A matter of trust

Mass industrial action is a relatively rare occurrence in Australian medicine.

Those who have been in the profession long enough remember the challenges of 1983 and 1984. Problems associated with the introduction of Medicare saw visiting medical officers (VMOs) nationwide threaten to resign.

In New South Wales, some interns found themselves gaining much more experience than they had anticipated when 70 of the state’s orthopaedic surgeons stopped work, led by the indomitable Bruce Shepherd.¹

There have been work stoppages and threats of resignations since but, for the most part, contract negotiations between the profession and state and federal governments take place quietly behind closed doors.

However, three decades since the national VMO dispute, Queensland doctors are now mired in one of the worst industrial disputes the Australian medical profession has ever seen, with the potential to cripple Queensland’s public hospital system.

“I have never seen morale so low, I have never seen trust so lost, and I’ve never seen doctors so angry”, says Dr Michael Bint, a 25-year veteran of Queensland medicine and member of the doctors’ taskforce negotiating with the government over the implementation of individual contracts in place of collective agreements.

The state’s specialists have been branded fraudsters and liars, and have been accused of everything from rorting the system to not being able to read a contract properly.

Talk about the loss of trust between Queensland Health and its doctors is widespread in public hospitals.

By the start of April at the Sunshine Coast’s Nambour Hospital, where Dr Bint is the head of the department of respiratory medicine, the situation had driven a huge number of the hospital’s specialist staff to say they would offer their resignations on the government-imposed 30 April deadline if the contracts remained as they were.

In addition to Dr Bint and the rest of the hospital’s department of respiratory medicine, the entire orthopaedic department was set to leave, together with 90% of the hospital’s anaesthetic department, 80% of the cardiology department, and 60% of intensive care and paediatrics.

From Cairns to Caboolture, it was a similar story at other metropolitan and regional hospitals across the state.

How did it come to this? And what are the implications, if any, for VMOs and senior medical officers (SMOs) in the rest of the country?

Individual contracts

The battle over individual contracts for Queensland’s VMOs and SMOs began in November 2013 when the Liberal National Party government changed the state’s industrial relations legislation.

As part of the legislation, a new high-income earners category removed salaried doctors from the protection of the Queensland Industrial Relations Commission.

The individual contracts put forward at the start of 2014 as replacements for the existing collective agreements provided no equivalent protection against unfair dismissal or changes in conditions.

Queensland doctors were outraged. More than 1000 attended what became known as the Pineapple meeting in Brisbane on 21 March, and 200 more participated via communications technology.²

They demanded one of three options:

1. A return to the original award agreement;
2. A modified award to include some of the efficiencies sought by the government; or
3. At the very least, a contract with a secure industrial underpinning allowing for independent, binding arbitration and appeal.

Outside Queensland, there is already a mix of collective agreements and individual contracts for SMOs and VMOs in states and territories around the country.

Collective agreements are negotiated with the state governments in NSW, Tasmania, South Australia and Western Australia by the state branches of the Australian Salaried Medical Officers Federation (ASMOF), drawing on the resources of the local branches of the Australian Medical Association.

Elsewhere, such as in Victoria, the Northern Territory and ACT, there are individual contracts but, unlike Queensland, these contracts are underpinned by an industrial instrument under the federal Fair Work Australia legislation.

The proposed Queensland contracts do not include the certainty of an established independent appeals and arbitration system.

Beyond rhetoric

The usual practice is that when one agreement draws to an end, the state health department proposes a new one and the union responds.

Remuneration, hours and conditions under which hospital work is done are often where negotiations get stuck.

Strategic Industrial Relations Officer with the South Australian Salaried Medical Officers Association, Andrew Murray, has overseen six agreements during his career, not all of them for that association. He says that it can be to the employer’s benefit to prolong such negotiations thereby delaying the implementation of any increases, but that every dispute, even the Queensland one, gets resolved one way or another and industrial action is the very last resort.

“At the end of day, it’s probably better to try and sit down and work it out, even if there’s a bit of rhetoric and that sort of stuff. Ultimately, both sides have an equal obligation to try and find an answer and that has to be the underpinning from the beginning — you have to resolve the dispute.

“Very few disputes are so ideological as to be beyond resolution but sometimes you have to find a way to get past the ideological rhetoric to get to the substance of the decision.”

To that end, Mr Murray says it is often helpful to avoid stating a public position unless absolutely necessary, as it is much harder to reverse a publicly stated line.

An agenda

In Queensland the public positions have been clearly stated. ASMOF alone has spent $200,000 on a 2-week advertising campaign to inform the public of the threat to job security for the state’s top doctors.

Director General of Queensland Health, Ian Maynard, says the move to the new contracts is part of the government’s broader industrial relations agenda — which includes the future outsourcing of all public hospital pathology and radiology.

If doctors won’t sign and instead offer their resignations effective 1 July, then the state will look overseas and interstate for replacements. To that end, a special team has been established within the department to ramp up international recruitment.

Mr Maynard says the key driver of the switch to individual contracts is to improve the focus on performance, accountability, productivity, quality and value-for-money patient care.

The MJA Careers asked the Director General what evidence there was that individual contracts would achieve that, but instead he explained why collective agreements couldn’t succeed in achieving these goals.

He cited a recent conversation with an unnamed metropolitan health and hospital service chief executive who had complained about not being able to get three members of a particular craft group to begin working at a different location.

“He didn’t get traction. The union got involved. The union refused to support and accept the need for those services to be provided from that location and it ended up in a stalemate which couldn’t be moved forward.”

Concern about the ability of specialists to be allocated to work in different locations without their agreement was one of the major concerns in the initial Queensland Health contract.

A later addendum to the contract put forward by Queensland Health stated that health services would be required to have a specialist’s agreement before reallocating his or her services. The end result is that the contract and its addendum may not help the chief executive cited in Mr Maynard’s example.

Patient care

In 1984, Dr Tony Sara was one of the interns who found himself applying skin traction when the NSW orthopaedic surgeons stopped work.

Now national president of ASMOF, he says that like Queensland Health, the union is making plans if the threatened resignations take place.

“If … the resignations go ahead on the first of July, which is a Tuesday, then elective surgery will cease.

“There may be enough emergency doctors to take care of emergencies. There may be enough anaesthetists to take care of emergency cases.

“If there’s not, colleagues will still take care of the public of Queensland in terms of emergencies, life-saving, limb-saving surgery, medical conditions, intensive care and so on.”

He believes that if the government in Queensland is successful with the proposed contracts, then other states and territories may be emboldened to see whether they can follow suit.

“In our view that is detrimental to the public of Australia and detrimental to the profession of medicine.”

Mr Maynard acknowledges that whatever the result of the fracas, there is a long road ahead to rebuild the trust required in the public system in Queensland.

“I acknowledge it’s going to take time to rebuild trust and engagement with doctors. I don’t expect trust to be rebuilt overnight because we’ve changed some words in a contract or because some legislation has been passed.”

But at Nambour Hospital and elsewhere, Dr Bint says that it may already be too late.

“Some people are so disillusioned and so affronted and so offended so that even if there is a resolution, they’ll go anyway.”

1 Dr John Harrison 2009; speech to the Australian Orthopaedic Association dinner to honour Dr Bruce Shepherd. http://www.adf.com.au/archive.php?doc_id=179 (accessed Apr 2014).
2 Miles J. Meeting of doctors over public specialist contracts votes no confidence in Health Minister Lawrence Springborg. The Courier Mail (Brisbane) 2014; 14 Mar. http://www.couriermail.com.au/news/queensland/meeting-of-doctors-over-public-specialist-contracts-votes-no-confidence-in-health-minister-lawrence-springborg/story-fnihsrf2-1226846379327 (accessed Apr 2014).