More doctors

More doctors

Ahead of the 2023 NSW Election, AMA (NSW) had one key ask…

NSW has a good health system which is built upon the day-to-day heroism of doctors and other healthcare workers.

It is a system, however, that has been losing ground over many years. Patients wait – for treatments, for surgeries, for appointments, for care because of under-resourcing and an attitude that our system is “good enough”. Our patients deserve better: better access to doctors across the State, a doctor to do the jobs that patients expect doctors to do, and doctors that have the support and equipment to deliver high quality care that leaves no one behind. 

Our health system is falling behind on every measure. If we continue on this trajectory, our hospitals will be overrun, and patients will face dire healthcare consequences. We cannot expand the capacity of the health system without addressing workforce shortages.

AMA (NSW) is calling on the State to harness the same political will it took to effectively safeguard the lives of millions of residents during the pandemic and apply that same energy, funding, time, and strategic decision-making to tackling the healthcare challenges that are fuelling the public hospital crisis.

The pandemic response was demonstrative of the State’s capacity to respond to the crisis at hand. Whilst the COVID threat has waned, the State faces new challenges – hospital logjams, long elective surgery waitlists, and an ever-growing population with increasingly complex, chronic conditions. 

AMA (NSW) launched its 2023 Election Priorities document NSW Hospitals: Advanced Life Support Needed which highlights three aims for the next government: support our health system; support rural healthcare; and support doctors’ health and wellbeing.

Support our health system

Topping the list of priorities is workforce.

In preparing our report, we asked doctors around the State about their experiences and what they saw as the major challenges facing healthcare delivery in NSW.

The responses were unanimous – we need more healthcare workers. We need more allied health, we need more nurses, we need more midwives, but specifically we need more doctors. While all members of the care team are important, doctors are central to that team.

NSW cannot have a world-class health system without doctors. Nor can it substitute its way out of employing more doctors.

AMA (NSW) engaged Deloitte to provide an analysis of the workforce pressures the NSW health system is currently facing. The evidence in Deloitte’s Medical Workforce Pressures in NSW supports a case for change. Specifically, it found that the growth in demand for healthcare services is outstripping population growth. As a result, health workers in NSW will need to become 40% more productive by 2050 to meet forecast demand.

Doctors are already struggling to meet current demands. Our surveys have identified high levels of burnout with 8 in 10 doctors reporting workplace stress and only third of respondents feeling valued in their roles. The government can no longer rely on the goodwill of doctors to keep the plates spinning.

The system simply cannot meet the current challenges without adequate funding and improvements in workforce. This cannot be done without addressing the current wages policy and updating the Staff Specialist Award and modernising contractual arrangements for VMOs. NSW is losing ground to other jurisdictions that offer better remuneration and support to doctors. 

In addition, we recognise the need to use our resources smarter. We need to build the capacity of doctors, who play a central role on the care team, to ensure their hours are maximised to provide the best care possible to patients. 

Support rural healthcare

AMA (NSW)’s 2023 Election Priorities also includes specific recommendations to improve rural and regional healthcare. The rural health inquiry shone a spotlight on many areas for improvement and the next Government must be responsible for implementing the report’s recommendations.  

There needs to be greater support for the specialist workforce to increase healthcare access in regional areas and improve retention. Similarly, we are calling on government to implement recommendations that provide greater training opportunities for the next generation of regional doctors. 

Support doctors’ health and wellbeing

Lastly, we have highlighted the importance of doctors’ health and wellbeing. The Government must care for the carers if our medical workforce is to fulfill the great task of providing world class care to NSW residents. 

After two years of the pandemic and sustained pressure on doctors to keep up with patient demand, we know there is a significant level of workplace stress, which leads to poorer mental health. 

Time for solutions
The next Government is taking the helm at a pivotal point in history and has an opportunity to shape a health system that is not only responsive to the current needs of the population, but also takes into account the changing needs of future populations. We know the problems that exist and we know the solutions. We’re asking the next NSW Government to trust the same people that got us through COVID, to guide us through the current challenges facing the health system. 

Dear NSW Government,

We are deeply invested in advocating for improved health services and care for patients. We work shoulder to shoulder with other doctors, as well as nurses, allied health, and hospital staff, and we see the day-today impact our health system has on patients’ lives. We have built our professional lives around caring for people and feel a great responsibility for ensuring that the ongoing provision of care is to the standard NSW patients deserve. We love our hospitals and recognise the incredible demands currently facing the system. With this in mind, we feel it is our duty to raise our concerns about the immense challenges facing our hospitals. 

Rise in demand 

Over the past decade, there has been an increase in public demand for health services. The volume of work has escalated, and doctors are working at unsustainable rates. There is a feeling of desperation and futility as we make greater sacrifices and yet fall further behind. Whilst we have seen major public hospital builds over the past five years, we have not seen the same investment in staffing of our public hospitals. 

Public hospital staff were working at an incredible pace prior to the pandemic, and this has continued to escalate without abatement despite moving to COVID-normal. 

It is exhausting. And while there is management pressure to take leave and allotted days off, we feel burdened by the realisation that there is not enough fat in the system to absorb the extra work this creates for our colleagues. There is chronic understaffing in all areas. 

Our nursing teams are also burnt out. They are leaving as they feel undervalued and burdened by too many patients to do the job they have trained for. Those in critical care are having to turn patients away from services because of a lack of nurses and the quality of care once admitted is hampered by inadequate allied health care staff and pharmacists. Allied health staff are considered a luxury and remain unsupported to do the work they need to do in public hospitals. Without allied health staff, public hospital doctors cannot provide the care patients need. 

Outdated agreements 

The wages cap and Award conditions are further demoralising. The outdated Staff Specialist Award and the wages cap in NSW has led to many hours of unpaid work and a skills loss throughout NSW due to the inability of NSW Health to attract and retain highly skilled staff.

The NSW Staff Specialist Award was written prior to the establishment of team based, 21st Century world- class medicine and stands in stark contrast to the updated Victorian and Queensland Awards. This has meant that whilst we all invest our time and NSW money into training world-class doctors – they leave for better packages in other states. The VMO arrangements are also outdated and need immediate attention. 

It is frustrating to see NSW hospitals train experts in clinical care and then witness the best of these trainees leave – attracted by better remuneration packages and administrative support by interstate hospitals where their skills and training are highly valued. 

NSW must get rid of the current wages policy which creates a false economy for permanent staff versus expensive locums. We need to build a future where staff are proud and happy to work in NSW Health, knowing they can provide the very best of care for patients and their own families simultaneously.  

Financial restrictions 

This has become steadily worse over the last 30 years and is stifling improvements to patient care. Any proposal to employ a new person or open a clinic is subject to a detailed business case that requires such an enormous amount of detail that it can only be completed with assistance of a business manager. It is nearly impossible to suggest any changes that will not cost something. This puts downward pressure on advancements that support high quality care. 

Furthermore, the capital allowance of equipment replacement is inadequate. NSW Treasury expect this to be paid from the No2 accounts or hospital foundations. Most specialties do not have adequate funds to cover these equipment costs and the foundations have many other demands on their funds. The result is that equipment is not replaced in a timely fashion but rather in a chaotic manner in response to failure, and then often only after a prolonged delay. 

Outpatient services 

Improvements need to be made to outpatient services in order to improve patient care. Incompatible computer systems have created significant communication problems between hospital care teams and general practitioners. 

For most specialties, prolonged delays of a year or more are common. 

Operating a health system that trades off the goodwill of specialists is not a long-term solution and further disenfranchises hospital doctors. 

In conclusion 

We need a government that will focus on investing in and rebuilding our NSW health staff. The public of NSW needs to know that investing in the public health system is a priority if we are to build a world-class health system and workforce into the next decade. 

Yours Sincerely, 

New South Wales Medical Staff Executive Council 

A/Prof Kathryn Carmo-Browning
Co-Chair – Metropolitan 

Dr Kate Sellors 

Co-Chair – Rural and Regional 

Dr Setthy Ung
Deputy Chair 

Dr Mark Priestley
Secretary 

Dr Bruce Cooper
Treasurer 

The NSW MSEC is an organisation representing the 40 Medical Staff Councils of the public hospitals of NSW.