AMA 15th National Conference 2003 - AMA President Media Conference - Dr Trevor Mudge, AMA Vice President - Work/life Flexibility Policy Discussion

MUDGE: Good afternoon, everybody. Thank you for joining us. I'm Trevor Mudge, the Vice President of the AMA and involved in the Doctors in Training Committee, which has largely been behind the work/life project that we've been discussing here at the national conference this afternoon.

I'm joined by a panel here who I will introduce briefly to you: Dr Jill Sewell, who's with me, a senior paediatrician and the Deputy Chair of the Royal Australian College of Physicians; Dr Joseph Sgroi, who's a flexible trainee doctor and the Chair of our Doctors in Training Committee and a federal councillor of the AMA; next to him I have Mr Nick Brown, who's the President of the Australian Medical Students' Association; Professor Peter Thursby, who's a senior vascular surgeon from Sydney with a long involvement in teaching; and Dr Linda Sheehan, who's also a flexible trainee from Sydney and the Chair of the Doctors in Training Committee here locally in New South Wales.

We've been talking this afternoon about changing the culture that's existed within the profession of working long hours and putting one foot on the training rung and not looking sideways until you get off it six years later to a culture which recognises the need for doctors to have varied and wholesome lives just like everybody else, to spend time with their family and to have flexible training which meets the needs of our younger people of both genders.

And we have some very interesting research commissioned by the AMA which Dr Sheehan might like to tell you about and I'm very happy for any of the panel to be asked questions.

Linda, do you want to talk about what the research shows amongst our juniors?

SHEEHAN: The AMA conducted some research of junior doctors around Australia looking at how they perceive their workplace arrangements and training requirements are and also what they perceive to be the major barriers to increasing flexibility in workplace practice and training arrangements. And essentially those focus groups came up with a few key points.

The first key point was that lifestyle and flexible working practices were identified as the key issue for most trainees in how they make vocational choice, how they choose their medical speciality and their future training commitments. That other areas were important but that that was the primary focus in making decisions about where they go with their medical practice.

And secondly that the culture of the medical profession was seen as the key barrier by junior medical staff, as to why that flexibility is not available yet and that culture is, I guess, the focus today that we want to bring out some sense or some commitment from the profession to change, bringing, I guess, medicine more in line with, I think, general social change regarding increased flexible in training demand by employees.

I guess the final thing that came out of the research project was that there were a few key areas that were identified to be the main ways of implementing flexibility. Most of those areas were in initiatives such as part-time work, job share arrangements, control over the numbers of hours you work and when those hours are and also the ability to have some input into placement of where your workplace will be, such as your rural terms and other sorts of training requirements.

They were the three things that came out of the focus group research on junior doctors.

MUDGE: Joseph, do you want to talk about your experiences as a part-time trainee?

SGROI: Just to talk about the second stage of the project before I move onto myself, which is one

MUDGE: However, in the present way in which hospitals are set up, your ability to gain skills quickly is diminished by the tension between state and federal funding battles, the closure of outpatients, so that it isn't simply a workforce flexibility issue, it extends right across the breadth and depth of access to patients in public hospitals and the very short times they are in hospitals for the students and junior doctors to access training with them as patients.

SEWELL: Skill centres aren't just designed for part-time trainees, they're designed for all trainees to learn those sort of procedural skills.

SHEEHAN: They just sort of came into this as a way of educating all about, thinking about training in a different way, that it doesn't have to be the old way, there's all sorts of new ways that we can train junior doctors to be good specialists and skills centre is just one of those way. There's a myriad of options and possibilities now that just weren't around 10, 20 years ago and, I guess, it came out in the discussion, the dinosaurs of the profession, they should think about these alternative routes with training and it's part of looking at options for flexibility. It doesn't have to be the way it's always been.

MUDGE: And again, that's not unique to the medical profession. I think that the days of the Shipping News have probably gone from journalism too.

QUESTION: What other problems are doctors having?

SGROI: Without overstating the divorce rate, because we won't overstate it now, the, I suppose, the perception that doctors work long hours, so on and so forth, does have impact, it does have impact on family life, it does have impact on your relationship with your wife or your husband and your children. There are untold, you can't quantify or qualify what impact that- -

QUESTION: Is substance abuse one of them?

SGROI: I think there's anecdotal evidence that there is an increased rate of substance abuse amongst doctors. I don't think that's something that we can definitely - we can say. And I think that that is a result of increased stresses placed upon doctors and the thing that work/life flexibility is doing is decreasing stress. If you're able to work in an environment and in a capacity which suits your flexible lifestyle patterns, the person's going to be less stressed and there's going to be less tendency to have, to move down that path.

This is what it's all about.

THURSBY: And it does produce increased opportunities for self-education.

BROWN: Those figures about substance abuse, high morbidity and high mental illness rates, they're not anecdotal. We get taught this at medical school, these days. It's coming into the curriculum. It's self-help, it's how can you, as a doctor, look after yourself? And I think this is all part and parcel of that process and it's something that needs to happen. It's an evolution, it's happening, in some areas it's happened and if the medical profession doesn't catch up it will get left behind and it will start to create long term problems for itself. I said inside as well, why should doctors be happy working in conditions which in other professions would be deemed hazardous and they wouldn't be allowed to work in? Let's sort of get the whole attitude of we're doctors, we can handle working - out and let's get the grim reality check in and let's change with the times.

QUESTION: What the immediate steps to achieve this plan:

SGROI: As I said in my speech, a lot of it is going to be lobbying and that is lobbying hospitals to implement programs.

I think the first thing is actually developing a formal AMA - we have AMA policy but developing guidelines and pathways to flexible training opportunities and also providing a facility for doctors who are in training to be able to access other doctors who are in training who want to enter into a job share arrangement because at the moment it's really left up to you as an individual to find someone else who wants to do job sharing so the AMA is certainly looking at a web based program to facilitate an open dialogue between doctors.

The other thing is lobbying hospitals, lobbying medical colleges so they develop policies based not only on flexibility but also on the educational component so how much time does a trainee need to become a good specialist and so whether that means implementing skill centres or increasing training time for part-time trainees and taking into consideration lectures and conferences they need to attend, all these need to be thought about so that this issue can progress.

Ends