The price is not right - NSW psychiatrists resign

Article by emr.poetry( on instagram) / Keeping Up Apperients (on Substack)

Next Tuesday morning, residents of New South Wales could be waking up to a much lighter mental health workforce, with over two-thirds of the state’s publically appointed psychiatrists gone.

It is the pointy end of multiple attempts at negotiating with NSW Health for a pay rise that would make consultant psychiatrists’ salaries commensurate with their workload and expertise, and on par with the surrounding states - specifically a rise of 25%. Having failed to convince the government, these psychiatrists have voted to leave the public service - not strike, but actually resign - effective in seven days from now. The NSW Health Minister, the Hon. Ryan Park’s pleas at a national press-conference recently to “please don’t do this,” have been met with derision by the medical community, with the Minister’s actions being likened to that of a ‘14 year old boy going through a break up for the first time’. Similarly, NSW Health social media pages have turned off the ability to comment on many of their recent posts after an upswell of sentiments by doctors and the general public (some less diplomatic than others) in solidarity with the psychiatrists’ mass resignation. One psychiatrist, Dr Pramudie Gunaratne, called the government’s actions ‘gaslighting’ when the Minister Park begged psychiatrists to “remain at the table” after, as the psychiatrists say, NSW Health were never even there themselves.

But not everyone is a fan of the psychiatrists’ gamble. Dr Nick Coatsworth, ex-deputy chief medical officer weighed in on the controversy, stating ‘the medical professional argument is always about being at breaking point and the system collapsing in one of the best-funded health systems in the world, and curiously, the solution always seems to benefit the medical professional group in question’.

Regardless of your opinion, this is by far the strongest display of industrial action amongst doctors in Australia in, perhaps, living memory.

So, I had a chat to a psychiatry registrar employed by NSW Health, and is part of the key working group behind the mass resignation. They wished to remain anonymous. (By the way, I had this idea way before AusDoc released their article. Bastards.)

What can you tell me about the timeline of what’s going on here, what the psychiatrists are asking for and what the negotiations with the government have been so far?

Basically there’s a big shortage of psychiatrists all over the world, in Australia but also New South Wales (NSW). The problem in NSW is that they pay psychiatrists about 30% less than the neighbouring states of Queensland and Victoria, and even less than other states around Australia. And of course, as a psychiatrist, you can earn a heap more money if you want to go into private practice. So, when people finish their training, after they’ve been tortured and abused by the public healthcare system for the past five to ten years they have to make a choice about what they’re going to do next. And, at the moment, the choice is [either] earn two to three times the salary in Private with patients who really want to see you, who have been waiting months, who want an ADHD diagnosis or want to do talking therapies or whatever else - or, if you’re really masochistic and want to work in the public system, you can go to Queensland or Victoria where the cost of living is lower and you can get paid more. So, people are just leaving NSW. They’re voting with their feet. You know: that’s capitalism. So that’s been going on for quite a while and we’ve got to this situation where there’s 30% of all public psychiatry positions in NSW being unfilled. So about 15 months ago the psychiatrists and a bunch of professional bodies went to NSW Health and said ‘we actually can’t operate like this anymore, it’s really unsafe, we’re working multiple jobs with these really high acuity patients and we need you to do something to fill these positions’. And NSW Health frankly had no idea. When the psychiatrists first went to them, they didn’t even know how many locums and VMOs they were using in the state. They didn’t know how many positions were unfilled. They weren’t even collecting the data. And so it’s been really hard to get traction and eventually the psychiatrists started threatening a bit more, and saying if you guys don’t do something about this we’re going to quit. We just can’t do this anymore. And again, nothing happened. And it just kept going and going. When it started getting close to the deadline of when they were going to quit, it looked like the government was going to take some action - they [the government] said: ‘okay, you need to come up with a plan to come up with some cost savings, to help offset the cost of paying more to get more staff’ which wasn’t hard because the cost of locums and VMOs is way more than the cost of staff specialists. And then the government took it to this Treasury expenditure review meeting and came back out of the meeting and said ‘oh, actually we’re not going to give you the pay rise we said we’d give you - we’re not going to give you any pay rise - it’s zero percent - and we want you to put in place these efficiency measures you’ve come up with and do that for six months and then we’ll consider a pay rise.’ So as you can imagine people were just furious. This was right before Christmas and then they had a big meeting and voted overwhelmingly that they were going to resign, and within two days of that meeting nearly 200 of the state staff specialist psychiatrists out of about 295 had resigned.

What has the government offered since then?

They’ve basically offered lies and gaslighting. They are claiming that they are offering a 10.5% pay rise but that is a complete lie. That is a separate negotiation that is the award negotiation for all doctors in the state. They offered all the doctors in the state, via the union, a 10.5% pay rise and that was rejected by all doctors, so psychiatrists couldn’t have accepted that independently even if they had wanted to. The Premier, the Health Minister, the Mental Health Minister - none of them have met with the psychiatrists since they had that vote to resign, and there have been zero offers. Instead you’ve seen the health minister come on TV and put doe eyes on and say ‘please, don’t do it, no!’ but there hasn’t been anything in the way of actual offers and negotiations.

Can you tell me a bit about what the conditions for psychiatrists - and, by virtue of that, psychiatry trainees - working in the public system in NSW are like at the moment?

Things are really hard at the moment. There are a lot of trainees that aren’t able to access supervision, [despite] the complexity of our patients both in terms of the risk that we carry with them but as well as just how hard it can be to deal with someone who is really complex and has a complex mental illness. We’re supposed to have direct supervision by someone working in our service and already some [trainees] are not getting access to that. We’ve got psychiatrists who are working across multiple roles, some in the community being responsible for hundreds of patients and we’re talking patients who might be medication non-compliant, who might have paranoid schizophrenia, who might be really risky people to be only having very light oversight of. The reality is if something goes wrong with those patients, it’s the psychiatrist who gets called up before the Coroner’s Court, or who gets targeted for blame if something goes wrong. So it’s pretty high stakes at the moment.

You may or may not have seen Dr Nick Coatsworth’s comments on Sunday, that are going around at the moment. I’ll read you some of what he said: “While we should respect all employees’ right to withdraw labour, this action sets a disturbing precedent and could trigger an ‘arms race’ of public spending as different jurisdictions gazump each other on medical specialists awards.” He also mentions the 10.5% pay increase over three years, which as you’ve said is relating to a separate union matter applying to all doctors in NSW. He says that, after these concessions, these pay increases, the group has “still arrived at the conclusion that they should undertake mass industrial action and resign en masse”. What do you say to these comments by Dr Nick Coatsworth?

I generally take the attitude that you shouldn’t feed the trolls and Nick Coatsworth is probably the health sector’s number one troll at this point. He doesn’t seem to have another job besides selling stuff and trolling people on the internet. So I don’t really care what Nick Coatsworth has to say, because I don’t think he really knows what he’s talking about.

He cites the figures that public clinicians, he’s referring to psychiatrists here, are on a package of $438,000 per year including superannuation. Is that an accurate figure?

That is another complete and utter lie that the government was selling to journalists on background. They’ve been spreading around that figure and not been willing to admit that it’s them that’s spreading that figure. The salaries for NSW staff specialist psychiatrists are publicly available on the internet. The top salary for a staff specialist [psychiatrist] in NSW is $251,618, and when you take into account all possible special allowances and other things, the maximum possible income (and this is what is on the NSW Health website) is $354,479. So that [$438,000] figure is just completely invented. It’s another example of people like Nick’s inability to prioritise fact and figure out what they’re talking about before they open their mouth, because all you need to do is Google it and you can find the rates on the website. The basic thing is, too, do these people believe in market capitalism or not? It’s a market, and psychiatrists can get a large amount of money in this market. It would be better if there were more psychiatrists to fill those [public] jobs but that’s not the situation at the moment, so we need to pay people for what their worth so that we can fill those jobs. It’s as simple as that.

Do you think that improving psychiatrists’ salaries is going to lead to improvement in conditions for patients receiving mental health care in NSW?

I don’t think it’s the only thing. I think we have huge shortages in all of mental healthcare. I think there’s still lots of stigma towards mental health and it’s not treated as importantly as other areas of health. With my nursing colleagues, there are huge shortages there as well. Psychologists, other allied health... So I think that’s still an issue and I think that we have a long way to go in terms of improving care generally in mental health and making it less coercive and more patient-focussed and supportive and less traumatising. But it’s very hard to provide quality patient-focussed care when you are treating two or three times as many patients as you ought to be in a day. It’s very hard to stop and listen properly in that environment.

I’ve had some people reach out to me including [mental health] nursing staff and other allied health workers, and one that approached me said that while they, in principle, support the pay rise for psychiatrists, they’re frustrated and they’re underpaid and they find it hard to stomach psychiatrists wanting a pay rise beyond $250,000 a year.

I completely get it. I think our nursing colleagues do the most incredible work, and they are underpaid and they do deserve a lot more pay. And they deserve to have their unfilled positions filled as well. That’s the first thing. The second thing is: these doctors asking for these pay rises - they’re not actually asking for it for themselves, because they could get a much bigger pay rise just going into the private sector or moving interstate. They’re actually asking for it because they want the empty positions to be filled. And in the end, that is the most important thing. The figures are that a third of the positions in the state are unfilled and if we don’t pay more, we don’t have a way of filling them. And if anyone could come up with a different way of filling those positions, without paying more, I’d be happy to hear it. I just want the positions filled.

So what happens next? The mass resignation is now happening in 7 days. What happens the day after?

I’m shit scared. I’m going into a rotation where basically all of the bosses are quitting and I’m going to be in a very acute, high risk environment. I don’t know how this is going to work. I think probably what is going to happen is we’re going to see huge build ups in EDs and there is going to be a massive bed block and the government is going to be forced to act. I really hope that’s the worst that happens and people just have long waits in ED and we have a lot of bed block - I really hope there’s not a tragedy, because that would be completely preventable. If someone dies, the government could have prevented that. And that would be so awful.