.
The State Government has set a 30 April deadline to sign the new contracts, which would go into effect on 7 July. Given that SMOs are required to provide three months notice before resigning, the threatened mass resignations may be two weeks away.
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